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This is the author's version which has not been fully edited and
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Date of publication xxxx 00, 0000, date of current version xxxx 00, 0000.
Digital Object Identifier 10.1109/[Link] Number

Machine Learning-Based Box Models for

Pregnancy Care and Maternal Mortality
Reduction: A Literature Survey
Issac Neha Margret1, Dr. K. Rajakumar2, Dr. K. V. Arulalan3, Dr. Manikandan S4, Dr.
Valentina5
1,2
School of Computer Science and Engineering, V.I.T, Vellore, Tamilnadu, 632014 India
3
Paediatrician, A A Child Care Clinic, Vellore, Tamilnadu, 632014 India
4
Scientist, DRDO, Bangalore, Karnataka, 560037 India
5
Department of Automation and Applied Informatics, University of Arad, 77 B-dul Revolutiei, 310130 Arad, Romania

Corresponding author: Dr. K. Rajakumar (e-mail: [Link]@[Link]).

"This research work for the literature review paper was conducted independently and was not sponsored or supported by any funding agency."

ABSTRACT Maternal mortality is a major public health concern worldwide. It is the number of preventable
deaths that occur each year due to pregnancy and childbirth. The research investigates how machine learning
may be used to minimize maternal mortality. Historical data on maternal health is used to develop predictive
models, early detection systems, and resource allocation techniques. Machine learning helps to identify risk
factors, monitor vital signs, and improve access to care. This allows for targeted interventions and better
healthcare delivery. The challenges of data accessibility and model interpretation are addressed, highlighting
the ethical and equitable applications of machine learning in maternal healthcare. This study emphasizes the
potential of machine learning to reduce maternal mortality rates and the pressing need for its incorporation
into healthcare systems worldwide.

INDEX TERMS Artificial Intelligence, Box Models, Machine learning algorithms, Maternal mortality,
Pregnancy care

I. INTRODUCTION such as a lack of access to high-quality healthcare and

Maternal mortality remains a pressing global health pregnancy and childbirth complications [6].
concern, defined as the mortality of a woman within 42 days In India, maternal mortality remains a significant issue,
of childbirth, pregnancy, or termination of pregnancy. with 10,000 maternal deaths per 4.3 million live births from
Despite notable healthcare progress, high maternal mortality 1997 to 2020 [3]. Despite efforts to improve healthcare
rates persist, reflecting both a nation's healthcare system and infrastructure and access, disparities and socioeconomic
its commitment to gender equality [1], [2]. Efforts to reduce factors continue to impact maternal health outcomes,
maternal mortality underscore advancements in healthcare especially in rural and marginalized communities [3], [5].
and society's moral obligation to safeguard women's health More investment and innovation are needed to address these
during and after pregnancy [3]. However, globally, maternal challenges effectively. Advancements in healthcare
mortality rates remain high, particularly in regions with technology, including machine learning and deep learning,
limited access to quality healthcare and pregnancy show potential for reducing maternal mortality rates in India
complications. In recent years, significant efforts have been and other countries, aligning with sustainable development
made to reduce the global maternal mortality rate [2]. As of goals [3].
the most recent available knowledge update, in September Recent studies emphasize understanding the long-term
2021 the global rate of Maternal Mortality was effects of pregnancy to mitigate maternal mortality risk
approximately 211 Maternal deaths per 100,000 Live Births effectively [7]. Emerging research suggests placental
(MLLB). The highest MLLB rates are found in Sub-Saharan characteristics may predict a woman's future health, offering
African and South Asian countries including the USA [4] valuable insights for proactive interventions [2]. Advances
and India [5], which are attributed to a variety of factors, in healthcare infrastructure, access to qualified midwives,
and improved emergency obstetric care have demonstrated

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positive impacts on reducing maternal mortality in various Time Series Analysis delves into temporal trends and
regions [8], [9], [10]. These advancements reflect the patterns in maternal mortality rates using methods like
ongoing commitment of global health organizations, autoregressive integrated moving average (ARIMA) models
governments, and healthcare providers to ensure safe and and seasonal decomposition. By uncovering underlying
healthy pregnancies for all women, ultimately aiming to temporal patterns, researchers gain a deeper understanding
eliminate maternal mortality [11]. of maternal mortality dynamics, enabling tailored
Data-driven approaches, particularly machine learning, interventions [19].
and deep learning models play a crucial role in identifying Risk Scoring Systems, such as the Modified Early
and predicting maternal mortality risk [12], [13]. By Obstetric Warning Score (MEOWS) and Maternal Severity
leveraging clinical information, demographic data, and real- Index (MSI), evaluate maternal complication severity and
time vital signs, these models enable healthcare providers to predict adverse outcomes, including mortality. Leveraging
prioritize care and resources for pregnant women at high risk, clinical and physiological parameters, these systems stratify
facilitating timely interventions and reducing the likelihood patients by risk level, aiding in prompt intervention [20].
of maternal mortality [14]. As the field of machine learning Decision tree algorithms, like Classification and
continues to evolve, its potential in addressing maternal Regression Trees (CART), have been utilized for maternal
mortality grows, offering hope for further advancements in mortality prediction [49], [75]. They offer a structured
reducing maternal mortality rates and ensuring healthier framework by recursively partitioning data based on
pregnancies and safer childbirths for women worldwide [15]. predictor variables. This transparent decision-making
Furthermore, the integration of deep learning models into process reveals risk factor hierarchies contributing to
maternal health initiatives holds promise for enhancing the maternal death [21], [22].
accuracy and efficiency of risk prediction, contributing to Expert Opinion and Clinical Guidelines amalgamate
more effective strategies for reducing maternal mortality evidence-based practices and expert consensus to identify
[15]. Deep learning algorithms offer new avenues for risk factors and recommend interventions for reducing
understanding and addressing the multifaceted determinants maternal mortality [23], [24], [25]. These guidelines serve as
of maternal mortality [16]. A comprehensive approach to invaluable resources for public health interventions and
reducing maternal mortality encompasses advancements in clinical decision-making.
healthcare infrastructure, proactive interventions informed While traditional methods have significantly contributed
by long-term research, and the utilization of data-driven and to understanding maternal mortality, there is a growing
deep-learning models for risk prediction and intervention demand for more advanced techniques, such as machine
[15]. By addressing the complex interplay of medical, social, learning and deep learning, to enhance predictive capabilities
and environmental factors, we can work towards a future and ultimately reduce maternal mortality rates.
where maternal mortality is no longer a reality, ensuring the
health and well-being of women worldwide. III. STRUCTURED PROCESS
The goal of this literature review is to assess the current
II. BACKGROUND status of research in the field of “Maternal mortality
Pregnancy care and maternal mortality prediction have reduction using machine learning & deep learning
traditionally relied on established methodologies rooted in models/techniques” and to identify areas that need to be
statistical analysis and epidemiological research. These further explored. The following sections are summarized
include Multivariable Regression Analysis, Survival below: The approach utilized for carrying out this review
Analysis, Time Series Analysis, Risk Scoring Systems, (which incorporates the creation of research questions) is
Decision Trees, and the integration of Expert Opinion and described in Section III. From Section IV through Section
Clinical Guidelines. These methods play a crucial role in VII, the outcomes of the literature survey/related work to the
comprehending the multifaceted factors influencing study topics are presented along with our interventions or
maternal mortality rates [17-25]. discussions of box models in pregnancy care and maternal
Multivariable Regression Analysis enables researchers to mortality in several tables. Section VIII examines the
assess the impact of multiple predictors, such as maternal possible consequences of our findings. Section IX gives an
age, socioeconomic status, healthcare access, and pre- overall summary of this research compared with the existing
existing medical conditions, on maternal death likelihood. literature highlighting the novelty. Section X concludes with
This method facilitates estimating the influence of various a summary.
factors while accounting for potential confounding variables
[17]. A. HYPOTHESE AND OBJECTIVES
Survival Analysis techniques, such as Kaplan-Meier curves RQ1. What types of data sources, including electronic health
and Cox proportional hazards models, provide a robust records and medical imaging, have been integrated into
framework for analyzing time-to-event data concerning machine learning models to improve maternal mortality
maternal mortality. They consider censored observations and prediction?
covariates, offering insights into temporal dynamics and RQ2. What machine learning and deep learning-based
identifying critical intervention windows [18]. techniques, algorithms, and models are used to identify and
predict the risk of maternal mortality?
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RQ3. What specific areas of focus or study targets have been various digital library sources. These 71 papers are
identified for research aimed at improving pregnancy care collectively used in answering the research questions, i.e.,
and reducing maternal mortality rates? RQ1, RQ2, RQ3 and RQ4. A few other journal articles
RQ4. How have machine learning-based clinical decision (PubMed, and, Frontiers) and websites related to maternal
support systems demonstrated their effectiveness in reducing health and pregnancy care were referred to get clear
maternal mortality rates, and what are the key findings from knowledge about this topic and to frame the content of this
studies and implementations? paper.
Figure 2 illustrates the trends in publications concerning
B. ANALYSIS OF PAPER CHARACTERISTICS the utilization of machine learning and deep learning-based
In this section, you’ll find information on how many research box models in pregnancy care and initiatives aimed at
papers on phishing are out there, where to find them, how to reducing maternal mortality rates from 2008 to 2024.
filter them, and publication trends broken down by year. Initially, the activity was minimal, with only one publication
per year recorded from 2008 to 2014. However, there was a
noticeable surge in publications from 2015 onwards,
indicating a burgeoning interest and investment in this
particular domain. The data reveals fluctuations, suggesting
varying degrees of engagement and research output across
different years. Notably, significant peaks were observed in
2020 and 2022, with 16 and 11 publications respectively,
signaling heightened attention and potential substantial
advancements during those periods. Despite occasional
fluctuations, the overarching trend reflects a steady increase
in publications over time, underscoring the growing
acknowledgment of the potential of machine learning and
DL-based methodologies in enhancing pregnancy care and
mitigating maternal mortality rates.

