The development of a hybrid expert system for the interpretation of fetal acid-base status

Fuzzy-based framework for diagnosis of acid-base disorders

The main objective of this research is to develop a fuzzy-based framework for diagnosis of different acid-base disorders. There are several acid-base disorders that cause many clinical complications and their proper diagnosis is the only way for their efficient treatment. The common disorders are metabolic acidosis, metabolic alkalosis, non-anion gap acidosis, anion-gap acidosis, acute respiratory alkalosis and chronic respiratory alkalosis. The proposed fuzzy-based framework was used to diagnose all of these disorders using four parameters directly measured in blood: hydrogen-ion concentration (pH), arterial blood carbon dioxide partial pressure (paCO₂), sodium ions concentration (Na⁺) and chloride ions concentration (Cl⁻) along with 12 features extracted from the directly measured parameters. The validation results showed that the developed framework has an accuracy of 94%, an average sensitivity of 88% and a specificity of 93%. These results imply that the developed fuzzy-based framework is accurate and reliable one and can be used to help clinicians specially the non-expert ones to provide correct and rapid diagnosis of acid-base disorders.

Neural network analysis of oxygenation signals in infants during sleep

The use of artificial neural networks (ANNs) to interpret sleep monitoring signals is described. Recordings from ten infants with apparent life threatening episodes were assigned into training feedforward R-PROP networks. In order to separate good signal from artefact, 60 second time frames of SaO2 and TcPO2 signals were processed and the mean and standard deviation values were used as inputs to the networks. Intra-human errors were minimized using this method whilst inter-human errors remained significant. To decrease the latter, the number of hidden units was increased to eight. Sensitivity figures of the SaO2 network were 0.93 and 0.9 for the training and test sets respectively whilst the specificity figures were 0.7 and 0.65 respectively. For the TcPO2 signals the above figures were 0.92, 0.85, 0.77 and 0.61 respectively.

Determinants of umbilical cord arterial 8-iso-prostaglandin F2alpha concentrations

OBJECTIVE

To determine the concentration of 8-isoPGF(2alpha) in cord blood as a measure of oxidative stress during labour, and to compare them with other established parameters of in vivo lipid peroxidation and with the acid-base status of the newborn.

METHOD

Umbilical cord arterial and venous blood samples were collected from 81 singleton term deliveries for determination of 8-isoPGF(2alpha), malondialdehyde and organic hydroperoxides. In addition, metabolites derived from the oxidative metabolism of purines during hypoxia-reoxygenation and routine cord blood of oxygen saturation, pH, pO2, pCO2, HCO3 and base excess were measured.

RESULTS

Arterial concentrations of 8-isoPGF(2alpha) were significantly higher in cases with fetal distress, tight nuchal cord (P < 0.001), the umbilical coiling index, and male sex (P < 0.05) (R2 = 0.48). No correlation was found with any parameter of acid-base status. In arterial and venous blood the concentrations of organic hydroperoxides and hypoxanthine significantly correlated with the fetal nuchal cord (P < 0.001) (R2 = 0.26 and 0.16, respectively).

CONCLUSION

Our findings indicate that 8-isoPGF2(alpha) in cord arterial blood is a suitable parameter to quantify a possible oxidative stress in the fetus during labour. Measurements of the F2-isoprostane concentrations in cord blood at labour provide a clinically useful method to assess the perinatal outcome.

A comparison of three ultrasound estimates of intrapartum oligohydramnios for prediction of fetal hypoxia-reperfusion injury

A prospective observational study assessed the predictive value of three techniques for amniotic fluid volume assessment on umbilical cord arterial lipid peroxide levels and acid-base balance. Women with singleton, term, cephalic presentation, and an initially normal fetal heart rate tracing were recruited. All pregnancies had the largest vertical pocket (LVP), two diameter pocket (2phi), and amniotic fluid index (AFI) assessments before and after amniotomy and cord arterial acid-base and lipid peroxide determinations at delivery. In 171 cases with confirmed cord arterial samples, malondialdehyde (MDA), organic hydroperoxide (OHP), pH and base excess (BE) were examined in relationship to intrapartum LVP, 2phi and AFI before and after amniotomy. Improvements in correlation between the estimates of amniotic fluid volume and outcome measures were observed 30 min after amniotomy, particularly with lipid peroxide measurements. Examination of scatter-plots using Lowess regression suggested that the correlation was only valid in cases of oligohydramnios but that the cutoff values recommended in the literature for defining oligohydramnios were not appropriate in our population sample. We suggest that oligohydramnios should be defined as an AFI < 8 cm or LVP < 4 cm. We concur with the recommendation of < 15 cm2 for the 2phi measurement.

