Isolation of Fetal ECG Signals from Abdominal ECG Using Wavelet Analysis

ObjectiveMonitoring the heartbeat of the fetus during pregnancy is a vital part in determining their health. Current fetal heart monitoring techniques lack the accuracy in fetal heart rate monitoring and features acquisition, resulting in diagnostic medical issues. The demand for a reliable method of non-invasive fetal heart monitoring is of high importance.MethodElectrocardiogram (ECG) is a method of monitoring the electrical activity produced by the heart. The extraction of the fetal ECG (FECG) from the abdominal ECG (AECG) is challenging since both ECGs of the mother and the baby share similar frequency components, adding to the fact that the signals are corrupted by white noise. This paper presents a method of FECG extraction by eliminating all other signals using AECG. The algorithm is based on attenuating the maternal ECG (MECG) by filtering and wavelet analysis to find the locations of the FECG, and thus isolating them based on their locations. Two signals of AECG collected at different locations on the abdomens are used. The ECG data used contains MECG of a power of five to ten times that of the FECG.ResultsThe FECG signals were successfully isolated from the AECG using the proposed method through which the QRS complex of the heartbeat was conserved, and heart rate was calculated. The fetal heart rate was 135 bpm and the instantaneous heart rate was 131.58 bpm. The heart rate of the mother was at 90 bpm with an instantaneous heart rate of 81.9 bpm.ConclusionThe proposed method is promising for FECG extraction since it relies on filtering and wavelet analysis of two abdominal signals for the algorithm. The method implemented is easily adjusted based on the power levels of signals, giving it great ease of adaptation to changing signals in different biosignals applications.     

A new method for the extraction of fetal ECG from the dependent abdominal signals using blind source separation and adaptive noise cancellation techniques

Background

The electrocardiogram (ECG) is a diagnostic tool that records the electrical activity of the heart, and depicts it as a series of graph-like tracings, or waves. Being able to interpret these details allows diagnosis of a wide range of heart problems. Fetal electrocardiogram (FECG) extraction has an important impact in medical diagnostics during the mother pregnancy period. Since the observed FECG signals are often mixed with the maternal ECG (MECG) and the noise induced by the movement of electrodes or by mother motion, the separation process of the ECG signal sources from the observed data becomes quite complicated. One of its complexity is when the ECG sources are dependent, thus, in this paper we introduce a new approach of blind source separation (BSS) in the noisy context for both independent and dependent ECG signal source. This approach consist in denoising the observed ECG signals using a bilateral total variation (BTV) filter; then minimizing the Kullbak-Leibler divergence between copula densities to separate the FECG signal from the MECG one.

Results

We present simulation results illustrating the performance of our proposed method. We will consider many examples of independent/dependent source component signals. The results will be compared with those of the classical method called independent component analysis (ICA) under the same conditions. The accuracy of source estimation is evaluated through a criterion, called again the signal-to-noise-ratio (SNR). The first experiment shows that our proposed method gives accurate estimation of sources in the standard case of independent components, with performance around 27 dB in term of SNR. In the second experiment, we show the capability of the proposed algorithm to successfully separate two noisy mixtures of dependent source components - with classical criterion devoted to the independent case - fails, and that our method is able to deal with the dependent case with good performance.

Conclusions

In this work, we focus specifically on the separation of the ECG signal sources taken from skin two electrodes located on a pregnant woman’s body. The ECG separation is interpreted as a noisy linear BSS problem with instantaneous mixtures. Firstly, a denoising step is required to reduce the noise due to motion artifacts using a BTV filter as a very effective one-pass filter for denoising. Then, we use the Kullbak-Leibler divergence between copula densities to separate the fetal heart rate from the mother one, for both independent and dependent cases.