18 16
Frequency of Publications

16
14
11
12 10
10 8
8 6 6
6 4
3
4 2
1 1 1 1 1 1 1 1
2
0
2005 2010 2015 2020 2025
Publication Year

Figure 1. Selection Process of the Papers

Figure 2. Year-wise Publications of the Selected Papers

Figure 1 illustrates the paper selection process. Initially, IV. DATA SOURCES
more than 8,000 documents were sourced from 4 digital The data used in the selected papers is from different sources
libraries and several respected journal articles. like hospitals, and the results gathered from the interviews
An initial filtering process is initiated by evaluating the and online surveys by clinicians, doctors, other physicians,
titles of the selected papers. The results of this evaluation are and several other gynecologists. It is difficult to address
used to select 405 papers, excluding those that do not meet every dataset in this literature survey. So the datasets are
the criteria for inclusion in the study. The abstracts of the classified into a few classes like Electronic health records,
chosen papers are then thoroughly examined, leading to a Medical imaging, vital sign monitoring, genomic and genetic
further filtering process which results in the selection of 117 data, socioeconomic data, environmental and behavioral, and
papers. Subsequently, a detailed analysis of the remaining lifestyle data. For ease of understanding the information is
papers is conducted to provide further clarifications. Of these given in the tabular format as shown in below Table I instead
117 papers, 74 papers were read through carefully to remove of being presented in paragraphs.
any ambiguities, resulting in 71 papers for study from

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Here is a tabular overview of the data sources from the

chosen papers that fall into any of these categories: EHRs, [57],[53],[79], Socioeconomic Socioeconomic factors, such as
Medical imaging, and Machine learning models to enhance [83] Data (SED ) income, education, and access to
maternal mortality prediction. healthcare, can impact maternal
mortality. ML & DL models can
incorporate this data to assess the
TABLE I social determinants of health.
TYPE OF DATA SOURCES IN THE SELECTED PAPERS
[71] Environmental Information on environmental
Reference No. Data Description and Contribution to Data (ED) factors such as air quality,
Source/Input Maternal Mortality Prediction pollution levels, and climate
parameters conditions.
[46],[62],[75] Survey and Medical data is collected by
Interview conducting surveys and interviews [12],[74-76] Behavioral and Information about maternal
with women patients by doctors Lifestyle Data behaviors and lifestyle choices,
and clinicians. This data is then (BLD) such as smoking, alcohol
fed into a machine learning (ML) consumption, substance abuse,
or deep learning (DL) model for and diet, can be used to assess risk
processing and predicting results. and inform interventions.
This helps in addressing the issue
of maternal mortality.

[42],[43],[44] Electronic Medical history, vital signs, test

The percentages of the data sources used in the selected
Health Records findings, and details on past papers are depicted clearly in Figure 7. Together, these data
(EHR) pregnancies are all included in sources give a better understanding of how a pregnant
EHRs for each patient. Machine woman is doing and how her pregnancy fits into the bigger
learning models can utilize EHR
picture. Machine learning and deep learning algorithms use
data to identify risk factors and
predict maternal mortality. these different types of data to figure out if there are any risk
factors, make predictions about how likely it is that a
[45],[53],[61], Medical The results of medical imaging pregnant woman will die, and make more accurate and
[65] Imaging Data procedures like MRI, tailored tests to help improve outcomes. Demographic data
(MID) electrocardiographic images,
such as age, race, and ethnicity can have an impact on
echocardiogram images,
microscopic images, and maternal health outcomes, as well as geographic information
ultrasound scans can provide such as the distance to healthcare facilities or healthcare
important details about the deserts. Mobile health applications and wearable devices can
mother's and fetus's health. ML &
be used to monitor and predict maternal health metrics in real
DL models can analyze these
images to detect abnormalities and time.
assess maternal health.
V. MACHINE LEARNING- A BOX MODEL
[81],[84-86] Vital Sign Continuous monitoring of vital Artificial intelligence (AI) is an emerging science that has
Monitoring signs like heart rate, blood
the potential to completely transform several industries,
Data (MD) pressure, and oxygen saturation
can be integrated into ML & DL including machine learning (ML) and deep learning (DL),
models to detect sudden changes sometimes known as “box models” due to their systematic
that may indicate maternal distress approach to data analysis [55]. The concept of a "box model"
or complications.
is frequently utilized in both the machine learning and deep
Fluctuating fetal monitoring data,
including fetal heart rate and learning domains to categorize algorithms into three distinct
contraction, from CTG can be groups: "white box," "grey box," and "black box." These
evaluated by ML & DL models to categories are primarily defined by the level of
evaluate the severity of fetal
distress and its implications for the
interpretability and complexity inherent in the algorithms
health of the mother. [26-29]. "White box" models are known for their
transparency, providing clear insights into their decision-
[54],[74] Sensor and IoT Data collected through wearable making processes. Conversely, "black box" models, often
Data (SID) sensing devices is sent to both
cloud and local servers. Where
associated with deep learning architectures, operate with a
this data is analyzed by DL & ML level of opacity, making it challenging to understand the
models for the classification and underlying mechanisms guiding their outputs [55].
prediction tasks helping in Deep learning models, characterized by their intricate
reducing the maternal mortality
architectures consisting of multiple layers of interconnected
and aiding in pregnancy care.
neurons, predominantly fall under the "black box" category
[69] Genomic and Genetic information and genomic [26-29]. This classification is justified by several factors.
Genetic Data analysis to identify hereditary Firstly, the complexity and depth of neural networks make
(GD) conditions and genetic markers
associated with maternal
them less intuitively understandable compared to simpler
complications. models like linear regression or decision trees [55].
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Additionally, the hierarchical structure of deep learning The model is assessed for performance by splitting data
architectures leads to abstract feature representations spread into train and test sets in the data transformation phase and
across numerous layers, which can obscure the direct using metrics. The best model is chosen based on its ability
relationship between inputs and outputs [55]. As a result, to generalize to unseen data.
while deep learning models excel in tasks requiring The selected model's output or outcomes can be used to
abstraction and pattern recognition, their inner workings target objectives like predicting preterm labor and fetal
often defy straightforward interpretation [26-29]. growth and can be used in a clinical decision support system
Categorizing deep learning models as "black box" is or integrated into healthcare applications to assist healthcare
justified due to their inherent complexity and the challenges providers. Developing new applications may be necessary to
associated with interpreting their decision-making processes effectively utilize the model's output [55].
[26-29], [55]. Despite their impressive performance across The study targeted a diverse range of outcomes as shown
various domains, the opacity of deep learning models in Figure 4 in pregnancy care and maternal mortality
highlights the ongoing necessity for research aimed at reduction using accurate Box Models, from childbirth types
enhancing their interpretability and explainability [55]. (Normal / Caesarean Section) to mortality risks (High / Low/
Medium), including Risk level prediction during delivery
(High/Low/Medium), Fetal State Monitoring (Fetal
Conditions: Normal/Suspect/Pathological, Fetal birth weight
estimation, Fetal heart rate, Uterine contractions), Pregnancy
Risk prediction (Low/High/Medium), childbirth prediction
(successful/unsuccessful), Infections prediction emphasizing
the nuanced requirements of pregnancy care. Other study
targets include the prediction of Ectopic pregnancy, Early
detection of preterm delivery, Birth forecasting, Prediction
of Pre-Eclampsia, detection of Insulin needs, diet
Prescription, and analysis of maternal health, to estimate the
chance of success in IVF treatment (having a baby),
Prediction of anemia, Gestational age prediction, Prediction
of in virto fertilization-embryo transfer based on fetal heart
rate, Cardiomyopathy prediction, Image enhancement of
ureteral stones during pregnancy, Prediction of hypertension,
Prediction of postpartum depression, Identification of
tumors, Predict treatment (surgery/ medical treatment/
expectant management) for ectopic pregnancy and predict
the hotspots of age-adjusted mortality rates of lower
respiratory infections.
The selected papers discuss the potential of machine
learning-based box models to improve pregnancy care and
reduce maternal mortality. The methodology for designing
and implementing these models involves gathering and pre-
Figure 3. Basic Understanding of Methodology Used in the Machine
Leaning-Based Box Models in Pregnancy Care and the Reduction of processing data, selecting the appropriate model, predicting
Maternal Mortality various study targets, evaluating its performance, and
deploying it in a healthcare application. This can provide
The methodology for designing and implementing accurate predictions, aid in early detection of complications,
Machine Learning Box models for pregnancy care as shown and help healthcare providers make informed decisions.
in Figure 3, that is commonly used in several papers involves Different types of box models (white, grey, and black) are
gathering raw data from various sources, such as health used in these papers to illustrate their role in pregnancy care.
records and surveys, CTG data or ultrasonic images, and pre-
processing it to remove errors, missing values and noise A. WHITE BOX MODELS
before feeding it to the ML Model to generate output. Maternal mortality refers to the number of women who lose
Choosing the right machine learning model is important their lives while pregnant, giving birth, or shortly after
for a pregnancy care application. Options include white box childbirth. Machine learning is a potent weapon in the effort
models (like decision trees), grey box models (like random to alleviate this catastrophe, which is a worldwide problem
forests), and black box models (like neural networks). The
[54]. The identification, mitigation, and prediction of the risk
Figure 5 clearly illustrates the hierarchy or taxonomy of of maternal mortality are all significant tasks that are carried
machine learning-based box models. The decision should be out using white box machine learning models [26–29], which
based on the problem's complexity and available data [26- are very interpretable. These models provide healthcare
29], [55]. professionals with valuable insights into the causes of

