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Zhang Y, Gu A, Xiao Z, Xing Y, Yang C, Li J, Liu C. Wearable Fetal ECG Monitoring System from Abdominal Electrocardiography Recording. BIOSENSORS 2022; 12:bios12070475. [PMID: 35884277 PMCID: PMC9313261 DOI: 10.3390/bios12070475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 01/31/2023]
Abstract
Fetal electrocardiography (ECG) monitoring during pregnancy can provide crucial information for assessing the fetus’s health status and making timely decisions. This paper proposes a portable ECG monitoring system to record the abdominal ECG (AECG) of the pregnant woman, comprising both maternal ECG (MECG) and fetal ECG (FECG), which could be applied to fetal heart rate (FHR) monitoring at the home setting. The ECG monitoring system is based on data acquisition circuits, data transmission module, and signal analysis platform, which consists of low input-referred noise, high input impedance, and high resolution. The combination of the adaptive dual threshold (ADT) and the independent component analysis (ICA) algorithm is employed to extract the FECG from the AECG signals. To validate the performance of the proposed system, AECG is recorded and analyzed of pregnant women in three different postures (supine, seated, and standing). The result shows that the proposed system can record the AECG in different postures with good signal quality and high accuracy in fetal ECG and heart rate information. Sensitivity (Se), positive predictive accuracy (PPV), accuracy (ACC), and their harmonic mean (F1) are utilized as the metrics to evaluate the performance of the fetal QRS (fQRS) complexes extraction. The average Se, PPV, ACC, and F1 score are 99.62%, 97.90%, 97.40%, and 98.66% for the fQRS complexes extraction,, respectively. This paper shows the proposed system has a promising application in fetal health monitoring.
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Affiliation(s)
- Yuwei Zhang
- The State Key Laboratory of Bioelectronics, School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China;
- The State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China; (Z.X.); (Y.X.); (C.Y.); (J.L.)
| | - Aihua Gu
- The State Key Laboratory of Bioelectronics, School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China;
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
- Correspondence: (A.G.); (C.L.)
| | - Zhijun Xiao
- The State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China; (Z.X.); (Y.X.); (C.Y.); (J.L.)
| | - Yantao Xing
- The State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China; (Z.X.); (Y.X.); (C.Y.); (J.L.)
| | - Chenxi Yang
- The State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China; (Z.X.); (Y.X.); (C.Y.); (J.L.)
| | - Jianqing Li
- The State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China; (Z.X.); (Y.X.); (C.Y.); (J.L.)
| | - Chengyu Liu
- The State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China; (Z.X.); (Y.X.); (C.Y.); (J.L.)
- Correspondence: (A.G.); (C.L.)
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Validation of beat by beat fetal heart signals acquired from four-channel fetal phonocardiogram with fetal electrocardiogram in healthy late pregnancy. Sci Rep 2018; 8:13635. [PMID: 30206289 PMCID: PMC6134006 DOI: 10.1038/s41598-018-31898-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/29/2018] [Indexed: 11/08/2022] Open
Abstract
Fetal heart rate monitoring is an essential obstetric procedure, however, false-positive results cause unnecessary obstetric interventions and healthcare cost. In this study, we propose a low cost and non-invasive fetal phonocardiography based signal system to measure the fetal heart sounds and fetal heart rate. Phonocardiogram (PCG) signals contain acoustic information reflecting the contraction and relaxation of the heart. We have developed a four-channel recording device with four separated piezoelectric sensors harnessed by a cloth sheet to record abdominal phonogram signals. A multi-lag covariance matrix based eigenvalue decomposition technique was used to extract fetal and maternal heart sounds as well as maternal breathing movement. In order to validate the fetal heart sounds extracted by PCG signal processing, 10 minutes' simultaneous recordings of fetal Electrocardiogram (fECG) and abdominal phonogram from 15 pregnant women (27 ± 5-year-old) with fetal gestation ages between 33 and 40 weeks were obtained and processed. Highly significant (p < 0.01) correlation (r = 0.96; N = 270) was found between beat to beat fetal heart rate (FHRECG) from fECG and the same (FHRPCG) from fetal PCG signals. Bland-Altman plot of FHRECG and FHRPCG shows good agreement (<5% difference). We conclude that the proposed beat to beat fetal heart rate measurement system would be useful for monitoring fetal neurological wellbeing as a better alternative to traditional cardiotocogram based antenatal fetal heart rate monitoring.
