Non-Invasive Fetal Electrocardiogram Extraction Based on Novel Hybrid Method for Intrapartum ST Segment Analysis

This study focuses on non-invasive fetal electrocardiogram extraction based on a novel hybrid method, which combines the advantages of non-adaptive and adaptive approaches for non-invasive fetal electrocardiogram morphological analysis. Besides estimating fetal heart rate, which is the main parameter used in the clinical practice, this study provides non-invasive ST segment analysis on data from Abdominal and Direct Fetal Electrocardiogram Database consisting of simultaneous traditional - gold standard invasive fetal scalp electrode and non-invasive fetal electrocardiogram recorded during delivery. This innovative approach utilizing the combination of independent component analysis and recursive least squares algorithms has the potential to extract valuable information from non-invasive fetal electrocardiogram in order to identify eventual sign of fetal distress. This was a prospective observational study of non-invasive fetal electrocardiogram, using 4 abdominally sited electrodes, against the traditional fetal scalp electrode on 8 patients. In terms of fetal heart rate estimation, the accuracy was high for all 8 tested patients with average value equaled 0.20 beats per minute and average value of 1.96 standard deviation equaled 5.80 beats per minute. In 7 patients, it was possible to perform the ST segment analysis with high accuracy in determining T/QRS in comparison with the reference fetal scalp electrode signal with average values and 1.96 standard deviation equaled 0.008 and 0.031 respectively. This study thus demonstrates that ST segment analysis is feasible using non-invasive fECG using the proposed hybrid method.

[1]  Reza Sameni,et al.  Noninvasive fetal ECG: The PhysioNet/Computing in Cardiology Challenge 2013 , 2013, Computing in Cardiology 2013.

[2]  Juan Arteaga-Falconi,et al.  R-peak detection algorithm based on differentiation , 2015, 2015 IEEE 9th International Symposium on Intelligent Signal Processing (WISP) Proceedings.

[3]  Renjith V. Ravi,et al.  Diagnosis of Fetal Arrhythmia Using JADE Algorithm , 2020, 2020 7th International Conference on Smart Structures and Systems (ICSSS).

[4]  Erkki Oja,et al.  Independent component analysis: algorithms and applications , 2000, Neural Networks.

[5]  Algimantas Krisciukaitis,et al.  Multistage principal component analysis based method for abdominal ECG decomposition , 2015, Physiological measurement.

[6]  Janusz Jezewski,et al.  Determination of fetal heart rate from abdominal signals: evaluation of beat-to-beat accuracy in relation to the direct fetal electrocardiogram , 2012, Biomedizinische Technik. Biomedical engineering.

[7]  G. Pardi,et al.  Fetal electrocardiogram changes in relation to fetal heart rate patterns during labor. , 1974, American journal of obstetrics and gynecology.

[8]  Asoke K. Nandi,et al.  Noninvasive fetal electrocardiogram extraction: blind separation versus adaptive noise cancellation , 2001, IEEE Transactions on Biomedical Engineering.

[9]  J. Jezewski,et al.  Fetal electrocardiograms, direct and abdominal with reference heartbeat annotations , 2020, Scientific Data.

[10]  Janusz Jezewski,et al.  A Neuro-Fuzzy Approach to the Classification of Fetal Cardiotocograms , 2008 .

[11]  J. Westgate,et al.  Plymouth randomized trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring in 2400 cases. , 1993, American journal of obstetrics and gynecology.

[12]  Radek Martinek,et al.  Hybrid Methods Based on Empirical Mode Decomposition for Non-Invasive Fetal Heart Rate Monitoring , 2020, IEEE Access.

[13]  Alberto Macerata,et al.  A multi-step approach for non-invasive fetal ECG analysis , 2013, Computing in Cardiology 2013.

[14]  Radek Martinek,et al.  Novel Hybrid Extraction Systems for Fetal Heart Rate Variability Monitoring Based on Non-Invasive Fetal Electrocardiogram , 2019, IEEE Access.

[15]  Julien Oster,et al.  Noninvasive fetal electrocardiography for the detection of fetal arrhythmias , 2019, Prenatal diagnosis.

[16]  K. F. Tan,et al.  Detection of the QRS complex, P wave and T wave in electrocardiogram , 2000 .

