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1.
Sci Rep ; 14(1): 12615, 2024 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824217

RESUMO

Standard clinical practice to assess fetal well-being during labour utilises monitoring of the fetal heart rate (FHR) using cardiotocography. However, visual evaluation of FHR signals can result in subjective interpretations leading to inter and intra-observer disagreement. Therefore, recent studies have proposed deep-learning-based methods to interpret FHR signals and detect fetal compromise. These methods have typically focused on evaluating fixed-length FHR segments at the conclusion of labour, leaving little time for clinicians to intervene. In this study, we propose a novel FHR evaluation method using an input length invariant deep learning model (FHR-LINet) to progressively evaluate FHR as labour progresses and achieve rapid detection of fetal compromise. Using our FHR-LINet model, we obtained approximately 25% reduction in the time taken to detect fetal compromise compared to the state-of-the-art multimodal convolutional neural network while achieving 27.5%, 45.0%, 56.5% and 65.0% mean true positive rate at 5%, 10%, 15% and 20% false positive rate respectively. A diagnostic system based on our approach could potentially enable earlier intervention for fetal compromise and improve clinical outcomes.


Assuntos
Cardiotocografia , Aprendizado Profundo , Frequência Cardíaca Fetal , Frequência Cardíaca Fetal/fisiologia , Humanos , Gravidez , Feminino , Cardiotocografia/métodos , Redes Neurais de Computação , Monitorização Fetal/métodos , Processamento de Sinais Assistido por Computador , Feto
2.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 41(3): 494-502, 2024 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-38932535

RESUMO

In the extraction of fetal electrocardiogram (ECG) signal, due to the unicity of the scale of the U-Net same-level convolution encoder, the size and shape difference of the ECG characteristic wave between mother and fetus are ignored, and the time information of ECG signals is not used in the threshold learning process of the encoder's residual shrinkage module. In this paper, a method of extracting fetal ECG signal based on multi-scale residual shrinkage U-Net model is proposed. First, the Inception and time domain attention were introduced into the residual shrinkage module to enhance the multi-scale feature extraction ability of the same level convolution encoder and the utilization of the time domain information of fetal ECG signal. In order to maintain more local details of ECG waveform, the maximum pooling in U-Net was replaced by Softpool. Finally, the decoder composed of the residual module and up-sampling gradually generated fetal ECG signals. In this paper, clinical ECG signals were used for experiments. The final results showed that compared with other fetal ECG extraction algorithms, the method proposed in this paper could extract clearer fetal ECG signals. The sensitivity, positive predictive value, and F1 scores in the 2013 competition data set reached 93.33%, 99.36%, and 96.09%, respectively, indicating that this method can effectively extract fetal ECG signals and has certain application values for perinatal fetal health monitoring.


Assuntos
Algoritmos , Eletrocardiografia , Processamento de Sinais Assistido por Computador , Humanos , Eletrocardiografia/métodos , Gravidez , Feminino , Monitorização Fetal/métodos , Feto/fisiologia
3.
Women Birth ; 37(4): 101619, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38754249

RESUMO

BACKGROUND: A variety of technologies are used to monitor fetal wellbeing in labour. Different types of fetal monitoring devices impact women's experiences of labour and birth. AIM: This review aims to understand how continuous electronic fetal monitoring (CEFM) influences women's experiences, with a focus on sense of control, active decision-making and mobility. METHODS: A systematic search of the literature was conducted. Findings from qualitative, quantitative and mixed methods studies were analysed to provide a review of current evidence. FINDINGS: Eighteen publications were included. The findings were synthesised into three themes: 'Feeling reassured versus anxious about the welfare of their baby', 'Feeling comfortable and free to be mobile versus feeling uncomfortable and restricted', and 'Feeling respected and empowered to make decisions versus feeling depersonalised with minimal control '. Women experienced discomfort and a lack of mobility as a result of some CEFM technologies. They often felt anxious and had mixed feelings about their baby's welfare whilst these were in use. Some women valued the data produced by CEFM technologies about the welfare of their baby. Many women experienced a sense of depersonalisation and lack of control whilst CEFM technologies were used. DISCUSSION: Fetal monitoring technologies influence women's experiences of labour both positively and negatively. Wireless devices were associated with the most positive response as they enabled greater freedom of movement. CONCLUSION: The design of emerging fetal monitoring technologies should incorporate elements which foster freedom of movement, are comfortable and provide women with a sense of choice and control. The implementation of fetal monitoring that enables these elements should be prioritised by health professionals.


