Lukáš Hruban

Open access intrapartum CTG database

BackgroundCardiotocography (CTG) is a monitoring of fetal heart rate and uterine contractions. Since 1960 it is routinely used by obstetricians to assess fetal well-being. Many attempts to introduce methods of automatic signal processing and evaluation have appeared during the last 20 years, however still no significant progress similar to that in the domain of adult heart rate variability, where open access databases are available (e.g. MIT-BIH), is visible. Based on a thorough review of the relevant publications, presented in this paper, the shortcomings of the current state are obvious. A lack of common ground for clinicians and technicians in the field hinders clinically usable progress. Our open access database of digital intrapartum cardiotocographic recordings aims to change that.DescriptionThe intrapartum CTG database consists in total of 552 intrapartum recordings, which were acquired between April 2010 and August 2012 at the obstetrics ward of the University Hospital in Brno, Czech Republic. All recordings were stored in electronic form in the OB TraceVue®;system. The recordings were selected from 9164 intrapartum recordings with clinical as well as technical considerations in mind. All recordings are at most 90 minutes long and start a maximum of 90 minutes before delivery. The time relation of CTG to delivery is known as well as the length of the second stage of labor which does not exceed 30 minutes. The majority of recordings (all but 46 cesarean sections) is – on purpose – from vaginal deliveries. All recordings have available biochemical markers as well as some more general clinical features. Full description of the database and reasoning behind selection of the parameters is presented in the paper.ConclusionA new open-access CTG database is introduced which should give the research community common ground for comparison of results on reasonably large database. We anticipate that after reading the paper, the reader will understand the context of the field from clinical and technical perspectives which will enable him/her to use the database and also understand its limitations.

Sugammadex in a parturient with myotonic dystrophy

Myotonic dystrophy is a chronic, slowly progressing, highly variable, inherited multisystemic disease. It is characterized by wasting of the muscles (muscular dystrophy), cataracts, heart conduction abnormalities, endocrine changes, slow gastric and bowel emptying, and myotonia. Patients with myotonic dystrophy show myotonic responses to succinylcholine and neostigmine, and increased sensitivity to non-depolarising muscle relaxants. We report two cases of a parturient with myotonic dystrophy scheduled for Caesarean Section under general anaesthesia, once in 2009 and once in 2011. Muscle relaxant anaesthetic management in 2009 consisted of rocuronium and waiting for spontaneous neuromuscular blockade recovery with arteficial ventilation in the intensive care unit for 2 hours and 30 minutes postoperatively. In 2011, the same patient was indicated for the selective binding agent sugammadex ( 4 mg kg-1) to actively reverse deep neuromuscular blockade at the end of surgery. Train of Four ratio 0.9 was achieved in 2 minutes. There was no exacerbation of myotonia and no recurrence of muscle relaxation perioperatively in either case. These two obstetric cases provide evidence for the benefits of sugammadex in patients with myotonic dystrophy. We also suggest that it could be used in other patients with neuromuscular diseases.

Information retrieval from hospital information system

This paper details the process of mining information from a hospital information system that has been designed approximately 15 years ago. The information is distributed within database tables in large textual attributes with a free structure. Information retrieval from these information is necessary for complementing cardiotocography signals with additional information that is to be implemented in a decision support system.The basic statistical overview (n-gram analysis) helped with the insight into data structure, however more sophisticated methods have to be used as human (and expert) processing of the whole data were out of consideration: over 620,000 text fields contained text reports in natural language with (many) typographical errors, duplicates, ambiguities, syntax errors and many (nonstandard) abbreviations.There was a strong need to efficiently determine the overall structure of the database and discover information that is important from the clinical point of view. We have used three different methods: k-means, self-organizing map and a self-organizing approach inspired by ant-colonies that performed clustering of the records. The records were visualized and revealed the most prominent information structure(s) that were consulted with medical experts and served for further mining from the database.The outcome of this task is a set of ordered or nominal attributes with a structural information that is available for rule discovery mining and automated processing for the research of asphyxia prediction during delivery. The proposed methodology has significantly reduced the processing time of loosely structured textual records for both IT and medical experts.

