CHAPTER ONE
- INTRODUCTION
1.1 BACKGROUND OF THE STUDY
One of the latest innovations in modern day society is the increasing awareness of computer-based Expert Systems in problem solving.
Due to the emergence of Computers and the Internet, coupled with the large volume of data and records to be processed, and the speed at which such Data and Information are expected to be stored, retrieved, processed, and disseminated, the use of computers and the internet have increased over the years and have undergone series of developmental changes.
For any Nation in particular and the Society at large to be productive, there is an urgent need to effectively and efficiently face the ever-increasing technological challenges before it. Hence, the design and implementation of an Expert System in the areas of Education and Training, Health and Medicare, Commerce and Industry, Business and Entertainment, Transport and Aviation, Legal Practice, Military, Religion and the Gospel, etc, is inevitable.
To this end, there is yet a positive advancement towards creating Expert Systems with the functions that are normally associated with human intelligence, such as, reasoning, inference, and problem solving among others. This has to do with the designing and implementation of an intelligent computer program built for commercial applications using the programming techniques of Artificial Intelligence.
An Expert System (ES), also called a Knowledge Based System (KBS), is a computer program designed to simulate the problem solving behavior of an expert in a narrow domain or discipline.
In the context of this study, an Expert System is defined as a system that units the accumulated expertise of individual disciplines such as gynecology, ultrasonography, Computer Software Design & Engineering, into a framework that best addresses the specified, on-site needs of patients. In other words, Expert Systems combine the experimental and experiential knowledge with the intuitive reasoning skills of multitude specialists to aid doctors, patients, parents and homes in making the best decision.
This research attempts to create a Knowledge Based System (KBS) otherwise known as Expert Systems (ES) which can mimic human thought, understand logic and can handle the range of problems, which are coextensive with the range of problems to which the human mind has been applied. Typical example of such system is An Expert Medical diagnosis System for Estimation Foetal Parameters and Confirmation of Early Pregnancy in Women. The study is therefore entitled “AN EXPERT MEDICAL DIAGNOSIS SYSTEM FOR ESTIMATION OF FOETAL PARAMETERS AND CONFIRMATION OF EARLY PREGNANCY”.
Many families desire to know if the woman is pregnant even before she sees her menses. Even when a woman learns that she is pregnant, it is important to find out how old the pregnancy is. Knowing the age of the Fetus is a key to good healthcare during pregnancy. Following birth, assessing an infant’s weight, length, head circumference, condition of skin, hair, reflexes, muscle tone, posture, and vital signs can provide a ‘relative’ or ‘developmental’ gestational age. The ‘developmental’ gestational age may not match the calendar gestational age. For example, an infant born with a gestation age of 36 weeks may actually have a developmental gestational age of 38 weeks, and therefore behave more like a term infant than a premature infant.Determination of gestational age is an important factor in planning appropriate care for the fetus or infant. It provides important information regarding expected or potential problems and directly impacts the medical treatment plan for the baby.
Traditionally, the due date was based on the following:
- Date of the last menstrual period
- An early pelvic examination
- Measurement of the size of the uterus
- Quickening, or feeling the baby’s first movements
All of these are still part of routine obstetrical care. However, these methods are very unreliable for some groups of women, such as:
- Overweight or obese women
- Those that are unsure of their last menstrual period
- Women who have been taking oral contraceptives
- Women who have irregular menstrual cycles
Both low birth weight and excessive foetal weight at delivery are associated with an increased risk of newborn complications during labour and the puerperium. The prenatal complications associated with low birth weight are attributable to preterm delivery, intrauterine growth restriction (IUGR), or both. For excessively large fetuses, the potential complications associated with delivery include shoulder dystopia, brachial plexus injuries, bony injuries, and intrapartum asphyxia. The maternal risks associated with the delivery of an excessively large fetus include birth canal and pelvic floor injuries and postpartum hemorrhage. The occurrence of cephalopelvic disproportion is more prevalent with increasing foetal size and contributes to both an increased rate of operative vaginal delivery and cesarean delivery for macrocosmic fetuses compared with fetuses of normal weight.
The Expert System has been developed with detailed Knowledge Base [from Medical Consultants, Clinicians and Patients], and Inference Engine [Good and efficient programming facts and rules] to incorporates the basic concepts of clinical practice in ordered steps.
This includes, Pregnancy and the accompanying tests as ultrasound, Human Chorionic Gonadotropin [hCG] (a hormone present in women’s urine during pregnancy) test etc. which provides an Expert System with the following specific objectives namely Identification and Confirmation of Early Pregnancy, Estimation of Foetal Age or Gestational Age, Estimation of Conception Date, Estimation of Delivery Date, Estimation of Foetal Weight.