     

Detection and Processing Techniques of FECG Signal for Fetal Monitoring

Fetal electrocardiogram (FECG) signal contains potentially precise information that could assist clinicians in making more appropriate and timely decisions during labor. The ultimate reason for the interest in FECG signal analysis is in clinical diagnosis and biomedical applications. The extraction and detection of the FECG signal from composite abdominal signals with powerful and advance methodologies are becoming very important requirements in fetal monitoring. The purpose of this review paper is to illustrate the various methodologies and developed algorithms on FECG signal detection and analysis to provide efficient and effective ways of understanding the FECG signal and its nature for fetal monitoring. A comparative study has been carried out to show the performance and accuracy of various methods of FECG signal analysis for fetal monitoring. Finally, this paper further focused some of the hardware implementations using electrical signals for monitoring the fetal heart rate. This paper opens up a passage for researchers, physicians, and end users to advocate an excellent understanding of FECG signal and its analysis procedures for fetal heart rate monitoring system.     

An estimate of fetal autonomic state by time-frequency analysis of fetal heart rate variability.

In this study we present a noninvasive method that enables the investigation of the fetal heart rate (FHR) fluctuations. The objective was to design a quantitative measurement to assess the fetal autonomic nervous system and to investigate its development as a function of the gestational age. Our Medical Physics group has developed a complex algorithm for online beat-to-beat detection of the fetal ECG (FECG), extracted from the maternal abdominal ECG signal. We used our previously acquired FECG data, which includes noninvasive recordings of 200 maternal abdominal ECG signals. From these, we chose 35 cases of healthy pregnancies that we divided into three groups according to gestational age: Group 1, 23 +/- 2 wk; Group 2, 32 +/- 1 wk; and Group 3, 39 +/- 1 wk. The FHR variability was analyzed by a time-frequency decomposition based on a continuous wavelet transform. We showed that, independent of the gestational age, most of the FHR power is concentrated in the very-low-frequency range (0.02-0.08 Hz) and in the low-frequency range (0.08-0.2 Hz). In addition, there is power in the high-frequency range that correlates with the frequency range of fetal respiratory motion (0.4-1.7 Hz). In the intermediate-frequency range (0.2-0.4 Hz), the power is significantly smaller. The changes in the average power spectrum in relation to gestation time were carefully and quantitatively examined. The results imply that there is a neural organization during the last trimester of the pregnancy, and the sympathovagal balance is reduced with the gestational age.     

The ovarian and cervical regions of the rat uterus display a different contractile response to serotonin and prostaglandin F2alpha. I. The estrous cycle

In pharmacological studies using isolated tissues, the sensitivity to different agonists may vary depending on the anatomical region. The aim of the present study was to evaluate the in vitro contractile response to serotonin, prostaglandin F2alpha, and oxytocin of the ovarian and the cervical uterine segments isolated from rats in the four different stages of the rat estrous cycle. Non-cumulative curves were recorded for both, the ovarian and the cervical uterine segments. The cervical portion displayed a higher contractile response to serotonin and a lower response to PGF2alpha than the ovarian portion. Oxytocin induced similar responses in both uterine segments. The uterine ovarian segment displayed a similar sensitivity to serotonin in all the estrous cycle stages, whereas in the cervical segment, influenced by estrogens in diestrus and proestrus, an increase in contractility was observed. According to these findings, serotonin might participate in the spermatozoa transport toward the oviduct. The higher response of the ovarian portion to prostaglandin F2alpha is in line with its role during labor and delivery.     

Modeling Magnetomyograms of Uterine Contractions during Pregnancy Using a Multiscale Forward Electromagnetic Approach

Understanding the mechanisms of uterine contractions during pregnancy is especially important in predicting the onset of labor and thus in forecasting preterm deliveries. Preterm birth can cause serious health problems in newborns, as well as large financial burdens to society. Various techniques such as electromyography (EMG) and magnetomyography (MMG) have been developed to quantify uterine contractions. However, no widely accepted method to predict labor based on electromagnetic measurement is available. Therefore, developing a biophysical model of EMG and MMG could help better understand uterine contractions, interpret real measurements, and detect labor. In this work, we propose a multiscale realistic model of uterine contractions during pregnancy. At the cellular level, building on bifurcation theory, we apply generalized FitzHugh-Nagumo (FHN) equations that produces both plateau-type and bursting-type action potentials. At the tissue level, we introduce a random fiber orientation model applicable to an arbitrary uterine shape. We also develop an analytical expression for the propagation speed of transmembrane potential. At the organ level, a realistic volume conductor geometry model is provided based on magnetic resonance images of a pregnant woman. To simulate the measurements from the SQUID Array for Reproductive Assessment (SARA) device, we propose a sensor array model. Our model is able to reproduce the characteristics of action potentials. Additionally, we investigate the sensitivity of MMG to model configuration aspects such as volume geometry, fiber orientation, and pacemaker location. Our numerical results show that fiber orientation and pacemaker location are the key aspects that greatly affect the MMG as measured by the SARA device. We conclude that sphere is appropriate as an approximation of the volume geometry. The initial step towards validating the model against real MMG measurement is also presented. Our results show that the model is flexible to mimic the limited-propagation magnetic signature during the emergence and decay of a uterine contraction.     

