Preterm birth is a major cause of mortality and lifelong morbidity in childhood. Its complex and multifactorial origins limit the effectiveness of current clinical predictors and impede optimal care. In this study, a dual-branch deep learning architecture (PUUMA) was developed to predict gestational age (GA) at birth using T2* fetal MRI data from 295 pregnancies, encompassing a heterogeneous and imbalanced population. The model integrates both global whole-uterus and local placental features. Its performance was benchmarked against linear regression using cervical length measurements obtained by experienced clinicians from anatomical MRI and other Deep Learning architectures. The GA at birth predictions were assessed using mean absolute error. Accuracy, sensitivity, and specificity were used to assess preterm classification. Both the fully automated MRI-based pipeline and the cervical length regression achieved comparable mean absolute errors (3 weeks) and good sensitivity (0.67) for detecting preterm birth, despite pronounced class imbalance in the dataset. These results provide a proof of concept for automated prediction of GA at birth from functional MRI, and underscore the value of whole-uterus functional imaging in identifying at-risk pregnancies. Additionally, we demonstrate that manual, high-definition cervical length measurements derived from MRI, not currently routine in clinical practice, offer valuable predictive information. Future work will focus on expanding the cohort size and incorporating additional organ-specific imaging to improve generalisability and predictive performance.

Accurately predicting the outcome of a trial of labor after cesarean (TOLAC) is essential for guiding prenatal counseling and minimizing delivery-related risks. This study presents supervised machine learning models for predicting vaginal birth after cesarean (VBAC) using 643,029 TOLAC cases from the CDC WONDER Natality dataset (2017-2023). After filtering for singleton births with one or two prior cesareans and complete data across 47 prenatal-period features, three classifiers were trained: logistic regression, XGBoost, and a multilayer perceptron (MLP). The MLP achieved the highest performance with an AUC of 0.7287, followed closely by XGBoost (AUC = 0.727), both surpassing the logistic regression baseline (AUC = 0.709). To address class imbalance, class weighting was applied to the MLP, and a custom loss function was implemented in XGBoost. Evaluation metrics included ROC curves, confusion matrices, and precision-recall analysis. Logistic regression coefficients highlighted maternal BMI, education, parity, comorbidities, and prenatal care indicators as key predictors. Overall, the results demonstrate that routinely collected, early-pregnancy variables can support scalable and moderately high-performing VBAC prediction models. These models offer potential utility in clinical decision support, particularly in settings lacking access to specialized intrapartum data.

Foundation models are becoming increasingly effective in the medical domain, offering pre-trained models on large datasets that can be readily adapted for downstream tasks. Despite progress, fetal ultrasound images remain a challenging domain for foundation models due to their inherent complexity, often requiring substantial additional training and facing limitations due to the scarcity of paired multimodal data. To overcome these challenges, here we introduce FetalCLIP, a vision-language foundation model capable of generating universal representation of fetal ultrasound images. FetalCLIP was pre-trained using a multimodal learning approach on a diverse dataset of 210,035 fetal ultrasound images paired with text. This represents the largest paired dataset of its kind used for foundation model development to date. This unique training approach allows FetalCLIP to effectively learn the intricate anatomical features present in fetal ultrasound images, resulting in robust representations that can be used for a variety of downstream applications. In extensive benchmarking across a range of key fetal ultrasound applications, including classification, gestational age estimation, congenital heart defect (CHD) detection, and fetal structure segmentation, FetalCLIP outperformed all baselines while demonstrating remarkable generalizability and strong performance even with limited labeled data. We plan to release the FetalCLIP model publicly for the benefit of the broader scientific community.

