Search

Introduction: Noninvasive fetal heart rate monitoring using transabdominal fetal electrocardiographic detection is now commercially available and has been demonstrated to be an effective alternative to traditional Doppler ultrasonographic techniques. Our objective in this study was to compare the results of computerized identification of fetal heart rate patterns generated by ultrasound-based and transabdominal fetal electrocardiogram-based techniques with simultaneously obtained fetal scalp electrode-derived heart rate information., Material and Methods: We applied an objective computer-based analysis for recognition of fetal heart rate patterns (Monica Decision Support) to data obtained simultaneously from a direct fetal scalp electrode, Doppler ultrasound, and the abdominal-fetal electrocardiogram techniques. This allowed us to compare over 145 hours of fetal heart rate patterns generated by the external devices with those derived from the scalp electrode in 30 term singleton uncomplicated pregnancies during labor. The direct fetal scalp electrode is considered to be the most accurate and reliable technique used in current clinical practice, and was, therefore, used as the standard for comparison. The program quantified the baseline heart rate, long- and short-term variability. It indicated when an acceleration or deceleration was present and whether it was large or small., Results: Ultrasound was associated with significantly greater deviations from the fetal scalp electrode results than the abdominal fetal electrocardiogram technique in recognizing the correct baseline heart rate, its variability, and the presence of small and large accelerations and small decelerations. For large decelerations the two external methods were each not significantly different from the scalp electrode results., Conclusions: Noninvasive fetal heart rate monitoring using maternal abdominal wall electrodes to detect fetal cardiac activity more reliably reproduced the computerized analysis of heart rate patterns derived from a direct fetal scalp electrode than did traditional ultrasound-based monitoring. Abdominal-fetal electrocardiogram should, therefore, be considered a primary option for externally monitored patients., (© 2019 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

In fetal heart monitoring using Doppler ultrasound signals the cardiac information is commonly extracted from non-directional signals. As a consequence often some of the cardiac events cannot be observed clearly which may lead to the incorrect detection of the valve and wall motions. Here, directional signals were simulated to investigate their enhancement of cardiac events, and hence provide clearer information regarding the cardiac activities. First, fetal Doppler ultrasound signals were simulated with signals encoding forward and reverse motion then obtained using a pilot frequency. The simulation results demonstrate that the model has the ability to produce realistic Doppler ultrasound signals and a pilot frequency can be used in the mixing process to produce directional signals that allow the simulated cardiac events to be distinguished clearly and correctly.

Knowledge of the content of Doppler ultrasound signals from the fetal heart is essential if the performance of fetal heart rate (FHR) monitors based upon this technology is to be improved. For this reason instrumentation was constructed to enable the simultaneous collection of Doppler audio signals and the transabdominal fetal ECG (for signal registration), with a total of 22 recordings being made with an average length of around 20 minutes. These data demonstrate the transient nature of the Doppler audio data with wide variations in the signal content observable on a beat-to-beat basis. Short-time Fourier analysis enabled the content of the Doppler signals to be linked to six cardiac events, four valve and two wall motions, with higher frequency components being associated with the latter. This differing frequency content together with information regarding the direction of movement that can be discerned from Doppler signals provided a potential means of discriminating between these six events (which are unlikely to all contribute to the Doppler signal within the same cardiac cycle). Analysis of 100 records showed that wall contractions generate the most prominent signals, with atrial contraction recognisable in all records and ventricular wall contraction in 95% (although its amplitude is only around 30% of that of the atrial signal). Valve motion, with amplitudes between 15 and 25% that of the atrial wall signal, were visible in 75% of records. These results suggest means by which the six events that contribute to the Doppler signal may be distinguished, providing information that should enable an improvement in the current performance of Doppler ultrasound-based FHR monitors.

A means of monitoring foetal heart rate (FHR) during magnetic resonance imaging (MRI) is presented. Foetal heart rate was measured using a modified standard Doppler ultrasound based monitor. The transducer and lead from the monitor required alteration to reduce interference and distortion in the MR images to acceptable levels. These changes enabled high quality images to be produced with insignificant additional noise and distortion when the foetal heart rate was recorded simultaneously.

During labour the condition of the fetus is monitored by a cardiotocograph which displays fetal heart rate and a measure of uterine contractions. Ultrasound and tocodynamometer transducers are placed on the mother's abdomen and connected to a bedside monitor and display unit via a cable. This paper describes a prototype wireless system aimed at demonstrating the potential elimination of the cable which is undesirable in a number of respects. The radio link utilised operates at a frequency of 418 MHz with data compression and time division multiplexing (TDM) employed to allow up to 10 units to operate simultaneously on the same frequency in the same area. Data compression is achieved by extracting the Doppler ultrasound signal envelope and representing the frequency content of the signal using a zero crossing counting technique. Two Medium Access Control (MAC) protocols were considered, with a synchronised time division multiplexing system shown to offer greater throughput and resistance to interference than Carrier Sense Multiple Access (CSMA). This wireless RF telemetry system could be readily adapted for other multi-patient monitoring applications.

This paper outlines a method of reducing the data rate for transmitting fetal Doppler ultrasound audio signals. A specific application is cited where compression of the fetal Doppler signal is required to transmit information to cardiotocographs (CTGs) using radio telemetry. The method involves splitting the signal into amplitude and frequency components. The amplitude is represented by samples of the signal envelope whilst the frequency information is represented by the number of zero-crossings within fixed intervals (windows). With a careful choice of window size, it is shown that this method can be used to reproduce the signal with no audible difference when compared with the original waveform. A reduction in data rate of 15:1 is achieved.