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Li Z, Guo X, Shi W, He R, Zhong H. Study on the clinical value of the wearable foetal electrocardiogram monitoring system. Technol Health Care 2024:THC231752. [PMID: 39031401 DOI: 10.3233/thc-231752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
BACKGROUND Electronic foetal monitoring (EFM), a method to monitor foetal intrauterine conditions and foetal reserve capacity, is the most extensively used intrauterine monitoring technology in obstetrics. OBJECTIVE This study aims to compare the Thoth wearable foetal electrocardiogram (foetal ECG [FECG]) monitoring system with a traditional Doppler foetal heart monitoring system before labour to investigate their respective values in clinical application. METHODS A total of 393 pregnant women admitted to our hospital between 2020 and 2022 participated in this study. They were recruited using the convenience sampling method. We employed a paired design to assess the confusion rate, trend overlap, and foetal heart rate/ECG monitoring consistency, whereas a completely randomised design was used to measure pregnancy outcome indicators. The participants were divided into two groups using a random number table: the Thoth group (n= 196) and the traditional Doppler group (n= 197). Each group was monitored using the corresponding system. RESULTS The Thoth monitor demonstrated a lower confusion rate compared with the traditional Doppler monitor (0.25% vs 2.04%; χ2= 5.508, P= 0.019). The trend overlap in foetal heart rates was consistently 100%, with 91.2% of readings showing a consistency rate of ⩾ 95%. Additionally, the Thoth monitor recorded a higher cumulative interruption time in the foetal heart rate curve (12.13 ± 2.22 vs 21.02 ± 2.34; t= 18.471, P< 0.001) and more abnormal ECGs (21.21 ± 4.32 vs 18.21 ± 2.91; t= 7.582, P< 0.001) than the traditional Doppler system. CONCLUSION The Thoth wearable FECG monitor offers several advantages over the traditional Doppler foetal heart monitoring system. These include a reduced confusion rate, more accurate data collection, a lower rate of clinical misjudgement, reduced workload for medical staff, and enhanced comfort during vaginal delivery. The rates of emergency caesarean sections and neonatal asphyxia in the Thoth group were marginally lower than those in the Doppler group, which may be attributed to issues such as ECG disconnection or interference from the maternal heart rate.
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Affiliation(s)
- Zhaoxi Li
- Department of Obstetrical, Shenzhen People's Hospital, Shenzhen, China
| | - Xiaohui Guo
- Department of Obstetrical, Shenzhen People's Hospital, Shenzhen, China
| | - Wei Shi
- Department of Obstetrical, Shenzhen People's Hospital, Shenzhen, China
| | - Rongxia He
- Department of Obstetrical, Lanzhou University Second Hospital, Lanzhou, China
| | - Hua Zhong
- Department of Obstetrical, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Eenkhoorn C, Goos TG, Dankelman J, Franx A, Eggink AJ. Evaluation and patient experience of wireless noninvasive fetal heart rate monitoring devices. Acta Obstet Gynecol Scand 2024; 103:980-991. [PMID: 38229258 PMCID: PMC11019521 DOI: 10.1111/aogs.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/27/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION In clinical practice, fetal heart rate monitoring is performed intermittently using Doppler ultrasound, typically for 30 minutes. In case of a non-reassuring heart rate pattern, monitoring is usually prolonged. Noninvasive fetal electrocardiography may be more suitable for prolonged monitoring due to improved patient comfort and signal quality. This study evaluates the performance and patient experience of four noninvasive electrocardiography devices to assess candidate devices for prolonged noninvasive fetal heart rate monitoring. MATERIAL AND METHODS Non-critically sick women with a singleton pregnancy from 24 weeks of gestation were eligible for inclusion. Fetal heart rate monitoring was performed during standard care with a Doppler ultrasound device (Philips Avalon-FM30) alone or with this Doppler ultrasound device simultaneously with one of four noninvasive electrocardiography devices (Nemo Fetal Monitoring System, Philips Avalon-Beltless, Demcon Dipha-16 and Dräger Infinity-M300). Performance was evaluated by: success rate, positive percent agreement, bias, 95% limits of agreement, regression line, root mean square error and visual agreement using FIGO guidelines. Patient experience was captured using a self-made questionnaire. RESULTS A total of 10 women were included per device. For fetal heart rate, Nemo performed best (success rate: 99.4%, positive percent agreement: 94.2%, root mean square error 5.1 BPM, bias: 0.5 BPM, 95% limits of agreement: -9.7 - 10.7 BPM, regression line: y = -0.1x + 11.1) and the cardiotocography tracings obtained simultaneously by Nemo and Avalon-FM30 received the same FIGO classification. Comparable results were found with the Avalon-Beltless from 36 weeks of gestation, whereas the Dipha-16 and Infinity-M300 performed significantly worse. The Avalon-Beltless, Nemo and Infinity-M300 closely matched the performance of the Avalon-FM30 for maternal heart rate, whereas the performance of the Dipha-16 deviated more. Patient experience scores were higher for the noninvasive electrocardiography devices. CONCLUSIONS Both Nemo and Avalon-Beltless are suitable devices for (prolonged) noninvasive fetal heart rate monitoring, taking their intended use into account. But outside its intended use limit of 36 weeks' gestation, the Avalon-Beltless performs less well, comparable to the Dipha-16 and Infinity-M300, making them currently unsuitable for (prolonged) noninvasive fetal heart rate monitoring. Noninvasive electrocardiography devices appear to be preferred due to greater comfort and mobility.
