Supporting Evidence
Articles
Monica AN24 - Clinical Paper Review
The evidence supporting the use of the AN24 fetal ECG is rapidly growing, an overview of medical publications supporting its use has been provided. Please select your area of interest using the drop down menu below. This citation list will be periodically updated to reflect new publications supporting the benefits of the AN24.
AN24 Specific Publications
| Year | Citation | Area | Link |
2013 |
Intrapartum Fetal and Maternal Heart Rate Ambiguity- a Comparison of Doppler Ultrasound CTG and the Abdominal Fetal Electrocardiogram with Maternal Electrocardiogram Reinhard J, Hayes-Gill BR, Schiermeier S, Hatzmann W, Heinrich TM, Louwen F. Gynecologic and Obstetric Investigation 2013; 75: 101-8 |
OBJECTIVE / AIMS: To investigate the presence of signal ambiguity of intrapartum fetal heart rate (FHR) monitoring during delivery by comparing simultaneous CTG, abdominal fetal electrocardiogram (ECG) with continuous maternal ECG. METHODS: A total of 144 simultaneous CTG (Corometrics 250 series©), abdominal fetal ECG (Monica AN24TM) and maternal ECG (Monica AN24TM) 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 the Fisher’s exact and the Wilcoxon signed rank tests. RESULTS: Comparison of abdominal fetal ECG against CTG demonstrates significantly less “ MHR/FHR ambiguity” in both the first stage (mean 0.70% versus 1.22%, p<0.001) and 2nd stage of labour (mean 3.30% versus 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. |
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2013 |
Antenatal architecture and activity of the human heart Pervolaraki. E, Anderson. R, Benson. A, Hayes-Gill. B, Holden. A, Moore. B.J.R, Paley. M.N, Zhang. H Published online February 21, 2013 doi: 10.1098/rsfs.2012.0065 Interface Focus 6 April 2013 vol. 3 no. 2 20120065 |
Abstract: We construct the components for a family of computational models of the electrophysiology of the human foetal heart from 60 days gestational age (DGA) to full term. This requires both cell excitation models that reconstruct the myocyte action potentials, and datasets of cardiac geometry and architecture. Fast low-angle shot and diffusion tensor magnetic resonance imaging (DT-MRI) of foetal hearts provides cardiac geometry with voxel resolution of approximately 100 µm. DT-MRI measures the relative diffusion of protons and provides a measure of the average intravoxel myocyte orientation, and the orientation of any higher order orthotropic organization of the tissue. Such orthotropic organization in the adult mammalian heart has been identified with myocardial sheets and cleavage planes between them. During gestation, the architecture of the human ventricular wall changes from being irregular and isotropic at 100 DGA to an anisotropic and orthotropic architecture by 140 DGA, when it has the smooth, approximately 120° transmural change in myocyte orientation that is characteristic of the adult mammalian ventricle. The DT obtained from DT-MRI provides the conductivity tensor that determines the spread of potential within computational models of cardiac tissue electrophysiology. The foetal electrocardiogram (fECG) can be recorded from approximately 60 DGA, and RR, PR and QT intervals between the P, R, Q and T waves of the fECG can be extracted by averaging from approximately 90 DGA. The RR intervals provide a measure of the pacemaker rate, the QT intervals an index of ventricular action potential duration, and its rate-dependence, and so these intervals constrain and inform models of cell electrophysiology. The parameters of models of adult human sinostrial node and ventricular cells that are based on adult cell electrophysiology and tissue molecular mapping have been modified to construct preliminary models of foetal cell electrophysiology, which reproduce these intervals from fECG recordings. The PR and QR intervals provide an index of conduction times, and hence propagation velocities (approx. 1–10 cm s−1, increasing during gestation) and so inform models of tissue electrophysiology. Although the developing foetal heart is small and the cells are weakly coupled, it can support potentially lethal re-entrant arrhythmia |
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2012 |
Non-invasive Fetal ECG registration using Monica AN24 fetal monitoring system Department of Obstetrics, Leiden University Medical Center W.J. Kist, R. Franken, S.Vink, N.Blom, L. Rozendaal, D.Oepkes Poster presesentation at the 16th International Conference on Prenatal Diagnosis Miami, Florida, USA 3-6 June 2012