The weight of the fetus at any gestation can also be estimated with great accuracy using POLYNOMIAL EQUATIONS containing
- The Crown-rump Length (CRL)
- The Biparietal Diameter (BPD),
- Femur Length (FL),
- Abdominal Circumference (AC).
[See Literature Review Section 2.5 for details]
It is therefore the researcher’s intention to develop an Expert System capable of meeting the Specific Objectives which include among others:
- Identification and Confirmation of Early Pregnancy
- Estimation of Foetal Age or Gestational Age
- Estimation of Conception Date
- Estimation of Delivery Date,
- Estimation of Foetal Weight
1.2 MOTIVATION
The researcher’s wish to develop an Expert Medical Diagnosis System for the Estimation of Foetal Parameter and Confirmation of Early Pregnancy is born out of his desire to proffer solution to some observed problems or weaknesses associated with the present (existing) system.
Some of these problems, among others include:
- Much time spent in interrogation, interpretation and diagnosis or prescription of drugs.
- Misinterpretation of pregnancy symptoms by health officers.
- Wrong prescription of drugs due to misinterpretation of symptoms.
- Low or no consultation of health officers in remote areas, etc.
These problems will be discussed in detail in Chapter Three, under WEAKNESS OF THE PRESENT (EXISTING) SYSTEM. They are therefore the motivating factor for an Expert System to be developed. Hence, the aims and objectives of this system are to seek ways of curbing the dangers inherent with these problems.
1.3 AIMS AND OBJECTIVES OF THE STUDY
The general objective of this system is to develop an Expert System that can engage in behaviours that humans consider intelligent and a system, which can think, mimic human thoughts and understand Logics, and handle range of problems that are coextensive with the range to which the human mind has been applied, such as, in a clinical analyses of symptoms, diagnoses and estimation of some Foetal Parameters required to make good management and clinical decisions during pregnancy.
1.3.1 SPECIFIC OBJECTIVES
Specifically, the study seeks to develop Medical Diagnostic Expert System for:
- Identification and confirmation of early pregnancy
- Estimation of Foetal Age or Gestational Age
- Estimation of Conception Date
- Estimation of Delivery Date,
- Estimation of Foetal Weight
1.3.1 GENERAL OBJECTIVES
The general objectives of this study among others include:
- Develop Expert System necessary to give speed to clinical diagnoses and therapy with greater accuracy, efficiency and effectiveness.
- Make Medical practitioners more efficient and profitable.
- Use Expert System to remove or minimize errors due to human memory lapses, and the resultant wrong diagnoses and therapy.
- To enhance performance of “Junior Doctors, Medical Students and their Clinical Trainees” at the outset of Clinical training.
- Design tools to enhance the productivity of the Knowledge Engineers in building Medical Diagnostic Expert System
- Design an Expert System that can be used for the accurate estimation of Foetal Weight, Age, Conception Date, and delivery date, the focus of this study
- Design an Expert System whose goal is to make expertise available to decision makers and technicians who need answers quickly. There is never enough expertise to go round – certainly it is not always available at the right place and at the right time.
- To make the knowledge-based applications of Artificial Intelligence available which, in turn enhances productivity in other disciplines like Business, Science, Engineering, and the Military.
- Use Expert Systems to reduce the time it takes to diagnose and solve problems, and to perform routine tasks, thus freeing experts for more important work thereby increasing productivity.
- Train Parents, Medical Officers and the general public to use the developed Medical Diagnostic Expert System.
- required for patients’ medical report generation system and report processing To provide developed Expert Systems by continuously updating the database facility that will enable previous medical records about a patient to be recalled any time during pregnancy test.
- Use Expert System to provide a quick reference at homes and to serve as “ARTIFICIAL INTELLIGENT DOCTOR” on hospitals and homes for early pregnancy confirmation and estimation of foetal parameters.
This study is also designed to benefit fathers and mothers to be. The researcher hopes that Students, Medical Practitioners and other healthcare workers will also find professional medical care or attention by a qualified practitioner. the information useful. Our system however, should in no way be a substitute for
1.4 SCOPE OF THE STUDY
At this stage of the development, the system is not intended to provide an alternative to the services of specialist doctors or replace them entirely. This· study covers only the Estimation of Foetal Parameters [Foetal Age, Weight, Conception and Delivery Dates, and Confirmation of Early Pregnancy] during the first trimester.
The work is targeted at the application of oral interrogation in Medical Expert Systems. Extreme cases that involve the use of sophisticated equipment as X-ray, radiation of cancer, blood test etc., are not covered but are given recommendation for more specialized attention, where they are encountered. Disease cases and ailments that require the attention of a surgeon, orthopedist, gynecologist, etc, are referred to the appropriate authority if encountered.