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Affiliation(s)
- Chantal Eenkhoorn
- Department of Obstetrics and Gynecology, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Tom G. Goos
- Department of Neonatal and Pediatric Intensive Care, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
- Department of Biomechanical EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Jenny Dankelman
- Department of Biomechanical EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Alex J. Eggink
- Department of Obstetrics and Gynecology, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
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Coddington R, Scarf V, Fox D. Australian women's experiences of wearing a non-invasive fetal electrocardiography (NIFECG) device during labour. Women Birth 2023; 36:546-551. [PMID: 36925403 DOI: 10.1016/j.wombi.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Continuous electronic fetal monitoring devices can restrict women's freedom of movement and choice of positioning during labour and birth. Despite the use of continuous electronic fetal monitoring for the past 50 years, little attention has been paid to women's experiences of wearing different fetal monitoring devices in labour. AIM To explore women's views and experiences of wearing a beltless continuous electronic fetal monitoring device, the non-invasive fetal electrocardiogram during labour. METHODS A qualitative descriptive approach was taken. Recruitment was via a larger clinical feasibility study. Some women who consented to take part in the clinical feasibility study also consented to being interviewed during the postnatal period. Transcripts were thematically analysed. FINDINGS Women reported improved comfort when wearing the non-invasive fetal electrocardiogram device. They appreciated how it enabled freedom of movement and an ability to actively participate in labour. They compared their experience with previous use of cardiotocography which they felt compromised their bodily autonomy. All forms of continuous electronic fetal monitoring experienced by women resulted in the unwelcome experience of 'Poking and prodding' by the midwife. DISCUSSION Continuous electronic fetal monitoring can negatively impact women's labour and birth experience, particularly when the measurement of fetal wellbeing is prioritised. CONCLUSION The way in which continuous electronic fetal monitoring technology is designed and used is an important component of optimising physiological processes and positive experiences for women during labour and birth for women with complex pregnancies. Non-invasive fetal electrocardiograpy is a promising additional option for women.
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Affiliation(s)
- Rebecca Coddington
- Collaborative of Midwifery, Child and Family Health, University of Technology Sydney, Australia.
| | - Vanessa Scarf
- Collaborative of Midwifery, Child and Family Health, University of Technology Sydney, Australia
| | - Deborah Fox
- Collaborative of Midwifery, Child and Family Health, University of Technology Sydney, Australia
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Mendis L, Palaniswami M, Brownfoot F, Keenan E. Computerised Cardiotocography Analysis for the Automated Detection of Fetal Compromise during Labour: A Review. Bioengineering (Basel) 2023; 10:1007. [PMID: 37760109 PMCID: PMC10525263 DOI: 10.3390/bioengineering10091007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
The measurement and analysis of fetal heart rate (FHR) and uterine contraction (UC) patterns, known as cardiotocography (CTG), is a key technology for detecting fetal compromise during labour. This technology is commonly used by clinicians to make decisions on the mode of delivery to minimise adverse outcomes. A range of computerised CTG analysis techniques have been proposed to overcome the limitations of manual clinician interpretation. While these automated techniques can potentially improve patient outcomes, their adoption into clinical practice remains limited. This review provides an overview of current FHR and UC monitoring technologies, public and private CTG datasets, pre-processing steps, and classification algorithms used in automated approaches for fetal compromise detection. It aims to highlight challenges inhibiting the translation of automated CTG analysis methods from research to clinical application and provide recommendations to overcome them.
