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Hirono Y, Kai C, Yoshida A, Sato I, Kodama N, Uchida F, Kasai S. Extracting fetal heart signals from Doppler using semi-supervised convolutional neural networks. Front Physiol 2024; 15:1293328. [PMID: 39040082 PMCID: PMC11260753 DOI: 10.3389/fphys.2024.1293328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Cardiotocography (CTG) measurements are critical for assessing fetal wellbeing during monitoring, and accurate assessment requires well-traceable CTG signals. The current FHR calculation algorithm, based on autocorrelation to Doppler ultrasound (DUS) signals, often results in periods of loss owing to its inability to differentiate signals. We hypothesized that classifying DUS signals by type could be a solution and proposed that an artificial intelligence (AI)-based approach could be used for classification. However, limited studies have incorporated the use of AI for DUS signals because of the limited data availability. Therefore, this study focused on evaluating the effectiveness of semi-supervised learning in enhancing classification accuracy, even in limited datasets, for DUS signals. Data comprising fetal heartbeat, artifacts, and two other categories were created from non-stress tests and labor DUS signals. With labeled and unlabeled data totaling 9,600 and 48,000 data points, respectively, the semi-supervised learning model consistently outperformed the supervised learning model, achieving an average classification accuracy of 80.9%. The preliminary findings indicate that applying semi-supervised learning to the development of AI models using DUS signals can achieve high generalization accuracy and reduce the effort. This approach may enhance the quality of fetal monitoring.
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Affiliation(s)
- Yuta Hirono
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata, Japan
- TOITU Co. Ltd., Tokyo, Japan
| | - Chiharu Kai
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata, Japan
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
| | - Akifumi Yoshida
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
| | - Ikumi Sato
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata, Japan
- Department of Nursing, Faculty of Nursing, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoki Kodama
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
| | | | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
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2
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Zhang J, Xiao S, Zhu Y, Zhang Z, Cao H, Xie M, Zhang L. Advances in the Application of Artificial Intelligence in Fetal Echocardiography. J Am Soc Echocardiogr 2024; 37:550-561. [PMID: 38199332 DOI: 10.1016/j.echo.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/23/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
Congenital heart disease is a severe health risk for newborns. Early detection of abnormalities in fetal cardiac structure and function during pregnancy can help patients seek timely diagnostic and therapeutic advice, and early intervention planning can significantly improve fetal survival rates. Echocardiography is one of the most accessible and widely used diagnostic tools in the diagnosis of fetal congenital heart disease. However, traditional fetal echocardiography has limitations due to fetal, maternal, and ultrasound equipment factors and is highly dependent on the skill level of the operator. Artificial intelligence (AI) technology, with its rapid development utilizing advanced computer algorithms, has great potential to empower sonographers in time-saving and accurate diagnosis and to bridge the skill gap in different regions. In recent years, AI-assisted fetal echocardiography has been successfully applied to a wide range of ultrasound diagnoses. This review systematically reviews the applications of AI in the field of fetal echocardiography over the years in terms of image processing, biometrics, and disease diagnosis and provides an outlook for future research.
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Affiliation(s)
- Junmin Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Sushan Xiao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ye Zhu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zisang Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Haiyan Cao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging, Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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3
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Lezama-García K, Martínez-Burnes J, Baqueiro-Espinosa U, Villanueva-García D, Olmos-Hernández A, Hernández-Ávalos I, Mora-Medina P, Domínguez-Oliva A, Mota-Rojas D. Uterine dynamics, blood profiles, and electronic fetal monitoring of primiparous and multiparous bitches classified according to their weight. Front Vet Sci 2023; 10:1282389. [PMID: 38033635 PMCID: PMC10687277 DOI: 10.3389/fvets.2023.1282389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Perinatal mortality occurs in all species. In dogs, mortality rates have been reported to range from 5 to 35%. Electronic fetal and uterine monitoring has recently been used in domestic animals to monitor the mother and newborn before and during parturition. In this way, the fetal heart rate and uterine dynamics can be monitored. This study evaluated the uterine dynamics of bitches with different weights and parity. Ninety-six bitches and their 476 puppies were divided into four experimental groups containing 24 individuals each (12 primiparous bitches and 12 multiparous bitches), according to body weight: G1 (4-8 kg), G2 (8.1-16 kg), G3 (16.1 to 32 kg), and G4 (32.1 to 39.6 kg). The fetal heart rate decelerations (dip 2 patterns), uterine dynamics, and bitches' blood profiles were evaluated, including levels of glucose, lactate, pCO2, pO2, pH, HCO3-, and Ca++. The dam weight can affect the vitality of newborns and the uterine dynamics, with differences in the frequency, intensity, and duration of myometrial contractions. The expulsion interval between puppies was longest in primiparous bitches with low weight and shortest in multiparous bitches with high weight. The expulsion interval and the number of stillborn females were higher in primiparous bitches with high weight. Newborn male puppies were significantly heavier than newborn females.