1.4.1 PROBLEM DOMAIN
It is observe that an expert knowledge is specific to one problem domain as opposed to knowledge about general problem-solving techniques. For instance, a problem domain is the special problem area such as Medicine, Finance, Science, or Engineering and so forth that an expert can solve problems in, very well.
Like human expert, Expert System is generally designed to be expert in one problem domain. For example, you would not normally expect a chess expert to have expert knowledge about medicine. Hence, expertise in one problem domain does not automatically carry over to another.
This study is targeted at: The Estimation of Foetal Parameters [Foetal Age, Weight, Conception and Delivery], and Confirmation of Early Pregnancy, which serves as the problem Domain of this study.
1.4.2 KNOWLEDGE DOMAIN
The expert’s knowledge about solving specific problems is called the knowledge domain of the expert. For instance, a medical Expert System designed to diagnose infectious diseases will have a great deal of knowledge about certain symptoms in medicine and consists of knowledge about diseases, symptoms and treatments.
Anigbogu, S.O (2003) explained that the knowledge in Expert System may be either expertise or knowledge, which is generally available from books, magazines and knowledgeable persons. According to him, the term Expert System or Knowledge-Based System or knowledge based Expert System are often used synonymously. In fact, most people use Expert System simply because it is shorter, even though there may only possess a general knowledge. For this study therefore the knowledge domain comprised all available knowledge on Estimation of Foetal Parameters [Foetal Age, Weight, Conception And Delivery Date], and Confirmation of Early Pregnancy.Symptoms, diagnoses including laboratory and ultrasound tests required to measure Foetal Parameters and confirm early pregnancy in women. This is extensively discussed in chapter two of this study.
| Problem
Domain |
|
Knowledge Domain |
However the relationship between problem domain and knowledge domain is illustrated in fig 1.1 below
Fig 1.1 Problem and Knowledge Domain Relationship Illustrated
In the figure 1.1 shows that knowledge domain is entirely included within the problem domain. Secondly, the portion outside the knowledge domain symbolizes an area in which there is not yet knowledge about all the problems.
It is important to note here that an Expert System reasons or makes inferences in the same way a human expert would infer the solution of a problem within the knowledge domain that it knows about.
1.5 SIGNIFICANCE OF THE STUDY
Confirmation of early pregnancy is important in homes and families to find out the details of what to do and in what sequence, what to expect, why and how situations develop, the causative factors, their accompanying signs.
Also, respective and relative inferences and management strategies are vital aspects not only to the clinician but also to the home or patient. Where these details are provided at a less strenuous effort using an Expert System, the clinician will definitely find the exercise very interesting.
According to Alexander G. R et al (1996), most women experience emotional shifts and mood swings. Continuing, they claimed, it is natural to feel doubt, anxiety, and fear about pregnancy and childbirth, as well as happiness, excitement, and anticipation. It is therefore very important that as soon as one thinks one might be pregnant, one should have a confirmation. Confirmation of early pregnancy is therefore very important.
Limiting the potential complications associated with the birth of both small and excessively large fetuses requires that accurate estimation of foetal weight occur in advance of delivery. A review of the methods that can be used for the accurate estimation of foetal weight, Age, Conception Date, and delivery date is the focus of this study.
According to Abramowitz (1991), “Mean birth weight has been described as a function of gestational age.” In his own contribution Amini S. B. et al (1994) claimed that without adequate gestational dating, the standard foetal growth curves cannot be interpreted successfully. Therefore, this system provides clinical and private solutions to these problems with little or no strenuous efforts and with accompanying accuracy, effectiveness and efficiency.
1.6 STATEMENT OF THE PROBLEM
In the Medical profession, there have been instances where symptoms of illness are misunderstood or misinterpreted by health workers. Misinterpretations could result from inability of the health worker to comprehend the symptoms, or inattentiveness of the health worker due to much job pressure and dependence on human sense and memory for the analyses of the details involved in these symptoms. As a result of these misinterpreted symptoms, wrong diagnoses are made. Consequently, Harmful, and/or Non-Effective therapy or treatments may be administered.
In all professions, including the Medical profession, there are experts as there are quacks. Where the absence of the experts is the case, clinical exercise may become a suicide journey. Also In the course of clinical apprenticeship, there are stages when trainees and students feel overwhelmed by the details of the practice and would need an expert to consult, the absence of whom may hinder the intended exercise.
Also, oral interview has a very important advantage as a method of clinical diagnosis. It allows the clinician an opportunity to hear the details of the situations directly from the patient involved. However, the patients’ account of the intensity of the situation might not suffice, because the patient might attempt to withhold some facts which he or she assumes not respectable or shameful, or even unnecessary to effect a reliable conclusion as it might be an evasive one.