[17]  Karim Faez,et al.  A new method for extraction of fetal electrocardiogram signal based on Adaptive Nero-Fuzzy Inference System , 2011, 2011 IEEE International Conference on Signal and Image Processing Applications (ICSIPA).

[18]  Tahira Kazmi,et al.  ST Analysis of the Fetal ECG, as an Adjunct to Fetal Heart Rate Monitoring in Labour: A Review. , 2011, Oman medical journal.

[19]  C. Li,et al.  Detection of ECG characteristic points using wavelet transforms. , 1995, IEEE transactions on bio-medical engineering.

[20]  Hamid Hassanpour,et al.  Fetal ECG Extraction Using Wavelet Transform , 2006, 2006 International Conference on Computational Inteligence for Modelling Control and Automation and International Conference on Intelligent Agents Web Technologies and International Commerce (CIMCA'06).

[21]  G. Saha,et al.  Fetal ECG extraction from single-channel maternal ECG using singular value decomposition , 1997, IEEE Transactions on Biomedical Engineering.

[22]  Gustavo Camps-Valls,et al.  Foetal ECG recovery using dynamic neural networks , 2004, Artif. Intell. Medicine.

[23]  Said Ziani,et al.  Fetal Electrocardiogram Analysis Based on LMS Adaptive Filtering and Complex Continuous Wavelet 1-D , 2019 .

[24]  Paul Christian,et al.  The Significance of the Foetal Electrocardiogram During Labour with Detailed Report of One Case , 1971, Acta obstetricia et gynecologica Scandinavica.

[25]  Zhiming He,et al.  Fetal Electrocardiogram Extraction Based on Fast ICA and Wavelet Denoising , 2018, 2018 2nd IEEE Advanced Information Management,Communicates,Electronic and Automation Control Conference (IMCEC).

[26]  Jeffrey M. Hausdorff,et al.  Physionet: Components of a New Research Resource for Complex Physiologic Signals". Circu-lation Vol , 2000 .

[27]  Jan Nedoma,et al.  Non-Invasive Fetal Monitoring: A Maternal Surface ECG Electrode Placement-Based Novel Approach for Optimization of Adaptive Filter Control Parameters Using the LMS and RLS Algorithms , 2017, Sensors.

[28]  Susana Hornillo-Mellado,et al.  Fast Technique for Noninvasive Fetal ECG Extraction , 2011, IEEE Transactions on Biomedical Engineering.

[29]  Michael B Bracken,et al.  Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. , 2012, American journal of obstetrics and gynecology.

[30]  Li Yuan,et al.  An Improved FastICA Method for Fetal ECG Extraction , 2018, Comput. Math. Methods Medicine.

[31]  G. Clifford,et al.  Clinically accurate fetal ECG parameters acquired from maternal abdominal sensors. , 2011, American journal of obstetrics and gynecology.

[32]  R. Martínek,et al.  Is Abdominal Fetal Electrocardiography an Alternative to Doppler Ultrasound for FHR Variability Evaluation? , 2017, Front. Physiol..

[33]  C. Jutten,et al.  What ICA Provides for ECG Processing: Application to Noninvasive Fetal ECG Extraction , 2006, 2006 IEEE International Symposium on Signal Processing and Information Technology.

[34]  U. Hanson,et al.  Fetal monitoring with computerized ST analysis during labor: a systematic review and meta‐analysis , 2012, Acta obstetricia et gynecologica Scandinavica.

[35]  Sahil Verma,et al.  Efficient RR-interval time series formulation for heart rate detection , 2013, IMPACT-2013.

[36]  Gari D Clifford,et al.  Non-invasive fetal ECG analysis , 2014, Physiological measurement.

[37]  Derek Abbott,et al.  Fast T Wave Detection Calibrated by Clinical Knowledge with Annotation of P and T Waves , 2015, Sensors.

[38]  Naif Alajlan,et al.  A wavelet optimization approach for ECG signal classification , 2012, Biomed. Signal Process. Control..

[39]  Adam Pawlak,et al.  Selected design issues of the medical cyber-physical system for telemonitoring pregnancy at home , 2016, Microprocess. Microsystems.