Assuntos
Monitorização Fetal , Trabalho de Parto , Feminino , Humanos , Gravidez , Cardiotocografia/métodos , Tomada de Decisões , Países Desenvolvidos , Monitorização Fetal/métodos , Trabalho de Parto/psicologia , Gestantes/psicologia
4.
Eur J Obstet Gynecol Reprod Biol ; 298: 123-127, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38754278

RESUMO

OBJECTIVES: The use of telemonitoring in healthcare is generally increasing. Women with complicated pregnancies are using telemonitoring as an alternative to conventional management, encompassing hospitalization or frequent outpatient clinic visits. However, there is sparse evidence on how pregnant women experience monitoring of their unborn babies at home. Women might feel uncomfortable with this responsibility, and moreover they might miss face-to-face contact with healthcare personnel. STUDY DESIGN: The study setting was a Danish hospital with a tertiary obstetric unit attending approximately 3400 births annually. A qualitative study design with interview as method included 11 pregnant women with type 1 diabetes or Gestational Diabetes Mellitus. This design was used to investigate how pregnant women with complicated pregnancies experienced telemonitoring of the fetus. Reflexive thematic analysis was used to analyze the pregnant women's experiences of telemonitoring. RESULTS: Women with type 1 diabetes or Gestational Diabetes Mellitus found the advantages of telemonitoring to outweigh the disadvantages. They experienced telemonitoring as time-saving and that telemonitoring decreased the level of stress. Moreover, telemonitoring supports positive collaboration with healthcare professionals. The women also experienced a lack of coordination of consultations between different departments at the hospital and challenges with timing, feedback, and technical issues. Moreover, the women requested an opportunity to discuss family formation and emotions. CONCLUSIONS: Pregnant women with type 1 diabetes or Gestational Diabetes Mellitus benefit from the use of telemonitoring. To further improve the implementation and use of telemonitoring clinical implications, consider how timing and coordination of care, technical equipment, and feedback mechanisms could be improved.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Gestacional , Telemedicina , Humanos , Feminino , Gravidez , Adulto , Diabetes Gestacional/psicologia , Diabetes Gestacional/terapia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Gravidez em Diabéticas/terapia , Gravidez em Diabéticas/psicologia , Pesquisa Qualitativa , Frequência Cardíaca Fetal/fisiologia , Monitorização Fetal/métodos , Dinamarca
5.
PLoS One ; 19(5): e0303072, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38722999

RESUMO

Qualitative research about women and birthing people's experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable or invasive monitoring devices, however, most published research about fetal monitoring is focused on the wellbeing of the fetus. This manuscript is derived from a larger mixed methods study, 'WOmen's Experiences of Monitoring Baby (The WOMB Study)', aiming to increase understanding of the experiences of women and birthing people in Australia, of being monitored; and about the information they received about fetal monitoring devices during pregnancy. We constructed a national cross-sectional survey that was distributed via social media in May and June, 2022. Responses were received from 861 participants. As far as we are aware, this is the first survey of the experiences of women and birthing people of intrapartum fetal monitoring conducted in Australia. This paper comprises the analysis of the free text survey responses, using qualitative and inductive content analysis. Two categories were constructed, Tending to the machine, which explores participants' perceptions of the way in which clinicians interacted with fetal monitoring technologies; and Impressions of the machine, which explores the direct impact of fetal monitoring devices upon the labour and birth experience of women and birthing people. The findings suggest that some clinicians need to reflect upon the information they provide to women and birthing people about monitoring. For example, freedom of movement is an important aspect of supporting the physiology of labour and managing pain. If freedom of movement is important, the physical restriction created by a wired cardiotocograph is inappropriate. Many participants noticed that clinicians focused their attention primarily on the technology. Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience.