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Affiliation(s)
- Karina Lezama-García
- PhD Program in Biological and Health Sciences, Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Julio Martínez-Burnes
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Ciudad Victoria, Tamaulipas, Mexico
| | | | - Dina Villanueva-García
- Division of Neonatology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Adriana Olmos-Hernández
- Division of Biotechnology-Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Ismael Hernández-Ávalos
- Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli, Mexico
| | - Patricia Mora-Medina
- Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli, Mexico
| | - Adriana Domínguez-Oliva
- Neurophysiology, Behavior and Animal Welfare Assesment, DPAA, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assesment, DPAA, Universidad Autónoma Metropolitana, Mexico City, Mexico
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Williams CE, Berkowitz D, Rackin HM. Exploring the experiences of pregnant women in the U.S. during the first year of the Covid-19 pandemic. THE JOURNAL OF SOCIAL ISSUES 2022; 79:JOSI12567. [PMID: 36718412 PMCID: PMC9877755 DOI: 10.1111/josi.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 06/18/2023]
Abstract
In this paper, we integrate the stress process model with symbolic interactionism to frame our analysis of interviews with 35 women who were pregnant and/or gave birth during the first year of the Covid-19 pandemic. We detail three stressors, highlight their variation, and discuss how they coped with these stressors. Women reported having to navigate contradictory information about the public health crisis, but Black participants simultaneously endured added strain from a heightened awareness of racialized violence. To cope with an overabundance of precarious and contradictory messages, some women sought out information (i.e., information gatherers), others eschewed information (i.e., information avoiders), and most established protective "bubbles." Next, women experienced disruptions in pregnancy rituals but coped by reframing their expectations. This stressor, however, was less acute for women with a prior birth. Third, women shared feelings of social isolation and reduced social support, which were intensified if pregnancy complications occurred. Women coped by relying on telecommunication and at-home monitoring devices. Our study shows how pregnant women experienced and coped through adversity to mitigate stressors amid pandemonium.
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Affiliation(s)
| | - Dana Berkowitz
- Department of SociologyLouisiana State UniversityBaton RougeLouisianaUSA
| | - Heather M. Rackin
- Department of SociologyLouisiana State UniversityBaton RougeLouisianaUSA
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5
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Kodkin V. Cardiotocography in Obstetrics: New Solutions for "Routine" Technology. SENSORS (BASEL, SWITZERLAND) 2022; 22:5126. [PMID: 35890806 PMCID: PMC9320740 DOI: 10.3390/s22145126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This work is devoted to the problems of one of the most common screening examinations used in medical practice: fetal cardiotocography (CTG). The technology of ultrasonic monitoring of fetal heart rate (HR) variations has been used for more than 70 years. During this time, it has undergone many upgrades and has been characterized several times as a hopelessly outdated routine technology. Over the past 5-7 years, many in-depth studies and review papers on cardiotocography have appeared, which revealed both the problems and prospects of the technology. Basically, hopes are associated with artificial intelligence, which should increase the accuracy of the analysis of initially inaccurate measurements obtained using ultrasonic testing. At the same time, after the introduction of pulsed operating modes and the appearance of multi-chip sensors, the quality of the original signal remains practically unchanged. This circumstance makes the prospects of the technology very problematic. However, until now, there has not been a reliable replacement for this screening, which is equally safe, non-invasive, and accessible to a wide range of specialists, medical institutions, and patients. The paper discusses and substantiates proposals for improving the technology based on original (different from traditional CTG) methods of processing information received from ultrasonic sensors, which, in the author's opinion, allow for solving the main problems of CTG: identifying the correct direction of radiation to the fetal heart and to reliably evaluate beat-to-beat heart rate.