The effect of prostaglandin I on the contractility of the term pregnant human myometrium

Small myometrial strips were dissected from the upper and lower segments of the term pregnant human uterus. The specimens were superfused in organ chambers and contractile activity was recorded isometrically. In strips from the upper segment, prostacyclin (PGI2), induced an initial excitatory response followed in the majority of experiments by transient inhibition. In the lower segment the response was generally the same although direct inhibition without initial stimulation occurred in some cases. During the period of inhibition the specimens were refractory to iterated exposure to PGI2. Furthermore, during this period of PGI2-induced inhibition the muscle strip was also refractory to PGE2 but responded to PGF2 alpha and oxytocin by stimulation. After inhibition of spontaneous contractile activity induced by indomethacin PGI2 induced an excitatory response. The results do not indicate any critical change in the myometrial responsiveness of the upper uterine segment to PGI2 during labor. In strips from the lower segment obtained before labor there tended to be a dominance of non-responders and inhibition only as compared to the results during labor. Nevertheless, whether or not PGI2 under physiological or pharmacological conditions has any significant influence on the contractility of the term pregnant human uterus, still remains obscure. As judged from earlier reports from our laboratory and the present study it is evident that the uterine vessels are considerably more sensitive to the action of PGI2 than the myometrium.     

Detection of the fetal ECG during labour by an intrauterine probe

The feasibility of detecting the fetal ECG (FECG) from within the uterus in labour by a technique which is non-invasive to the fetus, has been investigated. The design of a special multi-electrode flexible probe has demonstrated that the FECG can be obtained with signal amplitudes of 20–300 μV and a success rate similar to that of the scalp electrode. Under favourable conditions very large signals can be detected in utero compared to a scalp electrode, but average signal amplitudes are lower. The probe is suitable as a carrier for other sensors such as pressure and temperature transducers. Currently, simultaneous FECG and intrauterine pressure measurement using a commercially available transducer within the same probe has been achieved.     

Effects of electrocardiography contamination and comparison of ECG removal methods on upper trapezius electromyography recordings

Electromyography (EMG) recordings from the trapezius are often contaminated by the electrocardiography (ECG) signal, making it difficult to distinguish low-level muscle activity from muscular rest. This study investigates the influence of ECG contamination on EMG amplitude and frequency estimations in the upper trapezius during muscular rest and low-level contractions. A new method of ECG contamination removal, filtered template subtraction (FTS), is described and compared to 30 Hz high-pass filter (HPF) and averaged template subtraction (ATS) methods. FTS creates a unique template of each ECG artifact using a low-pass filtered copy of the contaminated signal, which is subtracted from contaminated periods in the original signal. ECG contamination results in an over-estimation of EMG amplitude during rest in the upper trapezius, with negligible effects on amplitude and frequency estimations during low-intensity isometric contractions. FTS and HPF successfully removed ECG contamination from periods of muscular rest, yet introduced errors during muscle contraction. Conversely, ATS failed to fully remove ECG contamination during muscular rest, yet did not introduce errors during muscle contraction. The relative advantages and disadvantages of different ECG contamination removal methods should be considered in the context of the specific motor tasks that require analysis.     