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Vest AN, Zhou L, Bar-Cohen Y, Eli Loeb G. A novel method to estimate safety factor of capture by a fetal micropacemaker. Physiol Meas 2016; 37:1172-85. [PMID: 27340134 DOI: 10.1088/0967-3334/37/7/1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We have developed a rechargeable fetal micropacemaker in order to treat severe fetal bradycardia with comorbid hydrops fetalis, a life-threatening condition in pre-term non-viable fetuses for which there are no effective treatment options. The small size and minimally invasive form factor of our design limit the volume available for circuitry and a power source. The device employs a fixed-rate and fixed-amplitude relaxation oscillator and a tiny, rechargeable lithium ion power cell. For both research and clinical applications, it is valuable to monitor the electrode-myocardium interface in order to determine that adequate pacemaker output is being provided. This is typically accomplished by observing the minimal stimulus strength that achieves threshold for pacing capture. The output of our simple micropacemaker cannot be programmatically altered to determine this minimal capture threshold, but a safety factor can be inferred by determining the refractory period for ventricular capture at a given stimulus strength. This is done by measuring the minimal timing between naturally occurring QRS complexes and pacing stimuli that successfully generate a premature ventricular contraction. The method was tested in a pilot study in four fetal sheep and the data demonstrate that a relative measure of threshold is obtainable. This method provides valuable real-time information about the electrode-tissue interface.
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Affiliation(s)
- Adriana Nicholson Vest
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Denney Research Bldg, Ste 140, Los Angeles, CA 90089, USA
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Ye-Lin Y, Prats-Boluda G, Alberola-Rubio J, Garcia-Casado J. Combined method for fetal electrocardiogram extraction from noninvasive abdominal recordings. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:356-9. [PMID: 23365903 DOI: 10.1109/embc.2012.6345942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abdominal electrocardiogram (AECG) recording is a non-invasive method to assess fetal well-being during both pregnancy and delivery. However, AECG recording is contaminated by a series of physiological interferences which make difficult the extraction of morphological and temporal parameters of fetal ECG from the raw signals. In this work, it is proposed a combined method to extract the fetal ECG from AECG recording by removing the interferences on a cascade structure using a priori information about the signals nature. In this work, a total of 54 multichannel AECG recordings taken from 21 to 40 weeks of gestation were enrolled. Experimental results show that the proposed method outperforms conventional independent component analysis, and provides fetal heart rate detection in 80% of the cases. In addition it also permits to obtain fetal ECG morphology from AECG recordings.
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Affiliation(s)
- Y Ye-Lin
- Grupo de Bioelectrónica (I3BH, Universitat Politècnica de València), Valencia, Spain
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Kovács F, Horváth C, Balogh AT, Hosszú G. Fetal phonocardiography--past and future possibilities. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2011; 104:19-25. [PMID: 21146247 DOI: 10.1016/j.cmpb.2010.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 03/12/2010] [Accepted: 10/12/2010] [Indexed: 05/30/2023]
Abstract
The paper presents an overview of the 15 year long development of fetal phonocardiography including the works on the applied signal processing methods for identification of sound components. Based on the improvements achieved on this field, the paper shows that beyond the traditional CTG test the phonocardiography may be successfully applied for long-term fetal measurements and home monitoring. In addition, by indication of heart murmurs based on a comprehensive analysis of the recorded heart sound congenital heart defects can also be detected together with additional features in the third trimester. This makes an early widespread screening possible combined with the prescribed CTG test even at home using a telemedicine system.
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Affiliation(s)
- Ferenc Kovács
- Pázmány Péter Catholic University, Faculty of Information Technology, H-1083 Budapest, Práter-u. 50/a, Hungary.
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Kovacs F, Horváth C, Balogh ÁT, Hosszú G. Extended Noninvasive Fetal Monitoring by Detailed Analysis of Data Measured With Phonocardiography. IEEE Trans Biomed Eng 2011; 58:64-70. [DOI: 10.1109/tbme.2010.2071871] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Arias-Ortega R, Gaitán-González MJ, Yáñez-Suarez O. Implementation of a real-time algorithm for maternal and fetal heart rate monitoring in a digital signal controller platform. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:2354-7. [PMID: 21097225 DOI: 10.1109/iembs.2010.5627881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An LMS-based algorithm to monitor fetal and maternal heart rate in real time was implemented and evaluated on a development platform. Hardware has three modules: dsPIC30F digital signal controller, a low-noise analog front end and a storage stage. They were evaluated using on-chip debugging tools and a patient simulator. Algorithm performance was tested using simulation tools and real data. Other measures like process run-times and power consumption, were analyzed to evaluate the design feasibility. Dataset was conformed by 25 annotated records from different gestational age pregnant women. Sensitivity and accuracy were used as performance measures. In general, sensitivity was high for maternal (95.3%) and fetal (87.1%) detections. Results showed that the chosen architecture can run efficiently the algorithm processes, obtaining high detection rates under appropriate SNR conditions.
