Method, apparatus and computer program product for examination of intra-uterus condition of a fetus
20170319126 · 2017-11-09
Inventors
- Gábor SIPKA (Szeged, HU)
- Márta FIDRICH (Szeged, HU)
- Tibor SZABÓ (Szeged, HU)
- Tamás NAGY (Szeged, HU)
- Vilmos BILICKI (Szeged, HU)
- György BÁRTFAI (Szeged, HU)
- Tamás BITÓ (Szeged, HU)
- Róbert MINGESZ (Szeged, HU)
- Zoltán GINGL (Szeged, HU)
- Tibor GYIMÓTHY (Szeged, HU)
- Gergely VADAI (Szeged, HU)
- Gergely MAKAN (Szeged, HU)
- Melinda VÁNYA (Szeged, HU)
- Mária JAKÓ (Szeged, HU)
- Ráhel ZÖLEI-SZÉNÁSI (Szeged, HU)
- János BORBÁS (Szeged, HU)
Cpc classification
A61B5/7282
HUMAN NECESSITIES
A61B5/002
HUMAN NECESSITIES
A61B5/6898
HUMAN NECESSITIES
A61B5/11
HUMAN NECESSITIES
International classification
A61B5/00
HUMAN NECESSITIES
A61B5/11
HUMAN NECESSITIES
Abstract
Mechanical vibrations induced by the heart of the foetus, together with other vibrations coming from the body of the pregnant mother, are sensed by the at least one electro-mechanical transformer placed on the body surface of the pregnant mother, the vibrations are transformed into electrical signals and processed. The electrical signals are pre-amplified, frequencies including the heart sound of the pregnant mother are removed from amplified electrical signals of the perceived vibrations by active bandpass filtering, the signal level reduction due to bandpass filtering is compensated for by amplification, and the filtered signal is transferred to a device for processing and evaluation. A device suitable for implementing the method, and a computer-readable medium are proposed, the latter comprising instructions to be run on the device, e.g. the smartphone, for processing the measured signals, displaying them visually, showing trends and making proposals to the user based on the processed signals.
Claims
1. A method for the examination of intra-uterine condition of a foetus, the method comprising: sensing, by at least one sensor placed on a body surface of a pregnant mother, mechanical vibration induced by the heart of the foetus in the uterus, together with other vibrations coming from the body of the pregnant mother; transforming the perceived vibration into an electrical signal; transmitting the electrical signal so received to a signal processing unit, processing and evaluating the transmitted electrical signal in said signal processing unit; during the signal processing, pre-amplifying said electrical signals with a manually adjustable gain or by automatic gain control; removing the frequencies including the heartbeat of the pregnant mother from the amplified electrical signals of the perceived vibration by active bandpass filtering; compensating for a signal level reduction caused by said bandpass filtering by further amplification; subjecting the filtered signal to further transformation before evaluation by modulating said filtered signal to a carrier frequency in the range of 5.5-6.5 kHz and transmitting the modulated filtered signal for further evaluation; performing evaluation by first demodulating, then processing said modulated signal; and displaying acoustically and/or optically said evaluated signal to a user.
2. The method according to claim 1, characterised in that performing evaluation comprises: defining mechanical vibration induced by the heart of the foetus as foetal heart frequency with the help of a peak detecting algorithm.
3. The method according to claim 2, characterised in that performing evaluation comprises: defining a baseline, calculating heart variability based on signal oscillation and signal amplitude, and looking for heart frequency acceleration and deceleration.
4. The method according to claim 1, characterised by further comprising: during the evaluation, recording at least one of the following: movements of the foetus, contractions of the myometrium.
5. (canceled)
6. The method according to claim 1, characterised in that performing evaluation further comprises at least one of the following: defining the predefined circumstances of the heartbeat recording considered special in advance, storing said heartbeat recordings made in a scheduled way for reference.
7-8. (canceled)
9. The method according to claim 1, characterised by further comprising waking up the sleeping foetus by vibration in the case of pregnant mothers in Weeks 38-41.
10. The method according to claim 6, characterised by further comprising performing the heartbeat recordings continuously, and saving an actual recording within a predefined time window, in a scheduled way.