[40]  Willis J. Tompkins,et al.  A Real-Time QRS Detection Algorithm , 1985, IEEE Transactions on Biomedical Engineering.

[41]  A. Khandoker,et al.  Model based estimation of QT intervals in non-invasive fetal ECG signals , 2020, PloS one.

[42]  D. Panigrahy,et al.  Extraction of fetal ECG signal by an improved method using extended Kalman smoother framework from single channel abdominal ECG signal , 2017, Australasian Physical & Engineering Sciences in Medicine.

[43]  Alberto J. Palma,et al.  Efficient wavelet-based ECG processing for single-lead FHR extraction , 2013, Digit. Signal Process..

[44]  Pan Du,et al.  Bioinformatics Original Paper Improved Peak Detection in Mass Spectrum by Incorporating Continuous Wavelet Transform-based Pattern Matching , 2022 .

[45]  Shuang Song,et al.  Influence of Electrode Placement on Signal Quality for Ambulatory Pregnancy Monitoring , 2014, Comput. Math. Methods Medicine.

[46]  R. Swarnalath,et al.  A Novel Technique for Extraction of FECG using Multi Stage Adaptive Filtering , 2010 .

[47]  Pablo Laguna,et al.  A wavelet-based ECG delineator: evaluation on standard databases , 2004, IEEE Transactions on Biomedical Engineering.

[48]  Gari D Clifford,et al.  An open-source framework for stress-testing non-invasive foetal ECG extraction algorithms , 2016, Physiological measurement.

[49]  Ali Ghaffari,et al.  A new mathematical based QRS detector using continuous wavelet transform , 2008, Comput. Electr. Eng..

[50]  Tullia Todros,et al.  Fetal electrocardiography ST analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward. , 2019, American journal of obstetrics and gynecology.

[51]  Chi-Jie Lu,et al.  An Improved Independent Component Analysis Algorithm Based on Artificial Immune System , 2013 .

[52]  Vaidotas Marozas,et al.  Noninvasive fetal QRS detection using an echo state network and dynamic programming , 2014, Physiological measurement.

[53]  B. Hayes-Gill,et al.  Comparison of non-invasive fetal electrocardiogram to Doppler cardiotocogram during the 1st stage of labor , 2010, Journal of perinatal medicine.

[54]  K. Rosen,et al.  The effects of intrapartum hypoxia on the fetal QT interval , 2004, BJOG : an international journal of obstetrics and gynaecology.

[55]  Janusz Jezewski,et al.  Evaluating the fetal heart rate baseline estimation algorithms by their influence on detection of clinically important patterns , 2016 .

[56]  K. Greene,et al.  ST waveform changes of the fetal electrocardiogram during labour—a clinical study , 1985, British journal of obstetrics and gynaecology.

[57]  Yan Huawen,et al.  Automatic identifying of maternal ECG source when applying ICA in fetal ECG extraction , 2018 .

[58]  K. Maršál,et al.  Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance , 2007, BJOG : an international journal of obstetrics and gynaecology.

[59]  Thomas P Sartwelle,et al.  Electronic Fetal Monitoring: A Bridge Too Far , 2012, The Journal of legal medicine.

[60]  R. Vullings,et al.  Multi-Channel Fetal ECG Denoising With Deep Convolutional Neural Networks , 2020, Frontiers in Pediatrics.

[61]  Marian Kotas,et al.  Combined Application of Independent Component Analysis and Projective Filtering to Fetal ECG Extraction , 2008 .

[62]  Christian Jutten,et al.  Fetal ECG Extraction by Extended State Kalman Filtering Based on Single-Channel Recordings , 2013, IEEE Transactions on Biomedical Engineering.

[63]  Adam Gacek,et al.  A new approach to cardiotocographic fetal monitoring based on analysis of bioelectrical signals , 2003, Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439).

[64]  D. Ayres-de-Campos,et al.  FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography , 2015, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[65]  Matthew Hogg,et al.  ST analysis for intrapartum fetal monitoring , 2015 .

[66]  Lucia Billeci,et al.  A Combined Independent Source Separation and Quality Index Optimization Method for Fetal ECG Extraction from Abdominal Maternal Leads , 2017, Sensors.