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Affiliation(s)
- Vladimir Kodkin
- Department of Electric Drive and Mechatronics, South Ural State University, 454080 Chelyabinsk, Russia
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6
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Vargas-Calixto J, Warrick P, Kearney R. Estimation and Discriminability of Doppler Ultrasound Fetal Heart Rate Variability Measures. Front Artif Intell 2021; 4:674238. [PMID: 34490419 PMCID: PMC8417534 DOI: 10.3389/frai.2021.674238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Continuous electronic fetal monitoring and the access to databases of fetal heart rate (FHR) data have sparked the application of machine learning classifiers to identify fetal pathologies. However, most fetal heart rate data are acquired using Doppler ultrasound (DUS). DUS signals use autocorrelation (AC) to estimate the average heartbeat period within a window. In consequence, DUS FHR signals loses high frequency information to an extent that depends on the length of the AC window. We examined the effect of this on the estimation bias and discriminability of frequency domain features: low frequency power (LF: 0.03–0.15 Hz), movement frequency power (MF: 0.15–0.5 Hz), high frequency power (HF: 0.5–1 Hz), the LF/(MF + HF) ratio, and the nonlinear approximate entropy (ApEn) as a function of AC window length and signal to noise ratio. We found that the average discriminability loss across all evaluated AC window lengths and SNRs was 10.99% for LF 14.23% for MF, 13.33% for the HF, 10.39% for the LF/(MF + HF) ratio, and 24.17% for ApEn. This indicates that the frequency domain features are more robust to the AC method and additive noise than the ApEn. This is likely because additive noise increases the irregularity of the signals, which results in an overestimation of ApEn. In conclusion, our study found that the LF features are the most robust to the effects of the AC method and noise. Future studies should investigate the effect of other variables such as signal drop, gestational age, and the length of the analysis window on the estimation of fHRV features and their discriminability.
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Affiliation(s)
| | - Philip Warrick
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada.,PeriGen Inc., Montreal, QC, Canada
| | - Robert Kearney
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
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7
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Kupka T, Matonia A, Jezewski M, Jezewski J, Horoba K, Wrobel J, Czabanski R, Martinek R. New Method for Beat-to-Beat Fetal Heart Rate Measurement Using Doppler Ultrasound Signal. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4079. [PMID: 32707863 PMCID: PMC7435740 DOI: 10.3390/s20154079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Abstract
The most commonly used method of fetal monitoring is based on heart activity analysis. Computer-aided fetal monitoring system enables extraction of clinically important information hidden for visual interpretation-the instantaneous fetal heart rate (FHR) variability. Today's fetal monitors are based on monitoring of mechanical activity of the fetal heart by means of Doppler ultrasound technique. The FHR is determined using autocorrelation methods, and thus it has a form of evenly spaced-every 250 ms-instantaneous measurements, where some of which are incorrect or duplicate. The parameters describing a beat-to-beat FHR variability calculated from such a signal show significant errors. The aim of our research was to develop new analysis methods that will both improve an accuracy of the FHR determination and provide FHR representation as time series of events. The study was carried out on simultaneously recorded (during labor) Doppler ultrasound signal and the reference direct fetal electrocardiogram Two subranges of Doppler bandwidths were separated to describe heart wall movements and valve motions. After reduction of signal complexity by determining the Doppler ultrasound envelope, the signal was analyzed to determine the FHR. The autocorrelation method supported by a trapezoidal prediction function was used. In the final stage, two different methods were developed to provide signal representation as time series of events: the first using correction of duplicate measurements and the second based on segmentation of instantaneous periodicity measurements. Thus, it ensured the mean heart interval measurement error of only 1.35 ms. In a case of beat-to-beat variability assessment the errors ranged from -1.9% to -10.1%. Comparing the obtained values to other published results clearly confirms that the new methods provides a higher accuracy of an interval measurement and a better reliability of the FHR variability estimation.