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maternal mortality, which can improve care and potentially contributing to maternal mortality and morbidity in women.
save lives. Here are some input parameters/risk factors [30], Additionally, unsafe abortion, hypertensive disease or
[31], [47] to consider: eclampsia during pregnancy, obstructed labor, and
Clinical Biomarkers - Issac Kofi et al. [74] suggested that malnutrition in pregnant women are also identified as risk
signs like blood pressure and heart rate, as well as lab tests, factors associated with adverse maternal outcomes.
give us a general idea of how your mom is doing. These input parameters can also be drawn from medical
Medical History - Mario WL et al. [52] recommended that images, vital monitoring data, sensors, Internet of Things
previously diagnosed illnesses, surgery, and chronic diseases (IoT) data, etc.
provide insight into the woman’s overall health and potential These input factors, when assessed by a white box
risks. machine learning model [74], [75], enable healthcare
Prenatal Care Data - The authors John Mark et al. [55], practitioners to make educated decisions, detect high-risk
and Alam et al. [57] stated that the data on the number and pregnancies, and adapt treatments to prevent maternal
quality of prenatal care visits, as well as adherence to mortality and to identify the risk factors [35]. These models
prescribed care protocols. contribute greatly to continuing efforts to protect maternal
Demographic Information - In this paper [55] Yuhan et al. health globally by combining the power of data with
concluded that age, ethnicity, race, and socioeconomic interpretability. White box models are distinguished by their
background all contribute to differences in maternal health capacity to offer a complete explanation of their predictions
outcomes. [55]. This article provides a tabular list as shown in Table II
Geographic Data - Mollalo et al. [71] suggested that the of some of the most commonly used white box models.
patient's geographical location, including access to
healthcare institutions, transportation, and regional B. GREY BOX MODELS
healthcare infrastructure plays a vital role in maternal Maternal mortality risk identification, reduction, and
healthcare outcomes. prediction are difficult tasks that need a delicate balance
Social Determinants - The authors Md Sakib et al. [57], between the interpretability of white box models [26-29] and
Guvenir et al. [53], Akhtar et al. [79], and Bogale et al. [83] the predictive capability of black box models. Grey box
determined that the indirect influences on maternal health models [36] integrate features of both white box and black
include income, education, living circumstances, and access box techniques, providing a degree of transparency while
to healthcare services. using the predictive powers of more complex algorithms.
Obstetric History - Moreira et al. [52], Islam et al. [46], This balanced approach enables healthcare practitioners to
and Fernandez et al. [70] mentioned Details about past understand the primary risk factors for maternal mortality
pregnancies, including problems and outcomes, gestational while benefiting from the predicted accuracy provided by
weight, obesity [32], etc., to identify potential recurring increasingly complex algorithms [40], [41]. Finally, grey
risks. box machine learning models can bridge the gap between
Behavioral Data - Patel et al. [75], and Zhen et al. [85] transparency and predictive power, making them a
stated that diet, physical activity, drug use, and smoking significant tool in attempts to improve maternal health
behaviors are examples of lifestyle variables that can have a outcomes. Here's a list of such models along with brief
substantial influence on a mother's health. descriptions in tabular form as shown in Table III.
Genetic Factors - Moreira et al. [52] mentioned Hereditary
hazards and family medical history, taking into account any C. BLACK BOX MODELS / DEEP LEARNING MODELS
genetic predisposition. Black box machine learning algorithms have also found a
Multiple Pregnancies – Chep P et al. [39], and Li-Chun role in the identification, reduction, and prediction of
Liu et al. [33] stated that Carrying numerous fetuses, such as maternal mortality risks. Few ML models fall under this
twins or triplets, might increase the chance of maternal category due to their complexity of human understanding.
problems. Deep learning algorithms, on the other hand, are often
Substance Abuse - The authors Bautista et al. [55], Akhtar referred to as black box models due to their inherent
et al. [79], and Dawit et al. [83] found that using alcohol, complexity and opacity [26-29]. These models, which are
cigarettes, or illegal substances while pregnant is a risk factor distinguished by their complexity and lack of
that can lead to a variety of issues. interpretability, employ powerful algorithms to handle large
Infections - Rafael et al. [64], D. Desseauve et al. [34] datasets and forecast maternal mortality risk [55]. While they
found that infections/ bacterial vaginosis during pregnancy excel at high predicted accuracy, they frequently lack the
can significantly increase maternal mortality risk, making it openness and interpretability that white box models provide
an essential factor to address in the model. [26-29]. However, when combined with clinical skill and
Other – According to Bale JR et al. [1], hemorrhage, domain knowledge, their ability to uncover subtle patterns
which refers to excessive loss of blood from the genital tract and links across large datasets can be a tremendous tool in
within 24 hours of delivery, severe anemia characterized by ongoing attempts to lower maternal death [Link] section
insufficient blood volume, and various infections such as provides Table IV, showing common examples and
sepsis, malaria, and viral hepatitis, pose significant risks frequency of black box machine learning in selected papers.

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Figure 4. The Basic Taxonomy of Various Study Targets in Pregnancy Care

Figure 5. The Taxonomy of Various Machine Learning Based Box Models in Pregancy Care and Maternal Mortality Reduction

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TABLE II
WHITE BOX MODELS IN MATERNAL MORTALITY REDUCTION

Reference No. Model Description / Intervention

[64],[71],[72],[75] Linear Regression (LR) Maternal mortality prediction using a linear regression model uses input parameters (e.g. maternal
age, access to healthcare, Socio-Economic status, etc.) to create a linear relationship between these
variables and maternal mortality rates (MDRs). The linear regression model is then fitted to
historical data to calculate MDRs for each of these parameters. This helps healthcare practitioners
and policymakers to identify determinants of MDRs and design interventions to reduce MDRs.

[43],[53],[54],[59] Logistic Regression (Binary In contrast to linear regression, LRM models a binary result—Maternal Mortality (1) vs. No
Logistic Regression, Multi- Mortality (0). Fitting the model to historic data and applying the logistic function calculates
Class Logistic Regression) probabilities, helping to assess risk and inform strategies for improving maternal healthcare.

[52],[57],[65],[66] Decision Trees (DT), J48 Maternal mortality prediction is made easier by using a Decision Tree model. It takes data from
different factors, like age, healthcare, and socioeconomic status, and breaks it down into branches.
This way, it can predict how likely or unlikely a mother is to die. It's a simple way to identify risk
factors and create targeted interventions to help reduce maternal mortality.

[47],[78],[80],[10 Random Forests (RF) A Random Forest Model for Maternal Mortality Prediction is a collection of decision trees that uses
0] input variables to generate predictions from multiple individual decision trees. This model is capable
of providing a reliable and accurate estimation of maternal mortality risk, particularly when dealing
with complex relationships between variables. This model provides valuable information for
healthcare planning and intervention to reduce maternal mortality.

[52],[83] Gradient Boosting (GB) It uses input parameters to build a series of decision trees. Each decision tree corrects the mistakes
from the previous one. Gradient Boosting iteratively improves predictions and focuses on tough
cases, giving highly accurate Maternal Mortality risk estimates. It's great for understanding complex
patterns and is useful for optimizing interventions to lower Maternal Mortality rates.

[57],[65],[67] Support Vector Machines It uses input parameters to classify the likelihood of maternal mortality. The hyperplane of the SVM
(SVM) model maximizes the range between classes, thus separating data points into different categories.
This model is useful in situations where the relationship between mortality and survival is non-
linear, as it provides accurate predictions and aids in the implementation of targeted healthcare
interventions.

[23],[43],[44] Linear Discriminant LDA for Maternal Mortality Prediction is a statistical approach that uses input factors to figure out
Analysis (LDA) the best way to separate maternal mortality outcomes from non-maternal outcomes. It works by
projecting the data into a smaller space and making sure the distance between the two groups is as
close as possible. It's great for reducing dimensionality and classifying data, helping to identify risk
factors, and predicting Maternal Mortality based on the input features.

[42],[47],[51] k-Nearest Neighbors (KNN) The K-NN classifies a new data point for Maternal Mortality by comparing it to its K nearest
neighbors in the training data set. K is a parameter that can be defined by the user. It predicts based
on the majority of the nearest neighbors. It's a straightforward yet effective way to assess Maternal
Mortality risk and allocate resources in healthcare.

[79],[80],[87] Naive Bayes (NB) Using Bayes' theorem, it calculates the probability of Maternal Mortality based on the input-risk
parameters, assuming independence between the variables (i.e., a naive hypothesis). By comparing
the probability of different outcomes, the Naive Bayes predicts whether Maternal Mortality is likely
or not. This model is simple and effective for risk assessment in Maternal Healthcare.

[43] Generalized Linear Models Is different from regular linear regression because it can work with non-Gaussian distribution and
(GLM) binary outcomes, so it can be used to predict Maternal Mortality (binary: yes, or no). It uses a link
function (like logistic) to estimate the probability of Maternal Mortality, which can give us useful
information about risk factors and help us take preventive measures in Maternal Healthcare.

[78],[85] Rule-Based Models (RBM) These rules are typically developed by domain specialists and are used to predict maternal mortality
(LightGBM, C4.5, C5.0) risk. While rule-based models provide transparency and readability, their effectiveness is contingent
upon the quality and completeness of the rules. They may not capture complex non-linear
relationships between variables. Nevertheless, rule-based modeling can be an effective initial risk
assessment tool in maternal healthcare settings.

[49],[75] RuleFit Model (RFM) These models use input parameters to generate predictive rules automatically from the data, which
CART are then expressed in decision trees to predict the risk of maternal mortality. RuleFit provides the
advantage of uncovering complex relationships within the data while preserving its
comprehensibility, making it an invaluable tool for risk evaluation and insight into maternal
healthcare.

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TABLE III
GREY BOX MODELS IN THE MATERNAL MORTALITY REDUCTION

Reference No. Model Description / Intervention

[65] Decision Trees with A moderate-depth Decision Tree (e.g., the Extra Trees) uses input parameters to build a tree-structured
moderate depth (Extra Decision Tree with multiple Decision Nodes. Unlike a traditional decision tree, an Extra Tree
Trees) introduces randomization during node splitting to minimize overfitting. The Extra Trees model
predicts the mother’s mortality by walking through the tree and predicting the mother’s death based
on the characteristics at each node. This model balances interpretability with predictive accuracy in
the risk assessment of maternal mortality.