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Background: Reliable non-invasive recording of the fetal electrocardiogram (fECG) has been pursued by obstetric researchers for decades. Many fetal pathologic conditions could be monitored more accurately if fECG could be obtained. The Monica AN 24, a new, portable fetal monitoring device can make 20 hour recordings of fetal and maternal cardiac electrical signals and uterine activity with 5 abdominal stickers. Objective: Aim of our study was to evaluate the feasibility of obtaining interpretable fECG signals of human fetuses in the second and third trimester. Material and methods: Prospective cohort study in uncomplicated singleton pregnancies. Registrations of 30 minutes were made from 14 to 38 weeks’ gestation. Primary outcome was success rate of obtaining a fECG with recognizable P-wave, QRS complex and ST segment, analyzable with the DK 1.4a software. Secondary outcome was influence of BMI and gestational age. Results: In total 178 registrations were made in 82 pregnancies. In 138 (78%), a fECG could be analyzed. From 14-22 weeks (n=57), success-rate was 86%.BMI did not influence success-rate. Conclusion: With the Monica AN 24 andDK 1.4a software, we could record and analyze a fetal ECG in almost 80% of pregnancies in the second and third trimester.BMI played no role. This device has the potential to become an important additional tool in fetal diagnosis and monitoring of the many conditions that affect fetal cardiac function. |
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2012 |
Intrapartum signal quality with external fetal heart rate monitoring: a two way trial of external Doppler CTG ultrasound and the abdominal fetal electrocardiogram
Maternal-Fetal Medicine Arch Gynecol Obstet Published online 20.06.2012
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Abstract 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.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. |
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2012 |
Fetal and maternal heart rate confusion during intra-partum monitoring: comparison of trans-abdominal fetal electrocardiogram and Doppler telemetry. Stampalija T, Signaroldi M, Mastroianni C, Rosti E, Signorelli V, Casati D, Ferrazzi EM The Journal of Maternal - Fetal & Neonatal medicine 2012 Aug;25(8):1517-20. Epub 2011 Dec 3.
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Objective: To compare intra-partum performance of trans-abdominal electrocardiogram with Doppler telemetry. Methods: In this prospective longitudinal study, simultaneous monitoring with trans-abdominal ECG and Doppler telemetry was performed in 41 uncomplicated term singleton pregnancies during labour. Results: The overall success rate for FHR monitoring was similar between trans-abdominal ECG and Doppler telemetry (88.5 ± 16.7% vs 89.4 ± 7.6%), except for the second stage of labour. A significantly higher rate of confusion (p < 0.001) between fetal and maternal heart was found for Doppler telemetry (4.5 ± 4.5%) compared with trans-abdominal ECG (1.3 ± 1.9%), especially in the second stage and during maternal movements. Conclusions: Trans-abdominal ECG monitoring is feasible, with comparable success rate to traditional Doppler telemetry, without interfering with maternal mobility or requiring midwife intervention. The reduction in maternalfetal heart rate confusion from trans-abdominal ECG could reduce incorrect obstetric interpretation. |
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2012 |
Prenatal Foetal Non-invasive ECG instead of Doppler CTG – A Better Alternative? |
Introduction: This study aimed to evaluate foetal signal quality obtained using an antenatal foetal ECG system (Monica 24™) and compare it with Doppler ultrasound CTG monitoring (Corometrics ® 250 series). |
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2012 |
Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes Cohen W, Ommani S, Hassan S, Mirza F, Solomon M, Brown R, Schifin B, Himsworth J, Hayes-Gill B August 2012 Acta Obstetricia et Gynecologica Scandinavica 2012 Nordic Federation of Societies of Obstetrics and Gynecology
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Abstract
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.