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Affiliation(s)
- Lochana Mendis
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC 3010, Australia; (M.P.); (E.K.)
| | - Marimuthu Palaniswami
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC 3010, Australia; (M.P.); (E.K.)
| | - Fiona Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, VIC 3084, Australia;
| | - Emerson Keenan
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC 3010, Australia; (M.P.); (E.K.)
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, VIC 3084, Australia;
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Frenken MWE, Van Der Woude DAA, Vullings R, Oei SG, Van Laar JOEH. Implementation of the combined use of non-invasive fetal electrocardiography and electrohysterography during labor: A prospective clinical study. Acta Obstet Gynecol Scand 2023; 102:865-872. [PMID: 37170633 PMCID: PMC10333653 DOI: 10.1111/aogs.14571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Fetal electrocardiography (NI-fECG) and electrohysterography (EHG) have been proven more accurate and reliable than conventional non-invasive methods (doppler ultrasound and tocodynamometry) and are less affected by maternal obesity. It is still unknown whether NI-fECG and EHG will eliminate the need for invasive methods, such as the intrauterine pressure catheter and fetal scalp electrode. We studied whether NI-fECG and EHG can be successfully used during labor. MATERIAL AND METHODS A prospective clinical pilot study was performed in a tertiary care teaching hospital. A total of 50 women were included with a singleton pregnancy with a gestational age between 36+0 and 42+0 weeks and had an indication for continuous intrapartum monitoring. The primary study outcome was the percentage of women with NI-fECG and EHG monitoring throughout the whole delivery. Secondary study outcomes were reason and timing of a switch to conventional monitoring methods (i.e., tocodynamometry and fetal scalp electrode or doppler ultrasound), repositioning of the abdominal electrode patch, success rates (i.e., the percentage of time with signal output), and obstetric and neonatal outcomes. CLINICAL TRIAL REGISTRATION Dutch trial register (NL8024). RESULTS In 45 women (90%), NI-fECG and EHG monitoring was used throughout the whole delivery. In the other five women (10%), there was a switch to conventional methods: in two women because of insufficient registration quality of uterine contractions and in three women because of insufficient registration quality of the fetal heart rate. In three out of five cases, the switch was after full dilation was reached. Repositioning of the abdominal electrode patch occurred in two women. The overall success rate was 94.5%. In 16% (n = 8) of women, a cesarean delivery was performed due to non-progressing dilation (n = 7) and due to suspicion of fetal distress (n = 1). Neonatal metabolic acidosis did not occur. Two neonates (4%) were admitted to the neonatal intensive care unit for complications not related to intrapartum monitoring. CONCLUSIONS NI-fECG and EHG can be successfully used during labor in 90% of women. Future research is needed to conclude whether implementation of electrophysiological monitoring can improve obstetric and neonatal outcomes.