[80] Rule-based models with a Fuzzy set theory enables the model to represent uncertainty and imperfections in input data in a
limited number of rules nuanced and incremental manner, which is especially useful in healthcare settings where variables do
(Fuzzy Logic) not necessarily have linear boundaries. Fuzzy rules are then applied to predict maternal mortality,
allowing for a flexible and comprehensible approach to evaluate risk and guide maternal healthcare
decisions.

[72] Regression Trees with In contrast to deep trees, moderate regression models are trimmed to a moderate level to avoid
moderate depth overfitting. By examining the features at every node and how they relate to each other, a moderate
regression model can predict maternal mortality rates (MDRs). This makes it an excellent tool for
evaluating risk factors and forecasting MDR outcomes in a straightforward and easy-to-understand
way
.
[46] Stacking Classifier A Stacking Classifying Model for Maternal Mortality Prediction is a combination of multiple base
classifiers that take into account input parameters. The base classifiers generate individual predictions
on maternal mortality, which are then combined with meta-classifiers to create a final, more precise
prediction. Stacking combines the power of diverse classifiers to provide improved predictive
performance by combining their outputs, thereby increasing the precision of Maternal Mortality Risk
Assessment and Healthcare Planning.

[24],[46],[108], Gradient Boosting (eg. It integrates the predictions of several weak learners (generally decision trees) into a robust ensemble
[109] AdaBoost) model. AdaBoost assigns different weightings to data points. Each iteration, emphasizes misclassified
examples. The result is a strong predictor that is well-equipped to handle complex relationships
between variables. This model is especially useful for Maternal Maternal Mortality Risk Assessment
and helps to improve healthcare decision-making.

[52] Bagged Trees (Bootstrap The Bagged Trees model uses a technique called Bagging to repeatedly aggregate the dataset and
Aggregating) construct multiple decision trees. By combining their predictions, the Bagged Trees model reduces
variance and improves the accuracy of Maternal mortality risk estimation. Bagged Trees provides a
robust approach to Maternal mortality prediction by using multiple perspectives and managing
complex relationships within the dataset.

TABLE IV
BLACK BOX / DEEP LEARNING MODELS IN THE MATERNAL MORTALITY REDUCTION

Reference No. Model Description

[60], [61], [82], Gradient Boosting (e.g., Gradient boosting models build a set of decision trees in sequence, with each decision tree
[83] XGBoost, CatBoost, correcting the errors from the previous one. Gradient boosting models capture complex
Stochastic) relationships and provide high-quality maternal mortality risk estimates. These models help
healthcare providers to identify critical factors and design targeted interventions to lower maternal
mortality.

[65] Gaussian Process Models These models characterize the relationship between input variables and various study targets in
(GPM) maternal healthcare, including maternal mortality, as probabilistic functions rather than single-
point estimates. This probabilistic approach enables the quantification of uncertainty in predictions,
which is crucial for risk analysis and healthcare planning. By embracing uncertainty, these models
become powerful tools for comprehensive risk assessment and informed decision-making in
maternal healthcare analysis, especially when leveraging medical imaging datasets for prediction.

[51] Complex Tree-Based Models Maternal mortality prediction models based on complex tree-based models use input parameters to
(Boosted Trees like GB construct complex decision tree structures. These models capture complex interactions between
models) features, allowing for accurate Maternal Mortality Risk Assessment (MMRAP). Their ability to
deal with nonlinear relationships, as well as feature importance analysis, make them valuable tools
in determining critical factors and driving targeted interventions to reduce Maternal mortality rates.

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[57], [74], [76], Ensemble Models (EM) The optimal approach to maternal mortality prediction involves integrating the outcomes of diverse
[89] ML and DL models, each considering factors like maternal age, access to healthcare, socio-
economic background, and medical imaging data. By amalgamating various algorithms and
harnessing the collective insights of these models, ensemble techniques enhance their predictive
accuracy and reliability. These ensemble models utilize methodologies such as Random Forest,
CNN, MLP, Gradient Boosting, Bagging, and Stacking, providing a holistic and adaptable
framework for evaluating maternal mortality risk and enabling more informed healthcare decisions
and interventions, particularly in the context of predicting a range of study targets from medical
imaging datasets.

[43], [44], [58], Artificial Neural Networks Artificial Neural Networks (ANNs) employed in maternal healthcare leverage inputs such as MRI
[70], [87], [100] scans, electrocardiographic images, echocardiogram images, microscopic images, and ultrasound
scans to predict various study targets including fetal state monitoring, risk level prediction,
mortality prediction, pregnancy risk prediction, infection prediction, birth mode prediction, and
childbirth prediction. These ANNs consist of multiple layers of artificial neurons, which effectively
learn intricate patterns and relationships within the diverse data inputs. Through training, these
networks dynamically adjust their weights to enhance prediction accuracy, thereby serving as
invaluable tools for assessing risks and informing healthcare decisions in maternal health contexts.

[45], [85], [92- Convolutional Neural Convolutional Neural Networks (CNNs) excel in processing image data such as MRI scans,
99], [101] Networks (CNNs) electrocardiographic images, echocardiogram images, microscopic images, ultrasound scans, and
spatial data. However, they are not as effective in predicting maternal mortality based on factors
like age, healthcare access, and socioeconomic status. While CNNs efficiently extract features from
images and data grids using convolution layers, their application in maternal mortality prediction
is limited due to the nature of the data. Typically, maternal mortality prediction relies on tabular
data and other machine-learning techniques like logistic regression or decision trees to derive
accurate insights from non-image data sources.

[53], [62], [75], Back Propagation Neural A Backpropagation Neural Network (BPNN) consists of interconnected layers of neurons. Through
[76], [105], Networks (Feed Forward a back-propagating algorithm, it iteratively adjusts weights and biases to minimize prediction
[106], [25] Neural Networks) e.g. Multi- errors. BPNNs are adept at capturing intricate relationships within data, including medical imaging
Layer Perceptron (MLP) data, and are trained to forecast various study targets related to maternal mortality rates. This
capability facilitates versatile and robust risk assessment in maternal healthcare.

[68] Radial Basis Function Neural The RBFNN model is employed to forecast a range of study targets in maternal healthcare,
Networks (RBFNN) leveraging medical imaging datasets. It comprises three tiers: an input level, a hidden level
featuring radial labeling, and an output level. By discerning intricate relationships within the data,
the RBFNN employs non-linear mapping between inputs and outcomes to anticipate risks and
prognoses associated with maternal health.

[48], [66], [68], Bayesian GLM (Bayesian In maternal healthcare prediction, a Bayesian GLM integrates Bayesian statistics into its
[88], [102] Multi-Layer Perceptron, framework, incorporating medical imaging datasets alongside input variables such as maternal age,
Bayesian Perceptron (BPT)) access to healthcare, socio-economic status, and others. Instead of offering a single-point estimate,
this GLM generates a probability distribution of model parameters, facilitating the quantification
of uncertainty. By doing so, it aids in assessing both the likelihood of various study targets and the
associated uncertainty, furnishing valuable insights for healthcare planning and decision-making
in maternal healthcare.

[86] Genetic Algorithm (GA) A genetic algorithm builds a population of predictive models, builds them over generations, selects
and changes the best-performing models, and finally builds a model that predicts Maternal
Mortality optimally. Although genetic algorithms are not widely used in healthcare, they offer a
novel and flexible way to explore complex relationships in Maternal Mortality data.

[76] Probabilistic Neural Networks PNNs work by estimating the probability distribution of each input feature from the MID and then
(PNN) combining them to forecast maternal mortality. Due to the probabilistic nature of the model, it is
possible to quantify uncertainty in predictions. As a result, PNNs are beneficial for risk assessment
in the field of maternal healthcare by providing an understanding of the probability of maternal
mortality to the input features.

[86] Extreme Learning Machines Extreme Learning Machines (ELMs) represent straightforward and swift-learning artificial neural
(ELM) networks. They commence by randomly initializing weights and biases within hidden layers and
swiftly training the output layer, rendering them particularly suitable for large medical imaging
datasets. ELMs excel in predicting a spectrum of study targets in maternal healthcare by discerning
intricate relationships between inputs and outputs. This capability facilitates swift and precise risk
assessment in maternal healthcare, especially when leveraging medical imaging datasets for
prediction tasks.

[103] Azure Virtual Network V-Net is a CNN designed for predicting maternal mortality and pregnancy care, using medical
(V-Net) images and other data. It uses skip connections and deep convolutional layers to extract important
patterns and features related to maternal health. With training on specific datasets, it accurately
identifies potential complications, helping healthcare providers make informed decisions for
personalized care.
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[104] Recurrent Neural Network Recurrent Neural Networks (RNNs) leverage sequential medical imaging data to forecast a
(RNN) multitude of study targets in maternal healthcare, including outcomes and risk factors for maternal
mortality. Their strength lies in their ability to effectively process time-varying information,
employing feedback loops to retain knowledge of past inputs. Through continuous learning from
labeled medical imaging datasets, RNNs enhance their predictive accuracy, offering timely insights
to healthcare professionals to nurture maternal well-being throughout pregnancy.

[107] Generative adversarial Generative Adversarial Networks (GANs) employ two neural networks, a generator and a
networks (GAN) discriminator, to produce authentic medical imaging datasets related to maternal health and discern
them from real data. This methodology facilitates the generation of diverse scenarios to recognize
risk factors and interventions aimed at averting maternal mortality.