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Affiliation(s)
- Tomasz Kupka
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Adam Matonia
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Michal Jezewski
- Department of Cybernetics, Nanotechnology and Data Processing, Silesian University of Technology, PL44100 Gliwice, Poland; (M.J.); (R.C.)
| | - Janusz Jezewski
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Krzysztof Horoba
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Janusz Wrobel
- Łukasiewicz Research Network—Institute of Medical Technology and Equipment, PL41800 Zabrze, Poland; (A.M.); (J.J.); (K.H.); (J.W.)
| | - Robert Czabanski
- Department of Cybernetics, Nanotechnology and Data Processing, Silesian University of Technology, PL44100 Gliwice, Poland; (M.J.); (R.C.)
| | - Radek Martinek
- Department of Cybernetics and Biomedical Engineering, VSB—Technical University of Ostrava, 70800 Ostrava-Poruba, Czech Republic;
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Widatalla N, Kasahara Y, Kimura Y, Khandoker A. Model based estimation of QT intervals in non-invasive fetal ECG signals. PLoS One 2020; 15:e0232769. [PMID: 32392232 PMCID: PMC7213701 DOI: 10.1371/journal.pone.0232769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
The end timing of T waves in fetal electrocardiogram (fECG) is important for the evaluation of ST and QT intervals which are vital markers to assess cardiac repolarization patterns. Monitoring malignant fetal arrhythmias in utero is fundamental to care in congenital heart anomalies preventing perinatal death. Currently, reliable detection of end of T waves is possible only by using fetal scalp ECG (fsECG) and fetal magnetocardiography (fMCG). fMCG is expensive and less accessible and fsECG is an invasive technique available only during intrapartum period. Another safer and affordable alternative is the non-invasive fECG (nfECG) which can provide similar assessment provided by fsECG and fMECG but with less accuracy (not beat by beat). Detection of T waves using nfECG is challenging because of their low amplitudes and high noise. In this study, a novel model-based method that estimates the end of T waves in nfECG signals is proposed. The repolarization phase has been modeled as the discharging phase of a capacitor. To test the model, fECG signals were collected from 58 pregnant women (age: (34 ± 6) years old) bearing normal and abnormal fetuses with gestational age (GA) 20-41 weeks. QT and QTc intervals have been calculated to test the level of agreement between the model-based and reference values (fsECG and Doppler Ultrasound (DUS) signals) in normal subjects. The results of the test showed high agreement between model-based and reference values (difference < 5%), which implies that the proposed model could be an alternative method to detect the end of T waves in nfECG signals.
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Affiliation(s)
- Namareq Widatalla
- Next Generation Biological Information Technology, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
- * E-mail:
| | - Yoshiyuki Kasahara
- Next Generation Biological Information Technology, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
- Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Kimura
- Next Generation Biological Information Technology, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
- Advanced Interdisciplinary Biomedical Engineering, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ahsan Khandoker
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi, UAE
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9
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Alnuaimi S, Jimaa S, Kimura Y, Hadjileontiadis LJ, Khandoker AH. Fetal Cardiac Timing Events Estimation from Doppler Ultrasound Signal Cepstrum Analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4677-4681. [PMID: 31946906 DOI: 10.1109/embc.2019.8857659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Early diagnosis of the cardiac abnormalities during the pregnancy may reduce the risk of perinatal morbidity and mortality. Doppler ultrasound signals (DUS), which is commonly used for monitoring the fetal heart rate, can also be used for identifying the event timings of fetal cardiac valve motions. In this paper, we propose a non-invasive technique to identify the fetal cardiac timing events on the basis of analysis of fetal DUS (10 normal subjects and 6 abnormal subjects). We proposed using the cepstrum analysis which enabled the frequency contents of the Doppler signals to be linked to the opening and closing of the heart's valves (Aortic and mitral). The time intervals from R peak of fetal ECG to opening and closing of aortic valve were found to be 123.83±7.41 (msec) and 222.85±21.21 (msec), respectively. The time intervals from R peak to opening and closing of mitral valve were found to be 295.03±13.62 (msec) and 31.97±3.34 (msec), respectively. This feature is essential for diagnosing the disorder of cardiac rhythm, extremely used for diagnosis of heart abnormalities.
