Neural Comput & Applic (2013) 23:1583–1589
DOI 10.1007/s00521-012-1110-3
ORIGINAL ARTICLE
Prediction of fetal state from the cardiotocogram recordings
using adaptive neuro-fuzzy inference systems
Hasan Ocak • Huseyin Metin Ertunc
Received: 23 November 2011 / Accepted: 23 July 2012 / Published online: 9 August 2012
© Springer-Verlag London Limited 2012
Abstract In this study, a new scheme was presented for
the prediction of fetal state from fetal heart rate (FHR) and
the uterine contraction (UC) signals obtained from car-
diotocogram (CTG) recordings. CTG recordings are widely
used in pregnancy and provide very valuable information
regarding fetal well-being. The information effectively
extracted from these recordings can be used to predict
pathological state of the fetus and makes an early inter-
vention possible before there is an irreversible damage to
the fetus. The proposed scheme is based on adaptive neuro-
fuzzy inference systems (ANFIS). Using features extracted
from the FHR and UC signals, an ANFIS was trained to
predict the normal and the pathological state. The method
was tested with clinical data that consist of 1,831 CTG
recordings. Out of these 1,831 recordings, 1,655 of them
were classified as normal and the remaining 176 were
classified as pathological by a consensus of three expert
obstetricians. It was demonstrated that the ANFIS-based
method was able to classify the normal and the pathologic
states with 97.2 and 96.6 % accuracy, respectively.
Keywords Fetal state · Prediction · Fetal heart rate
(FHR) · ANFIS
· M. Ertunc
H. Ocak (&) H.
Department of Mechatronics Engineering, Kocaeli University,
Umuttepe Campus, 41380 Kocaeli, Turkey
e-mail: hocak@kocaeli.edu.tr
H. M. Ertunc
e-mail: hmertunc@kocaeli.edu.tr
1 Introduction
Cardiotocography (CTG), introduced into clinical practice
in the late 1960s, is the continuous recording and the
monitoring of the fetal heart rate (FHR) and the uterine
contractions (UC) during pregnancy, typically in the third
trimester. Figure 1 depicts a typical CTG recording in
which FHR and UC are at the upper and lower parts of the
figure, respectively. Since the fetus is not available for
direct observations, CTG is widely used by obstetricians
for assessing fetal well-being. This information is of great
importance since it allows for the early identification of a
pathological state (i.e., congenital heart defect, fetal dis-
tress or hypoxia, etc.) and assists the obstetrician to predict
future complications and intervene before there is an irre-
versible damage to the fetus.
Despite its usefulness, there has been some controversy
as to the utility and the effectiveness of CTG monitoring,
especially in low-risk pregnancies [1]. The debates mainly
originate from the fact that the recordings are visually
analyzed by experts, thus the interpretations are subjective
and are not reproducible. In addition, it was shown that
over-reliance on the test has led to increased misdiagnosis
of fetal distress and hence increased cesarean deliveries [2].
Although guidelines were developed for assessing the
information present in the CTG recordings, inter-observer
and intra-observer variations in the interpretations and the
misdiagnosis of fetuses (false positives) due to different
experience level of the experts still constitute a big
dilemma [3–5]. To increase the utility and the effectiveness
of the CTG monitoring and minimize the inconsistencies in
the interpretations, a lot of effort has been devoted by
researchers from both medical and engineering back-
grounds toward developing computerized systems for the
analysis and the classification of CTG recordings.
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Fig. 1 A sample CTG recording (upper graph is FHR and the lower
one is UC)
Various techniques have been proposed in the literature
for the prediction and classification of fetal state from CTG
recordings. In a study presented in [6], FHR signals
recorded between 38 and 40 week gestation were classified
using a statistical method. Auto-regressive moving-average
(ARMA) model parameters of 3 min FHR segments were
used as features for a retrospective classification of the
FHR segments, using a linear discriminant function.
Compared with visual classification results, the computer/
observer classification agreement was found to be 85 %. In
another study [7], 36 FHR patterns belonging to hypoxic
(low supply of oxygen) and normal fetuses were classified
using hidden Markov models (HMMs). Twelve time and
frequency domain features were used to train two separate
models for the two fetal states. The models were then used
to identify the fetal state as being either hypoxic or normal.
A maximum overall classification rate of 83 % was
reported after testing of various HMM configurations. The
authors of [8] used time domain parameters such as mean,
standard deviation, approximate entropy and frequency
domain parameters obtained from the power spectral den-
sity (PSD) of the FHR signals along with fuzzy inference
systems (FIS) to identify two very common fetal patho-
logical conditions: intra-uterine growth retardation (IUGR)
and type-I diabetes. Support vector machines (SVM) were
used in another study [9] to identify fetuses compromised
and suspicious of developing metabolic acidosis. Data set
consisted of 80 FHR recordings. The authors reported
77 % classification accuracy. The method proposed in [10]
uses nonlinear features such as fractal dimension, approx-
imate entropy and Lempel–Ziv complexity along with
naive Bayes and support vector machine (SVM) classifiers
to classify FHR signals as normal or pathological. Results
based on 189 recordings revealed an overall sensitivity and
specificity of 70 %. Methods based on wavelets [11] and
neural networks [12] have also been proposed. A com-
parative study of neural networks and statistical methods is
presented in [13].
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Neural Comput & Applic (2013) 23:1583–1589
In this study, we proposed an ANFIS-based fetal state
prediction scheme. ANFIS, the less-known approach
compared with ANN, is a soft computing technique that
combines the benefits of feed-forward calculation of output
and back-propagation of learning capability of artificial
neural networks and human-like reasoning style of fuzzy
logic. ANFIS-based models are very powerful universal
approximators with the ability of interpretable IF–THEN
rules, and they are applied in many fields such as system
identification, fuzzy control, data processing.