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Affiliation(s)
- Maria W. E. Frenken
- Department of Obstetrics and GynecologyMáxima MCVeldhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Daisy A. A. Van Der Woude
- Department of Obstetrics and GynecologyMáxima MCVeldhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Rik Vullings
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Swan G. Oei
- Department of Obstetrics and GynecologyMáxima MCVeldhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Judith O. E. H. Van Laar
- Department of Obstetrics and GynecologyMáxima MCVeldhovenThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
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Reis‐de‐Carvalho C, Nogueira P, Ayres‐de‐Campos D. Quality of fetal heart rate monitoring with transabdominal fetal ECG during maternal movement in labor: A prospective study. Acta Obstet Gynecol Scand 2022; 101:1269-1275. [PMID: 35959521 PMCID: PMC9812089 DOI: 10.1111/aogs.14434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Transabdominal electrocardiographic (TAfECG) acquisition of fetal heart rate (FHR) signals has recently been introduced into leading commercial cardiotocographic (CTG) monitors. Continuous wireless transmission of signals has raised the possibility of the technology being used during maternal mobilization in labor. This study aims to evaluate signal quality and accuracy of TAfECG acquisition of FHR signals during static and active maternal positions in labor when compared with Doppler signals and with the gold-standard method of fetal scalp electrode (FSE). MATERIAL AND METHODS A total of 76 women with singleton term pregnancies in the active first stage of labor had simultaneously acquired FHR with TAfECG, Doppler, and FSE. Participants were asked to complete a supervised mobilization scheme, comprising five sequential 10-min periods of lying down, standing, sitting, walking, and rocking on the birthing ball. The three FHR signals were compared, defining signal loss as the percentage of signals under 20 bpm or exceeding 250 bpm and accuracy as the difference with FSE values. Computer analysis was used to quantify variability, accelerations, and decelerations. Static labor positions (lying down, standing, and sitting) were compared with active labor positions (walking and rocking on the birthing ball). RESULTS Average signal loss was 5.3% with TAfECG (3.2% in static and 7.4% in active positions) and 15.5% with Doppler (8.3% in static and 30.7% in active positions). Average accuracy was 3.5 bpm with TAfECG (1.9 bpm in static and 5.04 bpm in active positions) and 13.9 bpm with Doppler (3.2 bpm in static and 24.7 bpm in active positions). Average variability was similar with TAfECG and FSE in static positions but significantly higher with TAfECG in active positions (23.6 vs. 13.5 bpm, p < 0.001). CONCLUSIONS In static labor positions, TAfECG provides a low signal loss, similar to that obtained with FSE, and a good signal accuracy, so the technique can be considered reliable when the mother is lying down, standing, or sitting. During maternal movement, TAfECG causes an artificial increase in FHR variability, which can cause false reassurance regarding fetal oxygenation. Doppler signals are unreliable during maternal movements.
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Affiliation(s)
- Catarina Reis‐de‐Carvalho
- Department of Obstetrics and GynecologyMedical School ‐ Santa Maria University HospitalLisbonPortugal
- Medical School ‐ Santa Maria University HospitalLisbonPortugal
| | - Paulo Nogueira
- Medical School ‐ Santa Maria University HospitalLisbonPortugal
- Biomathematics LaboratoryInstitute for Preventive Medicine and Public HealthLisbonPortugal
| | - Diogo Ayres‐de‐Campos
- Department of Obstetrics and GynecologyMedical School ‐ Santa Maria University HospitalLisbonPortugal
- Medical School ‐ Santa Maria University HospitalLisbonPortugal
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Habraken V, Spanjers MJ, van der Woude DA, Guid Oei S, van Laar JO. Experiences with intrapartum fetal monitoring in the Netherlands: a survey study. Eur J Obstet Gynecol Reprod Biol 2022; 278:159-165. [DOI: 10.1016/j.ejogrb.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/04/2022]
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Fotiadou E, van Sloun RJG, van Laar JOEH, Vullings R. A dilated inception CNN-LSTM network for fetal heart rate estimation. Physiol Meas 2021; 42. [PMID: 33853039 DOI: 10.1088/1361-6579/abf7db] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/14/2021] [Indexed: 01/16/2023]
Abstract
Objective. Fetal heart rate (HR) monitoring is routinely used during pregnancy and labor to assess fetal well-being. The noninvasive fetal electrocardiogram (ECG), obtained by electrodes on the maternal abdomen, is a promising alternative to standard fetal monitoring. Subtraction of the maternal ECG from the abdominal measurements results in fetal ECG signals, in which the fetal HR can be determined typically through R-peak detection. However, the low signal-to-noise ratio and the nonstationary nature of the fetal ECG make R-peak detection a challenging task.Approach. We propose an alternative approach that instead of performing R-peak detection employs deep learning to directly determine the fetal HR from the extracted fetal ECG signals. We introduce a combination of dilated inception convolutional neural networks (CNN) with long short-term memory networks to capture both short-term and long-term temporal dynamics of the fetal HR. The robustness of the method is reinforced by a separate CNN-based classifier that estimates the reliability of the outcome.Main results. Our method achieved a positive percent agreement (within 10% of the actual fetal HR value) of 97.3% on a dataset recorded during labor and 99.6% on set-A of the 2013 Physionet/Computing in Cardiology Challenge exceeding top-performing state-of-the-art algorithms from the literature.Significance. The proposed method can potentially improve the accuracy and robustness of fetal HR extraction in clinical practice.