Parameters extraction and monitoring in uterine EMG signals. Detection of preterm deliveries

The aim of this paper is to classify between labor contractions and pregnancy contractions. Various types of parameters have been extracted from the electrohysterogram (EHG), mainly from the original EHG or from different frequency bands. They have been computed from different signal databases obtained with different recording protocols. The results of these studies are sometime controversial. The aim of this paper is to compute 17 parameters selected from the literature on the same signal database, either on the original EHG or after wavelet packet decomposition, and then to compare their power to discriminate between contractions recorded during pregnancy and labor. We thus obtain a selection of parameters that allow the best discrimination between pregnancy and labor contractions, when computed on the same signals, either on the original EHG or on selected frequency bands.     

Characterizing the Propagation of Uterine Electrophysiological Signals Recorded with a Multi-Sensor Abdominal Array in Term Pregnancies

The objective of this study was to quantify the number of segments that have contractile activity and determine the propagation speed from uterine electrophysiological signals recorded over the abdomen. The uterine magnetomyographic (MMG) signals were recorded with a 151 channel SARA (SQUID Array for Reproductive Assessment) system from 36 pregnant women between 37 and 40 weeks of gestational age. The MMG signals were scored and segments were classified based on presence of uterine contractile burst activity. The sensor space was then split into four quadrants and in each quadrant signal strength at each sample was calculated using center-of-gravity (COG). To this end, the cross-correlation analysis of the COG was performed to calculate the delay between pairwise combinations of quadrants. The relationship in propagation across the quadrants was quantified and propagation speeds were calculated from the delays. MMG recordings were successfully processed from 25 subjects and the average values of propagation speeds ranged from 1.3–9.5 cm/s, which was within the physiological range. The propagation was observed between both vertical and horizontal quadrants confirming multidirectional propagation. After the multiple pairwise test (99% CI), significant differences in speeds can be observed between certain vertical or horizontal combinations and the crossed pair combinations. The number of segments containing contractile activity in any given quadrant pair with a detectable delay was significantly higher in the lower abdominal pairwise combination as compared to all others. The quadrant-based approach using MMG signals provided us with high spatial-temporal information of the uterine contractile activity and will help us in the future to optimize abdominal electromyographic (EMG) recordings that are practical in a clinical setting.     

Diagnosis of labor: a prospective study

Accurate diagnosis of the onset of labor remains a problem in obstetrics. Criteria commonly used to diagnose labor have never been scientifically evaluated. This prospective study involved 423 pregnant women who presented themselves with uterine contractions to 2 Italian hospitals (248 nulliparous patients total and 175 multiparous total) and who were either admitted or advised to return home. The obstetrician on duty collected data using a standardized form that listed common criteria for labor diagnosis. Multivariate analysis showed that a reduction of the interval between consecutive uterine contractions, odds ratio [OR] = 1.42; 95% confidence interval [95%CI] 1.06-1.90); abdominal pain of increasing intensity (OR = 1.42; 95% CI 1.01-2.02); cervical effacement (OR = 1.4; 95%CI 1.12-1.77); and cervical dilation (OR = 1.91; 95% CI 1.53-2.38) were significant markers of the onset of labor. On the other hand, backache had a negative diagnostic value (OR = 0.78; 95% CI 0.61-0.99). The value of criteria such as regular uterine contractions, loss of mucous plug, changes in intestinal habits, vomiting, pain that is relieved by walking, and changes in breathing pattern did not reach statistical significance.     

The effect of prostaglandin I2 on the contractility of the term pregnant human myometrium

Small myometrial strips were dissected from the upper and lower segments of the term pregnant human uterus. The specimens were superfused in organ chambers and contractile activity was recorded isometrically.In strips from the upper segment, prostacyclin (PGI₂), induced an initial excitatory response followed in the majority of experiments by transient inhibition. In the lower segment the response was generally the same although direct inhibition without initial stimulation occurred in some cases.During the period of inhibition the specimens were refractory to iterated exposure to PGI₂. Furthermore, during this period of PGI₂-induced inhibition the muscle strip was also refractory to PGE₂ but responded to PGF_2α and oxytocin by stimulation.After inhibition of spontaneous contractile activity induced by indomethacin PGI₂ induced an excitatory response.The results do not indicate any critical change in the myometrial responsiveness of the upper uterine segment to PGI₂ during labor. In strips from the lower segment obtained before labor there tended to be a dominance of non-responders and inhibition only as compared to the results during labor. Nevertheless, whether or not PGI₂ under physiological or pharmacological conditions has any significant influence on the contractility of the term pregnant human uterus, still remains obscure.As judged from earlier reports from our laboratory and the present study it is evident that the uterine vessels are considerably more sensitive to the action of PGI₂ than the myometrium.     

