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Expert systems for fetal assessment in labour

Overview of attention for article published in Cochrane database of systematic reviews, April 2015
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (88th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (57th percentile)

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16 tweeters
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1 Facebook page

Citations

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11 Dimensions

Readers on

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115 Mendeley
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Title
Expert systems for fetal assessment in labour
Published in
Cochrane database of systematic reviews, April 2015
DOI 10.1002/14651858.cd010708.pub2
Pubmed ID
Authors

Jennifer E Lutomski, Sarah Meaney, Richard A Greene, Anthony C Ryan, Declan Devane

Abstract

Cardiotocography (CTG) records the fetal heart rate in relation to maternal uterine contractions and is one of the most common forms of fetal assessment during labour. Despite guidelines for CTG interpretation, substantial inter- and intra-observer variation in interpretation has been reported among maternity care providers. Misinterpretation of CTG readings can lead to poor decisions, which can result in unnecessary intervention or delay or withholding of necessary intervention. Expert systems (ESs) represent a type of applied artificial intelligence, which can assist in complex clinical decision-making and potentially serve as a mechanism to improve interpretation of fetal heart rate tracings. To evaluate the effectiveness of continuous or intermittent CTG monitoring during labour with an ES compared with (1) continuous or intermittent CTG monitoring during labour without an ES or (2) intermittent auscultation with a Pinard stethoscope or hand-held Doppler ultrasound device. Outcomes of interest included incidence of perinatal mortality, caesarean delivery, operative vaginal birth, fetal blood sampling, artificial rupture of amniotic membranes, oxytocin augmentation of labour, maternal satisfaction with labour, neonatal seizures, fetal acidaemia, hypoxic ischaemic encephalopathy, admission to neonatal special care and/or neonatal intensive care unit and an Apgar score less than seven at five minutes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 October 2014), Open Grey (6 October 2014) ProQuest Dissertation & Theses Database (6 October 2014) and reference lists of retrieved studies. Randomised and quasi-randomised controlled trials comparing continuous or intermittent CTG monitoring during labour with an ES with continuous or intermittent CTG monitoring without an ES were eligible for this review. Trials comparing continuous or intermittent CTG monitoring during labour with an ES with intermittent auscultation with a Pinard or hand-held Doppler were also eligible. Two review authors independently assessed the eligibility and quality of the trials as well as extracted data to ensure accuracy. The authors of included trials were contacted to clarify aspects of the study design that were not clearly reported in the original trial publications. No studies comparing CTG monitoring during labour with an ES to intermittent auscultation were identified.Two randomised controlled trials comparing CTG monitoring during labour with an ES versus CTG without an ES were identified and included in the qualitative synthesis of results, but only one trial (n = 220) provided data for quantitative analysis. Both trials were classified as low risk of bias.There was no strong evidence that CTG with an ES has an effect on the incidence of caesarean delivery (risk ratio (RR) 0.61; 95% confidence interval (CI) 0.35 to 1.04) when compared with CTG with fetal blood sampling.There was no strong evidence supporting a reduction in the incidence of neonatal seizures (RR 0.33; 95% CI 0.01 to 8.09) or fetal acidaemia (RR 0.50; 95% CI 0.09 to 2.67) in women monitored using a CTG with an ES versus a CTG without an ES. Overall perinatal mortality could not be ascertained for this trial since data on early neonatal deaths were unavailable. Although fetal deaths were recorded, no fetal deaths occurred in either arm of the trial, and thus no risk estimates could be derived.There was no strong evidence supporting a reduction in the incidence of forceps-assisted vaginal birth (RR 0.50; 95% CI 0.05 to 5.43), hypoxic ischaemic encephalopathy (RR 0.33; 95% CI 0.01 to 8.09), admission to the neonatal intensive care unit (RR 0.40; 95% CI 0.08 to 2.02) or an Apgar less than seven at five minutes (RR 0.50; 95% CI 0.13 to 1.95).The trial did not report on artificial rupture of amniotic membranes,oxytocin augmentation of labour ormaternal satisfaction with labour. Two trials met the inclusion criteria for this review but one trial did not provide data for any of this review's outcomes. The single trial that did contribute data was underpowered to evaluate the association between CTG monitoring with an ES and the primary outcomes of interest. No recommendations for clinical practice can be made at this time. Adequately powered trials are necessary before the impact of ESs for fetal assessment in labour can be determined.

Twitter Demographics

The data shown below were collected from the profiles of 16 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 115 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Brazil 1 <1%
Unknown 114 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 30 26%
Student > Bachelor 14 12%
Researcher 14 12%
Student > Ph. D. Student 13 11%
Other 6 5%
Other 12 10%
Unknown 26 23%
Readers by discipline Count As %
Medicine and Dentistry 38 33%
Nursing and Health Professions 17 15%
Psychology 9 8%
Social Sciences 7 6%
Computer Science 4 3%
Other 10 9%
Unknown 30 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 13. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 October 2018.
All research outputs
#1,193,843
of 13,647,261 outputs
Outputs from Cochrane database of systematic reviews
#3,540
of 10,695 outputs
Outputs of similar age
#25,633
of 227,039 outputs
Outputs of similar age from Cochrane database of systematic reviews
#99
of 235 outputs
Altmetric has tracked 13,647,261 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 91st percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 10,695 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.0. This one has gotten more attention than average, scoring higher than 66% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 227,039 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 88% of its contemporaries.
We're also able to compare this research output to 235 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 57% of its contemporaries.