Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor

Warmerdam, G.J.J.; Vullings, Rik; Laar, Judith O E H van; Jagt, M.B. van der Hout-van der; Bergmans, J.W.M.; Schmitt, L.; Oei, S.G.

doi:10.1088/0967-3334/37/3/387

Cited by 21 publications

(31 citation statements)

References 46 publications

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“…The use of NI-fECG for foetal monitoring offers many diagnostic opportunities. Since it delivers beat-to-beat information on the FHR, based on the QRS-complexes of the foetal ECG, foetal heart rate variability of both foetuses can be analysed through spectral analysis [18][19][20]. This could aid in the diagnosis and surveillance of TTTS in monochorionic twin pregnancies, but also pre-eclampsia and foetal growth restriction, which are more common in multiple gestation [21].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of non-invasive Foetal electrocardiography in a twin pregnancy

Noben

Westerhuis

Laar

et al. 2020

BMC Pregnancy Childbirth

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Background: Twin pregnancy is associated with increased perinatal mortality. Close foetal monitoring is therefore warranted. Doppler Ultrasound cardiotocography is currently the only available method to monitor both individual foetuses. Unfortunately, the performance measures of this method are poor and erroneous monitoring of the same twin with both transducers may occur, leaving the second twin unmonitored. In this study we aimed to determine the feasibility of monitoring both foetuses simultaneously in twin gestation by means of non-invasive foetal electrocardiography (NI-fECG), using an electrode patch on the maternal abdomen. Methods: A NI-fECG recording was performed at 25 + 3 weeks of gestation on a multiparous woman pregnant with dichorionic diamniotic twins. An electrode patch consisting of eight adhesive electrodes was applied on the maternal abdomen, yielding six channels of bipolar electrophysiological measurements. The output was digitized and stored for offline processing. The recorded signals were preprocessed by suppression of high-frequency noise, baseline wander, and powerline interference. Secondly, the maternal ECG was subtracted and segmentation into individual ECG complexes was performed. Finally, ensemble averaging of these individual ECG complexes was performed to suppress interferences. Results: Six different recordings were obtained from each of the six recording channels. Depending on the orientation and distance of the fetal heart with respect to each electrode, a distinction could be made between each fetus based on the morphology of the signals. Yielding of the fetal ECGs was performed manually based on the QRS complexes of each fetus. Conclusion: NI-fECG with multiple electrodes allows for monitoring of the fetal heart rate and ECG of both individual fetuses in twin pregnancies.

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Section: Discussionmentioning

confidence: 99%

Feasibility of non-invasive Foetal electrocardiography in a twin pregnancy

Noben

Westerhuis

Laar

et al. 2020

BMC Pregnancy Childbirth

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“…5 clearly shows quite an overlap between the two classes indicating that a perfect classification, in the current setting, may be impossible. Therefore new features, including also information coming from the UC signal [ 71 ], and/or better algorithms for classification are needed. This work can therefore act as a benchmark for the evaluation of new features and algorithms, since it only requires the extraction of three features and the use of a computational method, the training of which can be done really fast.…”

Section: Discussionmentioning

confidence: 99%

Investigating pH based evaluation of fetal heart rate (FHR) recordings

et al. 2017

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Cardiotocography (CTG) is a standard tool for the assessment of fetal well-being during pregnancy and delivery. However, its interpretation is associated with high inter- and intra-observer variability. Since its introduction there have been numerous attempts to develop computerized systems assisting the evaluation of the CTG recording. Nevertheless these systems are still hardly used in a delivery ward. Two main approaches to computerized evaluation are encountered in the literature; the first one emulates existing guidelines, while the second one is more of a data-driven approach using signal processing and computational methods. The latter employs preprocessing, feature extraction/selection and a classifier that discriminates between two or more classes/conditions. These classes are often formed using the umbilical cord artery pH value measured after delivery. In this work an approach to Fetal Heart Rate (FHR) classification using pH is presented that could serve as a benchmark for reporting results on the unique open-access CTU-UHB CTG database, the largest and the only freely available database of this kind. The overall results using a very small number of features and a Least Squares Support Vector Machine (LS-SVM) classifier, are in accordance to the ones encountered in the literature and outperform the results of a baseline classification scheme proving the utility of using advanced data processing methods. Therefore the achieved results can be used as a benchmark for future research involving more informative features and/or better classification algorithms.

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“…However, fMCG is available in a few centers worldwide due to its high cost (Hoyer et al, 2017). fECG can be obtained through electrodes placed on the mother's abdomen (Hoyer et al, 2017) or directly on the fetal cranium during labor (Warmerdam et al, 2016). fECG performs less accurate measurement and, between 28 and 32 weeks gestational age (GA), is less reliable since the fetus is almost entirely covered by the vernix caseosa, which isolates the fetus hindering the recording (Hoyer et al, 2017).…”

Section: The Ans Development and Its Relationship With Hrvmentioning

confidence: 99%

“…Together with continuous fHRV assessment, the selective measurement and comparison among the fHRV metrics obtained during labor contractions and the ones obtained between successive contractions managed to better detect fetal distress (Warmerdam et al, 2018). Several fHRV metrics increased during contractions and decreased during rest periods (Romano et al, 2006;Cesarelli et al, 2010;Warmerdam et al, 2016), and this variability was lower in fetuses with acidosis than in healthy ones, pointing at a lower cardiovascular adaptation capacity (Warmerdam et al, 2016). Entropy metrics, such as SampEn and ApEn, could also detect fetal distress from the 30th week GA (Ferrario et al, 2006).…”

Section: The Ans Development and Its Relationship With Hrvmentioning

confidence: 99%

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

Chiera¹,

Cerritelli²,

Casini³

et al. 2020

Front. Neurosci.

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Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often timeconsuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a noninvasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby's overall wellbeing and neurological development to detect stress-/painrelated behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby's stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant's HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant's clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients' health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.

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Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor

Cited by 21 publications

References 46 publications

Feasibility of non-invasive Foetal electrocardiography in a twin pregnancy

Feasibility of non-invasive Foetal electrocardiography in a twin pregnancy

Investigating pH based evaluation of fetal heart rate (FHR) recordings

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

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