Almost all methods presented in the literature used
features extracted only from FHR signals to classify fetal
states. An extensive set of diagnostic features extracted
from both FHR and UC signals were used in this work. The
FHR- and UC-based features were used to train an ANFIS,
which is then used to predict fetal state being normal or
abnormal. On contrary to existing FHR classification and
prediction schemes that were tested with a limited clinical
data set, we tested the new scheme with an extensive
clinical data that consist of 1,831 CTG recordings, out
which 1,655 were classified as normal and the remaining
176 were classified as pathological by a consensus of three
expert obstetricians. It was shown that the new scheme was
able to predict fetal state with a very high accuracy. When
compared with widely used artificial neural network
(ANN), the proposed ANFIS-based scheme performs an
average of 2 % better in terms of classification accuracies.
2 Technical background on ANFIS
ANFIS is one of the first neuro-fuzzy systems and was
introduced by Jang in 1993 [14]. Basically, ANFIS is a
multilayer feed-forward network consisting of nodes and
directional links, which combines the learning capabilities
of a neural network and reasoning capabilities of fuzzy
logic. This hybrid structure of the network can extend the
prediction capabilities of ANFIS beyond ANN and fuzzy
logic techniques when they are used alone. Analyzing the
mapping relation between the input and output data,
ANFIS can establish the optimal distribution of member-
ship functions using either a back-propagation gradient
descent algorithm alone or in combination with a least-
squares method.
ANFIS uses the fuzzy if–then rules involving premise
and consequent parts of Sugeno-type fuzzy inference sys-
tem [14]. For the sake of simplicity, it is assumed that the
inference system has two inputs x and y and one output f.A
typical rule set with two fuzzy if–then rules for a first-order
Sugeno fuzzy model can be expressed as,
1. If x is A1 and y is B1, then f1 ¼ p1 x þ q1 y þ r1
2. If x is A2 and y is B2, then f2 ¼ p2 x þ q2 y þ r2
Neural Comput & Applic (2013) 23:1583–1589
where p1, p2, q1, q2, r1 and r2 are linear parameters in the
consequent parts, while A1, A2, B1 and B2 are nonlinear
parameters.
The corresponding equivalent ANFIS architecture for
two-input first-order Sugeno fuzzy model with two rules is
shown in Fig. 2. The architecture of the ANFIS system
consists of five layers, namely, the fuzzy layer, product
layer, normalized layer, de-fuzzy layer and total output
layer. The node functions in the same layer are of the same
function family as described in the following [14]:
Layer 1 This first layer is called fuzzy layer. The
adjustable nodes in this layer are represented by square
nodes and marked by A1, A2, B1 and B2 with x and y out-
puts. A1, A2, B1 and B2 are the linguistic labels (small,
large, etc.) used in the fuzzy theory for dividing the
membership functions. The node function in this layer that
determines the membership relation between the input and
output functions can be given by
O1;i ¼ lAi ðxÞ; i ¼ 1; 2;
ð1Þ
O1;j ¼ lB ðyÞ; j ¼ 1; 2:
where O1,i and O1,j denote the output functions, and lAi and
lB denote the appropriate membership functions.
Layer 2 This is the product layer, and every node is a
fixed node marked by a circle node and labeled by G. The
output w1 and w2 are the weight functions of the next layer.
The output of this layer, O2,i, is the product of the input
signals and given by
O2;i ¼ wi ¼ lAi ðxÞlBi ðyÞ; i ¼ 1; 2: ð2Þ
The output signal of each node, wi, represents the firing
strength of a rule.
Layer 3 This is the normalized layer, and every node in
this layer is a fixed node, marked by a circle node and
labeled by N. The nodes normalize the firing strength by
calculating the ratio of firing strength for this node to the
sum of all the firing strengths, that is,
wi
O3;i ¼ w ¼ ; i ¼ 1; 2: ð3Þ
w1 þ w2
Fig. 2 The architecture of ANFIS
1585
Layer 4 This is the de-fuzzy layer having adaptive nodes
and marked by square nodes. The node function in this
layer is given by a nonfuzzy equation
O4;i ¼ wifi ¼ wiðpix þ qiy þ riÞ; i ¼ 1; 2: ð4Þ
where wi is the normalized firing strength output from the
previous layer and {pi, qi, ri} is the parameter set of this
node. These parameters are linear and referred as conse-
quent parameters of this node.
Layer 5 This is the last layer that simply computes the
overall system output as the summation of all incoming
signals. Every node in this layer is a fixed node, marked by
circle node and labeled by R. The node function is given by
P
X i wi f
O5;i ¼ wifi ¼ P ; i ¼ 1; 2: ð5Þ
i i wi
Note that the system output is the weighted sum of the
results of the rules. The number of fuzzy sets is determined
by the number of nodes in Layer 1. On the other hand, the
dimension of Layer 4 determines the number of fuzzy rules
employed in the architecture that shows the complexity and
flexibility of the ANFIS architecture.
Similar to ANNs, an ANFIS network can be trained
based on supervised learning to reach from a particular
input to a specific target output. In the forward pass of the
hybrid algorithm of the ANFIS, the node outputs go for-
ward until Layer 4, and consequent linear parameters (pi,
qi, ri) are identified by the least-squares method using
training data. In the backward pass, the error signals
propagate backwards and the premise nonlinear parameters
(ai, bi, ci) are updated by gradient descent. In other words,
while the adjustment of the consequent parameters is
realized in the forward pass, antecedent parameters are
adjusted during the backward pass. In short, the parameters
associated with membership functions will change during
this procedure. As seen in Fig. 2, the circular parameters
are not adaptive, that is, they are fixed nodes with no
changing parameters, while the square nodes are adaptive
in which the parameters are changed during training. Jang
et al. [15] provided the detailed description and the math-
ematical background of the hybrid learning algorithm.
When the premise parameters are kept at fixed values, the
overall output can be represented as a linear combination of
the consequent parameters.
3 Methods
3.1 Clinical data and feature set
The data used in this study were obtained from UCI
Machine Learning Repository [16] and originated from a
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1586 Neural Comput & Applic (2013) 23:1583–1589