[110] Gated Recurrent Units (GRU) Gated Recurrent Units (GRUs), tailored for maternal mortality prediction and pregnancy care,
analyze sequential maternal health data encompassing prenatal care, demographics, and medical
imaging datasets to anticipate outcomes and study targets. Employing gating mechanisms, they
adeptly manage data flow and capture prolonged dependencies inherent in the data. Trained on
diverse maternal health datasets, including medical imaging data, GRUs become proficient in
modeling intricate temporal patterns associated with pregnancy complications and mortality risks.
This enables healthcare providers to detect risks early and implement personalized interventions,
thereby enhancing maternal well-being and outcomes.

[94] Residual Network (ResNet) Res-Net architecture has revolutionized medical image processing for pregnancy care. By
leveraging its deep learning capabilities, Res-Net effectively processes medical images, extracting
intricate features that aid in predicting study targets. This has significant implications for maternal
mortality reduction, providing valuable insights into pregnancy health. Notably, Res-Net's strength
lies in segmentation, enabling precise identification of anatomical structures and abnormalities in
medical images. This enhanced segmentation accuracy facilitates improved diagnosis and
monitoring, contributing to safer pregnancies and healthier outcomes for both mothers and
newborns.

[120-130] Universal Network (U-Net) U-Net architecture revolutionizes medical image processing, particularly in pregnancy care. It
ingests medical images, such as ultrasounds, and meticulously processes them, leveraging deep
learning algorithms to extract meaningful insights. By segmenting these images, U-Net aids in
identifying critical anatomical structures and abnormalities, enabling precise study targets for
prenatal care. This advanced segmentation capability empowers healthcare providers with
invaluable information to monitor fetal development, assess risks, and intervene promptly,
ultimately contributing to the reduction of maternal mortality.

In the field of maternal healthcare, there is a high demand accuracy and efficacy in maternal healthcare prediction
for deep learning models or black box models that are tasks.
specifically designed for medical imaging datasets. These Deep learning models play a significant role in addressing
models are important as they help predict a variety of study the issue of maternal mortality by detecting potential
targets, such as fetal state monitoring, mortality prediction, complications and risk factors at an early stage. They analyze
pregnancy risk prediction, infection prediction, birth mode medical imaging data comprehensively, allowing healthcare
prediction, and childbirth prediction. Unlike traditional professionals to identify threats to maternal health and well-
machine learning models, deep learning models are skilled being. This early detection leads to timely interventions and
at identifying complex patterns and features from medical personalized treatment strategies, ultimately contributing to
imaging datasets, making it possible to analyze them the reduction of maternal mortality rates. Moreover, these
accurately and comprehensively. While machine learning models provide valuable insights into the underlying
models are effective at predicting study targets using mechanisms of maternal health issues, guiding the
numerical or categorical data, they often struggle to capture development of innovative solutions and improving overall
the complex information present in medical imaging data. maternal healthcare outcomes.
Deep learning models, on the other hand, can learn
hierarchical representations and thus provide unparalleled

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TABLE V
OVERVIEW OF CDSS DEVELOPED USING ML & DL MODELS IN PREGNANCY CARE & MATERNAL MORTALITY REDUCTION

Reference ML & DL Inputdata / Risk factors Output / Findings Limitations CDSS Role in Maternal
No. Models (Study target) Mortality Reduction

[44] RF mode of last delivery, Predicting whether a No discussion of biases or Predicts birth mode to help
blood pressure (BP), delivery will be a C- confounding factors like clinicians make informed
age, hemoglobin, iron, section or a normal healthcare access and decisions and reduce
miscarriages, abortions, delivery. socioeconomic status in the delivery complications.
hypertension, folic acid, study.
breathing, headache, and
diabetes.

[45] LOR Obstetric ultrasound Detection and Due to potential Early detection of
images of ovarian identification of ovarian difficulties or drawbacks, ovarian tumors can lead
tumors. tumors. the paper does not to timely interventions
discuss deep learning and better health
algorithms. outcomes for women.

[48] Binary LOR Unsure dates, pain, Probability of Data from a multi-center Early detection of ectopic
bleeding, previous Intrauterine pregnancy, study is still being pregnancies and other
miscarriage, site, right failing pregnancy of collected, so the current complications leads to
ovary, Serum hCG at 0 unknown location models are untested on quick intervention, which
hours, previous ectopic, (PUL), and ectopic diverse populations and can prevent negative
uterus, free fluid in pregnancy prediction. institutions. outcomes and decrease
PoD, Serum hCG at 48 maternal mortality.
hours, left ovary

[49] CART BP, height, maternal Prediction of Pregnancy 200 training and 40 test Identifying high-risk
age, weight, gravidity, risk- High/Low/Medium cases were used, but they pregnancies early can lead to
gestational age, may not represent all better interventions and
amniotic fluid loss, populations. monitoring, reducing risks
weight gain, and maternal mortality rates.
hyperglycemia, uterine
contractions, fetal
movement, seizures,
albuminuria, placental
localization, basal fetal
heart rate, umbilical
Doppler, growth of the
fetus.
‘
[50] RF Cardiotocography Categorize fetal The paper does not include an Fetal health assessment leads
(CTG) data of fetal conditions as Normal, evaluation of how applicable to better outcomes for both
movements, fetal heart Suspect, or Abnormal the findings are to other mother and baby.
rate, uterine to identify potential situations or contexts.
contractions, fetal issues early on and
accelerations, ensure a safe pregnancy
for both mother and
baby.

[53] SVM Age-related Estimation of The reliability of the CDSS is IVF success prediction leads
infertility, female having a baby not guaranteed. to better resource allocation
age, male blood (chance) in IVF and reduced maternal
type, semen analysis Treatment mortality rates.
category, sperm
count, male age,
female blood type,
BMI, female age,
and other factors

[54] DT WSD (Wearable Predicting the risk level During the process of Early identification of
Sensing Device) data of pregnancy and collecting maternal healthcare maternal health risks can
– Age, BP, heart rate, maternal health data, there is a possibility that help prevent complications
diastolic BP, biases or limitations may arise and reduce maternal
temperature, systolic due, to the utilization of mortality rates.
BP, glucose devices.

[55] RF Abortions, fetal Prediction of or low The study did not address the Identifying high-risk
age, illness risk and highrisk- privacy concerns that may pregnancies early can
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regarding pregnancy arise within the Telemedicine improve outcomes and

pregnancy, framework. reduce maternal mortality.
mother’s age,
delivery number,
Other illnesses,
medical & illegal
drugs taken,
smoking, alcohol
consumption

[67] SVM Obstetrical parameters, Predicting labor onset The study did not include Predicting labor onset type
EHG parameters, and type patients who had C-sections, can help prepare for
both the combined elective cesarean deliveries childbirth and reduce risks
parameters or pregnancy complications. during labor and delivery.
This could potentially affect
the generalizability of the
findings.

[68] MLP BP, age at pregnancy, Prediction of livebirth Because there have been Early detection of pregnancy
cardiac problems, & spontaneous abortion limited trials it remains complications leads to timely
pulmonary problems, uncertain whether CDSS has interventions, potentially
platelets count before any effect, on the outcomes of decreasing negative
and during pregnancy in patients, with outcomes and maternal
pregnancy, anti- SLE. deaths.
hypertensive use, the
flare of lupus,
anemia, serum
albumin level, other
parameters

[69] DT Moment (pre- Prediction of diet The CDSS may not be Accurately predicting dietary
prandial/post- prescription and applicable, to types of and insulin needs can help
prandial), glycemia, detection of the need of diabetes due to its focus, on manage gestational diabetes,
meal, and diet changes insulin gestational diabetes lack of lowering risks and improving
generalizability, and outcomes.
insufficient data size.

[70] SVM Fertilized egg size, Prediction of treatment There is a lack of research, on The CDSS accurately
beta-HCG level, no. of for Ectopic pregnancies decision support systems, for predicts treatment for ectopic
earlier gestations, like expectant cases involving pregnancies. pregnancies, preventing
Location of the management, surgery, complications and deaths.
fertilized egg, no. of medical treatment,
previous abortions, no.
of C-section
deliveries, Other
parameters

[72] GBR Diabetes mellitus, Sepsis prediction After analyzing the health Early detection prevents
platelets, BMI records (EHRs) of a perinatal harm and lowers maternal
medical center it is possible deaths.
that the findings of this study
may not be applicable, to a
broader population.

[76] Probabilistic CTG data Assessment of fetal state Neither overfitting nor Assessment of fetal health
NN like pathological, complexity are addressed in leads to better outcomes for
suspect, or normal the study. both mother and baby.

[80] Fuzzy CTG data Labor stage Data is limited leading to Predicting labor onset type
logic classification underfitting of the model and can help prepare for
may also affect the model’s childbirth and potentially
robustness. decrease risks and
complications.

[86] GA CTG data Fetal Certain limitations or Assessment of fetal health

wellbeing(abnormal challenges would arise in a helps prevent complications.
/normal) assessment clinical setting, such as
inaccurate or inexact
predictions.

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[87] ANN Educational level, Prediction of A lack of information on the Early identification of
neuroticism, no. of postpartum study's sample size and postpartum depression
people living, age, depression demographic characteristics prevents adverse outcomes
psychiatric makes it difficult to and reduces maternal
antecedents, life events determine the external mortality rates.
after delivery, validity of the study.
emotionalalterations
during pregnancy,
labor situation during
pregnancy, economic
level, baby’s gender

[90] SVM Fetal Heart Ultrasonic Normal and Model unable to work in real- Assessing fetal health helps
Standard Planes Data abnormal world, accuracy decreases with prevent problems for both
fetal planes larger data, may not detect mother and baby.
classification plane abnormalities.

[91] MLP Fetal Ultrasonic Image Classification An imbalanced dataset led to Fetal health assessment helps
Data of the incorrect predictions for some prevent negative outcomes
ultrasonic classes due to low inter-class for both mother and baby.
Images into variance.
cervix,
abdomen,
femur, brain,
thorax, and
other parts

[95] CNN Maternal age, menstrual Prediction of The system currently relies on Early detection of undesired
cycle, type of fetal health a clinical dataset of 96 weight gain trends through
pregnancy, fetal age, status pregnant women, which may the application enables timely
past delivery number, not be representative of the lifestyle-based interventions,
diabetes history, entire population reducing the risk of adverse
hypertension, fetal complications and potentially
health status, past lowering maternal mortality
surgical operations of rates.
mother, presence of
disabled persons in
mother’s and father’s
family, the result of
double, triple, and quad
test, drug usage,
smoking, and alcohol
consumption.

