Localised plasmonic hybridisation mode optical fibre sensing of relative humidity.

This work reports an optical fibre probe functionalised with 'cotton-shaped' gold-silica nanostructures for relative humidity (RH) monitoring. The sensor response utilises the localised surface plasmon resonance (LSPR) of self-assembled nanostructures: gold nanospheres (40 nm) surrounded by one layer of poly (allylamine hydrochloride) and hydrophilic silica nanoparticles (10-20 nm) on the end-facet of an optical fibre via a wavelength shift of the reflected light. Sensor optimisation is investigated by varying the density of gold nanoparticles on the end-facet of an optical fibre. It is demonstrated that the plasmonic hybridisation mode appearing when the average gold interparticle distance is small (Median: 7.5 nm) is more sensitive to RH after functionalisation than the singular plasmonic mode. The plasmonic hybridisation mode sensor demonstrates a high linear regression to RH with a sensitivity of 0.63 nm/%RH and excellent reversibility. The response time (T10-90%) and recovery time (T90-10%) are calculated as 1.2 ± 0.4 s and 0.95 ± 0.18 s. The sensor shows no measurable cross-talk to temperature in the tested range between 25 °C to 40 °C and the 95% limit of agreement is 3.1%RH when compared to a commercial reference sensor. Simulation with finite element analysis reveals a polarisation-dependent plasmonic hybridisation with a redshift of plasmonic wavelength as a decrease of the interparticle distance and a higher refractive index sensitivity, which results in a high sensitivity to RH as observed in the experiment.

Fibre Bragg Grating Based Interface Pressure Sensor for Compression Therapy.

Compression therapy is widely used as the gold standard for management of chronic venous insufficiency and venous leg ulcers, and the amount of pressure applied during the compression therapy is crucial in supporting healing. A fibre optic pressure sensor using Fibre Bragg Gratings (FBGs) is developed in this paper to measure sub-bandage pressure whilst removing cross-sensitivity due to strain in the fibre and temperature. The interface pressure is measured by an FBG encapsulated in a polymer and housed in a textile to minimise discomfort for the patient. The repeatability of a manual fabrication process is investigated by fabricating and calibrating ten sensors. A customized calibration setup consisting of a programmable translation stage and a weighing scale gives sensitivities in the range 0.4-1.5 pm/mmHg (2.6-11.3 pm/kPa). An alternative calibration method using a rigid plastic cylinder and a blood pressure cuff is also demonstrated. Investigations are performed with the sensor under a compression bandage on a phantom leg to test the response of the sensor to changing pressures in static situations. Measurements are taken on a human subject to demonstrate changes in interface pressure under a compression bandage during motion to mimic a clinical application. These results are compared to the current gold standard medical sensor using a Bland-Altman analysis, with a median bias ranging from -4.6 to -20.4 mmHg, upper limit of agreement (LOA) from -13.5 to 2.7 mmHg and lower LOA from -32.4 to -7.7 mmHg. The sensor has the potential to be used as a training tool for nurses and can be left in situ to monitor bandage pressure during compression therapy.

Fetal cardiac dysfunction in intrahepatic cholestasis of pregnancy is associated with elevated serum bile acid concentrations.