Diffusion MRI (dMRI) provides unique insights into fetal brain microstructure in utero. Longitudinal and cross-sectional fetal dMRI studies can reveal crucial neurodevelopmental changes but require precise spatial alignment across scans and subjects. This is challenging due to low data quality, rapid brain development, and limited anatomical landmarks. Existing registration methods, designed for high-quality adult data, struggle with these complexities. To address this, we introduce FetDTIAlign, a deep learning approach for fetal brain dMRI registration, enabling accurate affine and deformable alignment. FetDTIAlign features a dual-encoder architecture and iterative feature-based inference, reducing the impact of noise and low resolution. It optimizes network configurations and domain-specific features at each registration stage, enhancing both robustness and accuracy. We validated FetDTIAlign on data from 23 to 36 weeks gestation, covering 60 white matter tracts. It consistently outperformed two classical optimization-based methods and a deep learning pipeline, achieving superior anatomical correspondence. Further validation on external data from the Developing Human Connectome Project confirmed its generalizability across acquisition protocols. Our results demonstrate the feasibility of deep learning for fetal brain dMRI registration, providing a more accurate and reliable alternative to classical techniques. By enabling precise cross-subject and tract-specific analyses, FetDTIAlign supports new discoveries in early brain development.

The rapid advancement of Artificial Intelligence (AI) in healthcare presents a unique opportunity for advancements in obstetric care, particularly through the analysis of cardiotocography (CTG) for fetal monitoring. However, the effectiveness of such technologies depends upon the availability of large, high-quality datasets that are suitable for machine learning. This paper introduces the Oxford Maternity (OxMat) dataset, the world's largest curated dataset of CTGs, featuring raw time series CTG data and extensive clinical data for both mothers and babies, which is ideally placed for machine learning. The OxMat dataset addresses the critical gap in women's health data by providing over 177,211 unique CTG recordings from 51,036 pregnancies, carefully curated and reviewed since 1991. The dataset also comprises over 200 antepartum, intrapartum and postpartum clinical variables, ensuring near-complete data for crucial outcomes such as stillbirth and acidaemia. While this dataset also covers the intrapartum stage, around 94% of the constituent CTGS are antepartum. This allows for a unique focus on the underserved antepartum period, in which early detection of at-risk fetuses can significantly improve health outcomes. Our comprehensive review of existing datasets reveals the limitations of current datasets: primarily, their lack of sufficient volume, detailed clinical data and antepartum data. The OxMat dataset lays a foundation for future AI-driven prenatal care, offering a robust resource for developing and testing algorithms aimed at improving maternal and fetal health outcomes.

We introduce a conditional implicit neural atlas (CINA) for spatio-temporal atlas generation from Magnetic Resonance Images (MRI) of the neurotypical and pathological fetal brain, that is fully independent of affine or non-rigid registration. During training, CINA learns a general representation of the fetal brain and encodes subject specific information into latent code. After training, CINA can construct a faithful atlas with tissue probability maps of the fetal brain for any gestational age (GA) and anatomical variation covered within the training domain. Thus, CINA is competent to represent both, neurotypical and pathological brains. Furthermore, a trained CINA model can be fit to brain MRI of unseen subjects via test-time optimization of the latent code. CINA can then produce probabilistic tissue maps tailored to a particular subject. We evaluate our method on a total of 198 T2 weighted MRI of normal and abnormal fetal brains from the dHCP and FeTA datasets. We demonstrate CINA's capability to represent a fetal brain atlas that can be flexibly conditioned on GA and on anatomical variations like ventricular volume or degree of cortical folding, making it a suitable tool for modeling both neurotypical and pathological brains. We quantify the fidelity of our atlas by means of tissue segmentation and age prediction and compare it to an established baseline. CINA demonstrates superior accuracy for neurotypical brains and pathological brains with ventriculomegaly. Moreover, CINA scores a mean absolute error of 0.23 weeks in fetal brain age prediction, further confirming an accurate representation of fetal brain development.

