Simulation study on the effect of tissue geometries to fluence composition for non-invasive fetal pulse oximetry

Review of optical methods for fetal monitoring in utero

The current technology for monitoring fetal wellbeing during child birth is cardiotocography. However, CTG has high false positive rates that lead to unnecessary emergency Cesarean deliveries and false negatives that result in birth injuries. To curtail these issues, fetal pulse oximetery has been a topic of interest for many decades. Fetal pulse oximetry would yield the oxygen saturation of the fetus in utero and provide a more robust marker for clinicians to make decisions about performing emergency Cesarean deliveries. Here, we present a review of biomedical optical developments related to transabdominal fetal pulse oximetery in the biophotonics field and the challenges that must be overcome to make transabdominal pulse oximetry a clinical reality.

Design and In Vivo Evaluation of a Non-Invasive Transabdominal Fetal Pulse Oximeter

OBJECTIVE

Current intrapartum fetal monitoring technology is unable to provide physicians with an objective metric of fetal well-being, leading to degraded patient outcomes and increased litigation costs. Fetal oxygen saturation (SpO2) is a more suitable measure of fetal distress, but the inaccessibility of the fetus prior to birth makes this impossible to capture through current means. In this paper, we present a fully non-invasive, transabdominal fetal oximetry (TFO) system that provides in utero measures of fetal SpO2.

METHODS

TFO is performed by placing a reflectance-mode optode on the maternal abdomen and sending photons into the body to investigate the underlying fetal tissue. The proposed TFO system design consists of a multi-detector optode, an embedded optode control system, and custom user-interface software. To evaluate the developed TFO system, we utilized an in utero hypoxic fetal lamb model and performed controlled desaturation experiments while capturing gold standard arterial blood gases (SaO2).

RESULTS

Various degrees of fetal hypoxia were induced with true SaO2 values ranging between 10.5% and 66%. The non-invasive TFO system was able to accurately measure these fetal SpO2 values, supported by a root mean-squared error of 6.37% and strong measures of agreement with the gold standard.

CONCLUSION

The results support the efficacy of the presented TFO system to non-invasively measure a wide-range of fetal SpO2 values and identify critical levels of fetal hypoxia.

SIGNIFICANCE

TFO has the potential to improve fetal outcomes by providing obstetricians with a non-invasive measure of fetal oxygen saturation prior to delivery.

Estimating the Shape of the Fetal Pulse Curve for Transabdominal Pulse Oximetry using Synchronous Averaging. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020;2020:1-4. [PMID: 33017916 DOI: 10.1109/embc44109.2020.9176692]

A sufficient oxygen supply of the fetus is necessary for a proper development of the organs. Transabdominal fetal pulse oximetry is a method that allows to measure the oxygenation of the fetal blood non-invasively by placing the light sources and photodetectors on the belly of the pregnant woman. The shape of the measured fetal pulse wave is needed to extract parameters for the estimation of the oxygen saturation. This work presents an extension of our previously presented signal processing strategy that allows to extract an average shape of the fetal pulse wave from noisy mixed photoplethysmograms (PPG) with dominating maternal and very weak fetal signal components. An adaptive noise canceller and a comb filter are used to suppress the maternal component. The quality of the resulting fetal signal is sufficient to identify single pulse waves in time domain. Further processing demonstrates the extraction of the mean shape of a single fetal pulse wave by synchronous averaging of several detected pulses. The method is evaluated with different datasets of several simulated and synthetic signals measured with a tissue mimicking phantom. The feasibility of the approach is demonstrated by preparing the mixed PPGs to perform fetal pulse oximetry in future studies. However, clinical measurements are needed to finally evaluate the proposed system beyond synthetic datasets.

Extraction of the Fetal Pulse Curve for Transabdominal Pulse Oximetry using Adaptive and Comb Filters

The fetal pulse curve can be captured by placing light sources and detectors on the belly of a pregnant woman. Following the principle of reflection pulse oximetry, the light emitted into the abdomen is modulated by pulsing maternal and fetal arteries. The acquired signal is a mixture of a weak fetal and a dominating maternal photoplethysmogram (PPG). A first step towards estimation of the fetal oxygen level is the reconstruction of the purely fetal signal in time domain. As already shown in a former work, comb filters are well suited for the task, in case the fetal heart rate is known. In this work we extend the method by utilizing an adaptive noise canceller (ANC) to estimate the fetal pulse rate for comb filter design. Synthetic test signals with constant and time variable pulse rates are generated in order to achieve reproducible conditions. The ANC is fed by the mixed PPG and the maternal reference signal to reduce the dominant maternal components. The fetal pulse rate is computed by evaluating peaks in the resulting signal in time and frequency domain. The findings are used for comb filter design. It is shown that the extraction of the fetal pulse curve from the synthetic mixed PPGs by using the proposed strategy is promising. Clinical test measurements are the next step for evaluation.

Improved FPGA controlled artificial vascular system for plethysmographic measurements

The fetal oxygen saturation is an important parameter to determine the health status of a fetus, which is until now mostly acquired invasively. The transabdominal, fetal pulse oximetry is a promising approach to measure this non-invasively and continuously. The fetal pulse curve has to be extracted from the mixed signal of mother and fetus to determine its oxygen saturation. For this purpose efficient algorithms are necessary, which have to be evaluated under constant and reproducable test conditions. This paper presents the improved version of a phantom which can generate artificial pulse waves in a synthetic tissue phantom. The tissue phantom consists of several layers that mimic the different optical properties of the fetal and maternal tissue layers. Additionally an artificial vascular system and a dome, which mimics the bending of the belly of a pregnant woman, are incorporated. To obtain data on the pulse waves, several measurement methods are included, to help understand the behavior of the signals gained from the pulse waves. Besides pressure sensors and a transmissive method we integrated a capacitive approach, that makes use of the so called “Pin Oscillator” method. Apart from the enhancements in the tissue phantom and the measurements, we also improved the used blood substitute, which reproduces the different absorption characteristics of fetal and maternal blood. The results show that the phantom can generate pulse waves similar to the natural ones. Furthermore, the phantom represents a reference that can be used to evaluate the algorithms for transabdominal, fetal pulse oximetry.

Principle study on the signal connection at transabdominal fetal pulse oximetry

Transabdominal fetal pulse oximetry is an approach to measure oxygen saturation of the unborn child non-invasively. The principle of pulse oximetry is applied to the abdomen of a pregnant woman, such that the measured signal includes both, the maternal and the fetal pulse curve. One of the major challenges is to extract the shape of the fetal pulse curve from the mixed signal for computation of the oxygen saturation. In this paper we analyze the principle kind of connection of the fetal and maternal pulse curves in the measured signal. A time varying finite element model is used to rebuild the basic measurement environment, including a bulk tissue and two independently pulsing arteries to model the fetal and maternal blood circuit. The distribution of the light fluence rate in the model is computed by applying diffusion equation. From the detectors we extracted the time dependent fluence rate and analyzed the signal regarding its components. The frequency spectra of the signals show peaks at the fetal and maternal basic frequencies. Additional signal components are visible in the spectra, indicating multiplicative coupling of the fetal and maternal pulse curves. We conclude that the underlying signal model of algorithms for robust extraction of the shape of the fetal pulse curve, have to consider additive and multiplicative signal coupling.