Predicting Fetal Outcomes from Cardiotocography Signals Using a Supervised Variational Autoencoder

Abstract

Objective: To develop and interpret a supervised variational autoencoder (VAE) model for classifying cardiotocography (CTG) signals based on pregnancy outcomes, addressing interpretability limits of current deep learning approaches. Methods: The OxMat CTG dataset was used to train a VAE on five-minute fetal heart rate (FHR) segments, labeled with postnatal outcomes. The model was optimised for signal reconstruction and outcome prediction, incorporating Kullback-Leibler divergence and total correlation (TC) constraints to structure the latent space. Performance was evaluated using area under the receiver operating characteristic curve (AUROC) and mean squared error (MSE). Interpretability was assessed using coefficient of determination, latent traversals and unsupervised component analyses. Results: The model achieved an AUROC of 0.752 at the segment level and 0.779 at the CTG level, where predicted scores were aggregated. Relaxing TC constraints improved both reconstruction and classification. Latent analysis showed that baseline-related features (e.g., FHR baseline, baseline shift) were well represented and aligned with model scores, while metrics like short- and long-term variability were less strongly encoded. Traversals revealed clear signal changes for baseline features, while other properties were entangled or subtle. Unsupervised decompositions corroborated these patterns. Findings: This work demonstrates that supervised VAEs can achieve competitive fetal outcome prediction while partially encoding clinically meaningful CTG features. The irregular, multi-timescale nature of FHR signals poses challenges for disentangling physiological components, distinguishing CTG from more periodic signals such as ECG. Although full interpretability was not achieved, the model supports clinically useful outcome prediction and provides a basis for future interpretable, generative models.