[102] BPT BMI, Total weight gain Prediction of Difficult to predict early with The personalized Bayesian
(kgs), Weight gain in gestational limited data. Tested on approach for early
the first trimester, rate weight gain – European and Chinese intervention in gestational
of weight gain in the Normal, populations, unsure about weight gain management can
second and third below normal, effectiveness on other help prevent excessive or
trimesters above normal populations. The average error insufficient weight gain
in predicting weight gain is 2.4 during pregnancy, which is
kgs and 2.82 kgs, with associated with adverse
potential for improvement. complications and increased
The study relies on self- risk of maternal mortality.
reporting and may have biases
and inaccuracies.

VI. MACHINE LEARNING-BASED CLINICAL DECISION data-driven insights. By enhancing risk identification and
SUPPORT SYSTEM providing personalized care, these systems make a
A CDSS (Clinical Decision Support System) for Maternal significant contribution to achieving safer pregnancies and
Mortality Risk Identification and Reduction, utilizing the improved maternal outcomes. Here is a tabular overview
latest machine learning technologies [55], is a pioneering shown in Table V of how CDSS based on machine learning
approach to assist healthcare providers in delivering safer is effective in reducing Maternal Mortality Rates (MDRs) in
and more efficient care to pregnant women. An AI-powered terms of key findings.
CDSS offers a range of advantages, such as early risk
identification, personalized care, timely interventions, and
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Utilizing artificial intelligence (AI), machine learning been fully developed to identify the risk factors that may
models, and Deep learning models, and Clinical Decision contribute to the death of a pregnant woman or child during
Support Systems (CDSS) have the potential to make a the trimesters of pregnancy.
significant impact on the global effort to reduce maternal
mortality rates. These systems gather data from various
sources, including Electronic Health Records (EHRs),
50
ultrasound images, and sensor data, to accurately predict and
evaluate crucial factors in pregnancy care. For example, by 41
50 38
predicting the mode of delivery, CDSS enables healthcare
providers to make informed decisions and potentially reduce 40
complications associated with childbirth. Additionally, early

Frequency
identification of high-risk pregnancies, fetal abnormalities, 30 21
and pregnancy complications allows for timely 20 13 9
interventions, leading to better outcomes for both mother and 7
baby. Furthermore, CDSS can predict and manage 10 1
pregnancy-related conditions such as gestational diabetes 0
and sepsis, optimizing maternal health outcomes. Through Total White Box Grey Box Black Box
personalized risk assessments and treatment Models Models / DL
recommendations, these systems empower healthcare Models
professionals to provide tailored and proactive care, Selected Papers with CDSS, No CDSS, & Box Models
ultimately contributing to the reduction of maternal mortality
CDSS No CDSS
rates worldwide. However, it is crucial to address limitations
such as data biases, generalizability issues, and ethical
considerations to ensure the effective and ethical Figure 6. Total Frequency of the Selected Papers with CDSS & without
implementation of CDSS in maternal healthcare. CDSS
Among the selected 71 papers, 50 lack CDSS, which is one
of the most significant limitations of these papers. Although VII. OTHER APPLICATIONS
the remaining 21 papers addressed CDSS development, Machine learning-based pipeline modeling is a new strategy
some limitations were addressed as part of interventions that employed in pre-eclampsia or hypertension in pregnant
may contribute to future research on addressing these women [84]. A smart health system based on IoT for
limitations. ambulatory maternal and fetal monitoring [56] is a game-
Out of the 71 publications that were chosen, only 21 (30%) changing strategy for improving prenatal care. This system
concentrated on developing CDSS, whereas 50 (70%) allows real-time, remote monitoring of fetal and maternal
applied ML-based box models and DL-based black box health indicators by integrating IoT sensors and utilizing
models to detect risk factors and categorize or predict the Convolutional Neural Networks (CNNs), guaranteeing early
outcome as shown in Figure 6. The application of CDSS is identification of abnormalities and prompt treatments [111]
not given enough attention. The first row, labeled "CDSS," In the changing environment of maternal healthcare, the
represents models that provide clinical decision support. Out ideas of Industry 4.0 [73] and the coming Industry 5.0 [112]
of 21 of these papers, 13 are transparent and easy to are catalyzing revolutionary advances in maternal mortality
understand (white box), one falls in between (grey box), and risk identification and prediction. Industry 4.0, defined by
seven are more complex and harder to understand (black box the integration of cyber-physical systems, big data analytics
or deep learning). The second row, "No CDSS," refers to [63], and the Internet of Things – IoT [77], Artificial
papers without clinical decision support. Out of 50 such Intelligence support systems for hybrid data management
papers, 41 are transparent, nine are in between, and 38 are platform for monitoring depression and anxiety symptoms in
complex. This data tells us that both types of models are the perinatal period [113] and other risk factors during
used, but a significant number of them, especially those various stages of pregnancy [114] has led to the development
without clinical decision support, rely on more complex of enhanced monitoring technologies that improve real-time
algorithms, which might be harder to interpret. data gathering and analysis throughout pregnancy and labor.
The major findings show how machine learning and deep
learning-driven CDSS may effectively lower maternal VIII. DISCUSSIONS & RESULTS
mortality rates through enhanced early diagnosis,
individualized treatment, effective resource allocation, better Data Source plays a pivotal role in shaping predictive models
decision-making, a decrease in inequities, and support for aimed at maternal health enhancement. Delving into the
population-based measures. Several limitations are specifics, Figure 7 provides a comprehensive breakdown of
described in the above-developed CDSS or applications. the sources fueling the development of machine learning and
Table V indicates that CDSS or applications for maternal deep learning models across various categories (RQ1).
mortality reduction utilizing ultrasonic images have not yet
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the most prevalent, accounting for 23 instances, constituting

approximately 29.9% of the total count. Following closely
are Random Forests (RF) and K-Nearest Neighbors (KNN),
encompassing around 24.7% and 20.8% of the data, with 19
and 16 instances, respectively. While Decision Trees (DT),
Linear Regression (LR), and Logistic Regression (LogReg)
also make appearances, their representation is comparatively
limited.

Figure 7. Total Frequency of the Data Sources for Different Box Models
in the Selected Papers

Electronic Health Records (EHR) emerge as the dominant

source, boasting 15 instances in White Box Models,
followed closely by Grey Box Models with 18 instances, and
Black Box / DL Models with 11 instances. Monitoring Data
(MD) also commands a significant presence across all model
categories, with 10 instances in White Box Models, 12
instances in Grey Box Models, and 5 instances in Black Box
/ DL Models. Social and Economic Data (SED) also feature
prominently across the board, with 8 instances in White Box
Models, 7 instances in Grey Box Models, and 3 instances in Figure 8. Total Frequency of White Box Models in the Selected Papers
Black Box / DL Models. Behavioural Data (BD) and Sensor
& IOT Data (SID) exhibit consistent representation as well, To improve predictions, we should explore ensemble
providing valuable insights into maternal health across all techniques that combine the strengths of multiple transparent
model types. Conversely, Genomic Data (GD) and models. Future research should prioritize including domain-
Environmental Data (ED) are relatively underrepresented, specific features and expert knowledge during model
with minimal instances observed across the model development to address challenges in maternal health.
categories. This comprehensive overview underscores the In Figure 9, the utilization of various grey box models
diverse array of data sources leveraged in the development within the realm of pregnancy care and maternal mortality
of predictive models for maternal health, highlighting the reduction is depicted (RQ2). Among these models,
integral role played by Electronic Health Records, AdaBoost emerges as the most prominent, with 4 instances
Monitoring Data, and Social and Economic Data in accounting for approximately 36.4% of the total counts.
advancing our understanding and intervention strategies in Other models, including Decision Trees with depth, Fuzzy
maternal care. Logic, Regression Trees, Stacking Classifiers, and Bagged
Maternal health research is advancing with technologies Trees, are each represented by a single instance, indicating
like AI and machine learning. Big data and predictive their less frequent utilization in this context.
analytics can personalize interventions for high-risk AdaBoost is highly effective at improving predictive
pregnancies, reducing maternal mortality rates and performance by combining multiple weak classifiers. There
improving outcomes worldwide [117], [118], [119]. is potential to optimize ensemble learning techniques like
Addressing socioeconomic disparities and improving access AdaBoost, especially when used with deep learning models,
to healthcare for marginalized communities is crucial. to increase prediction accuracy and interpretability.
Collaborative efforts can pave the way to a future with no Integrating domain knowledge and expert insights into the
maternal mortality, ensuring the health and well-being of development of grey box models is essential to ensure their
women and their families for generations to come. relevance and effectiveness in tackling complex maternal
The data illustrated in Figure 8 reveals the utilization of health challenges. Future research could enhance grey box
various machine learning-based white box models in models by incorporating advanced methodologies like
pregnancy care and maternal mortality reduction (RQ2). transfer and reinforcement learning [116]. Collaborations
Among these, Support Vector Machines (SVM) emerge as
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between healthcare professionals, data scientists, and models in addressing maternal health challenges, with UNet
policymakers can lead to innovative solutions for maternal and CNNs emerging as the most prominent choices.
health. By integrating technological advancements with
domain expertise, we can work towards mitigating maternal
mortality rates and promoting maternal well-being globally.