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Affiliation(s)
- R Arias-Ortega
- Universidad Autónoma Metropolitana - Iztapalapa, D.F., México.
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Kovács F, Török M, Horváth C, Balogh AT, Zsedrovits T, Nagy A, Hosszú G. A new, phonocardiography-based telemetric fetal home monitoring system. Telemed J E Health 2010; 16:878-82. [PMID: 20925563 DOI: 10.1089/tmj.2010.0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this article is to describe a new, phonocardiography-based fetal telemonitoring system, which, due to its passive nature, allows long-term measurements even at the home of the pregnant woman. The input element of the system was the home monitor with two sensors for recording the trans-abdominal fetal heart signal and the uterine contractions. The recorded signal was transmitted by mobile network and Internet to an Evaluation Center, where it was analyzed in detail to obtain information about possible dysfunction of the fetal heart. The investigations on this system made clear that by advanced processing of the recorded signal the system captured many additional cardiac features compared with the traditional ultrasound-based cardiotocographic procedure.
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Affiliation(s)
- Ferenc Kovács
- Faculty of Information Technology, Pázmány Péter Catholic University, Budapest, Hungary
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Kovács F, Kersner N, Kádár K, Hosszú G. Computer method for perinatal screening of cardiac murmur using fetal phonocardiography. Comput Biol Med 2009; 39:1130-6. [DOI: 10.1016/j.compbiomed.2009.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 08/07/2009] [Accepted: 10/01/2009] [Indexed: 11/30/2022]
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Anastasiadis P, Anninos PA, Lüdinghausen MV, Kotini A, Galazios G, Limberis B. Fetal magnetocardiogram recordings and Fourier spectral analysis. J OBSTET GYNAECOL 2009; 19:390-3. [PMID: 15512338 DOI: 10.1080/01443619964715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Power spectral analysis of fetal magnetocardiogram (FMCG) data was evaluated in 64 pregnancies, using the non-invasive one channel superconducting quantum interference device (DC-SQUID), in order to investigate the power spectral amplitude distribution in the frequency range between 2 and 3 Hz. In all cases with normal and uncomplicated pregnancies, the data from the fetal heart and specifically the QRS complexes, were identifiable and unaffected by any maternal cardiac activity and furthermore the power spectral amplitudes, which varied between 120 and 350 fT/Hz, were directly related to gestational age.
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Affiliation(s)
- P Anastasiadis
- Department of Obstetrics and Gynaecology, Medical School, Demokrition University of Thrace, Alexandroupolis, Greece
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Martens SMM, Rabotti C, Mischi M, Sluijter RJ. A robust fetal ECG detection method for abdominal recordings. Physiol Meas 2007; 28:373-88. [PMID: 17395993 DOI: 10.1088/0967-3334/28/4/004] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this paper, we propose a new method for FECG detection in abdominal recordings. The method consists of a sequential analysis approach, in which the a priori information about the interference signals is used for the detection of the FECG. Our method is evaluated on a set of 20 abdominal recordings from pregnant women with different gestational ages. Its performance in terms of fetal heart rate (FHR) detection success is compared with that of independent component analysis (ICA). The results show that our sequential estimation method outperforms ICA with a FHR detection rate of 85% versus 60% of ICA. The superior performance of our method is especially evident in recordings with a low signal-to-noise ratio (SNR). This indicates that our method is more robust than ICA for FECG detection.
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Affiliation(s)
- Suzanna M M Martens
- Department of Electrical Engineering, University of Technology Eindhoven, Eindhoven, The Netherlands.