A woman wants to know if she is pregnant even before she sees her menses. Also she wants to know how old the pregnancy is and consequently determine due date of delivery. Pregnancy related studies have basic signs and approaches, all or some of which the patient can give account of, depending on the presentation and its developmental stage. But there are multiplicities of such pregnancy related cases obtainable now. The multiplicity and complexity of such pregnancy related attentions have rendered the human sense or memory insufficient of their accruing characteristics, symptoms, diagnosis and treatment
Some Medical dispensary units as well as affiliate health centers are remotely located and out of reach of qualified specialist or clinicians. The available health officers in such remote places would need a detailed reference and consultation guide in order to face with difficult or unfamiliar cases and presentations. It is therefore hoped, that this project would be avery good supplement and also bring the diagnoses to the door step of individuals.
1.7 LIMITATIONS OF THE STUDY
The information provided herein is intended for general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. The information should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call your local emergency number for all medical emergencies. Use of this Expert System is subject to the terms and conditions contained therein.
This study is not meant to substitute for the advice of a physician or medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. The Expert System is designed tocomplement and not intended to diagnose, treat, cure, or prevent any disease. Again in all estimations within the system, exclusion criteria were multiple pregnancy, intrauterine death and major structural or chromosomal anomalies. This project work was limited as a result of scarce resources and also the limited time given to the researcher to carry out the research.
1.8 DEFINITION OF TERMS
Childbirth: – It is usually occur about 38 weeks after conception, approximately 40 weeks from the last normal menstrual period (LMP) in human
Conception: – The process by which a woman or female animal become pregnant or the time when these happens.
EDD: – Expected Date of Delivery.
Embryo: – It is used to describe the developing offspring during the first 8 weeks following conception.
Expert System: It is programming computer to make decision in real-life situation. It is also called Knowledge Based System (KBS) a computer program designed to simulate the problem solving behavior of a human expert in a narrow domain or discipline.
Fetus: – used for 2 month of development until birth.
Games Playing: – Programming computers to play games such as chess and Checkers
Gestational Age: – It usually determined by the date of the woman last menstrual period and assuming ovulation occurred on day fourteen of the menstrual cycle.
Gynecologist: – An expert in the science of the disease of woman and pregnancy.
LMP: – Last Menstrual Period.
Malaise: – General feeling of the body discomfort without clear sign of an illness.
Midwifery: – Is the non-surgical field that cares for pregnancy and pregnant women.
Multifarious Woman: – A woman who has already given birth at least two times
Natural Language: – Programming computer to understand Natural human language.
Neural Network: – Systems that simulate intelligence by attempting to reproduce the types of physical connections that occur in animal brains.
Obstetrics: – Is the surgical field that studies and cares for high risk pregnancy.
Post Mature/Post Term: – Event from 42 week (294 days)
Pre Mature/Pre Term: – Event before completion of 37 weeks.
Primiparous Woman: – A woman pregnant for the first time.
Robotics: -Programming computer to see, hear and react to other sensory stimuli.
Self-Medication: – Arbitrary application of drugs by a patient without doctor’s· attention.
Surgeon: – A doctor who specialize in operation (surgery)
Coextensive– With the same range or limit, sharing the same limits, boundaries or scope.
Contraceptives – device preventing fertilization a pill taken by a woman regularly to prevent pregnancy.
Puerperium – Period after child birth. The period immediately after child birth when the womb is returning to its normal size, lasting approximately six weeks.
Intrauterine – Existing, occurring, or designed to be used inside the womb.
Dystocia – Unusually difficult childbirth.
Brachial – Relating to resembling an arm, foreleg, or wing.
Plexus –A network of nerves, blood vessels, or other vessels in the body.
Asphyxia – Suffocation as a result of physical blockage of the airway or inhalation of toxic gases, causing a lack of oxygen and unconsciousness.
Chorionic – A hormone that helps maintain a pregnancy.
Gonadotropin – A hormone that is present in women’s urine during pregnancy.
1.9 CONTRIBUTION FOR ICT BODY OF KNOWLEDGE
- ICT body of knowledge would want to see an expert system to be used and communicated via the globe internet. This system will achieve its contribution to the needs & aspiration of ICT body of knowledge.
- The ICT body of knowledge will want to know the best equation for predicating foetal weight, age, and also the derived equation for estimating conception date, delivery date, etc. This is again achieved by expert system being developed which will definitely meet the needs of ICT body of knowledge.
- Equation for estimating date of conception for instance have not yet been given wide publication or view, this system will make this available and hence contribute immensely for the ICT body of knowledge.
- The researcher hopes that Students, Medical Practitioners and other healthcare workers will also find the information useful.
In addition, this system is very educative and hence will attract future researchers for further development and contribution which will in turn contribute to the ICT body of knowledge
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