11. The method according to claim 1, characterised by further comprising at least one of the following: emitting a warning signal in case of sudden temporary heart rhythm decline, emitting a warning signal in case of permanently low foetal heart rhythm, emitting a warning signal in case of permanently high foetal heart rhythm, emitting a warning signal in case of bradycardia, i.e. foetal heart frequency of less than 120/minute, emitting said warning signal in case of tachycardia, i.e. foetal heart frequency in excess of 160/minute.
12. The method according to claim 11, characterised in that by further comprising emitting said warning signal independently or as supplement to a short text message, SMS.
13-16. (canceled)
17. The method according to claim 1, characterised by further comprising analysing at least one of the following: a basic rhythm of the heart based on continuous monitoring, foetal movements based on the quantities of movement over a predefined period, periodic foetal heart rhythm changes associated with contractions.
18. The method according to claim 17, characterised by further comprising: inferring sleep-wakefulness-movement periods of the foetus from the continuous monitoring.
19-20. (canceled)
21. The method according to claim 17, characterised by further comprising inferring special movement of the foetus from detecting heart rhythm differing from the basic rhythm.
22. The method according to claim 4, characterised by further comprising providing feedback if it is determined during signal processing that the recording is inadequate.
23. The method according to claim 1, characterised by further comprising filtering out the frequencies including also the heartbeat of the pregnant mother depending on the position of the foetus, cut-off spectra of the frequencies to be filtered out being the one under 20 Hz and above 200 Hz for occiput posterior position, and under 70 Hz and above 300 Hz for occiput anterior position.
24. A device for the examination of the intra-uterine condition of the foetus, comprising at least one electro-acoustic transducer (22) sensing mechanical vibration, a portable multifunctional communication device (21), where the at least one electro-acoustic transducer (22) comprising a device that can be fastened adjacent to the uterus on the body of the pregnant mother, and the electro-acoustic transducer (22) is connected to the communication device (21) by one of a wired or wireless connection, furthermore where the communication device (21) is provided with at least one of an acoustical and optical display unit, furthermore, the communication device (21) comprises a signal evaluating unit, where the signal evaluating unit comprising a unit evaluating and displaying input data based on the stored instructions, characterised in that a filtering and signal conditioning stage (23) is inserted between the electro-acoustic transducer (22) sensing mechanical vibration and the portable multi-functional communication device (21); the filtering and signal conditioning stage (23) comprises a pre-amplifier (24) provided with manual or automatic gain control, the output of which is connected to the input of a band-pass filter (25), the output of the latter is connected through an amplifier (26) to the input of the frequency modulator (27) where the bandpass filter (25) comprising an active band pass filter (25) cutting off sharply the frequencies of around under 20 Hz and above 200 Hz and under around 70 Hz and above 300 Hz comprising also the heartbeat of the pregnant mother.
25. The device according to claim 24, characterised in that the input of a power amplifier (28) is connected to the output of the bandpass filter (25), and the output of the former is led to the input of a loudspeaker (29) or earphone (30).
26. The device according to claim 24, characterised in that the measuring unit (11) is arranged on an elastic belt that can be placed on the body of the pregnant mother.
27. The device according to claim 24, characterised in that the measuring unit (11) is connected to the communication device (21) by one of a wired connection and a short-range wireless protocol.
28. (canceled)
29. The device according to claim 24, characterised in that the frequency modulator (27) connected to the output of the amplifier (26) after the bandpass filter (25) is realized as stage modulating the signal led to it to the carrier frequency in the 5.5-6.5 kHz spectrum.
30. A non-transitory computer-readable medium having instructions stored thereon that, when executed, cause a communication device (21) to undertake the steps of the method according to claim 1.
Description
[0020] The invention will be presented in more detail via a possible realization, taken in conjunction with the accompanying drawings, wherein:
[0021]
[0022]
[0023]
[0024]
[0025]
[0026]
[0027]
[0028] Reference will now be made to the exemplary embodiments illustrated, and specific language will be used herein to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended.
[0029] Before the present invention is disclosed and described, it is to be understood that this invention is not limited to the particular structures, process steps, or materials disclosed herein, but is extended to equivalents thereof as would be recognized by those ordinarily skilled in the relevant arts. It should also be understood that terminology employed herein is used for the purpose of describing particular embodiments only and is not intended to be limiting.