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2012 |
Average acceleration and deceleration capacity of the fetal heart rate in normal pregnancy and in pregnancies complicated by fetal growth restriction E. M. Graatsma, E.J.H. Mulder, B. Vasak, S.M. Lobmaier, S. Pildner von Steinburg, K.T.M Schneider, G. Schmidt, G.H.A. Visser The Journal of Maternal –Fetal and Neonatal Medicine, 2012;25(12):2517-2522
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Objective: To study fetal heart rate (FHR), its short term variability (STV), average acceleration capacity (AAC), and average deceleration capacity (ADC) throughout uncomplicated gestation, and to perform a preliminary comparison of these FHR parameters between small-for-dates (SFD) and control fetuses. Method: Prospective observational study of 7 h FHR-recordings obtained with a fetal-ECG monitor in the second half of uncomplicated pregnancies (n=90) and pregnancies complicated by fetal SFD (n=30). FHR and STV were calculated according to established analysis. True beat-to-beat FHR, recorded at 1 ms accuracy, was used to calculate AAC and ADC using Phase Rectified Signal Averaging (PRSA). Mean values of FHR, STV, AAC, and ADC derived from recordings in SFD fetuses were compared with the reference curves. Results: Compared with the control group the mean z-scores for STV, AAC, and ADC in SFD fetuses were lower by 1.0 SD, 1.5 SD, and 1.7 SD, respectively (p<0.0001 for all comparisons). In SFD fetuses, both the AAC and ADC z-scores were lower than the STV z-scores (p<0.02 and p<0.002, respectively). Conclusion: Analysis of the AAC and ADC as recorded with a high resolution fECG recorder may differentiate better between normal and SFD fetuses than STV. |
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2012 |
Accuracy and Reliability of Uterine Contraction Identification Using Abdominal Surface Electrodes Barrie Hayes-Gill, Sarmina Hassan, Fadi G. Mirza, Sophia Ommani, John Himsworth, Molham Solomon, Raymond Brown, Barry S. Schifrin and Wayne R. Cohen Clinical Medicine Insights: Women’s Health 2012:5 65–75 |
Abstract |
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2012 |
Is the fetal heart rate affected by uterine contractions during pregnancy? A pilot study Sletten. J, Kiserud. T, Kessler. J Acta Obstet Gyn Scan, 2012. 91(Supplement s159): p. 59-149 Poster presented at the Nordic meeting of Obstetrics and Gynecology in June 2012
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Background; New monitoring technology enables long-term recording of the fetal heart rate without discomfort for the mother. The initial aim of this pilot study was to test the feasibility and success rate of a new fetal Holter monitor. We observed linear correlations between maternal and fetal heart rates, and hypothesised that uterine activity during pregnancy affects the fetal heart rate. Method: Twelve pregnant women were monitored with a potable Holter device, which (Monica AN24, Monica Healthcare Ltd), which recorded the maternal and fetal electrocardiogram (ECG) and electrohystergram (EHG) by five abdominal electrodes. The recordings were performed outside the hospital and participants were not imposed any restrictions for their activities during the time of the recording. Data on the fetal and maternal heart rates and the strength of uterine contractions was available in 2 seconds epoch during the entire recording. The EHG data were categorised into a basal level, and slightly, moderately or severely increased uterine activity (UA). Each participant’s data was analysed separately. Results: The recordings lasted 18.8 hours (range 17.4-19.3) and were taken at a gestational age of 32+6 weeks (range 25+0-38+2). Data on maternal and fetal ECG was available for 99.9% and 73.1% of the recorded time, respectively. There was a linear correlation between maternal and fetal heart rates in 11/12 cases. Beta coefficient was at mean 0.189; for participants < 36 weeks (N=7) 0.106 and for those ≥ 36 weeks (N=5) 0.305. In all participants UA affected the fetal heart rate. Compared to the basal tone, mild, moderate and severe UA were associated with a mean increase of the fetal heart rate by 1.37, 4.1 and 5.9 beats/min respectively Conclusion: The relationship between fetal and maternal heart rates could reflect a circadian rhythmicity in the mother and the fetus. Uterine contractions during pregnancy, accompanied by increased umbilical blood flow, may represent a physiological challenge for the development and adaptation of the fetal cardiovascular system.