BACKGROUND & AIMS: Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of stillbirth. This study aimed to assess the relationship between bile acid concentrations and fetal cardiac dysfunction in patients with ICP who were or were not treated with ursodeoxycholic acid (UDCA). METHODS: Bile acid profiles and NT-proBNP, a marker of ventricular dysfunction, were assayed in umbilical venous serum from 15 controls and 76 ICP cases (36 untreated, 40 UDCA-treated). Fetal electrocardiogram traces were obtained from 43 controls and 48 ICP cases (26 untreated, 22 UDCA-treated). PR interval length and heart rate variability (HRV) parameters were measured in 2 behavioral states (quiet and active sleep). RESULTS: In untreated ICP, fetal total serum bile acid (TSBA) concentrations (r = 0.49, p = 0.019), hydrophobicity index (r = 0.20, p = 0.039), glycocholate concentrations (r = 0.56, p = 0.007) and taurocholate concentrations (r = 0.44, p = 0.039) positively correlated with fetal NT-proBNP. Maternal TSBA (r = 0.40, p = 0.026) and alanine aminotransferase (r = 0.40, p = 0.046) also positively correlated with fetal NT-proBNP. There were no significant correlations between maternal or fetal serum bile acid concentrations and fetal HRV parameters or NT-proBNP concentrations in the UDCA-treated cohort. Fetal PR interval length positively correlated with maternal TSBA in untreated (r = 0.46, p = 0.027) and UDCA-treated ICP (r = 0.54, p = 0.026). Measures of HRV in active sleep and quiet sleep were significantly higher in untreated ICP cases than controls. HRV values in UDCA-treated cases did not differ from controls. CONCLUSIONS: Elevated fetal and maternal serum bile acid concentrations in untreated ICP are associated with an abnormal fetal cardiac phenotype characterized by increased NT-proBNP concentration, PR interval length and HRV. UDCA treatment partially attenuates this phenotype. LAY SUMMARY: The risk of stillbirth in intrahepatic cholestasis of pregnancy (ICP) is linked to the level of bile acids in the mother which are thought to disrupt the baby's heart rhythm. We found that babies of women with untreated ICP have abnormally functioning hearts compared to those without ICP, and the degree of abnormality is closely linked to the level of harmful bile acids in the mother and baby's blood. Babies of women with ICP who received treatment with the drug UDCA do not have the same level of abnormality in their hearts, suggesting that UDCA could be a beneficial treatment in some ICP cases, although further clinical trials are needed to confirm this.

Accurate neonatal heart rate monitoring using a new wireless, cap mounted device.

AIM: A device for newborn heart rate (HR) monitoring at birth that is compatible with delayed cord clamping and minimises hypothermia risk could have advantages over current approaches. We evaluated a wireless, cap mounted device (fhPPG) for monitoring neonatal HR. METHODS: A total of 52 infants on the neonatal intensive care unit (NICU) and immediately following birth by elective caesarean section (ECS) were recruited. HR was monitored by electrocardiogram (ECG), pulse oximetry (PO) and the fhPPG device. Success rate, accuracy and time to output HR were compared with ECG as the gold standard. Standardised simulated data assessed the fhPPG algorithm accuracy. RESULTS: Compared to ECG HR, the median bias (and 95% limits of agreement) for the NICU was fhPPG -0.6 (-5.6, 4.9) vs PO -0.3 (-6.3, 6.2) bpm, and ECS phase fhPPG -0.5 (-8.7, 7.7) vs PO -0.1 (-7.6, 7.1) bpm. In both settings, fhPPG and PO correlated with paired ECG HRs (both R2  = 0.89). The fhPPG HR algorithm during simulations demonstrated a near-linear correlation (n = 1266, R2  = 0.99). CONCLUSION: Monitoring infants in the NICU and following ECS using a wireless, cap mounted device provides accurate HR measurements. This alternative approach could confer advantages compared with current methods of HR assessment and warrants further evaluation at birth.

Optical Fibre Sensor for Capillary Refill Time and Contact Pressure Measurements under the Foot.

Capillary refill time (CRT) refers to the time taken for body tissue to regain its colour after an applied blanching pressure is released. Usually, pressure is manually applied and not measured. Upon release of pressure, simple mental counting is typically used to estimate how long it takes for the skin to regain its colour. However, this method is subjective and can provide inaccurate readings due to human error. CRT is often used to assess shock and hydration but also has the potential to assess peripheral arterial disease which can result in tissue breakdown, foot ulcers and ultimately amputation, especially in people with diabetes. The aim of this study was to design an optical fibre sensor to simultaneously detect blood volume changes and the contact pressure applied to the foot. The CRT probe combines two sensors: a plastic optical fibre (POF) based on photoplethysmography (PPG) to measure blood volume changes and a fibre Bragg grating to measure skin contact pressure. The results from 10 healthy volunteers demonstrate that the blanching pressure on the subject's first metatarsal head of the foot was 100.8 ± 4.8 kPa (mean and standard deviation), the average CRT was 1.37 ± 0.46 s and the time to achieve a stable blood volume was 4.77 ± 1.57 s. For individual volunteers, the fastest CRT measured was 0.82 ± 0.11 and the slowest 1.94 ± 0.49 s. The combined sensor and curve fitting process has the potential to provide increased reliability and accuracy for CRT measurement of the foot in diabetic foot ulcer clinics and in the community.