Assuntos
Monitorização Fetal , Trabalho de Parto , Humanos , Feminino , Gravidez , Austrália , Monitorização Fetal/métodos , Adulto , Estudos Transversais , Inquéritos e Questionários , Parto , Adulto Jovem
6.
Sensors (Basel) ; 24(9)2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38733053

RESUMO

The fetal electrocardiogram (FECG) records changes in the graph of fetal cardiac action potential during conduction, reflecting the developmental status of the fetus in utero and its physiological cardiac activity. Morphological alterations in the FECG can indicate intrauterine hypoxia, fetal distress, and neonatal asphyxia early on, enhancing maternal and fetal safety through prompt clinical intervention, thereby reducing neonatal morbidity and mortality. To reconstruct FECG signals with clear morphological information, this paper proposes a novel deep learning model, CBLS-CycleGAN. The model's generator combines spatial features extracted by the CNN with temporal features extracted by the BiLSTM network, thus ensuring that the reconstructed signals possess combined features with spatial and temporal dependencies. The model's discriminator utilizes PatchGAN, employing small segments of the signal as discriminative inputs to concentrate the training process on capturing signal details. Evaluating the model using two real FECG signal databases, namely "Abdominal and Direct Fetal ECG Database" and "Fetal Electrocardiograms, Direct and Abdominal with Reference Heartbeat Annotations", resulted in a mean MSE and MAE of 0.019 and 0.006, respectively. It detects the FQRS compound wave with a sensitivity, positive predictive value, and F1 of 99.51%, 99.57%, and 99.54%, respectively. This paper's model effectively preserves the morphological information of FECG signals, capturing not only the FQRS compound wave but also the fetal P-wave, T-wave, P-R interval, and ST segment information, providing clinicians with crucial diagnostic insights and a scientific foundation for developing rational treatment protocols.


Assuntos
Eletrocardiografia , Redes Neurais de Computação , Processamento de Sinais Assistido por Computador , Humanos , Eletrocardiografia/métodos , Feminino , Gravidez , Aprendizado Profundo , Monitorização Fetal/métodos , Algoritmos , Feto
7.
Physiol Meas ; 45(5)2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38722552

RESUMO

Objective.Perinatal asphyxia poses a significant risk to neonatal health, necessitating accurate fetal heart rate monitoring for effective detection and management. The current gold standard, cardiotocography, has inherent limitations, highlighting the need for alternative approaches. The emerging technology of non-invasive fetal electrocardiography shows promise as a new sensing technology for fetal cardiac activity, offering potential advancements in the detection and management of perinatal asphyxia. Although algorithms for fetal QRS detection have been developed in the past, only a few of them demonstrate accurate performance in the presence of noise and artifacts.Approach.In this work, we proposePower-MF, a new algorithm for fetal QRS detection combining power spectral density and matched filter techniques. We benchmarkPower-MFagainst three open-source algorithms on two recently published datasets (Abdominal and Direct Fetal ECG Database: ADFECG, subsets B1 Pregnancy and B2 Labour; Non-invasive Multimodal Foetal ECG-Doppler Dataset for Antenatal Cardiology Research: NInFEA).Main results.Our results show thatPower-MFoutperforms state-of-the-art algorithms on ADFECG (B1 Pregnancy: 99.5% ± 0.5% F1-score, B2 Labour: 98.0% ± 3.0% F1-score) and on NInFEA in three of six electrode configurations by being more robust against noise.Significance.Through this work, we contribute to improving the accuracy and reliability of fetal cardiac monitoring, an essential step toward early detection of perinatal asphyxia with the long-term goal of reducing costs and making prenatal care more accessible.