Figure 10. Total Frequency of Black Box / DL Models in the Selected

Papers

Deep learning-based black box models are widely used in

Figure 9. Total Frequency of Grey Box Models in the Selected Papers maternal health. Hybrid models combining deep and
traditional machine learning can improve accuracy and
The data depicted in Figure 10 provides insights into the interpretability. The explainability and transparency of
utilization of various deep learning-based black box models models must be enhanced for better understanding and
within the domain of pregnancy care and maternal mortality acceptance. Comprehensive and diverse datasets can
reduction endeavors (RQ2). Among the listed models, UNet strengthen robustness and personalized interventions in
and Convolutional Neural Networks (CNN) emerge as the maternal care.
most prevalent, constituting approximately 20% and 18% of Figure 11 illustrates the distribution of machine learning-
the total instances, with 11 and 10 counts. Following closely based models within the realm of pregnancy care and
are Multi-layer Perceptron (MLP) and Bayesian Perceptron maternal mortality reduction (RQ2). White box models
(BPT), each representing around 13% and 9% of the data, dominate the landscape, comprising the majority with 54
with 7 and 5 counts, respectively. Ensemble Models (EM) instances, accounting for approximately 60.5% of the total
contribute approximately 5% of the data, with 3 instances counts. Following are black box models or deep learning
listed, suggesting the utilization of combined deep learning models with 44 instances, constituting around 28.3% of the
and machine learning approaches. Other models collectively data, while grey box models are the least represented, with
account for approximately 11% of the data, with 6 instances 10 instances, making up roughly 6.6%. The prevalence of
listed, indicating the usage of various machine learning white box models indicates a preference for transparency and
algorithms such as boosted trees, Xboost, Catboost, and interpretability in modeling approaches, which can foster
stochastic boost, alongside the specified deep learning better understanding and trust among healthcare
models. The remaining models, including Gaussian practitioners.
Processes (GPM), Genetic Algorithms (GA), Probabilistic In terms of future directions, further research could focus
Neural Networks (PNN), V-Net, Recurrent Neural Networks on refining and optimizing white box models to enhance
(RNN), Generative Adversarial Networks (GAN), Extreme their predictive accuracy and applicability in addressing
Learning Machines (ELM), Gated Recurrent Units (GRU), complex maternal health challenges. Additionally, efforts
and Radial Basis Function Neural Networks (RBFNN), should be directed towards integrating these models into
ResNet each contribute one instance, suggesting their less clinical practice to support informed decision-making and
frequent usage in this context. Overall, the data underscores improve maternal health outcomes. By leveraging the
the diverse utilization of deep learning-based black box strengths of white box models and integrating them
effectively into healthcare systems, there is potential to
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enhance patient care and contribute to the reduction of Figure 12. Year-wise frequency of the Box models in the selected papers

maternal mortality rates.

The majority of these models referred to as white box
models, witnessed a steady increase in numbers, reaching
significant peaks in 2020 and 2022. Despite being fewer in
number, grey box models also exhibited sporadic growth,
particularly evident in 2020. In contrast, black box models,
though less prevalent overall, maintained a consistent
presence, especially in 2018 and 2022.
The data underscores a progressive shift towards the
integration of machine learning techniques in pregnancy care
and efforts to reduce maternal mortality, highlighting diverse
but escalating contributions from various models over the
years.
The data presented in Figure 13 provides information
about the frequency of study targets and the use of different
types of box models (white box, grey box, and black box or
DL models) in the context of maternal mortality reduction
and pregnancy care (RQ3).
According to the data, Fetal State Monitoring is the most
frequently studied area, with a total frequency of 8 and
predominantly utilizing Black Box Models or DL Models.
Mortality Prediction and Birth Mode Prediction are also
heavily studied, with a total frequency of 6 and 5
respectively, and are mainly associated with White Box
Models.
Additionally, Risk Level Prediction and Child Birth
Figure 11. Total Frequencies of Different Box Models in the Selected Prediction have moderate frequencies, with a total frequency
Papers of 3 each. Mortality Prediction is commonly addressed with
White Box Models, while Child Birth Prediction sees more
Figure 12 illustrates the evolution and implementation of utilization with Black Box Models or DL Models.
a variety of machine learning-based box models aimed at Pregnancy Risk Prediction and Infection Prediction have
improving pregnancy care and reducing rates of maternal relatively lower frequencies, with a total frequency of 2 each.
mortality from 2008 to 2024. Upon analysis, it is evident that Both are mainly associated with White Box Models. This
there was minimal utilization or acceptance of these models interpretation provides insights into the distribution of model
between 2008 and 2010, as indicated by the low numbers types across diverse medical predictive tasks, indicating
across all categories. However, a gradual increase in varying preferences based on the specific
utilization becomes apparent from 2015 onwards, marking requirements of each task.
the emergence of two distinct trends. In the field of maternal health, it would be beneficial to
explore Black Box Models or DL Models further for Fetal
16 15 State Monitoring. These models have a high frequency and
are critically important. Additionally, there may be
14
opportunities to enhance the predictive accuracy and
12
10
interpretability of White Box Models for Mortality
10
Prediction. This is an area of concern that requires attention.
Frequency

8 Efforts should be directed towards addressing the

8 underrepresentation of Grey Box Models, particularly in
6
6 5 areas such as Birth Mode Prediction, where they are
4 4
3 3 relatively less utilized. It is also important to incorporate
4
2 2 2 more diverse and comprehensive datasets into model
1 1 1 1 1 1 1 1 1
2
0 0 0 0 0 0 0 0 0 0 0 0 development. This could improve the effectiveness of
0 predictions in all targeted study areas, ultimately
contributing to improved maternal health outcomes.
2012

2014

2016
2008
2009
2010
2011

2013

2015

2017
2018
2019
2020
2021
2022
2023
2024

Publication Year
White Grey Black

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Figure 14. Frequency of the Evaluation Metrics for the Various Study
Targets in the selected papers