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Affiliation(s)
- E Fotiadou
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, 5612 AP, The Netherlands
| | - R J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, 5612 AP, The Netherlands
| | - J O E H van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, 5504 DB, The Netherlands
| | - R Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, 5612 AP, The Netherlands
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Frenken MWE, Thijssen KMJ, Vlemminx MWC, van den Heuvel ER, Westerhuis MEMH, Oei SG. Clinical evaluation of electrohysterography as method of monitoring uterine contractions during labor: A propensity score matched study. Eur J Obstet Gynecol Reprod Biol 2021; 259:178-184. [PMID: 33684672 DOI: 10.1016/j.ejogrb.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Electrohysterography is a non-invasive technique to monitor uterine activity and has a significantly higher sensitivity compared to conventional external tocodynamometry. Whether this technique could lead to improved obstetrical outcomes is still unknown. In this propensity score matched study, clinical results of the first pilot implementing electrohysterography during labor were evaluated. The hypothesis tested is that electrohysterography will help to optimize uterine activity and thereby lead to fewer obstetric interventions. Secondary outcomes were Apgar score, arterial umbilical pH values, first stage labor duration, episiotomy rate and postpartum vaginal blood loss. STUDY DESIGN From November 2017 until October 2018, electrohysterography was introduced as a standard alternative for monitoring uterine activity in high-risk deliveries. It could be applied in case of induced labor, previous cesarean delivery, body mass index ≥30 kg/m2 or an inadequate external tocodynamometry monitoring. Outcomes were compared to a matched group of women in which external tocodynamometry was applied for uterine activity monitoring during labor. These women were identified using propensity scores. RESULTS A total of 348 women received electrohysterography as standard method of uterine monitoring during labor. A match (1:1 ratio) was found for 317 women, resulting in a total population of 634 women. No significant differences were seen in obstetric interventions (i.e. cesarean deliveries and assisted vaginal deliveries) between the electrohysterography and tocodynamometry group (P = 0.80). No statistically significant differences were seen regarding the secondary outcomes. CONCLUSIONS This first pilot study implementing electrohysterography as monitoring method during labor in a high-risk population did not result in statistically significant differences regarding obstetric interventions, low Apgar scores or low umbilical artery pH values. Therefore, we suggest that electrohysterography causes no harm and we recommend further implementation and evaluation in clinical practice.
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Affiliation(s)
- Maria W E Frenken
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, the Netherlands.
| | - Kirsten M J Thijssen
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - Maria W C Vlemminx
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - Edwin R van den Heuvel
- Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Department of Mathematics & Computer Science, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, the Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, the Netherlands
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Vullings R, van Laar JOEH. Non-invasive Fetal Electrocardiography for Intrapartum Cardiotocography. Front Pediatr 2020; 8:599049. [PMID: 33363064 PMCID: PMC7755891 DOI: 10.3389/fped.2020.599049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
Fetal monitoring is important to diagnose complications that can occur during pregnancy. If detected timely, these complications might be resolved before they lead to irreversible damage. Current fetal monitoring mainly relies on cardiotocography, the simultaneous registration of fetal heart rate and uterine activity. Unfortunately, the technology to obtain the cardiotocogram has limitations. In current clinical practice the fetal heart rate is obtained via either an invasive scalp electrode, that poses risks and can only be applied during labor and after rupture of the fetal membranes, or via non-invasive Doppler ultrasound technology that is inaccurate and suffers from loss of signal, in particular in women with high body mass, during motion, or in preterm pregnancies. In this study, transabdominal electrophysiological measurements are exploited to provide fetal heart rate non-invasively and in a more reliable manner than Doppler ultrasound. The performance of the fetal heart rate detection is determined by comparing the fetal heart rate to that obtained with an invasive scalp electrode during intrapartum monitoring. The performance is gauged by comparing it to performances mentioned in literature on Doppler ultrasound and on two commercially-available devices that are also based on transabdominal fetal electrocardiography.
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Affiliation(s)
- Rik Vullings
- Biomedical Diagnostics Lab Eindhoven, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Nemo Healthcare, Veldhoven, Netherlands
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