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2011 |
Continuous Remote Fetal Monitoring With MONICA AN24 Rauf. Z, O’ Brien. E, Popescu.F, Stampalija. T, Lavender. T, Alfirevic. Z Paper presented at the Meeting of Society for Maternal-Fetal Medicine (SMFM) California USA The 31st Annual Meeting February 2011 |
Aim: To evaluate the feasibility of trans-abdominal ECG (aECG) monitoring with portable device (Monica AN24) during outpatient labor induction. |
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2011 |
Power spectral analysis of trans-abdominal fetal ECG at beginning of labour as a predictor of adverse pregnancy outcome Stampalija. T, Eleuteri. A, Signaroldi. M, Mastroianni. C, Fisher. A, Ferrazzi. E, Alfirevic. Z Paper presented at the Meeting of Society for Maternal-Fetal Medicine (SMFM) California USA The 31st Annual Meeting February 2011 |
Obective: To evaluate fetal heart rate, obtained by trans-abdominal ECG R-R intervals, by power spectral density (PSD), and compare normal values with findings obtained in acidemic fetuses. |
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2011 |
Fetal and maternal heart rate confusion during intra-partum monitoring: comparison of trans-abdominal fetal ECG and Doppler telemetry |
Objective: Fetal monitoring by Doppler is well established standard of care. Doppler signal quality, signal loss and FHR/MHR confusion are the main pitfalls. Restriction of mobility during the first stage of labour by Doppler probes is the second major problem, since mobility reduces the length of labour (Cochrane Systematic Review, 2009). The availability of non invasive FHR monitoring technique that would possibly reduce signal errors, without interfering with patient mobility, might carry significant advantages. New leadless, non invasive trans-abdominal fetal and maternal ECG monitoring is available.
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2011 |
Uterine Activity Monitoring during Labour – A Multi-Centre, Blinded Two-Way Trial of External Tocodynamometry against Electrohysterography
J. Reinhard , B. R. Hayes-Gill , S. Schiermeier , H. Löser , L. M. Niedballa , E. Haarmann , A. Sonnwald , 10.1055/s-0031-1291210 Z Geburtsh Neonatol 2011; 215: 199–204 |
Purpose: The aim of this study was to determine the quality of intrapartum uterine activity (UA) monitoring in daily practice during the first and second stages of labour. The total duration of inadequate UA monitoring is quantified in relation to the technique applied, namely, external tocodynamometry (TOCO) or electrohysterography (EHG). Material and Methods: 144 UA recordings, collected from deliveries at the Marien-Hospital Witten, Germany, were analysed by obstetricians based at different centres. The included recordings were from singleton and simultaneously with external TOCO and EHG monitored pregnancies. External TOCO and EHG UA recordings were blinded. Results: The percentages of “ adequate ” UA recordings in the first and second stages of labour were much higher for the external EHG than the external TOCO mode (p < 0.001). All doctors evaluated the UA assessment as “ easier ” (p < 0.001) using the EHG compared with TOCO . Conclusion: Intrapartum UA monitoring in daily practice via the EHG mode provides a more recognisable UA trace than the TOCO. |
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2011 |
Home Labour Induction with Retrievable Prostaglandin Pessary and Continuous Telemetric Trans-Abdominal Zubair Rauf, Ediri O’Brien, Tamara Stampalija, Florin P. Ilioniu, Tina Lavender, Zarko Alfirevic PLoS ONE 6(11): e28129. doi:10.1371/journal.pone.0028129 |
Objective: To evaluate the feasibility of continuous telemetric trans-abdominal fetal electrocardiogram (a-fECG) in women undergoing labour induction at home. Study Design: Low risk women with singleton term pregnancy undergoing labour induction with retrievable, slow-release dinoprostone pessaries (n = 70) were allowed home for up to 24 hours, while a-fECG and uterine activity were monitored in hospital via wireless technology. Semi-structured diaries were analysed using a combined descriptive and interpretive approach. Results: 62/70 women (89%) had successful home monitoring; 8 women (11%) were recalled because of signal loss. Home monitoring lasted between 2–22 hours (median 10 hours). Good quality signal was achieved most of the time (86%, SD 10%). 3 women were recalled back to hospital for suspicious a-fECG. In 2 cases suspicious a-fECG persisted, requiring Caesarean section after recall to hospital. 48/51 women who returned the diary coped well (94%); 46/51 were satisfied with home monitoring (90%). Conclusions: Continuous telemetric trans-abdominal fetal ECG monitoring of ambulatory women undergoing labour induction is feasible and acceptable to women. |
