title: Development and evaluation of an algorithm for computer analysis of maternal heart rate during labor.
abstract: BACKGROUND
  Maternal heart rate (MHR) recordings are morphologically similar and sometimes coincident with fetal heart rate (FHR) recordings and may be useful for maternal-fetal monitoring if appropriately interpreted. However, similarly to FHR, visual interpretation of MHR features may be poorly reproducible.
  
  
  METHODS
  A computer algorithm for on-line MHR analysis was developed based on a previously existing version for FHR analysis. Inter-observer and computer-observer agreement and reliability were assessed in 40 one-hour recordings obtained from 20 women during the last 2h of labor. Agreement and reliability were evaluated for the detection of basal MHR, long-term variability (LTV), accelerations and decelerations, using proportions of agreement (PA) and Kappa statistic (K), with 95% confidence intervals (95% CI). Changes in MHR characteristics between the first and the second hour of the tracings were also evaluated.
  
  
  RESULTS
  There was a statistically significant inter-observer and computer-observer agreement and reliability in estimation of basal MHR, accelerations, decelerations and LTV, with PA values ranging from 0.72 (95% CI: 0.62-0.79) to 1.00 (95% CI: 0.99-1.00), and K values ranging from 0.44 (95% CI: 0.28-0.60) to 0.89 (95% CI: 0.82-0.96). Moreover, basal MHR, number of accelerations and LTV were significantly higher in the last hour of labor, when compared to the initial hour.
  
  
  CONCLUSIONS
  The developed algorithm for on-line computer analysis of MHR recordings provided good to excellent computer-observer agreement and reliability. Moreover, it allowed an objective detection of MHR changes associated with labor progression, providing more information about the interpretation of maternal-fetal monitoring during labor.
authors.affiliation: Nélio Mendonça Hospital, Funchal, Portugal; School of Medicine, University of Porto, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Pinto
authors.affiliation: School of Medicine, University of Porto, Portugal; São João Hospital Porto, Portugal; CINTESIS - Centre for Research in Technologies and Health Information Systems, Porto, Portugal. Electronic address: jbernardes59@gmail.com.
authors.forename: João
authors.initials: J
authors.lastname: Bernardes
authors.affiliation: School of Medicine, University of Porto, Portugal; CINTESIS - Centre for Research in Technologies and Health Information Systems, Porto, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Costa-Santos
authors.affiliation: School of Medicine, University of Porto, Portugal; INEB - Institute of Biomedical Engineering, Porto, Portugal.
authors.forename: Célia
authors.initials: C
authors.lastname: Amorim-Costa
authors.affiliation: Nélio Mendonça Hospital, Funchal, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: Silva
authors.affiliation: School of Medicine, University of Porto, Portugal; São João Hospital Porto, Portugal; INEB - Institute of Biomedical Engineering, Porto, Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Ayres-de-Campos
mesh_terms: D000328:Adult; D000465:Algorithms; D015148:Cardiotocography / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy; D012815:Signal Processing, Computer-Assisted; D055815:Young Adult
keywords: Agreement; Cardiotocography; Computer analysis; Fetal heart rate; Maternal heart rate; Reliability