Assuntos
Algoritmos , Eletrocardiografia , Processamento de Sinais Assistido por Computador , Humanos , Eletrocardiografia/métodos , Feminino , Gravidez , Monitorização Fetal/métodos , Feto/fisiologia
9.
Lupus ; 33(7): 685-692, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38571373

RESUMO

OBJECTIVE: The aim of this study was to explore the parents' experiences of home monitoring of the fetal heart rhythm. Women with anti-SSA/Ro52 autoantibodies carry a 2%-3% risk of giving birth to a child with congenital heart block (CHB), following transplacental transfer and antibody-mediated inflammation in the fetal conduction system during 18th to 24th gestational week. Early detection and subsequent treatment have been reported to decrease morbidity and mortality. Therefore, home monitoring of the fetal heart rhythm by Doppler has been offered at our fetal cardiology center. This study was undertaken to explore the lived experience of the routine. METHODS: Participants were recruited from a single fetal cardiology center. Consecutive sampling was used. The inclusion criteria were women with SSA/Ro52 antibodies who had undergone Doppler examinations within the last two and a half years at the hospital and had monitored the fetal heartbeat at home. A semi-structured questionnaire was created, and the participants were interviewed individually. The interviews were transcribed verbatim and analyzed according to qualitative content analysis. RESULTS: The overall theme was defined as "walking on thin ice," with six underlying categories: reality, different strategies, gain and loss, healthcare providers, underlying tension, and conducting the examinations again, all with a focus on how to handle the home monitoring during the risk period. CONCLUSION: Both the mother and the co-parent expressed confidence in their own abilities and that the monitoring provided them with the advantage of growing a bond with the expected child. However, all the participants described a feeling of underlying tension during the risk period. The results show that home monitoring is not experienced as complicated or a burden for the parents-to-be and should be considered a vital part of the chain of care for mothers at risk for giving birth to a child with CHB. However, explaining the teamwork between the different caregivers, for the patients involved, their areas of expertise, and how they collaborate with the patient continues to be a pedagogic challenge and should be developed further.


Assuntos
Anticorpos Antinucleares , Bloqueio Cardíaco , Frequência Cardíaca Fetal , Pais , Humanos , Feminino , Gravidez , Adulto , Pais/psicologia , Bloqueio Cardíaco/congênito , Bloqueio Cardíaco/imunologia , Bloqueio Cardíaco/diagnóstico , Anticorpos Antinucleares/sangue , Autoanticorpos/sangue , Inquéritos e Questionários , Masculino , Ribonucleoproteínas/imunologia , Monitorização Fetal/métodos
10.
Infant Behav Dev ; 75: 101949, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38663329

RESUMO

Fetal movement is a crucial indicator of fetal well-being. Characteristics of fetal movement vary across gestation, posing challenges for researchers to determine the most suitable assessment of fetal movement for their study. We summarize the current measurement strategies used to assess fetal movement and conduct a comprehensive review of studies utilizing these methods. We critically evaluate various measurement approaches including subjective maternal perception, ultrasound, Doppler ultrasound, wearable technology, magnetocardiograms, and magnetic resonance imaging, highlighting their strengths and weaknesses. We discuss the challenges of accurately capturing fetal movement, which is influenced by factors such as differences in recording times, gestational ages, sample sizes, environmental conditions, subjective perceptions, and characterization across studies. We also highlight the clinical implications of heterogeneity in fetal movement assessment for monitoring fetal behavior, predicting adverse outcomes, and improving maternal attachment to the fetus. Lastly, we propose potential areas of future research to overcome the current gaps and challenges in measuring and characterizing abnormal fetal movement. Our review contributes to the growing body of literature on fetal movement assessment and provides insights into the methodological considerations and potential applications for research.