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2011 |
Intrapartum External Fetal Monitoring in Obese Women Rauf. Z, Ommani. S, Payne. B, Brown. R, Hassan. S, Hayes-Gill. B R, Cohen. W, Alfirevic. Z Paper presented at The Perinatal Medicine 2011 15-17 June 2011 Harrogate International Centre, UK |
Objectives: To evaluate the success of intrapartum external fetal monitoring in obese women. Methods: Group 1 ( Liverpool Women’s Hospital): A retrospective analysis of data for 400 labouring women with singleton pregnancies at ≥37+0 weeks gestation, stratified into four BMI groups (<30, 30-34.9, 35-39.9; ≥40). For each group we calculated the rate of suboptimal CTG recordings defined as the need for fetal scalp electrode (FSE). Group 2 (Temple University Hospital Pennsylvania & Queens University Hospital New York) 19 obese women simultaneously monitored in labour with Doppler ultrasound (conventional external CTG), FSE (internal CTG-FSE) and wireless external abdominal fetal (aECG) monitoring device (MONICA AN24). Reliability was assessed with Positive Percent Agreement defined as the percentage of the time when external fetal monitoring (aECG or CTG) gave an interpretable trace within 10% of the value reported by FSE. Results: Conventional external CTG monitoring in women with high BMI was associated with high percentage of labours requiring FSE monitoring (2% for BMI<30, 23% for BMI 30-34.9; 32% for BMI 35-39.9; and 45% for BMI>40). When FSE recordings from 19 labouring women with BMI >35 were compared with simultaneously obtained aECG and external CTG recordings, the Positive Percent Agreement was 88.4% for aECG and 68.7% for the CTG. Conclusion: The external ECG monitoring with Monica AN24 may provide a useful alternative to Doppler CTG for women with high BMI. |
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2011 |
Function organization of extracardial effects on the fetus cardiac rhythm and studies of their formation during the antenatal development Gudkov.GV, Pustovaya.JN, Turichenko.O, Kuban state medical university, Krasnodar, Russia 19.12.2011 http://vestnik.kmldo.ru/archive/18/
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Results obtained allowed to recommend for using in obstetrics the new technologies for fetus cardiac rhythm variable till the moment of sonography visualization of systole (10-12 weeks). The EGK halter using allowed to perform the cardiotokographic studies in earlier gestation periods (from 20-23 weeks vs 28-30 weeks in routine CTG), to obtain the additional information about cardiac oxygenation by morphologic analysis of bioelectrical cardiac activity. The data obtained combined with literature data suggested that fetus cardiac monitoring in earlier gestation periods revealed the studies of physiological development of its adaptative-regulatory systems and to diagnose the feto-placentar disturbances. |
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2010 |
Maternal and fetal heart rate confusion during labour Bhogal.K, Reinhard.J |
This article gives an overview of the pattern of the MHR during labour in continuous maternal and fetal heart rate monitoring using an abdominal maternal and fetal electrocardiograph monitor (abfECG) in contrast with more traditional Doppler methods. The exploration of the pattern of the MHR during labour and delivery demonstrates how an incorrect assessment of fetal wellbeing could be made if the monitor was used in isolation and the MHR was being reported rather than the FHR. This article also explores how midwives can minimise the risk of such incidents occurring. |
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2010 |