Although the use of multiple stacks can handle slice-to-volume motion correction and artifact removal problems, there are still several problems: 1) The slice-to-volume method usually uses slices as input, which cannot well solve the problem of uniform intensity distribution and complementarity in regions of different fetal MRI stacks; 2) The integrity of 3D space is not considered, which adversely affects the discrimination and generation of globally consistent information in fetal MRI; 3) Fetal MRI with severe motion artifacts in the real-world cannot achieve high-quality super-resolution reconstruction. To address these issues, we propose a novel fetal brain MRI high-quality volume reconstruction method, called the Radiation Diffusion Generation Model (RDGM). It is a self-supervised generation method, which incorporates the idea of Neural Radiation Field (NeRF) based on the coordinate generation and diffusion model based on super-resolution generation. To solve regional intensity heterogeneity in different directions, we use a pre-trained transformer model for slice registration, and then, a new regionally Consistent Implicit Neural Representation (CINR) network sub-module is proposed. CINR can generate the initial volume by combining a coordinate association map of two different coordinate mapping spaces. To enhance volume global consistency and discrimination, we introduce the Volume Diffusion Super-resolution Generation (VDSG) mechanism. The global intensity discriminant generation from volume-to-volume is carried out using the idea of diffusion generation, and CINR becomes the deviation intensity generation network of the volume-to-volume diffusion model. Finally, the experimental results on real-world fetal brain MRI stacks demonstrate the state-of-the-art performance of our method.

Although machine learning (ML) models of AI achieve high performances in medicine, they are not free of errors. Empowering clinicians to identify incorrect model recommendations is crucial for engendering trust in medical AI. Explainable AI (XAI) aims to address this requirement by clarifying AI reasoning to support the end users. Several studies on biomedical imaging achieved promising results recently. Nevertheless, solutions for models using tabular data are not sufficient to meet the requirements of clinicians yet. This paper proposes a methodology to support clinicians in identifying failures of ML models trained with tabular data. We built our methodology on three main pillars: decomposing the feature set by leveraging clinical context latent space, assessing the clinical association of global explanations, and Latent Space Similarity (LSS) based local explanations. We demonstrated our methodology on ML-based recognition of preterm infant morbidities caused by infection. The risk of mortality, lifelong disability, and antibiotic resistance due to model failures was an open research question in this domain. We achieved to identify misclassification cases of two models with our approach. By contextualizing local explanations, our solution provides clinicians with actionable insights to support their autonomy for informed final decisions.

To assess fetal health during pregnancy, doctors use the gestational age (GA) calculation based on the Crown Rump Length (CRL) measurement in order to check for fetal size and growth trajectory. However, GA estimation based on CRL, requires proper positioning of calipers on the fetal crown and rump view, which is not always an easy plane to find, especially for an inexperienced sonographer. Finding a slightly oblique view from the true CRL view could lead to a different CRL value and therefore incorrect estimation of GA. This study presents an AI-based method for a quality assessment of the CRL view by verifying 7 clinical scoring criteria that are used to verify the correctness of the acquired plane. We show how our proposed solution achieves high accuracy on the majority of the scoring criteria when compared to an expert. We also show that if such scoring system is used, it helps identify poorly acquired images accurately and hence may help sonographers acquire better images which could potentially lead to a better assessment of conditions such as Intrauterine Growth Restriction (IUGR).

OBJECTIVES: Childhood blindness from retinopathy of prematurity (ROP) is increasing as a result of improvements in neonatal care worldwide. We evaluate the effectiveness of artificial intelligence (AI)-based screening in an Indian ROP telemedicine program and whether differences in ROP severity between neonatal care units (NCUs) identified by using AI are related to differences in oxygen-titrating capability. All images were assigned an ROP severity score (1-9) by using the Imaging and Informatics in Retinopathy of Prematurity Deep Learning system. We calculated the area under the receiver operating characteristic curve and sensitivity and specificity for treatment-requiring retinopathy of prematurity. Using multivariable linear regression, we evaluated the mean and median ROP severity in each NCU as a function of mean birth weight, gestational age, and the presence of oxygen blenders and pulse oxygenation monitors.