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10
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Mohd Jalil R, Radzi NS, Yahaya Z, Muhar M. Fetal Atrial Ectopic Rhythm Detected Using Handheld Doppler. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:50-53. [PMID: 32284806 PMCID: PMC7136670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Atrial ectopic rhythm is one of the most common fetal arrhythmias that can present during the prenatal period. Detection of fetal arrhythmia can be made by auscultating fetal heart rate and rhythm using a fetal handheld Doppler, and this can be done even in a resource-limited setting. The finding of an abnormal fetal heart rate and rhythm should prompt early referral to a pediatric cardiologist, as this may improve clinical outcomes. We present a case of atrial ectopic rhythm detected in utero using a handheld Doppler.
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Affiliation(s)
- R Mohd Jalil
- M.D Mother and Child Healthcare Clinic of Sandakan, Sandakan District Health Office, Ministry of Health Malaysia
| | - N S Radzi
- MB BCH BAO, M.Family Meds (FMS Mother and Child Healthcare Clinic of Sandakan, Sandakan District Health Office, Ministry of Health Malaysia
| | - Z Yahaya
- M.D, M.Family Meds (FMS) Mother and Child Healthcare Clinic of Sandakan, Sandakan District Health Office, Ministry of Health Malaysia
| | - Mfa Muhar
- M.D Mother and Child Healthcare Clinic of Sandakan, Sandakan District Health Office, Ministry of Health Malaysia
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11
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Garcia-Canadilla P, Sanchez-Martinez S, Crispi F, Bijnens B. Machine Learning in Fetal Cardiology: What to Expect. Fetal Diagn Ther 2020; 47:363-372. [PMID: 31910421 DOI: 10.1159/000505021] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
In fetal cardiology, imaging (especially echocardiography) has demonstrated to help in the diagnosis and monitoring of fetuses with a compromised cardiovascular system potentially associated with several fetal conditions. Different ultrasound approaches are currently used to evaluate fetal cardiac structure and function, including conventional 2-D imaging and M-mode and tissue Doppler imaging among others. However, assessment of the fetal heart is still challenging mainly due to involuntary movements of the fetus, the small size of the heart, and the lack of expertise in fetal echocardiography of some sonographers. Therefore, the use of new technologies to improve the primary acquired images, to help extract measurements, or to aid in the diagnosis of cardiac abnormalities is of great importance for optimal assessment of the fetal heart. Machine leaning (ML) is a computer science discipline focused on teaching a computer to perform tasks with specific goals without explicitly programming the rules on how to perform this task. In this review we provide a brief overview on the potential of ML techniques to improve the evaluation of fetal cardiac function by optimizing image acquisition and quantification/segmentation, as well as aid in improving the prenatal diagnoses of fetal cardiac remodeling and abnormalities.
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Affiliation(s)
- Patricia Garcia-Canadilla
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain, .,Institute of Cardiovascular Science, University College London, London, United Kingdom,
| | | | - Fatima Crispi
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Bart Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,ICREA, Barcelona, Spain
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12
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Sulas E, Ortu E, Raffo L, Urru M, Tumbarello R, Pani D. Automatic Recognition of Complete Atrioventricular Activity in Fetal Pulsed-Wave Doppler Signals. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:917-920. [PMID: 30440540 DOI: 10.1109/embc.2018.8512329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Echocardiography is the gold standard for antenatal cardiological assessment. However, the adoption of this technique is challenging, since it is intrinsically operator-dependent and because of the different confounding factors related to the fetal heart size, the fetal movements and the ultrasound artifacts. Among the different options, fetal echocardiography is widely used, concurring to an early diagnosis of several cardiac pathologies. In this work, a neural network-based algorithm targeted at the identification of the most important features of Doppler fetal echocardiography videos is presented and evaluated on real signals. Compared to other approaches, the proposed algorithm works on a couple of ID signals, representing the pulse-wave Doppler envelope extracted from the video, thus preserving a Iightweight approach. For the validation, a small dataset was created, including recordings from five voluntary pregnant women 21st to 27th gestational week), for a total of 20 records, 10 seconds each. The dataset was annotated by an expert cardiologist in order to identify the epochs of the signal where a complete readable cardiac cycle could be identified. The performance of the method was evaluated through a 5-fold cross-validation. An average accuracy up to 88% was obtained, confirming the validity of the proposed approach and paving the way to future improvements of the technique.