Maternal Body Mass Index Does Not Affect Performance of Fetal Electrocardiography Graatsma EM, Miller J, Mulder EJ, Harman C, Baschat AA, Visser GH. Am J Perinatol. 2010 Aug;27(7):573-7. Epub 2010 Mar 1. |
The obesity epidemic challenges traditional antenatal fetal heart rate (FHR) monitoring technologies. Doppler signals in particular are attenuated. We sought to evaluate whether the performance of a novel transabdominal fetal electrocardiogram (fECG) device (AN24, Monica Healthcare) is influenced by body mass index (BMI). We performed a prospective observational study of singleton pregnancies (gestational age [GA] 20 to 41 weeks) monitored overnight with fECG. Recording quality ([RQ] %) of both the best hour and the total recording time of the FHR record were related to BMI. Two hundred four women were monitored. BMI ranged from 16.0 to 50.7 (median BMI 26.9). The correlation coefficient (with 95% confidence interval [CI]) between BMI and RQ was -0.35 (CI -0.60; -0.03) for the gestational age group 20(+0) to 25(+6) weeks, -0.08 (CI -0.28; 0.13) for GA 26(+0) to 33(+6) weeks, and -0.20 (CI -0.40; 0.03) for GA group > or =34(+0) weeks. Median RQ in obese women (BMI > or =30 kg/m(2)) was 97.4, 98.9, and 100%, respectively. BMI has no clinically significant influence on recording quality of FHR monitored with fECG. It can therefore be considered a good method for monitoring the fetal condition in pregnancies of obese women |
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2010 |
Comparison of non-invasive fetal electrocardiogram to Doppler cardiotocogram during the 1st stage of labor Reinhard. J, Hayes-Gill. B, Yi. Q, Hatzmann. H, Schiermeier. S J. Perinat. Med. 38 (2010) 179–185 |
Abstract Objective: We compared a non-invasive fetal electrocardiogram (fECG) to Doppler cardiotocogram (CTG) during the 1st stage of labor. Study design: This was a prospective observational study of non-invasive fECG using five abdominal electrodes and one Doppler ultrasound probe in 27 patients. Data were analyzed for reliability, clinical and statistical equivalence. Results: The fECG was similar to the traditional Doppler method. The fECG characterizes a fetal heart rate (FHR) trace in a similar way with regards to acceleration count, decelerations count and coincidence, variability and baseline. The FHR was overall correlated (Pearson’s rs0.91). Conclusion: This non-invasive fECG presents an alternative, reliable and accurate assessment for fetal well-being during the 1st stage of labor. |
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2009 |
Fetal Heart Rate Variability in Obstetric Cholestasis Jayawardane, DBIA. Hayes–Gill, BR. Loughna, PV. Broughton Pipkin,F. Paper presented at Fetal and Neonatal Physiological Society, USA 36th Annual Meeting September 2009 |
Introduction: Methods: FHR was derived from the RR interval. The trans-abdominal fetal e.c.g. was acquired over ~12h using a Monica AN24 FHR monitor. The short term variability (STV) was calculated according to Dawes and Redman based on the 3.75second FHR averages. The root mean square of successive difference (RMSSD), a measure of true beat-to-beat variability, was also calculated. Data are summarised as mean ± s.d. or median [IQR]. Results and Discussion: Technically-satisfactory recordings of the fetal e.c.g. were obtained from 17 women with OC (pruritus with serum BAC >14μmol/L or ALT >100U/L) and 17 women with uncomplicated pregnancies (NP). Comment: This will facilitate the identification of subtle changes in FHR variability and could reduce or abolish the need for alternate day use of antenatal cardiotocography in women with OC. |
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2009 |
A validation of electrohysterography for uterine activity monitoring during labour Benoit C.J, Gtaatsma E.M, Van Hagen E, Visser G.H The Journal of Maternal-Fetal and Neonatal Medicine. 2009; 00(0): 1-6 Department of Obstetrics, University Medical Centre, Utrecht, The Netherlands |
Objective: Validation of electrohysterography (EHG) as a method for uterine activity monitoring during labour by comparing with intra-uterine pressure catheter (IUCP) recordings. Prospective observational study. Population of the study was thirty-two women in labour, simultaneous recording of uterine activity with EHG and IUCP for at least 30 min.