Relative accuracy of computerized intrapartum fetal heart rate pattern recognition by ultrasound and abdominal electrocardiogram detection.

INTRODUCTION: Noninvasive fetal heart rate monitoring using transabdominal fetal electrocardiographic detection is now commercially available and has been demonstrated to be an effective alternative to traditional Doppler ultrasonographic techniques. Our objective in this study was to compare the results of computerized identification of fetal heart rate patterns generated by ultrasound-based and transabdominal fetal electrocardiogram-based techniques with simultaneously obtained fetal scalp electrode-derived heart rate information. MATERIAL AND METHODS: We applied an objective computer-based analysis for recognition of fetal heart rate patterns (Monica Decision Support) to data obtained simultaneously from a direct fetal scalp electrode, Doppler ultrasound, and the abdominal-fetal electrocardiogram techniques. This allowed us to compare over 145 hours of fetal heart rate patterns generated by the external devices with those derived from the scalp electrode in 30 term singleton uncomplicated pregnancies during labor. The direct fetal scalp electrode is considered to be the most accurate and reliable technique used in current clinical practice, and was, therefore, used as the standard for comparison. The program quantified the baseline heart rate, long- and short-term variability. It indicated when an acceleration or deceleration was present and whether it was large or small. RESULTS: Ultrasound was associated with significantly greater deviations from the fetal scalp electrode results than the abdominal fetal electrocardiogram technique in recognizing the correct baseline heart rate, its variability, and the presence of small and large accelerations and small decelerations. For large decelerations the two external methods were each not significantly different from the scalp electrode results. CONCLUSIONS: Noninvasive fetal heart rate monitoring using maternal abdominal wall electrodes to detect fetal cardiac activity more reliably reproduced the computerized analysis of heart rate patterns derived from a direct fetal scalp electrode than did traditional ultrasound-based monitoring. Abdominal-fetal electrocardiogram should, therefore, be considered a primary option for externally monitored patients.

Optical Fibre Sensor for Simultaneous Measurement of Capillary Refill Time and Contact Pressure.

The widely applied capillary refill time (CRT) measurement is currently performed by manually applying pressure and using a stopwatch to record the time taken for the skin to recover its normal colour after a blanching pressure is applied. This method is highly subjective and observer-dependent. This paper presents a new, integrated optical sensor probe, combining monitoring of the capillary refilling process with the blanching pressure applied. The sensor consists of an optical fibre-based reflectance photoplethysmography (PPG) sensor to measure the reflected light signal, as well as a fibre Bragg grating (FBG) to measure the applied blanching pressure and to indicate the time when pressure is released. This sensor was applied to calculate the CRT (1.38 ± 0.66 s) of 10 healthy adult volunteers with (55.2 ± 21.8 kPa) blanching pressures. The form of the capillary refilling data was investigated by fitting using an exponential regression model (R2 > 0.96). The integrated probe has the potential to improve the reliability of CRT measurements by standardising the optimum duration and magnitude of the pressure.

A Textile Sleeve for Monitoring Oxygen Saturation Using Multichannel Optical Fibre Photoplethysmography.