Table 1 Summary of the ECG features
LB FHR baseline (beats per minute)
AC # of accelerations per second
FM # of fetal movements per second
UC # of uterine contractions per second
DL # of light decelerations per second
DS # of severe decelerations per second
DP # of prolonged decelerations per second
ASTV Percentage of time with abnormal short-term variability
MSTV Mean value of short-term variability
ALTV Percentage of time with abnormal long-term variability
MLTV Mean value of long-term variability
Width Width of FHR histogram
Min Minimum of FHR histogram
Max Maximum of FHR histogram
Nmax # of histogram peaks
Nzeros # of histogram zeros
Mode Histogram mode
Mean Histogram mean
Median Histogram median
Variance Histogram variance
Tendency Histogram tendency: -1 = left asymmetric;
0 = symmetric; 1 = right asymmetric
study conducted in University of Porto. The data set con-
sists of measurements of fetal heart rate and uterine con-
traction features on 1,831 CTG recordings classified by
three expert obstetricians. A consensus classification label
was assigned to each of the data. Out of the 1,831
recordings, 1,655 were classified as normal fetal state and
the remaining 176 were classified as pathological. The
CTG recordings were automatically processed by an
automated CTG analysis program SisPorto 2.0 [17], and 21
diagnostic features were extracted from the recordings. The
features are illustrated in Table 1.
3.2 Prediction stage
In order to develop an ANFIS model for the experimental
system, the available data set, which consists of 1,831 input
vectors, was divided into training and test sets. Out of the
1,655 normal CTG recordings, 828 (50 %) recordings were
included in the training and the remaining 827 (50 %)
recordings were included in the test data set. Similarly, out
of the 176 pathological CTG recordings, 88 (50 %)
recordings were included in the training and the remaining
88 (50 %) recordings were included in the test data set.
Data included in the training and test data sets were ran-
domly selected from the normal and pathological data sets.
The ANFIS model was developed using MATLAB Fuzzy
Logic Toolbox [18]. In this model, a subtractive fuzzy
clustering was generated to establish a rule base
relationship between the input and output parameters. The
output of the ANFIS model was trained to be 0 for the
normal data and 1 for the pathological data. Each input
variable, which varies within a range, are clustered into
several cluster values in Layer 1 to build up fuzzy rules,
and each fuzzy rule is associated with several parameters of
membership functions in Layer 2 of the ANFIS architec-
ture given in Fig. 2. As the number of rules is increased, the
number of parameters of the membership functions
increases as well. Therefore, the data were divided into
groups called as clusters using the subtractive clustering
method to generate fuzzy inference system. Since the
subtractive fuzzy clustering can automatically determine
the number of clusters, the Sugeno-type fuzzy inference
system was implemented to obtain a concise representation
of a system’s behavior with a minimum number of rules.
The linear least square estimation was used to determine
each rule’s consequent equation. The fuzzy c-means was
used as a data clustering technique wherein each data point
belongs to a cluster to some degree that is specified by a
membership grade. Therefore, a radius value was given in
the MATLAB program to specify the cluster center’s range
of influence to all data dimensions of both input and output.
The neuro-fuzzy algorithm should be trained using a proper
set of training data so that the outputs can be esti- mated
based on the input–output data. Therefore, the data were
trained to identify the parameters of Sugeno-type fuzzy
inference system based on the hybrid algorithm combining
the least square method and the back-propaga- tion gradient
descent method. After training, fuzzy infer- ence
calculations of the developed model were performed. Then,
the input vectors from both the training and the test data set
were presented to the trained network and the responses of
the network, that is, the predicted output parameters, were
compared with the actual ones scored by
the experts.
4 Results and discussion
As mentioned in the previous section, the ANFIS model
was trained to generate a value of 0 for the normal CTG
data and 1 for the pathological CTG data. In order to
maximize the performance of the ANFIS model, the cluster
radius should be tuned properly. The cluster radius defines
the neighborhood of a cluster center. If the cluster radius
was specified by a small number, then there will be many
small clusters in the data, resulting in many rules. In con-
trast, specifying a large cluster radius will yield a few large
clusters in the data, resulting in fewer rules. The detailed
algorithm and process of implementing the subtractive
fuzzy clustering into ANFIS model for various values of
cluster radius can be found in [19, 20]. The values of the