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Alnuaimi S, Jimaa S, Kimura Y, Apostolidis GK, Hadjileontiadis LJ, Khandoker AH. Fetal Cardiac Timing Events Estimation From Doppler Ultrasound Signals Using Swarm Decomposition. Front Physiol 2019; 10:789. [PMID: 31281265 PMCID: PMC6597894 DOI: 10.3389/fphys.2019.00789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/04/2019] [Indexed: 11/23/2022] Open
Abstract
Perinatal morbidity and mortality can be reduced when any cardiac abnormalities during a pregnancy are diagnosed early. Doppler Ultrasound Signals (DUS) are often used to monitor the heart rate of a fetus and they can also be used to identify the timing events of fetal cardiac valve motions. This paper proposed a novel, non-invasive technique which can be used to identify the fetal cardiac timing events based upon the analysis of fetal DUS (based upon 66 normal subjects belonging to three differing age groups) which can later be used to estimate fetal cardiac intervals from a DUS signal. The foundation of this method is a novel decomposition method referred to as Swarm Decomposition (SWD) which makes it possible for the frequency contents of Doppler signals to be associated with cardiac valve motions. These motions include the opening (o) and closing (c) of Aortic (A) and Mitral (M) valves. When compared the SWD method results to the Empirical Mode Decomposition for the validation, the fetal cardiac timings were estimated successfully when isolating the constituent parts of analyzed DUS signals with reduced complexity compared to EMD method. Pulsed Doppler images are used in order to verify the estimated timings. Three fetal age groups were assessed in terms of their cardiac intervals: 16–29, 30–35, and 36–41 weeks. The time intervals (Systolic Time Interval, STI), (Isovolumic Relaxation Time, IRT), and (Pre-ejection Period, PEP) were found to change significantly (p < 0.05) across the three age groups. The evaluation of fetal cardiac performance can be enhanced, given that these findings can be leveraged as sensitive markers throughout the process.
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Affiliation(s)
- Saeed Alnuaimi
- Department of Electrical and Computer Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Shihab Jimaa
- Department of Electrical and Computer Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Georgios K Apostolidis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leontios J Hadjileontiadis
- Healthcare Engineering and Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ahsan H Khandoker
- Healthcare Engineering and Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
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Zhao Z, Zhang Y, Comert Z, Deng Y. Computer-Aided Diagnosis System of Fetal Hypoxia Incorporating Recurrence Plot With Convolutional Neural Network. Front Physiol 2019; 10:255. [PMID: 30914973 PMCID: PMC6422985 DOI: 10.3389/fphys.2019.00255] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/25/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Electronic fetal monitoring (EFM) is widely applied as a routine diagnostic tool by clinicians using fetal heart rate (FHR) signals to prevent fetal hypoxia. However, visual interpretation of the FHR usually leads to significant inter-observer and intra-observer variability, and false positives become the main cause of unnecessary cesarean sections. Goal: The main aim of this study was to ensure a novel, consistent, robust, and effective model for fetal hypoxia detection. Methods: In this work, we proposed a novel computer-aided diagnosis (CAD) system integrated with an advanced deep learning (DL) algorithm. For a 1-dimensional preprocessed FHR signal, the 2-dimensional image was transformed using recurrence plot (RP), which is considered to greatly capture the non-linear characteristics. The ultimate image dataset was enriched by changing several parameters of the RP and was then used to feed the convolutional neural network (CNN). Compared to conventional machine learning (ML) methods, a CNN can self-learn useful features from the input data and does not perform complex manual feature engineering (i.e., feature extraction and selection). Results: Finally, according to the optimization experiment, the CNN model obtained the average performance using optimal configuration across 10-fold: accuracy = 98.69%, sensitivity = 99.29%, specificity = 98.10%, and area under the curve = 98.70%. Conclusion: To the best of our knowledge, this approached achieved better classification performance in predicting fetal hypoxia using FHR signals compared to the other state-of-the-art works. Significance: In summary, the satisfied result proved the effectiveness of our proposed CAD system for assisting obstetricians making objective and accurate medical decisions based on RP and powerful CNN algorithm.