[67]  R. Strungaru,et al.  A NEW METHOD FOR FETAL ELECTROCARDIOGRAM DENOISING USING BLIND SOURCE SEPARATION AND EMPIRICAL MODE DECOMPOSITION , 2016 .

[68]  Sebastian Zaunseder,et al.  An ECG simulator for generating maternal-foetal activity mixtures on abdominal ECG recordings , 2014, Physiological measurement.

[69]  Yan-jun Zeng,et al.  Extraction of fetal electrocardiogram using recursive least squares and normalized least mean squares algorithms , 2011, 2011 3rd International Conference on Advanced Computer Control.

[70]  Viorel Ionescu,et al.  Fetal ECG Extraction from Multichannel Abdominal ECG Recordings for Health Monitoring During Labor , 2016 .

[71]  Elhassane Abdelmounim,et al.  Discrete Wavelet Transform based algorithm for recognition of QRS complexes , 2014, 2014 International Conference on Multimedia Computing and Systems (ICMCS).

[72]  Shalom Darmanjian,et al.  Monitoring uterine activity during labor: a comparison of 3 methods. , 2012, American journal of obstetrics and gynecology.

[73]  K. Rosen,et al.  Fetal ECG waveform analysis should improve fetal surveillance in labour. , 1990, Journal of perinatal medicine.

[74]  Dzati Athiar Ramli,et al.  Blind Source Separation (BSS) of Mixed Maternal and Fetal Electrocardiogram (ECG) Signal: A comparative Study , 2020, KES.

[75]  Piotr Podziemski,et al.  Fetal heart rate discovery: Algorithm for detection of fetal heart rate from noisy, noninvasive fetal ECG recordings , 2013, Computing in Cardiology 2013.

[76]  Mohammad Pooyan,et al.  A novel approach to the extraction of fetal electrocardiogram based on empirical mode decomposition and correlation analysis , 2017, Australasian Physical & Engineering Sciences in Medicine.

[77]  Rubén Martín-Clemente,et al.  The Maternal Abdominal ECG as Input to MICA in the Fetal ECG Extraction Problem , 2011, IEEE Signal Processing Letters.

[78]  A. Gupta,et al.  A novel approach to fetal ECG extraction and enhancement using blind source separation (BSS-ICA) and adaptive fetal ECG enhancer (AFE) , 2007, 2007 6th International Conference on Information, Communications & Signal Processing.

[79]  Luigi Raffo,et al.  Systematic analysis of single- and multi-reference adaptive filters for non-invasive fetal electrocardiography. , 2019, Mathematical biosciences and engineering : MBE.

[80]  K G Rosén,et al.  Alterations in the fetal electrocardiogram as a sign of fetal asphyxia--experimental data with a clinical implementation. , 1986, Journal of perinatal medicine.

[81]  M. Suganthy,et al.  Enhancement of SNR in fetal ECG signal extraction using combined SWT and WLSR in parallel EKF , 2019, Cluster Computing.

[82]  Rodica Strungaru,et al.  Performance comparison of four ICA algorithms applied for fECG extraction from transabdominal recordings , 2011, ISSCS 2011 - International Symposium on Signals, Circuits and Systems.

[83]  Fernando Andreotti,et al.  A Bayesian Filtering Framework for accurate extracting of the non-invasive FECG morphology , 2014, Computing in Cardiology 2014.

[84]  K. Ouni,et al.  ECG Signal Maxima Detection Using Wavelet Transform , 2006, 2006 IEEE International Symposium on Industrial Electronics.

[85]  Radek Martinek,et al.  A Review of Signal Processing Techniques for Non-Invasive Fetal Electrocardiography , 2020, IEEE Reviews in Biomedical Engineering.

[86]  A. Chow,et al.  Neonatal scalp abscess and fetal monitoring: factors associated with infection. , 1977, American journal of obstetrics and gynecology.

[87]  P. T. Vanathi,et al.  Separation Of Maternal And Fetal ECG Signals From The Mixed Source Signal Using FASTICA , 2012 .

[88]  Hau-Tieng Wu,et al.  Recovery of the fetal electrocardiogram for morphological analysis from two trans-abdominal channels via optimal shrinkage , 2019, Physiological measurement.