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Neural Comput & Applic (2013) 23:1583–1589
Table 2 Characteristic parameters of the ANFIS model
Number of nodes
Number of linear parameters
Number of nonlinear parameters
Total number of parameters
Number of training data pairs
Number of fuzzy rules
other parameters are dependent on the cluster radius. As
mentioned earlier, decreasing the cluster radius results in
too many small clusters in the data. Consequently, the
number of rules and the total number of linear and non-
linear parameters increase. However, this will decrease the
generalization ability of the ANFIS model. In other words,
the prediction performance will be very high for the
training data, whereas the prediction performance will be
very low for the test data. In this paper, by trial and error,
the optimal cluster radius was determined as 0.6. Other
characteristic parameters of the developed ANFIS model
are given in Table 2.
A threshold value of 0.3 is applied to the output of the
ANFIS model. An output value below the threshold value
is interpreted as normal CTG, and an output value above
the threshold value is interpreted as pathological CTG. The
same threshold value, selected based on the training data
set, is used for both the training and the test data sets. The
performance of the trained ANFIS model was evaluated
using both the training and the test data sets. Figures 3 and
4 depict the output of the ANFIS model for the training and
the test data sets, respectively. All of the 828 normal CTG
data in the training data set were correctly classified as
normal. Similarly, all of the 88 pathological CTG data in
the training data set were correctly classified as
Fig. 3 Output of the ANFIS for
the training data 2
Normal
Pathologic
1.5 Applied threshold
ANFIS output
0.5
-0.5
0 200
1587
pathological. Based on these numbers, the correct predic-
596
tion rates for both the normal and pathological data in the
286
training data set were 100 %. Out of the 827 normal data in
the test data set, 804 were correctly classified as normal
546
and the remaining 23 were misclassified as pathological.
832
Out of the 88 pathological data in the test data set, 85 were
1,282
correctly classified as pathological and only the remaining
13
three were misclassified as normal. Based on these num-
bers, the correct prediction rates of the normal and patho-
logical data in the test data set were 97.2 and 96.6 %,
respectively. Table 3 summarizes the prediction rates of
the ANFIS model. Besides the prediction rates, the table
also shows the number of data classified correctly along
with the number of misclassified data for the normal and
the pathological CTG. As illustrated in the table, the results
for the training data set are slightly better than the test data
set. This is an expected result since the model parameters
were tuned based on the training data. Still, the results for
the test data reveal that ANFIS modeling is an effective
means of predicting the fetal state from the CTG
recordings.
The proposed method was compared with widely used
artificial neural network (ANN)-based classifier for which a
feed-forward back-propagation neural network was used.
After testing with various configurations, the best perfor-
mance was achieved with a network having two hidden
layers. There were five neurons in the in the first hidden
layer and three neurons in the second hidden layer. Tan-
gent-sigmoid transfer functions were used in the hidden
layers, whereas a pure linear transfer function was used in
the output layer. The network was trained using Leven-
berg–Marquardt (LM) algorithm. The classifier was
implemented in MATLAB with the same training and the
test data used for the proposed scheme. The classification
Training results
400 600 800 1000 1200 1400 1600 1800 2000
Data index
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1588 Neural Comput & Applic (2013) 23:1583–1589