Assuntos
Movimento Fetal , Humanos , Movimento Fetal/fisiologia , Feminino , Gravidez , Monitorização Fetal/métodos , Ultrassonografia Pré-Natal/métodos , Imageamento por Ressonância Magnética/métodos , Magnetocardiografia/métodos , Feto/fisiologia , Feto/diagnóstico por imagem
11.
Comput Methods Programs Biomed ; 249: 108145, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38582038

RESUMO

BACKGROUND AND OBJECTIVE: Obstetricians use Cardiotocography (CTG), which is the continuous recording of fetal heart rate and uterine contraction, to assess fetal health status. Deep learning models for intelligent fetal monitoring trained on extensively labeled and identically distributed CTG records have achieved excellent performance. However, creation of these training sets requires excessive time and specialist labor for the collection and annotation of CTG signals. Previous research has demonstrated that multicenter studies can improve model performance. However, models trained on cross-domain data may not generalize well to target domains due to variance in distribution among datasets. Hence, this paper conducted a multicenter study with Deep Semi-Supervised Domain Adaptation (DSSDA) for intelligent interpretation of antenatal CTG signals. This approach helps to align cross-domain distribution and transfer knowledge from a label-rich source domain to a label-scarce target domain. METHODS: We proposed a DSSDA framework that integrated Minimax Entropy and Domain Invariance (DSSDA-MMEDI) to reduce inter-domain gaps and thus achieve domain invariance. The networks were developed using GoogLeNet to extract features from CTG signals, with fully connected, softmax layers for classification. We designed a Dynamic Gradient-driven strategy based on Mutual Information (DGMI) to unify the losses from Minimax Entropy (MME), Domain Invariance (DI), and supervised cross-entropy during iterative learning. RESULTS: We validated our DSSDA model on two datasets collected from collaborating healthcare institutions and mobile terminals as the source and target domains, which contained 16,355 and 3,351 CTG signals, respectively. Compared to the results achieved with deep learning networks without DSSDA, DSSDA-MMEDI significantly improved sensitivity and F1-score by over 6%. DSSDA-MMEDI also outperformed other state-of-the-art DSSDA approaches for CTG signal interpretation. Ablation studies were performed to determine the unique contribution of each component in our DSSDA mechanism. CONCLUSIONS: The proposed DSSDA-MMEDI is feasible and effective for alignment of cross-domain data and automated interpretation of multicentric antenatal CTG signals with minimal annotation cost.


Assuntos
Cardiotocografia , Monitorização Fetal , Gravidez , Feminino , Humanos , Cardiotocografia/métodos , Entropia , Monitorização Fetal/métodos , Contração Uterina , Frequência Cardíaca Fetal/fisiologia
14.
Nurs Womens Health ; 28(2): e1-e39, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38363259

RESUMO

Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.


Assuntos
Monitorização Fetal , Trabalho de Parto , Gravidez , Recém-Nascido , Feminino , Humanos , Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Auscultação/métodos , Cardiotocografia/métodos
15.
Phys Eng Sci Med ; 47(2): 563-573, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38329662

RESUMO

Fetal electrocardiogram (fECG) monitoring is crucial for assessing fetal condition during pregnancy. However, current fECG extraction algorithms are not suitable for wearable devices due to their high computational cost and multi-channel signal requirement. The paper introduces a novel and efficient algorithm called Adaptive Improved Permutation Entropy (AIPE), which can extract fetal QRS from a single-channel abdominal ECG (aECG). The proposed algorithm is robust and computationally efficient, making it a reliable and effective solution for wearable devices. To evaluate the performance of the proposed algorithm, we utilized our clinical data obtained from a pilot study with 10 subjects, each recording lasting 20 min. Additionally, data from the PhysioNet 2013 Challenge bank with labeled QRS complex annotations were simulated. The proposed methodology demonstrates an average positive predictive value ( + P ) of 91.0227%, sensitivity (Se) of 90.4726%, and F1 score of 90.6525% from the PhysioNet 2013 Challenge bank, outperforming other methods. The results suggest that AIPE could enable continuous home-based monitoring of unborn babies, even when mothers are not engaging in any hard physical activities.