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2009 |
Extraction and Analysis of Fetal ECG by transabdominal recording using Monica AN24 Stampalja T, Elevnen A, Fisher A, Dewhurst C, Alfirevic Z. Hospital and University of Liverpool, UK Presented at the 13th Annual BMFMS Conference 2009, Liverpool, UK |
Objective: To introduce a novel robust measure of fetal heart rate variability and report an initial longitudinal series of 19 healthy fetuses Results: in 17 out of 19 cases, HRV power remained constant over a period of 2 hours. In two cases, there was a significant upward trend. Conclusion: We have demonstrated that fetal HRV power can be estimated non-invasively from the transabdominal fECG. The changes in HRV power potentially provide a sophisticated method of assessing fetal condition before and during labour |
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2009 |
Signal Quality of Non-Invasive Foetal Electrocardiogram (ECG) During Labour
J. Reinhard1, B. R. Hayes-Gill2, Q. Yi3, H. Hatzmann1, S. Schiermeier1 |
Introduction: During labour non-invasive foetal heart rate monitoring is a routine method for the assessment of foetal well-being. This study examines an alternative assessment by foetal ECG during labour. Materials and Methods: 32 pregnant women admitted for delivery gave informed consent and were connected to the Monica AN24™. Foetal and maternal ECG signals, noise and patient satisfaction were evaluated during the 1st and 2nd stages of labour. Results: The median gestational age was 40 weeks (range 34–42). The women had a median BMI of 28.4 (range 24.0–49.5) and the medianbirth weight was 3400 g (range 1915–4470 g). The median total recording time was five hours and 18 minutes (range 38 minutes – 74 hours and 6 minutes). There was a statistical increase of noise from the beginning of the 1st stage of labour to the end of 1st stage of labour (p = 0.03) and until the end of the 2nd stage (p = 0.025). However, foetal and maternal ECG signal quality remained constant throughout labour. No correlation was identified between foetal and maternal ECG, noise and BMI as well as foetal birth weight. Conclusion: The results show that foetal and maternal ECG signal stays constant throughout labour. Even though noise significantly increases throughout labour, especially during the crowning phase, the foetal and maternal ECG signal can still be differentiated. |
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2008 |
NON-INVASIVE TRANSABDOMINAL MONITORING OF FECG AND UTERINE CONTRACTIONS IN SECOND HALF OF GESTATION Abstract 90 THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE |
Electrical activity as present over the pregnant abdomen can be used to record maternal and fetal electrocardiograms (ECG), as well as the electrohysterogram. The signals, recorded noninvasively by five electrodes, can provide prognostic information on the fetal condition and uterine activity from early pregnancy until term. Reliability and accuracy was confirmed in 25 women in early labour by recording fetal heart rate (FHR) and uterine contractions measured by the AN24 monitor (Monica Healthcare, Nottingham, UK) and compared it to simultaneously recorded data from the scalp electrode and intrauterine pressure catheter. After validity assessment proved to be successful, we performed another 150 overnight recordings (5pm–8am) in women with singleton pregnancies at 20–40 weeks gestation. 80/150 women with uncomplicated pregnancies used the monitor in their home environment, while the remaining 70/150 recordings concerned at risk pregnancies (hypertensive disorders, growth restriction, diabetes) and were performed either at home or in hospital. Quality assessment of the FHR recordings showed that signal quality was optimal when the recording was performed overnight (11pm–7am). Signal quality was (non-significantly) influenced by gestational age with a slight decline between 26–32 weeks, and was not influenced by body mass index (mean 26.9, range 16.0–43.8). In conclusion, the validity assessment has proven the accuracy and feasibility of this proposed method throughout the second half of (patho) physiological pregnancy. We now report our first data on the development of diurnal rhythms of FHR in healthy controls and that in growth restricted fetuses (n¼20) and fetuses of women with diabetes (n¼20). |
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2008 |
4th International Symposium on Diabetes and Pregnancy Hilton Istanbul Hotel March 29th – 31st Istanbul Turkey CONTINUOUS SIMULTANEOUS MATERNAL GLUCOSE AND FETAL HEART RATE MONITORING IN DIABETIC PREGNANCY E.M. Graatsma 1, E.J. Mulder 1, H.W. de Valk 2, G.H. Visser 1 1 Department Of Perinatology & Gynaecology; 2 Department Of Internal Medicine, University Medical Center Utrecht The Netherlands; |