Fig. 4 Output of the ANFIS for Test results

the test data 2
Normal
Pathologic
1.5 Applied threshold

ANFIS output
1

0.5

-0.5
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Data index

Table 3 Summary of the prediction results in numbers and percentages

Training data set Test data set
Normal CTG Pathological CTG Normal CTG Pathological CTG

Proposed ANFIS-based scheme Predicted as normal 828 (100 %) 0 (0 %) 804 (97.2 %) 3 (3.4 %)
Predicted as pathological 0 (0 %) 88 (100 %) 23 (2.8 %) 85 (96.6 %)
ANN-based scheme Predicted as normal 819 (98.9 %) 2 (2.3 %) 794 (96.0 %) 5 (5.7 %)
Predicted as pathological 9 (1.1 %) 86 (97.7 %) 33 (4.0 %) 83 (94.3 %)

results of the ANN-based scheme along with the proposed
ANFIS-based method are presented in Table 3. The correct
prediction rates of the normal and pathological data in the
test data set were 98.9 and 97.7 %, respectively, for the
ANN-based scheme as compared to 100 % for the pro-
posed ANFIS-based scheme. The correct prediction rates
of the normal and pathological data in the training data set
were 96.0 and 94.3 %, respectively, for the ANN-based
scheme as compared to 97.2 and 96.6 % for the proposed
ANFIS-based scheme. Consequently, the proposed scheme
outperforms the ANN-based scheme for an average of 2 %
for both the training and the test data sets in terms of
classification accuracies.
The proposed scheme can further be improved in several
ways. First, a feature reduction method, such as the genetic
algorithm, can be utilized to select the features that carry
the most useful information while eliminating the irrele-
vant ones. This will not only speed up the scheme but also
improve the classification rates. In addition, the scheme can
be modified to give more significance to reducing the
misclassification rate for the pathological CTG. When an
obstetrician incorrectly interprets a normal CTG as patho-
logical, he/she would most likely proceed with cesarean
delivery. This would just be a wrong decision on the type
of delivery that would not put the mother and the baby in
extra danger and can be tolerable. On the other hand, when
a pathological CTG is mistakenly evaluated as normal, a
decision of natural delivery might put both the baby’s and
the mother’s lives in danger. Therefore, misclassification of
pathological CTG as normal should be avoided as much as
possible, which can be accomplished through the feature
selection method.
5 Conclusions
CTG recordings carry very valuable information if inter-
preted correctly. The information extracted from these
recordings allows for the early identification of a patho-
logical state and assists the obstetrician to predict future
complications and take necessary actions. In this study, an
ANFIS-based scheme was presented for predicting the fetal
state (as normal or pathological) from CTG data. Twenty-
one diagnostic features extracted from the CTG recordings
by an automated CTG analysis program SisPorto 2.0 were
used to train an ANFIS model. The model was trained to
output 0 for the normal and 1 for the pathological data. The
trained model was then used to predict the fetal state given