[89]  Khaled Assaleh,et al.  Extraction of Fetal Electrocardiogram Using Adaptive Neuro-Fuzzy Inference Systems , 2007, IEEE Transactions on Biomedical Engineering.

[90]  Pablo Laguna,et al.  A database for evaluation of algorithms for measurement of QT and other waveform intervals in the ECG , 1997, Computers in Cardiology 1997.

[91]  Per Olofsson,et al.  New FIGO and Swedish intrapartum cardiotocography classification systems incorporated in the fetal ECG ST analysis (STAN) interpretation algorithm: agreements and discrepancies in cardiotocography classification and evaluation of significant ST events , 2018, Acta obstetricia et gynecologica Scandinavica.

[92]  K. D. Desai,et al.  A real-time fetal ECG feature extraction using multiscale discrete wavelet transform , 2012, 2012 5th International Conference on BioMedical Engineering and Informatics.

[93]  G.B. Moody,et al.  The impact of the MIT-BIH Arrhythmia Database , 2001, IEEE Engineering in Medicine and Biology Magazine.

[94]  J. Neilson,et al.  Fetal electrocardiogram (ECG) for fetal monitoring during labour. , 2013, The Cochrane database of systematic reviews.

[95]  C. Jutten,et al.  Filtering Electrocardiogram Signals Using the Extended Kalman Filter , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[96]  Radek Martinek,et al.  Adaptive signal processing techniques for extracting abdominal fetal electrocardiogram , 2016, 2016 10th International Symposium on Communication Systems, Networks and Digital Signal Processing (CSNDSP).

[97]  Jan Nedoma,et al.  Fetal ECG Preprocessing Using Wavelet Transform , 2018, ICCMS.

[98]  Yan Liang,et al.  Extraction for fetal ECG using single channel blind source separation algorithm based on multi-algorithm fusion , 2016 .

[99]  Guangchen Liu,et al.  An adaptive integrated algorithm for noninvasive fetal ECG separation and noise reduction based on ICA-EEMD-WS , 2015, Medical & Biological Engineering & Computing.

[100]  Sonia H. Contreras Ortiz,et al.  Fetal ECG extraction using independent component analysis by Jade approach , 2017, Symposium on Medical Information Processing and Analysis.

[101]  Joachim Behar,et al.  A Comparison of Single Channel Fetal ECG Extraction Methods , 2014, Annals of Biomedical Engineering.

[102]  Jacob Benesty,et al.  New Insights into the RLS Algorithm , 2004, EURASIP J. Adv. Signal Process..

[103]  G. Clifford,et al.  Evaluation of the fetal QT interval using non-invasive fetal ECG technology , 2016, Physiological measurement.

[104]  E. Chandraharan Handbook of CTG Interpretation: From Patterns to Physiology , 2017 .

[105]  K. Maršál,et al.  Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial , 2001, The Lancet.

[106]  Jan Nedoma,et al.  Comparative Effectiveness of ICA and PCA in Extraction of Fetal ECG From Abdominal Signals: Toward Non-invasive Fetal Monitoring , 2018, Front. Physiol..

[107]  L. Cordero,et al.  Scalp abscess: a rare complication of fetal monitoring. , 1971, The Journal of pediatrics.

[108]  Ronald T Wakai,et al.  The natural history of fetal long QT syndrome. , 2016, Journal of electrocardiology.

[109]  J. Rosser Fetal monitoring in practice. , 1998, The practising midwife.

[110]  D I Fotiadis,et al.  A Non-invasive Methodology for Fetal Monitoring during Pregnancy , 2009, Methods of Information in Medicine.

[111]  Yanjun Zeng,et al.  Research of fetal ECG extraction using wavelet analysis and adaptive filtering , 2013, Comput. Biol. Medicine.

[112]  P. K. Sahu,et al.  EKF with PSO technique for delineation of P and T wave in electrocardiogram(ECG) signal , 2015, 2015 2nd International Conference on Signal Processing and Integrated Networks (SPIN).

[113]  Joachim Behar,et al.  An Echo State Neural Network for Foetal ECG Extraction Optimised by Random Search , 2013 .

[114]  G. Clifford,et al.  A Review of Fetal ECG Signal Processing; Issues and Promising Directions. , 2010, The open pacing, electrophysiology & therapy journal.