Fetal cardiac time intervals in healthy pregnancies – an observational study by fetal ECG (Monica Healthcare System)

Wacker-Gußmann, Annette; Plankl, C; Sewald, M.; Schneider, Karl-Theo M.; Oberhoffer, Renate; Lobmaier, Silvia M.

doi:10.1515/jpm-2017-0003

Cited by 17 publications

(23 citation statements)

References 22 publications

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“…11. Following this observation, we note that difficulties in detecting T-waves via NI-FECG have been reported throughout the literature as summarised in [51]. While other causes may likely contribute to this phenomenon, the high level of vernix caseosa asymmetry reported in the back region by Akiba [17], Archana [18] and Visscher et al [19] presents a novel explanation for this effect.…”

Section: B Signal Morphologysupporting

confidence: 62%

The effects of asymmetric volume conductor modeling on non-invasive fetal ECG extraction

Keenan¹,

Karmakar²,

Palaniswami³

2018

Physiol. Meas.

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Objective: Non-invasive fetal electrocardiography (NI-FECG) shows promise for capturing novel physiological information that may indicate signs of fetal distress. However, significant deterioration in NI-FECG signal quality occurs during the presence of a highly non-conductive layer known as vernix caseosa which forms on the fetal body surface beginning in approximately the 28 th week of gestation. This work investigates asymmetric modeling of vernix caseosa and other maternal-fetal tissues in accordance with clinical observations and assesses their impacts for NI-FECG signal processing. Methods: We develop a process for simulating dynamic maternal-fetal abdominal ECG mixtures using a synthetic cardiac source model embedded in a finite element volume conductor. Using this process, changes in NI-FECG signal morphology are assessed in an extensive set of finite element models including spatially variable distributions of vernix caseosa. Results: Our simulations show that volume conductor asymmetry can result in over 70% error in the observed T/QRS ratio and significant changes to signal morphology compared to a homogeneous volume conductor model. Conclusion: Volume conductor effects must be considered when analyzing T/QRS ratios obtained via NI-FECG and should be considered in future algorithm benchmarks using simulated data. Significance: This work shows that without knowledge of the influence of volume conductor effects, clinical evaluation of the T/QRS ratio derived via NI-FECG should be avoided.Index Terms-Finite element method, non-invasive fetal electrocardiography (NI-FECG), T/QRS ratio, vernix caseosa, volume conductor model.

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Section: B Signal Morphologysupporting

confidence: 62%

The effects of asymmetric volume conductor modeling on non-invasive fetal ECG extraction

Keenan¹,

Karmakar²,

Palaniswami³

2018

Physiol. Meas.

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“…However, despite being available for many years, neither constitutes part of routine clinical practice. Signal processing has improved but f-ECG signal-to-noise ratio remains a limitation, especially around 27-36 weeks [7]. f-MCG is superior, but requires a shielded environment and has high maintenance costs [8] .…”

mentioning

confidence: 99%

Fetal dysrhythmias

Carvalho

2019

Best Practice & Research Clinical Obstetrics & Gynaecol

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Fetal dysrhythmias are common, usually manifesting as irregular rhythms. Whilst most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different aetiological and prognostic implications. We provide a flowchart for initial management of irregular rhythm, to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to haemodynamic compromise and may require in-utero therapy. Pharmacological treatment of tachycardia depends on type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if due to established complete heart block there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of auto-immune atrioventricular block. Sinus bradycardia (rate < 3 rd centile) may be a prenatal marker for long QT syndrome.

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“…There is growing interest in using CFM to interpret features of the fECG to either detect cardiac rhythm abnormalities or identify fetal compromise . Given that CFM can record the fECG with adequate quality for interpretation in a large number of cases, the interest in this methodology is likely to increase.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, CFM had high levels of participant satisfaction and was preferred to intermittent CTG. In addition to these studies of acceptability, recent studies have examined the feasibility of using CFM to measure components of the fetal ECG (fECG) and to determine factors (including gestation, maternal body mass index [BMI], uterine contractions, diurnal variation and fetal gender) which affect FHR parameters and the quality of the CFM recording.…”

Section: Introductionmentioning

confidence: 99%

A mixed‐methods evaluation of continuous electronic fetal monitoring for an extended period

Crawford

Anyadi

Stephens

et al. 2018

Acta Obstet Gynecol Scand

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Fetal cardiac time intervals in healthy pregnancies – an observational study by fetal ECG (Monica Healthcare System)

Abstract: Although limited and preclinical in its use, fECG (Monica Healthcare System) could be an additional useful tool to detect precise fCTIs from 32 weeks' gestational age onwards.

Cited by 17 publications

References 22 publications

The effects of asymmetric volume conductor modeling on non-invasive fetal ECG extraction

The effects of asymmetric volume conductor modeling on non-invasive fetal ECG extraction

Fetal dysrhythmias

A mixed‐methods evaluation of continuous electronic fetal monitoring for an extended period

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