The analysis of various box models in maternal health

prediction reveals differences in their performance metrics.
White Box Models exhibit moderate predictive capabilities,
with room for improvement in precision, recall, and overall
Figure 13. Frequency of the Study targets and Accurate Box models for accuracy. Grey Box Models show lower predictive
the Various Study Targets in the selected papers
performance, indicating the need for advanced algorithmic
techniques and feature engineering strategies. On the other
The performance metrics of various box models in
hand, Black Box / DL Models demonstrate the highest
maternal health prediction are delineated in the dataset as
predictive capabilities, showcasing the potential of deep
shown the Figure 14. White Box Models exhibit an accuracy
learning algorithms. Future directions could involve refining
of 13, a precision/specificity of 13, and a recall/sensitivity of
White Box Models with improved feature selection and
10. Additionally, the Mean Absolute Error (MAE) for White
optimizing hyperparameters, advancing Grey Box Models
Box Models stands at 2, with a Mean Squared Error (MSE)
with sophisticated modeling approaches, and leveraging
of 4 and a Root Mean Squared Error (RMSE) of 2. The Mean
state-of-the-art deep learning architectures for Black Box /
Absolute Percentage Error (MAPE) for White Box Models
DL Models. Additionally, integrating multi-modal data
is 5, while the Receiver Operating Characteristic Area Under
sources and interdisciplinary collaboration may enhance
the Curve (ROC AUC) is 8, alongside an additional attribute
predictive accuracy and guide effective healthcare
categorized as 'Other' with a value of 10.
interventions for maternal health outcomes.
In contrast, Grey Box Models demonstrate lower
Machine learning, including deep learning models, is used
performance metrics across most categories, with an
by CDSS to assist healthcare practitioners in making better
accuracy of 5, precision/specificity of 4, and
judgments. To provide real-time risk assessments, CDSS
recall/sensitivity of 4. The MAE for Grey Box Models is 1,
employs prediction models built from patient data. In the
with an MSE of 2 and an RMSE of 1. The MAPE for Grey
instance of maternal mortality, a CDSS may give early
Box Models stands at 3, while the ROC AUC is only 1, with
warnings and suggestions to high-risk pregnant women to
an 'Other' attribute value of 4.
assist healthcare practitioners in focusing on treatments and
On the other hand, Black Box / DL Models exhibit the
improving outcomes (RQ4).
highest performance metrics among the three categories,
Adding AI to CDSS improves their ability to reduce
with an accuracy of 21, precision/specificity of 19, and
Maternal Mortality [37], [38]. AI assists CDSS in
recall/sensitivity of 14. The MAE for Black Box / DL
determining if a pregnant woman is in danger by analyzing
Models is 3, with an MSE of 5 and an RMSE of 2. The
many types of data, such as non-medical aspects. This
MAPE for Black Box / DL Models is 6, while the ROC AUC
enables CDSS to do real-time evaluations, recommend
demonstrates a significant value of 13, alongside an 'Other'
treatments, and provide evidence-based advice to mothers.
attribute value of 7.
This enables healthcare practitioners to identify pregnant
These metrics underscore the varying performance levels
women who are at risk, select the appropriate interventions,
of different box models in predicting maternal health
and assist in reducing Maternal Mortality rates.
outcomes, with Black Box / DL Models showcasing the
Incorporating explainable AI (XAI) techniques can
highest predictive capabilities, followed by White Box
improve the transparency and efficiency of CDSS
Models and Grey Box Models.
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predictions, which can help healthcare practitioners to better a one-size-fits-all approach, but rather requires a thorough
understand and trust the system's recommendations [75], understanding of model characteristics, evaluation techniques,
[115]. This will lead to increased accuracy and credibility of and ethical considerations.
the system, which is crucial in maternal health. Going The findings underscore a progressive shift towards the
forward, deep learning models that are tailored to maternal integration of machine learning techniques in pregnancy care
health and that incorporate a broader range of patient data and efforts to reduce maternal mortality, highlighting diverse
sources should be developed and researched to enhance the but escalating contributions from various models over the
interpretability and accuracy of risk assessments. It is also years. While traditional methods have significantly
important to integrate CDSS into clinical workflows to contributed to understanding maternal mortality, there is a
achieve widespread adoption and make an impact in growing demand for more advanced techniques, such as
reducing maternal mortality rates. machine learning and deep learning, to enhance predictive
capabilities and ultimately reduce maternal mortality rates.
IX. SUMMARY & HIGHLIGHTS Most of the studies addressed in this analysis were
The current state of knowledge about the topic: implemented in urban hospitals using EHR neglecting hill
 The use of clinical decision support systems (CDSSs) stations and rural areas. A few other important findings of
[14] in healthcare delivery has various advantages and this review are:
can have a positive effect on the care of pregnant 1) Diverse and comprehensive datasets improve the
women. effectiveness of machine learning models in maternal
 Various studies [16] have demonstrated that machine- health.
learning algorithms are effective in addressing 2) White box models' transparency and interpretability
pregnancy diseases that affect maternal and fetal health. establish trust in pregnancy care decision-making.
 Several study methods are being explored to optimize 3) Grey box models offer adaptability that is vital in
pregnancy outcomes with AI and IoT [15], [114] accommodating the multifaceted nature of pregnancy
 This study [114] explores the use of supervised, care.
unsupervised, reinforcement, and deep learning models 4) Evaluation metrics provide insights into model
in pregnancy care. However, it leaves a gap in exploring performance, including trade-offs involved in predictive
box models for improving maternal mortality. modeling for pregnancy care.
Additions made by this study: 5) Examining evaluation metrics that take imbalances in
 This review highlights the need for machine learning class distribution into account is essential for accurate
and deep learning models in terms of box modeling for predictions.
pregnancy care which in turn helps in reducing the 6) Deep Learning / Black box model interpretability
mortality rates of women during pregnancy and after challenges are worth acknowledging.
delivery. 7) The future of machine learning in pregnancy care
 In this review, 71 papers addressing the application of requires developing more interpretable models,
ML models and DL models for Pregnancy care along improving complex models, and establishing clinical
with the various study targets and maternal mortality priority metrics.
were identified and summarized. 8) There is a lack of efficient use of ultrasound images in
 The review highlighted areas where machine learning- developing clinical decision-support systems for
based box models and deep learning-based black box pregnancy care.
models need to be improved to be used in clinical 9) There is a need to develop CDSS that uses ultrasound
pregnancy-care settings, including applicability, images to classify or predict risk factors in pregnancy.
explainability to a variety of populations, 10) Pregnancy care is undergoing significant research and
implementation, and user testing to assess maternal development in clinical decision support systems and
mortality and risks. international applications.
 This review highlights the need for CDSS and AI 11) Prioritizing interpretability in healthcare is necessary to
application development in the area of pregnancy care develop comprehensible and trustworthy models for
and reducing maternal mortality. clinical decision-making processes.
12) In the healthcare industry, prioritizing ethical and racial
X. CONCLUSION AND FUTURE DIRECTIONS principles in designing machine learning models is
The study of ML & DL-based box models in the field of essential.
Pregnancy care, maternal mortality reduction, and clinical 13) The use of ethnic and racial data of patients is crucial for
decision support systems unveil a landscape full of valuable promoting good health and reducing maternal mortality.
14) Adaptable models that take into account evolving
insights and considerations. These discoveries cover a wide
datasets, healthcare practices, and societal shifts are
range of aspects, from the importance of input data to the
crucial for maintaining the relevance of machine
intricate evaluation methods used to assess the models. As we
learning applications.
combine these insights, it becomes clear that the
implementation of machine learning in pregnancy care is not
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15) Collaboration among healthcare professionals, [9] Jhee, Jong Hyun, et al. "Prediction model development of late-onset
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ACKNOWLEDGMENT complications." Frontiers in Endocrinology 14 (2023): 1130139.
[17] Wilmoth, John R., et al. "A new method for deriving global estimates
I, Issac Neha Margret, extend my deepest appreciation to Dr. of maternal mortality." Statistics, politics, and policy 3.2 (2012).
Rajakumar K, my mentor from V.I.T – Vellore's School of [18] Say, Lale, et al. "Global causes of maternal death: a WHO systematic
Computer Science and Engineering, for their invaluable analysis." The Lancet global health 2.6 (2014): e323-e333.
[19] Ronsmans, Carine, and Wendy J. Graham. "Maternal mortality: who,
guidance, support, and mentorship during the composition of when, where, and why." The lancet 368.9542 (2006): 1189-1200.
this literature review paper. Their vast expertise and varied [20] Bowyer, Lucy. "The confidential enquiry into maternal and Child
viewpoints have significantly influenced my comprehension health (CEMACH). Saving mothers’ lives: reviewing maternal deaths
to make motherhood safer 2003–2005. The seventh report of the
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Additionally, I would like to acknowledge and thank R. [21] Getaneh, Temesgen, et al. "Adverse perinatal outcomes and its
Pavithra, Assistant Professor of Pediatrics Nursing from associated factors among adult and advanced maternal age pregnancy
TSRTC College of Nursing, Tarnaka, Hyderabad, for their aid in Northwest Ethiopia." Scientific reports 11.1 (2021): 14072.
[22] Smith, Emily R., et al. "Adverse maternal, fetal, and newborn
and motivation during this study. Their constructive feedback outcomes among pregnant women with SARS-CoV-2 infection: an
and encouragement have been exceedingly advantageous. individual participant data meta-analysis." BMJ global health 8.1
(2023): e009495.
[23] Mander, Rosemary, and Graeme D. Smith. "Saving Mothers’ Lives
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MISS. ISSAC NEHA MARGRET, born in DR. K. V. ARULALAN, is a highly esteemed

Telangana, India, always had a passion and pediatrician from Vellore, Tamilnadu, India. With
interest in computers and technology. She a career spanning over two decades, he has
completed her Master's degree in Computer dedicated his life to providing compassionate and
Science and Engineering at VNR VJIET in comprehensive care to children and their families.
Hyderabad in 2022. During her time at VNR Dr. Arulalan completed his medical education at
VJIET, Neha excelled in her studies and the prestigious Medical College and went on to
demonstrated a strong passion for research. After pursue his specialization in pediatrics at Vellore.
obtaining her Master's degree, she began teaching His passion for child health and his commitment to
at the Data Science Department at VNR VJIET as improving the lives of young patients have made
an assistant professor. Neha taught students about him a respected figure in the medical community.
data science and assisted them with their research projects, further He currently serves as the head of A A Child Care Clinic, where he
deepening her love for research, particularly in medical and satellite image continues to provide top-notch medical care for children from all walks of
processing, deep learning, and machine learning. life. Dr. Arulalan is also an active member of various medical societies,
Currently, Neha is pursuing her Ph.D. at V.I.T. Vellore in Tamil Nadu. including the Indian Academy of Paediatrics. His expertise and dedication
She aims to expand her knowledge and contribute to the improvement of have earned him recognition and accolades, making him a trusted and
computer science through her research. Neha is dedicated to finding sought-after pediatrician in Vellore and beyond.
innovative solutions to real-world problems using advanced technology.
Her primary interests lie in enhancing medical image processing, pregnancy
care, child care, and reducing maternal mortality.
Neha has presented her research at many prominent conferences and
journals and actively participates in workshops and seminars to stay abreast
of the latest developments in her field. Miss. Issac Neha Margret is a talented
young researcher with a solid educational background and a passion for
leveraging technology to assist people in the real world. With her ongoing DR. MANIKANDAN S, is a highly
Ph.D. studies and future aspirations, she aims to make a significant impact accomplished scientist currently working with the
in the field of computer science. Defence Research and Development
Organization (DRDO) in Bangalore, Karnataka,
India. He completed his Bachelor's degree in
Electrical Engineering from a prestigious
university in India and went on to pursue his M.E.
and Ph.D. in the same field. With over 15 years of
experience in the field of research and
development, Dr. Manikandan has made
DR. K RAJAKUMAR, is a respected expert in significant contributions in the areas of signal
computer science and engineering, serving as a processing, radar technology, and electronic warfare. His expertise lies in
Professor at the School of Computer Science and the design and development of advanced radar systems for military
Engineering, specifically in the Department of applications. He has published numerous papers in internationally renowned
Analytics. With a strong passion for both teaching journals and has also presented his work at various conferences. Dr.
and research, Dr. Rajakumar has made important Manikandan is a highly respected member of the DRDO community and
contributions to image processing, artificial has received several accolades for his contributions to the field of
intelligence, machine learning, and IoT. He engineering and satellite image processing. His dedication and passion for
started his journey in computer science at the his work have been instrumental in the success of many projects at DRDO.
esteemed College of Engineering, Guindy, Anna In his free time, Dr. Manikandan enjoys reading books and spending time
University, earning his M.E. and Ph.D. with his family.
Throughout his academic career, Dr. Rajakumar demonstrated
exceptional skills, receiving awards and praise for his research. He's been
teaching at the School of Computer Science and Engineering for 8 years,
guiding many students to success in their research endeavors. Dr.
Rajakumar's work extends beyond academia; he collaborates with industries
to develop healthcare solutions using his expertise in machine learning and
artificial intelligence, earning recognition and government grants for his
contributions. DR. VALENTINA, is a highly accomplished
A prolific writer, Dr. Rajakumar has published numerous papers and author and researcher in the field of automation
often speaks at international conferences. He also mentors startups and and applied informatics. She holds a Ph.D. from
participates in social initiatives, aiming to make a positive impact on society. the prestigious University of Arad and is currently
With his dedication and expertise, Dr. K Rajakumar continues to inspire a faculty member in the Department of
progress in computer science and engineering. Automation and Applied Informatics at the same
university. Her expertise and contributions in the
field of automation and informatics have greatly
impacted the academic and industrial
communities. She has published numerous articles in renowned journals and
has presented her work at international conferences. Dr. Valentina's research
interests include control systems, artificial intelligence, and data analytics.
Her dedication and passion for her work have earned her recognition and
awards, making her a highly regarded figure in her field. She continues to
actively engage in research and mentor students, inspiring the next
generation of scholars in the field of automation and applied informatics.

25 VOLUME XX, 2017

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