[0030] Phonocardiography, known under the abbreviation of PCG, is a non-invasive, observational (passive) examination method. Measuring takes place through the abdominal wall of the pregnant mother, at one or several sampling points. PCG is one of the earliest-used low-cost heart-function-testing methods: today's PCG devices are the upgraded versions of the initial stethoscope, then phonendoscope. However, PCG had been forced to the background for a long time by the current advanced ultrasound and CTG techniques. In our days, the use of the PCG is spreading again, for example in the field of telemedicine, thanks to the extensively wide spread of smart phones.
[0031] In case of phonocardiography, i.e. PCG-based, signal processing, the basis for all signal processing methods is provided by Joachim Nagel's publication of 1986, “New diagnostic and technical aspects of foetal phonocardiography”. fPCG has obvious advantages since it is cheap, safe and makes long-term monitoring at home feasible.
[0032] PCG devices detect sounds originating from the mechanical operation of the heart, in the 0.1-1000 Hz range, detected usually by pressure sensor operated by mechanical vibration—phonoacoustically. The various organs and tissues conduct, modulate, the mechanical vibrations of the heart differently, and that is how they reach the external skin surface of the body where the vibrations and waves are detected by mechanical acoustic and/or pressure sensors. Mechanical vibrations will be transformed first into analogue then into digital signals in the detector head filled with gas and in the tube.
[0033] It is an essential feature of the method and device according to the invention that they should be capable of determining foetal heart frequency by the phonocardigraphic, i.e. PCG, method. To do that, the foetal heart sound needs to be filtered out reliably from among the other incoming signals. The signal concerned is to be transformed into an input signal that can be interpreted by the evaluation devices, primarily smartphones, then into data and, finally, into relevant and reliable information for the user and, as the case may be, the medical staff. Of course, these functions do not replace medical diagnosis and therapy; the device does not constitute a medical device.
[0034] The method starts out from the fact that the acoustic signal of the foetal heart sound is an approximately periodic signal, with a frequency spectrum and amplitude that changes in time, close to noise level in the majority of cases in terms of signal level. The heart sound signal must be selected from among the detected signals based on some criterion that is valid for every signal coming from foetal heart sound.
[0035] The useful signals originating from the heart sound can be separated from the other signals by examining the frequency spectrum of the detected signals, that is, the signal we look for among the detected signals has a frequency pattern corresponding to the spectrum of the systolic component being a first component of the heart sound. The separation by frequency necessary for that is done by an active bandpass filter that can be applied most advantageously in the low frequency ranges. The most important practical requirement to be met by the filter circuits is to have the most even possible transmission in the pass-band, the sharpest cut in the blocking range and that phase shift in the pass-band should be the linear function of the frequency.
[0036] As can be seen in
TABLE-US-00001 TABLE 1 Feature (Name, calculation (<= 1 minute PCG sign) Indication Narrative registration) Typical values Interval RR intervals be- Time interval(s) between heartbeats 0.5-0.375 s between tween heart- (RRi -i.sup.th RR interval) heart- beats, also beats called RR intervals Normal FHR v. Instantaneous f.sub.i = 60/RRi normal value: frequency BFHR heart frequency (This is conditional on being able to 120-160/minute [1/minute] (1 minute): perceive the exact time of the heart- Value given based 60 divided by beat, on having a specific time that the on the section the interval device can detect, and on being able to where no acceler- between two measure/calculate continuously over the ation or decelera- heartbeats ins. interval between the two.) tion occurs and Average heart frequency (per 1 minute): Average of
[0037] Basic foetal heart rate, foetal movement, maternal uterine contraction are medically significant examination features. The signal behind the band-pass filter comprises together the maternal and the foetal heart sounds that are separated by the known Fourier spectrum calculation, considering that the foetal heart rhythm is approximately twice that of the maternal heart rhythm.
[0038] Foetal heartbeat variability and oscillation (fHRV) are calculated from the demodulated, band-passed signal, as indicated in Table 1 for a possible embodiment.