Assuntos
Abdome , Algoritmos , Eletrocardiografia , Entropia , Processamento de Sinais Assistido por Computador , Humanos , Feminino , Gravidez , Abdome/diagnóstico por imagem , Feto/diagnóstico por imagem , Monitorização Fetal
16.
J Obstet Gynecol Neonatal Nurs ; 53(3): e10-e48, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38363241

RESUMO

Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.


Assuntos
Monitorização Fetal , Frequência Cardíaca Fetal , Humanos , Feminino , Gravidez , Frequência Cardíaca Fetal/fisiologia , Monitorização Fetal/métodos , Auscultação Cardíaca/métodos , Auscultação/métodos , Cardiotocografia/métodos , Cardiotocografia/normas
17.
Curr Opin Anaesthesiol ; 37(3): 285-291, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38390901

RESUMO

PURPOSE OF REVIEW: Nonobstetric surgery during pregnancy is associated with maternal and fetal risks. Several physiologic changes create unique challenges for anesthesiologists. This review highlights physiologic changes of pregnancy and presents clinical recommendations based on recent literature to guide anesthetic management for the pregnant patient undergoing nonobstetric surgery. RECENT FINDINGS: Nearly every anesthetic technique has been safely used in pregnant patients. Although it is difficult to eliminate confounding factors, exposure to anesthetics could endanger fetal brain development. Perioperative fetal monitoring decisions require an obstetric consult based on anticipated maternal and fetal concerns. Given the limitations of fasting guidelines, bedside gastric ultrasound is useful in assessing aspiration risk in pregnant patients. Although there is concern about appropriateness of sugammadex for neuromuscular blockade reversal due its binding to progesterone, preliminary literature supports its safety. SUMMARY: These recommendations will equip anesthesiologists to provide safe care for the pregnant patient and fetus undergoing nonobstetric surgery.


Assuntos
Anestesia , Feto , Humanos , Gravidez , Feminino , Anestesia/métodos , Anestesia/efeitos adversos , Anestesia/normas , Feto/efeitos dos fármacos , Feto/cirurgia , Anestésicos/efeitos adversos , Anestésicos/administração & dosagem , Monitorização Fetal/métodos , Monitorização Fetal/normas , Complicações na Gravidez/prevenção & controle , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Anestesia Obstétrica/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/normas
18.
Crit Rev Biomed Eng ; 52(2): 1-14, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38305274

RESUMO

Combined the improved fast independent component analysis (FastICA) algorithm with the singular value decomposition algorithm, a single-channel fetal electrocardiogram (fECG) extraction method is proposed. First, the improved FastICA algorithm is used to estimate the maternal ECG component from a single-channel abdominal signal of pregnant women using an overrelaxation factor. Then, a preliminary estimate of the fECG signal is obtained by subtracting from the single-channel abdominal signal. Subsequently, the singular value decomposition algorithm is used to denoise the preliminarily estimated fECG signal to obtain a high signal-to-noise ratio. In addition, in the singular value decomposition algorithm for fetal arrhythmia, an improved method for constructing the ECG signal reconstruction matrix is proposed. Finally, the fECG extraction experiments on synthetic abdominal signals and actual abdominal signals (data from 49 abdominal channels sourced from DAISY database and the non-invasive fECG database in PhysioNet) are carried out. The experimental results show that the method in this paper can effectively improve the signal-to-noise ratio and the accuracy of fECG signal extraction, and is suitable for maternal or fetal arrhythmias. Compared with the FastICA algorithm, the signal-to-noise ratio of the fECG signal extracted by the method in this paper is improved by about 5 dB, and the accuracy of fECG extraction in the PhysioNet database can reach 96.54%.