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Affiliation(s)
- Zhidong Zhao
- Hangdian Smart City Research Center of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China
| | - Yang Zhang
- School of Communication Engineering, Hangzhou Dianzi University, Hangzhou, China
| | - Zafer Comert
- Department of Computer Engineering, Bitlis Eren University, Bitlis, Turkey
| | - Yanjun Deng
- College of Electronics and Information, Hangzhou Dianzi University, Hangzhou, China
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Gu J, Song H, Zhou W, Chen M. Transabdominal continuous echocardiographic monitoring of fetuses. Int J Obstet Anesth 2018; 39:146-148. [PMID: 30685300 DOI: 10.1016/j.ijoa.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J Gu
- Department of Anesthesiology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, PR China
| | - H Song
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - W Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - M Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Antoni ST, Lehmann S, Neidhardt M, Fehrs K, Ruprecht C, Kording F, Adam G, Schupp S, Schlaefer A. Model checking for trigger loss detection during Doppler ultrasound-guided fetal cardiovascular MRI. Int J Comput Assist Radiol Surg 2018; 13:1755-1766. [PMID: 30078152 DOI: 10.1007/s11548-018-1832-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Ultrasound (US) is the state of the art in prenatal diagnosis to depict fetal heart diseases. Cardiovascular magnetic resonance imaging (CMRI) has been proposed as a complementary diagnostic tool. Currently, only trigger-based methods allow the temporal and spatial resolutions necessary to depict the heart over time. Of these methods, only Doppler US (DUS)-based triggering is usable with higher field strengths. DUS is sensitive to motion. This may lead to signal and, ultimately, trigger loss. If too many triggers are lost, the image acquisition is stopped, resulting in a failed imaging sequence. Moreover, losing triggers may prolong image acquisition. Hence, if no actual trigger can be found, injected triggers are added to the signal based on the trigger history. METHOD We use model checking, a technique originating from the computer science domain that formally checks if a model satisfies given requirements, to simultaneously model heart and respiratory motion and to decide whether respiration has a prominent effect on the signal. Using bounds on the physiological parameters and their variability, the method detects when changes in the signal are due to respiration. We use this to decide when to inject a trigger. RESULTS In a real-world scenario, we can reduce the number of falsely injected triggers by 94% from more than 87% to less than 5%. On a subset of motion that would allow CMRI, the number can be further reduced to below 0.2%. In a study using simulations with a robot, we show that our method works for different types of motions, motion ranges, starting positions and heartbeat traces. CONCLUSION While DUS is a promising approach for fetal CMRI, correct trigger injection is critical. Our model checking method can reduce the number of wrongly injected triggers substantially, providing a key prerequisite for fast and artifact free CMRI.
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Affiliation(s)
- Sven-Thomas Antoni
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany.
| | - Sascha Lehmann
- Institute for Software Systems, Hamburg University of Technology, Hamburg, Germany
| | - Maximilian Neidhardt
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
| | - Kai Fehrs
- Center for Radiology and Endoscopy, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ruprecht
- Center for Radiology and Endoscopy, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Kording
- Center for Radiology and Endoscopy, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Center for Radiology and Endoscopy, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sibylle Schupp
- Institute for Software Systems, Hamburg University of Technology, Hamburg, Germany
| | - Alexander Schlaefer
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
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