Uterine motility in the cow during the estrous cycle. I. Spontaneous activity

This study describes a method for measuring intrauterine pressure (IUP) changes and uterine motility in cows. Spontaneous uterine motility was recorded during the estrous cycle in stanchioned, nonlactating dairy cows using a pair of miniature pressure transducers mounted 15 cm apart at the distal end of a dacron catheter placed in one uterine horn via the cervix. Clinical examination of ovarian status and determination of the peripheral plasma levels of estradiol-17beta and progesterone were used to determine the stages of the cycle. The pressure sensors recorded variations in muscular resting tension (tone) and the occurrence, spatial distribution, and force of the uterine contractions. Both tone and uterine activity varied significantly during the cycle. They were minimal during diestrus, increased during proestrus, reached maximal values at estrus, and then decreased. The highest synchronized motor activity with presence of peristaltic-antiperistaltic movements occurred during estrus. The prevailing direction of the uterine contractions during late estrus (immediate preovulatory period) was cervico-tubal.     

Fast ECG data compression algorithms suitable for microprocessor systems

ECG data compression techniques have received extensive attention in ECG analysis. Numerous data compression algorithms for ECG signals have been proposed during the last three decades. We describe two algorithms based on the scan-along polygonal approximation algorithm (SAPA) that are suitable for multichannel ECG data reduction on a microprocessor-based system. One represents a modification of SAPA (MSAPA) which adopts the method of integer division table searching to speed up data reduction; the other (CSAPA) combines MSAPA and TP, a turning-point algorithm, to preserve ST segment signals. Results show that our algorithms achieve a compression ratio of more than 5:1 and a percent rms difference (PRD) to the original signal of less than 3.5%. In addition, the maximum execution time of MSAPA for processing one data point is about 50μ s. Moreover, the CSAPA algorithm retains all of the details of the ST segment, which are important in ischaemia diagnosis, by employing the TP algorithm.     

Comparative studies on effects of estrogens and progesterone on the contractility of isolated uterine horns of rats

The effect of estrogens on the myometrial contractility of 70 isolated uterine horns of rats was investigated; 40 of the rats had been treated with progesterone and 30 with estrogen. Contractions were recorded isotonically in solutions with extracellular potassium concentration of 2.5 to 40 mM. The contractility of the myometrium of rats treated with estrogens was observed to be similar to the optimum contractility during labor, with the characteristic high amplitude of tension, low initial tension, and good coordination of contractions. The contractility of the uterine horns treated with progesterone was almost 1/2 lower and showed worse coordination of contractions. The difference between progesterone and estrogen is expressed through the quantitatively and qualitatively different influences on the motor function of the uterus.     

产后康复治疗仪使用时机对促进子宫收缩及刺激泌乳的效果观察

目的观察产后康复治疗仪时机对促进产后子宫收缩及刺激泌乳的效果。方法将146例初产妇按住院单双号分为观察组和对照组各73例,观察组产妇在胎儿前肩娩出后即采用产后康复治疗仪对双侧乳房及"气海"穴、"关元"穴进行电刺激,对照组在处理完第三产程后采用产后康复治疗仪对双侧乳房及"气海"穴、"关元"穴进行电刺激,两组产妇低频电刺激强度均以产妇能够耐受为度,观察两组产妇产后1、2h的出血量及产后2h泌乳量情况。结果两组产妇产后1、2h的出血量及产后2h泌乳量比较,差异具有统计学意义(P0.05)。结论在胎儿前肩娩出后即采用产后康复治疗仪对双侧乳房及"气海"穴、"关元"穴进行电刺激,可有效促进子宫收缩,减少产后出血,促进乳汁分泌,有利于产妇恢复及促进母乳喂养。     

Uterine Synchronization Analysis During Pregnancy and Labor Using Graph Theory,Classification Based on Neural Network and Deep Learning