Electronic Delivery Book: Structured Database Enables Analysis of Perinatal Risk Factors

The Electronic Delivery Book (EDB), an electronic information system, was developed in cooperation with obstetricians, midwives, and neonatologists from the University Hospital in Brno. The main aim was to create structured electronic documentation of selected delivery-related parameters based on the existing paper-based documentation. The system contains information from the different stages of delivery: parameters of the pregnancy, medications/interventions during the birth, outcome measures for the newborn(s), and primary attributes from neonatology. The EDB also allows creating overviews and basic statistics for everyday clinical needs and offers structured data for retrospective as well as prospective studies. One of the first results based on data collected using the EDB was the analysis aimed at identification of potential risk factors for low umbilical cord artery pH in term, singleton pregnancies. The data selected from EDB represents a basis for the retrospective case-control study. Cases were deliveries characterized by umbilical cord artery pH ≤7.05, controls were with no sign of hypoxia. In the database of 10637 deliveries, collected between 2014 and 2015 at the University Hospital in Brno, we identified 99 cases. Univariate analysis of clinical features was performed. The following risk factors were associated with low pH: the length of the first stage (odds ratio (OR) 1.40; 95% CI 1.04–1.89) and the length of the second stage of labor (OR 2.86; 1.70–4.81), primipara (OR 2.99; 1.90–4.71) and meconium stained fluid (OR 1.60; 1.07–2.38).

Synthetic osmotic dilators in the induction of labour—An international multicentre observational study

INTRODUCTION To evaluate the effects of synthetic osmotic dilators (Dilapan-S/ Dilasoft) in women who required induction of labour in a large prospective multicentre international observational study. MATERIALS AND METHODS Primary outcomes were duration of Dilapan-S/Dilasoft insertion (hours), total induction - delivery interval (hours) and the rate of vaginal deliveries within 24 h (%). Secondary outcomes were the number of dilators inserted, Bishop score increase after extraction of Dilapan-S/Dilasoft, complications during induction (uterine contractions, uterine tachysystole and hyperstimulation, effect on the fetus) and post induction (infections and neonatal outcomes), agents / procedures used for subsequent induction of labour, immediate rate of spontaneous labours following cervical ripening period, rate of spontaneous vaginal deliveries, rate of instrumental vaginal deliveries and caesarean sections. RESULTS Total of 543 women were recruited across 11 study sites, of which, 444 women were eligible for analysis. With Dilapan-S/Dilasoft use of <12 h (n = 188) the overall vaginal delivery rate was 76.6% with 45.7% of these births occurring within 24 h, 66% within 36 h and 75.5% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 24.3(±10.4) hours. With Dilapan-S/Dilasoft use of >12 h (n = 256), the overall vaginal delivery rate was 64.8%, with 16% of these births occurring within 24 h, 48.4% within 36 h and 54.7% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 39.1(±29.2) hours. The mean gain in the Bishops score was +3.6(±2.3). The mean number of Dilapan-S/Dilasoft dilators used was 3.8 (±1.1). The overall rate of caesarean section was 30.1%. The overall complication rate was low including infection risk. No adverse neonatal outcome was attributable to the use of Dilapan-S/Dilasoft. CONCLUSION Dilapan-S/Dilasoft are safe and effective methods for cervical ripening. Their use is associated with low maternal and neonatal complication rates. Future research should aim at level I clinical trials comparing Dilapan-S to other mechanical or pharmacological cervical ripening agents. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02318173.

Synthetic Osmotic Dilator Prior to Induction of Labor: Outcomes From International Observational E-Registry [13C]

Objective The aim of this data collection is to monitor post market clinical practice of the application of synthetic osmotic dilator for cervical ripening prior to induction of labor. The main focus was the rate of Caesarean sections. Additionally, we were aiming to confirm safety and tolerability of synthetic osmotic dilators in routine clinical practice as well as to provide clinical recommendations concerning number of dilators and duration of insertion.

Visualization in Information Retrieval from Hospital Information System

This paper describes the process of mining information from loosely structured medical textual records with no apriori knowledge. The typical patient record is filled with typographical errors, duplicates, ambiguities, syntax errors and many (nonstandard) abbreviations. In the paper we depict the process of mining a large dataset of ~50,000–120,000 records × 20 attributes in database tables, originating from the hospital information system (thanks go to the University Hospital in Brno, Czech Republic) recording over 11 years. The proposed technique has an important impact on reduction of the processing time of loosely structured textual records for experts.