Lipid peroxidation in cord blood at birth: the effect of labour

OBJECTIVE

To determine the effect of labour on free oxygen radical activity in the fetus, as reflected by lipid peroxide levels in umbilical cord arterial blood.

DESIGN

Prospective, observational study.

SETTING

Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong.

METHODS

Umbilical cord arterial and venous blood samples were collected from singleton term infants delivered by elective caesarean section. Base excess, PO2, pCO2 and pH were measured in both samples and compared to identify double venous samples. Cord arterial acid-base balance and concentrations of organic hydroperoxides and malondialdehyde were compared with those obtained from normal vaginal deliveries.

RESULTS

Cord arterial blood samples, obtained from cases of uncomplicated labour followed by spontaneous vaginal delivery, had significantly higher lipid peroxide concentrations than those delivered following elective caesarean section. This was most marked for malondialdehyde with a median value increased by 105%, whilst organic hydroperoxide was increased by only 27%. Of the acid-base parameters, base excess was increased by 78%, with only minimal changes in pH, pCO2 and PO2. These differences remained highly significant after including other pregnancy characteristics in multivariate analysis.

CONCLUSION

The findings indicate that high levels of free oxygen radical activity in the fetus are a function of the labour process, as are changes in acid-base balance.

Lipid peroxidation in cord blood: a randomised sequential pairs study of prophylactic saline amnioinfusion for intrapartum oligohydramnios

OBJECTIVE

To determine the efficacy of prophylactic intrapartum amnioinfusion in reducing cord arterial lipid peroxide levels in cases of intrapartum oligohydramnios.

DESIGN

Sequential randomised pairs trial.

SETTING

Delivery suite of a teaching hospital, the Chinese University of Hong Kong.

POPULATION

Women with singleton, term pregnancy, cephalic presentation, clear amniotic fluid and an amniotic fluid index < or = 5 cm, with a normal intrapartum fetal heart rate tracing within 30 minutes of amniotomy.

METHODS

Selected patients were randomised either for prophylactic saline amnioinfusion or as control cases. Cord arterial lipid peroxide concentrations and acid base balance were determined at delivery.

MAIN OUTCOME MEASURES

Operative intervention for fetal distress, cord arterial malondialdehyde and organic hydroperoxide levels, pH and base excess.

RESULTS

Amnioinfusion was associated with significant reductions in the incidence of operative delivery for fetal distress and in lipid peroxide levels, an increase in base excess, but no significant alteration in pH.

CONCLUSIONS

Oligohydramnios in labour is associated with high levels of lipid peroxidation, reflecting cellular damage by release of free radicals following hypoxia reperfusion. Prophylactic intrapartum saline amnioinfusion is an effective technique for the reduction of lipid peroxidation and of the incidence of operative intervention for fetal distress but has no significant effect on overall operative delivery rates.

Lipid peroxidation in cord blood: the effect of amniotic fluid volume

OBJECTIVE

To assess the effect of amniotic fluid volume on umbilical cord arterial lipid peroxide levels in relation to intrapartum events.

DESIGN

Prospective observational study.

SETTING

Delivery suite of a teaching hospital, the Chinese University of Hong Kong.

POPULATION

Women with singleton, term, cephalic presentation, and an initially normal fetal heart rate tracing.

METHODS

All pregnancies had amniotic fluid index assessments before and after amniotomy and cord arterial lipid peroxide determination at delivery. Multiple regression analysis.

MAIN OUTCOME MEASURES

Cord arterial malondialdehyde and organic hydroperoxide levels.

RESULTS

In 247 cases following amniotomy levels were inversely correlated with intrapartum amniotic fluid index. Amniotic fluid index during labour was an independent determinant of cord arterial lipid peroxide concentration, along with duration of second stage, absence of epidural, presence of tight nuchal cord entanglement and evidence of fetal distress.

CONCLUSIONS

Oligohydramnios during labour is associated with high levels of lipid peroxidation in the fetus, reflecting an increase in hypoxic cellular damage by free radicals.