Textile-based systems are an attractive prospect for wearable technology as they can provide monitoring of key physiological parameters in a comfortable and unobtrusive form. A novel system based on multichannel optical fibre sensor probes integrated into a textile sleeve is described. The system measures the photoplethysmogram (PPG) at two wavelengths (660 and 830 nm), which is then used to calculate oxygen saturation (SpO2). In order to achieve reliable measurement without adjusting the position of the garment, four plastic optical fibre (POF) probes are utilised to increase the likelihood that a high-quality PPG is obtained due to at least one of the probes being positioned over a blood vessel. Each probe transmits and receives light into the skin to measure the PPG and SpO2. All POFs are integrated in a stretchable textile sleeve with a circumference of 15 cm to keep the sensor in contact with the subject's wrist and to minimise motion artefacts. Tests on healthy volunteers show that the multichannel PPG sensor faithfully provides an SpO2 reading in at least one of the four sensor channels in all cases with no need for adjusting the position of the sleeve. This could not be achieved using a single sensor alone. The multichannel sensor is used to monitor the SpO2 of 10 participants with an average wrist circumference of 16.0 ± 0.6 cm. Comparing the developed sensor's SpO2 readings to a reference commercial oximeter (reflectance Masimo Radical-7) illustrates that the mean difference between the two sensors' readings is -0.03%, the upper limit of agreement (LOA) is 0.52% and the lower LOA is -0.58%. This multichannel sensor has the potential to achieve reliable, unobtrusive and comfortable textile-based monitoring of both heart rate and SpO2 during everyday life.

Real-Time Humidity Measurement during Sports Activity using Optical Fibre Sensing.

An optical fibre sensor for monitoring relative humidity (RH) changes during exercise is demonstrated. The humidity sensor comprises a tip coating of poly (allylamine hydrochloride) (PAH)/silica nanoparticles (SiO2 NPs) deposited using the layer-by-layer technique. An uncoated fibre is employed to compensate for bending losses that are likely to occur during movement. A linear fit to the response of the sensing system to RH demonstrates a sensitivity of 3.02 mV/% (R2 = 0.96), hysteresis ± 1.17% RH when 11 bilayers of PAH/SiO2 NPs are coated on the tip of the fibre. The performance of two different textiles (100% cotton and 100% polyester) were tested in real-time relative humidity measurement for 10 healthy volunteers. The results demonstrate the moisture wicking properties of polyester in that the relative humidity dropped more rapidly after cessation of exercise compared to cotton. The approach has the potential to be used to monitor sports performance and by clothing developers for characterising different garment designs.

Optical Fibre-Based Pulse Oximetry Sensor with Contact Force Detection.

A novel optical sensor probe combining monitoring of blood oxygen saturation (SpO2) with contact pressure is presented. This is beneficial as contact pressure is known to affect SpO2 measurement. The sensor consists of three plastic optical fibres (POF) used to deliver and collect light for pulse oximetry, and a fibre Bragg grating (FBG) sensor to measure contact pressure. All optical fibres are housed in a biocompatible epoxy patch which serves two purposes: (i) to reduce motion artefacts in the photoplethysmogram (PPG), and (ii) to transduce transverse loading into an axial strain in the FBG. Test results show that using a combination of pressure measuring FBG with a reference FBG, reliable results are possible with low hysteresis which are relatively immune to the effects of temperature. The sensor is used to measure the SpO2 of ten volunteers under different contact pressures with perfusion and skewness indices applied to assess the quality of the PPG. The study revealed that the contact force ranging from 5 to 15 kPa provides errors of <2%. The combined probe has the potential to improve the reliability of reflectance oximeters. In particular, in wearable technology, the probe should find use in optimising the fitting of garments incorporating this technology.

Multi-exposure laser speckle contrast imaging using a high frame rate CMOS sensor with a field programmable gate array.

A system has been developed in which multi-exposure laser speckle contrast imaging (LSCI) is implemented using a high frame rate CMOS imaging sensor chip. Processing is performed using a field programmable gate array (FPGA). The system allows different exposure times to be simulated by accumulating a number of short exposures. This has the advantage that the image acquisition time is limited by the maximum exposure time and that regulation of the illuminating light level is not required. This high frame rate camera has also been deployed to implement laser Doppler blood flow processing, enabling a direct comparison of multi-exposure laser speckle imaging and laser Doppler imaging (LDI) to be carried out using the same experimental data. Results from a rotating diffuser indicate that both multi-exposure LSCI and LDI provide a linear response to changes in velocity. This cannot be obtained using single-exposure LSCI, unless an appropriate model is used for correcting the response.

A Single-Chip CMOS Pulse Oximeter with On-Chip Lock-In Detection.

