A multicentre comparative study of 17 experts and an intelligent computer system for managing labour using the...

Area of Science:

• Perinatal Medicine
• Artificial Intelligence in Healthcare
• Clinical Decision Support Systems

Background:

• Cardiotocograms (CTGs) are crucial for fetal well-being monitoring during labor.
• Expert interpretation of CTGs can vary, impacting labor management consistency.
• Intelligent computer systems offer potential for standardized analysis of complex medical data.

Purpose of the Study:

• To evaluate if an intelligent computer system can achieve expert-level performance in labor management using CTGs, patient data, and fetal blood sampling.
• To assess the consistency and agreement among experienced clinicians in managing labor based on CTG interpretation.

Main Methods:

• Fifty intrapartum CTG cases with clinical data were independently reviewed twice by an intelligent computer system and 17 experienced fetal monitoring clinicians.
• CTG scoring was performed in 15-minute segments, with cervical dilatation and fetal scalp blood pH estimated upon request.
• Key outcome measures included consistency in scores, agreement on cesarean section recommendations, fetal blood sampling rates, and intervention strategies for various outcomes.

Main Results:

• The intelligent system demonstrated performance comparable to experts, significantly better than chance (67.33%, kappa = 0.31).
• The system exhibited high consistency (99.16%, kappa = 0.98) across independent uses.
• It recommended appropriate interventions, avoiding unnecessary procedures in normal deliveries and identifying birth asphyxia cases effectively, often matching or exceeding expert recommendations.

Conclusions:

• The intelligent computer system's performance was indistinguishable from expert clinicians but demonstrated superior consistency.
• This highlights the potential of intelligent systems to enhance CTG interpretation and reduce interventions.
• The study underscores the effectiveness of CTGs and prompts further investigation into discrepancies between CTG potential and current clinical practice outcomes.