Antenatal fetal heart rate (FHR) monitoring is usually restricted to relatively short-lasting periods, often one hour at a maximum. In women with diabetes glucose values vary largely over the day (1). Fetal compromise is likely to occur in case of maternal hyperglycaemia (and fetal hyperglycaemia) leading to fetal lactate accumulation. It is therefore of importance to monitor these fetuses especially during such episodes, to assess the capability of the fetus to cope with such situations. This requires prolonged FHR recordings and frequent glucose measurements. Recently, a novel non-invasive technique for continuous FHR monitoring has been developed based on the electric fetal heart signal (fECG) as obtained from electrodes placed on the maternal abdomen. With this method (Monica Healthcare) prolonged recordings (8-15 hours) can be made, that are of good quality especially during the night. Thus, combined assessment of maternal glucose using the continuous glucose monitoring system (CGMS) and numerical analysis of FHR traces obtained with the fECG-monitor gives the opportunity to study the effect of varying maternal glucose levels on FHR. Here we present preliminary data of continuous simultaneous measurements of maternal glucose and fetal heart rate, testing the hypothesis that FHR is related to maternal glucose levels. If further studies prove that the fECG-monitor is of additional value, a novel tool can be added to the arsenal of monitoring possibilities in pregnant women with diabetes. (1) Kerssen A, de Valk HW, Visser GHA. Day-to-day glucose variability during pregnancy in women with type1 diabetes mellitus BJOG 2004;111:919-924. |
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2008 |
Obesity in Obstetrics, New Challenges and Solutions Using Abdominal Fetal ECG Karnie Bhogal RM RGN, Clinical Specialist Monica Healthcare, Dr. Indu Asanka Jayawardane, Research Fellow Nottingham City Hospital Midwives Journal of the Royal College of Midwives Dec 2008/Jan 2009
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Abstract Obesity is now an important health problem and pregnancy coupled with obesity can result in the pregnancy being classified as high risk. Careful and close monitoring is therefore necessary. This article highlights some of the problems with Doppler ultrasound (CTG), in monitoring obese mothers, and how by using the technology of abdominal fetal ECG monitoring the quality of care in relation to fetal heart rate monitoring to this cohort can be improved. A study of 120 pregnancies, ranging from a body mass index (BMI) of 18 – 44, showed that obesity did not affect the success rate of the fetal heart rate (FHR) data. Keywords: Obesity; Pregnancy; Doppler Ultrasound; Fetal Electrocardiogram (Fetal ECG); Long-term Monitoring. Obesity is emerging as an important global health problem. Obese pregnant women are at high risk throughout the antenatal, intrapartum and postpartum period. Confidential Enquiries into Maternal and Child Health (CEMACH) Perinatal Mortality 2006 Report reveals that ‘of the women who had a stillbirth and a recorded BMI, 26% were obese (BMI >30).’ Obesity in pregnancy has been selected as CEMACH’s principle project with a maternal health focus for 2008-2011. There is currently no national clinical guideline available in the UK with regard to clinical care in obesity in pregnancy. |
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2008 |
Foetal electrocardiogram (EKG) is an alternative to Doppler ultrasound cardiotocogram (CTG) for antenatal assessment of foetal well-being – preliminary results J.Reinhard, H. Hatzmann, S. Schiermeier |
Abstract - English Introduction Abstract - German Einleitung |
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2008 |
Fetal electrocardiography: feasibility of long-term fetal heart rate recording Graatsma E, Jacod B, van Egmond L, Mulder E, Visser G. Fetal electrocardiography: feasibility of long-term fetal heart rate recordings. BJOG 2009;116:334–338.Department of Perinatology and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands |
The feasibility and accuracy of long-term transabdominal fetal electrocardiogram (fECG) recordings throughout pregnancy were studied using a portable fECG monitor. Fifteen-hour recordings of fetal heart rate (FHR) were performed in 150 pregnant women at 20–40 weeks of gestation and 1-hour recordings were performed in |
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2008 |
Non-invasive detection of significant uterine activity American Journal of Obstetrics and Gynecology, Volume 199, Issue 6, Pages S225-S225 J. Miller, K. Ty-Torredes, M. Schindel, C. Harman, A. Baschat |
OBJECTIVE: Intrapartum monitoring of uterine contractions with an
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2007 |
ANTENATAL TRANSABDOMINAL FETAL ECG FOR HEART RATE MONITORING: QUALITY ASSESSMENT OF A RENEWED MONITORING TECHNIQUE ELISABETH M. GRAATSMA, EDUARD J.H. MULDER, GERARD H A VISSER, |
OBJECTIVE: Non-invasive fetal heart rate (FHR) monitoring using the fetal-ECG signal as obtained from the maternal abdomen has the advantage of obtaining prolonged recordings, when compared to FHR monitoring using ultrasound. RESULTS: When total recording time was considered, 103/120 (86%) recordings were of good quality. This percentage increased to 92% (111/120 recordings) when only the night part (11pm-7am) was considered. Lower recording quality was obtained at 26-28 weeks (73%). |

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