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the features extracted from a CTG recording. Test results classification using support vector machines. IEEE Trans Biomed
based on extensive clinical data proved the proposed Eng 53(5):875–884
10. Spilka J, Chudacek V, Koucky M, Lhotska L (2009) Assessment
scheme to be very effective in correctly predicting the fetal of non-linear features for intrapartal fetal heart rate classification.
state. In: Proceedings of the 9th international conference on informa-
tion technology and applications in biomedicine, ITAB 2009,
Larnaca, pp 1–4
11. Georgoulas G, Stylios CD, Groumpos PP (2005) Feature
extraction and classification of fetal heart rate using wavelet
References analysis and support vector machines. Int J Artif Intell Tools
15:411–432
1. MacDonald D, Grant A, Sheridan-Pereira M, Boylan P, Chalmers
12. Magenes G, Signorini MG, Arduini D (2000) Classification of
I (1985) The Dublin randomized controlled trial of intrapartum
cardiotocographic records by neural networks Neural Networks.
fetal heart rate monitoring. Am J Obstet Gynecol 152(5):524–539
In: Proceedings of IEEE-INNS-ENNS international joint con-
2. Goddard R (2001) Electronic fetal monitoring is not necessary for
ference on neural networks (IJCNN’00), vol 3, pp 637–641
low risk labours. Br Med J 322:1436–1437
13. Magenes G, Signorini MG, Sassi R (2001) Multiparametric
3. Rooth G, Huch A, Huch R (1987) Guidelines for the use of fetal
analysis of fetal heart rate: comparison of neural and statistical
monitoring. Int J Gynecol Obstet 25:159–167
methods. Proc Medicon 2001:360–363
4. Bernardes J, Costa-Pereira A, Ayres-de-Campos D, van-Geijn
14. Jang J (1993) ANFIS: Adaptive network-based fuzzy inference
HP, Pereira-Leite L (1997) Evaluation of interobserver agreement
systems. IEEE Trans Syst Man Cybern 23:665–685
of cardiotocograms. Int J Gynecol Obstet 57(1):33–37
15. Jang JSR, Sun CT, Mizutani E (1997) Neuro-fuzzy and soft
5. Palomaki O, Luukkaala T, Luoto R, Tuimala R (2006) Intrapar-
computing. Prentice Hall, New Jersey
tum cardiotocography—the dilemma of interpretational variation.
16. Frank A, Asuncion A (2010) UCI machine learning repository.
J Perinat Med 34(4):298–302
University of California, School of Information and Computer
6. Jongsma HW, Nijhuis JG (1986) Classification of fetal and
Science, Irvine. http://archive.ics.uci.edu/ml
neonatal heart rate patterns in relation to behavioural states. Eur J
17. Ayres-de-Campos D, Bernardes J, Garrido A, Marques-de-Sa J,
Obstet Gynecol Reprod Biol 21(5–6):293–299
Pereira-Leite L (2000) SisPorto 2.0: a program for automated
7. Georgoulas G, Stylios CD, Nokas G, Groumpos PP (2004)
analysis of cardiotocograms. J Matern Fetal Med 5:311–318
Classification of fetal heart rate during labour using hidden
18. MATLAB Documentation (2000) Fuzzy toolbox user’s guide of
Markov models. Proc IEEE Int Joint Conf Neural Netw 3:2471–
MATLAB. The MathWorks, Inc
2474
19. Chiu SL (1994) Fuzzy model identification based on cluster
8. Signorini MG, de Angelis A, Magenes G, Sassi R, Arduini D,
estimation. J Intell Fuzzy Syst 2:267–278
Cerutti S (2000) Classification of fetal pathologies through fuzzy
20. Chang LC, Chang FJ (2001) Intelligent control of modeling of
inference systems based on a multiparametric analysis of fetal
real time reservoir operation. Hydrol Process 15:1621–1634
heart rate. Comput Cardiol 27:435–438
9. Georgoulas G, Stylios CD (2006) Predicting the risk of metabolic
acidosis for newborns based on fetal heart rate signal

13