Pulse oximetry is a noninvasive and continuous method for monitoring the blood oxygen saturation level. This paper presents the design and testing of a single-chip pulse oximeter fabricated in a 0.35 µm CMOS process. The chip includes photodiode, transimpedance amplifier, analogue band-pass filters, analogue-to-digital converters, digital signal processor and LED timing control. The experimentally measured AC and DC characteristics of individual circuits including the DC output voltage of the transimpedance amplifier, transimpedance gain of the transimpedance amplifier, and the central frequency and bandwidth of the analogue band-pass filters, show a good match (within 1%) with the circuit simulations. With modulated light source and integrated lock-in detection the sensor effectively suppresses the interference from ambient light and 1/f noise. In a breath hold and release experiment the single chip sensor demonstrates consistent and comparable performance to commercial pulse oximetry devices with a mean of 1.2% difference. The single-chip sensor enables a compact and robust design solution that offers a route towards wearable devices for health monitoring.

Influence of maternal body mass index on accuracy and reliability of external fetal monitoring techniques.

OBJECTIVE: To evaluate the performance of external electronic fetal heart rate and uterine contraction monitoring according to maternal body mass index. DESIGN: Secondary analysis of prospective equivalence study. SETTING: Three US urban teaching hospitals. SAMPLE: Seventy-four parturients with a normal term pregnancy. METHODS: The parent study assessed performance of two methods of external fetal heart rate monitoring (abdominal fetal electrocardiogram and Doppler ultrasound) and of uterine contraction monitoring (electrohystero-graphy and tocodynamometry) compared with internal monitoring with fetal scalp electrode and intrauterine pressure transducer. Reliability of external techniques was assessed by the success rate and positive percent agreement with internal methods. Bland-Altman analysis determined accuracy. We analyzed data from that study according to maternal body mass index. MAIN OUTCOME MEASURES: We assessed the relationship between body mass index and monitor performance with linear regression, using body mass index as the independent variable and measures of reliability and accuracy as dependent variables. RESULTS: There was no significant association between maternal body mass index and any measure of reliability or accuracy for abdominal fetal electrocardiogram. By contrast, the overall positive percent agreement for Doppler ultrasound declined (p = 0.042), and the root mean square error from the Bland-Altman analysis increased in the first stage (p = 0.029) with increasing body mass index. Uterine contraction recordings from electrohysterography and tocodynamometry showed no significant deterioration related to maternal body mass index. CONCLUSIONS: Accuracy and reliability of fetal heart rate monitoring using abdominal fetal electrocardiogram was unaffected by maternal obesity, whereas performance of ultrasound degraded directly with maternal size. Both electrohysterography and tocodynamometry were unperturbed by obesity.

Fabrication and assessment of a bio-inspired synthetic tracheal tissue model for tracheal tube cuff leakage testing.

Introduction: Leakage of orogastric secretions past the cuff of a tracheal tube is a contributory factor in ventilator-associated pneumonia. Current bench test methods specified in the International Standard for Anaesthetic and Respiratory Equipment (EN ISO 5361:2023) to test cuff leakage involve using a glass or plastic rigid cylinder model of the trachea. There is a need for more realistic models to inform cuff leakage. Methods: We used human computerised tomography data and additive manufacturing (3D printing), combined with casting techniques to fabricate a bio-inspired synthetic tracheal model with analogous tissue characteristics. We conducted cuff leakage tests according to EN ISO 5361:2023 and compared results for high-volume low-pressure polyvinyl chloride and polyurethane cuffs between the rigid cylinder trachea with our bio-inspired model. Results: The tracheal model demonstrated close agreement with published tracheal tissue hardness for cartilaginous and membranous soft tissues. For high-volume low-pressure polyvinyl chloride cuffs the leakage rate was >50% lower in the bio-inspired tracheal model compared with the rigid cylinder model (151 [8] vs 261 [11] ml h-1). For high-volume low-pressure polyurethane cuffs, much lower leakage rates were observed than polyvinyl chloride cuffs in both models with leakage rates higher for the bio-inspired trachea model (0.1 [0.2] vs 0 [0] ml h-1). Conclusion: A reproducible tracheal model that incorporates the mechanical properties of the human trachea can be manufactured from segmented CT images and additive manufactured moulds, providing a useful tool to inform future cuff development, leakage testing for industrial applications, and clinical decision-making. There are differences between cuff leakage rates between the bio-inspired model and the rigid cylinder recommended in EN ISO 5361:2023. The bio-inspired model could lead to more accurate and realistic cuff leakage rate testing which would support manufacturers in refining their designs. Clinicians would then be able to choose better tracheal tubes based on the outcomes of this testing.