1) ObjectivesPreterm birth caused by preterm labor is one of the major health problems in the world. In this article, we present a new framework for dealing with this problem through the processing of electrohysterographic signals (EHG) that are recorded during labor and pregnancy. The objective in this research is to improve the classification between labor and pregnancy contractions by using a new approach that focuses on the connectivity analysis based on graph parameters, representative of uterine synchronization, and comparing neural network and machine learning methods in order to classify between labor and pregnancy.2) Material and methodsafter denoising of the 16 EHG signals recorded from pregnant women abdomen, we applied different connectivity methods to obtain connectivity matrices; then by using the graph theory, we extracted some graph parameters from the connectivity matrices; finally, we tested different neural network and machine learning methods on the features obtained from both graph and connectivity methods in order to classify between labor and pregnancy.3) ResultsThe best results were obtained by using the logistic regression method. We also evidence the power of graph parameters extracted from the connectivity matrices to improve the classification results.4) ConclusionThe use of graph analysis associated with machine learning methods can be a powerful tool to improve labor and pregnancy classification based on the analysis of EHG signals.     

Inhibition of prostaglandin induced uterine activity in the second trimester of pregnancy by β-mimetic adrenergic agents

As a consequence of great individual variations among pregnant women in their response to prostaglandin medication, overstimulation of the uterus might occasionally occur. The need of a drug which could safely prevent excessive and undesirable prostaglandin-induced uterine contractions is therefore apparent.Two β-mimetic adrenergic compounds, orciprenaline and ritodrine, were tested with respect to their ability to reduce prostaglandin-induced uterine activity. Both compounds have successfully depressed the intensity, as well as the frequency of uterine contractions, which were previously induced by intrauterine administration of prostaglandin F_2α. With both drugs the reduction in uterine activity was closely dose-related and accompanied by a considerable increase in the maternal heart rate. While orciprenaline did not alter the maternal blood pressure, ritodrine produced a rise in systolic, and a fall in diastolic pressure. No other side effect was recorded. When the infusion ceased, uterine activity increased in various degrees.On the basis of the present findings the possible role of prostaglandins in the physiological regulation of the uterine contractions during pregnancy is discussed.     

Altered fetal pituitary-adrenal function in the ovine fetus treated with RU486 and meloxicam, an inhibitor of prostaglandin synthase-II

Term and preterm labor are associated with increased fetal hypothalamic-pituitary-adrenal (HPA) activation and synthesis of prostaglandins (PGs) generated through the increased expression of prostaglandin H synthase-II (PGHS-II) in the placenta. Inhibition of PGHS-II has been advocated as a means of producing uterine tocolysis, but the effects of such treatment on fetal endocrine functions have not been thoroughly examined. Because PGE(2) is known to activate the fetal HPA axis, we hypothesized that administration of meloxicam, a PGHS-II inhibitor, to sheep in induced labor would suppress fetal HPA function. Chronically catheterized pregnant ewes were treated with RU486, a progesterone receptor antagonist, to produce active labor, and then treated with either high-maintenance-dose meloxicam, graded-maintenance-dose meloxicam, or a saline infusion. Maternal uterine contraction frequency increased 24 h after the RU486 injection and the animals were in active labor by 48 +/- 4 h. RU486 injection led to increased concentrations of PGE(2), ACTH, and cortisol in the fetal circulation, and increased concentrations of 13,14 dihydro 15-ketoprostaglandin F(2 alpha) (PGFM) in the maternal circulation. Uterine activity was inhibited within 12 h of beginning meloxicam infusion at both infusion regimes. During meloxicam infusion there were significant decreases in fetal plasma PGE(2), ACTH, and cortisol concentrations, and PGFM concentrations in maternal plasma. In control animals, frequency of uterine contractions, maternal plasma PGFM, fetal plasma PGE(2), ACTH, and cortisol concentrations increased after RU486 administration, and continued to rise during saline infusion until delivery occurred. We conclude that RU486-provoked labor in sheep is associated with activation of fetal HPA function, and that this is attenuated during meloxicam treatment to a level considered compatible with pregnancy maintenance.