Assuntos
Monitorização Fetal , Processamento de Sinais Assistido por Computador , Feminino , Gravidez , Humanos , Monitorização Fetal/métodos , Eletrocardiografia/métodos , Algoritmos , Razão Sinal-Ruído
19.
Enferm. glob ; 23(73): 68-94, ene. 2024. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-228888

RESUMO

Introducción: El vínculo madre-feto juega un papel importante en la atención del embarazo, impactando los resultados del nacimiento. El monitoreo del movimiento fetal es una competencia fundamental para que las mujeres embarazadas lo hagan de manera independiente. Objetivo: Producir monitoreo audiovisual del movimiento fetal independiente y probar su efectividad en el apego materno-fetal y los resultados del parto. Métodos: La etapa I, desarrollo de Monitoreo de Bienestar Fetal Audiovisual, con estudio de literatura, etapas, desarrollo de escenarios, creación de audiovisuales, prueba de validez de expertos. La etapa 2 probó la efectividad de los medios audiovisuales sobre el apego materno-fetal con el instrumento Inventario de Apego Prenatal y los resultados del nacimiento a partir del peso del bebé al nacer. Diseño de un verdadero enfoque experimental de grupo de control pretest-postest. Muestras de mujeres embarazadas con antecedentes de atención prenatal en el Centro de Salud Kasihan II, Bantul, Yogyakarta, Indonesia con los siguientes criterios: embarazo único, normal, edad gestacional de 28 a 36 semanas. Los encuestados de 60 sujetos se dividieron en grupos experimentales y de control. Los datos normales se probaron mediante la prueba t pareada, la prueba t independiente y MANOVA. Resultados: Puntaje de prueba de validez de experto en contenido 81% muy válido, puntaje de validez de experto en medios 80.33%, válido. La aplicación audiovisual mostró los resultados de la prueba t pareada, tanto en el grupo experimental como en el control hubo diferencias en el pretest y postest, P<0.05. La prueba t de muestra independiente P < 0,05 y los resultados MANOVA simultáneos mostraron una puntuación de apego materno-fetal y un resultado del nacimiento P < 0,05 (AU)


Introduction: The mother-fetus bond plays an important role in pregnancy care, impacting birth outcomes. Monitoring fetal movement is a fundamental competence for pregnant women to do independently. Objective: to produce audiovisual monitoring of independent fetal movement and prove its effectiveness on maternal-fetal attachment and birth outcomes. Methods: Phase I, developing Audiovisual Fetal Well-being Monitoring, with literature study steps, developing scenarios, creating audiovisuals, testing the validity of experts. Stage 2 tested the effectiveness of audiovisual media on maternal-fetal attachment with the Prenatal Attachment Inventory instrument and birth outcomes from infant birth weight. Design of true experimental pretest-posttest control group approach. Samples of pregnant women with a history of antenatal care at the Kasihan II Health Center, Bantul, Yogyakarta, Indonesia with the following criteria: single pregnancy, normal, gestational age 28-36 weeks. Respondents of 60 subjects were divided into experimental and control groups. Normal data were tested by paired t test, independent t-test and MANOVA. Results: Content expert validity test score 81% very valid, media expert validity score 80.33%, valid. The audiovisual application showed the results of the paired t-test, both in the experimental and control groups there were differences in pretest and posttest, P <0.05. Independent sample t-test P < 0.05 and simultaneous MANOVA results showed maternal-fetal attachment score and birth outcome P < 0.05. Conclusion: Independent monitoring of fetal well-being using audiovisual media simultaneously affects the increase in maternal-fetal attachment scores and birth outcomes so it is recommended that second trimester pregnant women be taught techniques for counting fetal movements and practicing them routinely (AU)


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Monitorização Fetal/métodos , Relações Materno-Fetais , Resultado da Gravidez , Análise Multivariada
20.
Acta Obstet Gynecol Scand ; 103(5): 980-991, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38229258

RESUMO

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.


Assuntos
Cardiotocografia , Determinação da Frequência Cardíaca , Gravidez , Feminino , Humanos , Cardiotocografia/métodos , Monitorização Fetal/métodos , Eletrocardiografia , Frequência Cardíaca Fetal/fisiologia , Avaliação de Resultados da Assistência ao Paciente
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