Pulse oximeter bench tests under different simulated skin tones.

Pulse oximeters' (POs) varying performance based on skin tones has been highly publicised. Compared to arterial blood gas analysis, POs tend to overestimate oxygen saturation (SpO2) values for people with darker skin (occult hypoxemia). The objective is to develop a test bench for assessing commercial home and hospital-based POs in controlled laboratory conditions. A laboratory simulator was used to mimic different SpO2 values (~ 70 to 100%). Different neutral density and synthetic melanin filters were used to reproduce low signal and varying melanin attenuation levels. Six devices consisting of commercial home (Biolight, N = 13; ChoiceMMed, N = 18; MedLinket, N = 9) and hospital-based (Masimo Radical 7 with Neo L, N = 1; GE B450 Masimo SET with LNCS Neo L, N = 1; Nonin 9550 Onyx II™, N = 1) POs were reviewed and their response documented. Significant variations were observed in the recorded SpO2 values among different POs when exposed to identical simulated signals. Differences were greatest for lower SpO2 (< 80%) where empirical data is limited. All PO responses under low signal and melanin attenuation did not change across various simulated SpO2 values. The bench tests do not provide conclusive evidence that melanin does not affect in vivo SpO2 measurements. Research in the areas of instrument calibration, theory and design needs to be further developed.

Intrapartum heart rate ambiguity: a comparison of cardiotocogram and abdominal fetal electrocardiogram with maternal electrocardiogram.

OBJECTIVE/AIMS: To investigate the presence of signal ambiguity of intrapartum fetal heart rate (FHR) monitoring during delivery by comparing simultaneous cardiotocogram (CTG), abdominal fetal electrocardiogram (ECG) with continuous maternal ECG. METHODS: A total of 144 simultaneous CTG (Corometrics 250 series), abdominal fetal ECG (Monica -AN24™) and maternal ECG (Monica AN24™) recordings were evaluated. MAIN OUTCOME MEASURES: When the FHR is within 5 bpm of the maternal heart rate (MHR) acquired from the ECG, it is classified as 'MHR/FHR ambiguity'. Statistical analyses were performed with Fisher's exact test and the Wilcoxon signed-rank test. RESULTS: Comparison of abdominal fetal ECG against CTG demonstrates significantly less 'MHR/FHR ambiguity' in both the first stage (mean 0.70 vs. 1.22%, p < 0.001) and second stage of labour (mean 3.30 vs. 6.20%, p < 0.001). CONCLUSION: Intrapartum FHR monitoring in daily practice via the CTG modality provides significantly more 'MHR/FHR ambiguity' than abdominal fetal ECG, which also provides additional information on the MHR.

Laser doppler blood flow imaging using a CMOS imaging sensor with on-chip signal processing.

The first fully integrated 2D CMOS imaging sensor with on-chip signal processing for applications in laser Doppler blood flow (LDBF) imaging has been designed and tested. To obtain a space efficient design over 64 × 64 pixels means that standard processing electronics used off-chip cannot be implemented. Therefore the analog signal processing at each pixel is a tailored design for LDBF signals with balanced optimization for signal-to-noise ratio and silicon area. This custom made sensor offers key advantages over conventional sensors, viz. the analog signal processing at the pixel level carries out signal normalization; the AC amplification in combination with an anti-aliasing filter allows analog-to-digital conversion with a low number of bits; low resource implementation of the digital processor enables on-chip processing and the data bottleneck that exists between the detector and processing electronics has been overcome. The sensor demonstrates good agreement with simulation at each design stage. The measured optical performance of the sensor is demonstrated using modulated light signals and in vivo blood flow experiments. Images showing blood flow changes with arterial occlusion and an inflammatory response to a histamine skin-prick demonstrate that the sensor array is capable of detecting blood flow signals from tissue.

Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes.

OBJECTIVE: Compare the accuracy and reliability of fetal heart rate identification from maternal abdominal fetal electrocardiogram signals (ECG) and Doppler ultrasound with a fetal scalp electrode. DESIGN: Prospective open method equivalence study. SETTING: Three urban teaching hospitals in the Northeast United States. SAMPLE: 75 women with normal pregnancies in labor at >37 weeks of gestation. METHODS: Three fetal heart rate detection methods were used simultaneously in 75 parturients. The fetal scalp electrode was the standard against which abdominal fetal ECG and ultrasound were judged. MAIN OUTCOME MEASURES: The positive percent agreement with the fetal scalp electrode indicated reliability. Bland-Altman analysis determined accuracy. The confusion rate indicated how frequently the devices tracked the maternal heart rate. RESULTS: Positive percent agreement was 81.7 and 73% for the abdominal fetal ECG and ultrasound, respectively (p = 0.002). The abdominal fetal ECG had a lower root mean square error than ultrasound (5.2 vs. 10.6 bpm, p < 0.001). The confusion rate for ultrasound was 20-fold higher than for abdominal ECG (8.9 vs. 0.4%, respectively, p < 0.001). CONCLUSION: Compared with the fetal scalp electrode, fetal heart rate detection using abdominal fetal ECG was more reliable and accurate than ultrasound, and abdominal fetal ECG was less likely than ultrasound to display the maternal heart rate in place of the fetal heart rate.

Intrapartum signal quality with external fetal heart rate monitoring: a two way trial of external Doppler CTG ultrasound and the abdominal fetal electrocardiogram.

OBJECTIVE: The objective of this study was to assess the fetal heart rate (FHR) signal quality of non-invasive abdominal fetal electrocardiogram (fECG) in comparison to the Doppler ultrasound cardiotocogram (CTG) during the first and second stage of labour. STUDY DESIGN: This was a prospective observational study of non-invasive fECG using five abdominally sited electrodes against the traditional Doppler ultrasound CTG probe on 144 patients. Data were analysed for signal quality before and after outlier removal. RESULTS: Abdominal fECG signal quality was significantly better during the first stage of labour in comparison to Doppler CTG (median fECG reliability of 95.7 % vs. median 87.3 % for Doppler, p < 0.001), whereas during second stage of labour, equivalence was demonstrated (p > 0.05). For the first and second stage of labour, fECG showed 106/135 (78.5 %) and 46/98 (46.9 %) women having fetal signal loss below 20 %, respectively. Similarly, Doppler ultrasound demonstrated 104/135 (77.0 %) and 51/98 (52.0 %) women having fetal signal loss below 20 % during first and second stage of labour, respectively. CONCLUSION: The non-invasive abdominal fECG presents an improved FHR signal quality during the first stage of labour and an equivalent signal quality during the second stage.

Feasibility of a Novel ECG Electrode Placement Method in Newborn Infants.

BACKGROUND: International newborn resuscitation guidelines recommend electrocardiogram (ECG) heart rate (HR) monitoring at birth. We evaluated the application time of pre-set ECG electrodes fixed to a polyethene patch allowing adhesive-free attachment to the wet skin of the newborn chest. OBJECTIVES: Using a three-electrode pre-set ECG patch configuration, application success was calculated using video analysis and measured at three time points, the time to (1) apply electrodes; (2) detect recognizable QRS complexes after application; and (3) display a HR after application. METHOD: A prospective observational study in two UK tertiary maternity units was undertaken with 71 newborns including 23 who required resuscitation. RESULTS: The median (IQR) time for ECG patch application was 8 (6-10) seconds, detection of recognizable QRS complexes 8 (2-12) seconds, and time to output HR was 23 (15-37) seconds. CONCLUSION: Pre-set ECG chest electrodes allow rapid HR information at birth without electrode detachment or compromising skin integrity.