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12
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Anastasiadis PG, Kotini A, Anninos P, Adamopoulos A, Sigalas J, Koutlaki N. Chaotic and periodic analysis of fetal magnetocardiogram recordings in growth restriction. Prenat Diagn 2003; 23:405-9. [PMID: 12749039 DOI: 10.1002/pd.612] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We studied how chaotic and periodic heart rate dynamics differ between normal fetuses (n = 19) and intrauterine growth restricted fetuses (n = 11) at 34 to 37 weeks of gestation. We quantified the chaotic dynamics of each heart rate time series obtained by fetal magnetocardiography (FMCG) using correlation dimension. METHODS The FMCG was recorded digitally by a single-channel biomagnetometer in an electrically shielded room of low magnetic noise. The position of the fetal heart was determined using ultrasonography. RESULTS The correlation dimension was significantly lower in IUGR than in normal fetuses (p < 0.001, t-test). The periodic dynamics were also obtained by FMCG and measured by power spectrum. The low-frequency components and therefore the periodicity of the low-frequency range were significantly higher in IUGR than in normal fetuses (p < 0.001, t-test). CONCLUSIONS The analysis of FMCG recordings may offer important perspectives to understand significant features of the heart function of the fetuses. This technique improves the recognition of IUGR fetuses over healthy ones and may help improve perinatal morbidity and mortality.
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Affiliation(s)
- P G Anastasiadis
- Department of Obstetrics and Gynaecology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
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Piéri JF, Crowe JA, Hayes-Gill BR, Spencer CJ, Bhogal K, James DK. Compact long-term recorder for the transabdominal foetal and maternal electrocardiogram. Med Biol Eng Comput 2001; 39:118-25. [PMID: 11214263 DOI: 10.1007/bf02345275] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Foetal heart rate (FHR) monitoring is a proven means of assessing foetal health during the antenatal period. Currently, the only widely available instrumentation for producing these data is based on Doppler ultrasound, a technology that is unsuitable for long-term use. For nearly a century, it has been known that the foetal electrocardiogram (FECG) can be detected using electrodes placed on the maternal abdomen. Although these signals suggest an alternative means of FHR derivation, their use has been limited owing to problems of poor signal-to-noise ratio. However, the eminent suitability of the transabdominal FECG for long-term FHR monitoring has suggested that perseverance with the technique would be worthwhile. The paper describes the design, construction and use of a compact, long-term recorder of three channels of 24 h antenatal transabdominal data. Preliminary use of the recorder in around 400 short recording sessions demonstrates that FHR records of equivalent quality to those from Doppler ultrasound-based instruments can be extracted from such data. The success of FHR derivation is, on average, around 65% of the recording period from around 20 weeks gestation (although this figure is reduced from around 28-32 weeks, and the success rates exhibit a wide range when individual subjects are considered). These results demonstrate that the technique offers, not only a means of acquiring long-term FHR data that are problematic to obtain by other means, but also a more patient-friendly alternative to the Doppler ultrasound technique.
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Affiliation(s)
- J F Piéri
- School of Electrical & Electronic Engineering, University of Nottingham, UK
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Hamilton RM, Lee-Poy M, Kruger K, Silverman ED. Investigative methods of congenital complete heart block. J Electrocardiol 1998; 30 Suppl:69-74. [PMID: 9535483 DOI: 10.1016/s0022-0736(98)80035-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Congenital heart block (CHB) has been described for a century and related to the presence of maternal autoimmune disease for three decades, but little is understood about its mechanism. To explore the pathophysiology of CHB, technologies in both basic and clinical electrophysiology are being developed and applied. Human fetal rhythm is currently inferred from cardiac mechanical events by using fetal ultrasound, allowing for the detection of second and third-degree heart block. Fetal electrocardiography is being explored to assess its feasibility as a clinical tool to detect fetal first-degree block in the mid trimester. Sequential composite digital recordings from the maternal abdomen are made every 4 weeks from pregnancies at risk for congenital heart block. Filtering and averaging techniques are used to enhance the fetal signal. So far, these techniques have produced a fetal QRS complex trigger signal for use in three-dimensional fetal echocardiography. Because the human fetus cannot be studied directly, a Langendorff rabbit model of CHB has been developed. With 5-10 mL of human serum in 150-300 mL of Krebs solution, prolongation of the Wenckebach second-degree atrioventricular block cycle length occurred. This was reproduced by using serum from seven of eight CHB mothers as compared with none of six controls mothers.
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Affiliation(s)
- R M Hamilton
- Department of Pediatrics and Research Institute, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Ontario, Canada
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Lin CL, Wu HC, Liu TY, Lee MH, Kuo TS, Young ST. A portable monitor for fetal heart rate and uterine contraction. IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE : THE QUARTERLY MAGAZINE OF THE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY 1997; 16:80-4. [PMID: 9399090 DOI: 10.1109/51.637121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C L Lin
- Department of Electrical Engineering, National Taiwan University
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