[0039] To examine foetal movement, the pregnant mother can indicate the point in time when movement begins, and with that the signal section typical of movement can be delimited in the examined signal. This makes it possible to perform the statistical analysis of the movement patterns. Under special circumstances, the pregnant mother-foetus communication can be examined, for example with the help of amplifiers placed in a flexible belt fixing the device on the body, to examine for example movement occurring under the effect of musical sound.
[0040] In a preferred embodiment, sensors placed in a flexible belt make not only one-off, but also continuous 24-hour examination feasible. In this case, the examination of the foetal heart sound can be started at any time on the initiative of the pregnant mother. The individual measurements and their results get stored, one by one, in the smartphone, or they can be uploaded to a server in case of network connection. In the actual recording, if a certain event takes place, the pregnant mother can initiate in retrospect the saving of an expediently min. 30-minute time window where the event to be examined occurred.
[0041] After the evaluation of the psycho-physiological signals recorded during the representation or display performed in Step 9, it is possible to notify the physician, i.e. send an SMS or an e-mail, if one or several alert thresholds had been crossed. Thus for instance foetal heart rhythms that are permanently low—bradycardia, i.e. foetal heart frequency of less than 120/minute—or permanently high—tachycardia, i.e. foetal heart frequency in excess of 160/minute—can be signalled. In case of continuous monitoring or examination of at least 15-30 minutes, the basic rhythm of the heart (fHRV) is analysed as well, that makes it possible to identify the movement types and sleeping status, where faster and slower heart rhythm makes movement and sleep, respectively, likely, and through which sleep-wakefulness-movement periods can be identified. Special movements can also be examined during the measurement of heart rhythm deviating from the basic rhythm (e.g. while listening to music).
[0042] Motion tests can be analysed by examining the number and quantity of movements over a given interval. In weeks 38-41, load tests can be made by awakening the foetus. In case of continuous monitoring, periodic foetal heart rhythm changes associated with contractions can also be analysed on the basis of the periodically recorded data.
[0043] The device according to the invention that makes the execution of the proposed method feasible, presented here exclusively as preferred example, comprises two main units: an elastic belt that can be fixed on the abdomen of the pregnant woman and that hosts as can be seen in
[0044]
[0045] The measuring unit 11 comprises an electro-acoustic transducer stage 22 that is in the presented case a converted stethoscope that is sufficiently sensitive in the above-indicated frequency range. The output of the electro-acoustic transducer stage 22 is connected to the input of a filtering and signal conditioning stage 23 that performs amplification, signal filtering and signal conditioning in the monitored frequency range.
[0046]
[0047] The pre-amplifier 24 comprises two separate amplifier stages that should have automatic gain control or manually adjustable gain for the sake of easier use. The pre-amplifier 24 comprises a pre-amplifier stage constructed of an operational amplifier connected to an electrets microphone applied as acoustic sensor and, furthermore, a mike amplifier with automatic gain control. The latter is a most essential part of the pre-amplifier, since the foetal heartbeat, falling into a narrow frequency range, is very faint. The structure and operation of the stages mentioned above are known to those skilled in the art.
[0048] The disturbing effect of the noise of the maternal heartbeats needs to be removed, filtered out of the measured signal, to make the foetal heartbeat well-measurable. The typical, known, frequency spectra of the signals originating from the foetal and the maternal heartbeats, respectively, are shown in
[0049] The foetal heartbeat frequency depends on the position of the foetus: an occiput posterior position—resulting in a signal of higher frequency—and an occiput anterior position—resulting in a signal of lower frequency—are distinguished.
[0050] The foetal heartbeat spectra change during pregnancy.
[0051] The output of the bandpass filter 25 is connected in the present example to the input of a further controllable amplifier 26.
[0052] The smartphones proposed for utilisation filter and condition the microphone signals in different ways depending on their type. Therefore, to forward the signals to a smartphone, we have inserted a frequency modulator 27, in consideration of the fact that the modulated signal needs to be demodulated by the software in the smartphone afterwards. The signals are modulated preferably to a carrier frequency in the spectrum of 5.5-6.5 kHz.
[0053] According to a preferred embodiment and the one that is presented here, the filtering and signal conditioning stage 23 comprises a power amplifier 28 and an acoustical display that displays the foetal heart sounds audibly, facilitating to a large extent the placement of the acoustic sensor on the abdomen wall of the pregnant woman, i.e. the quick identification of the so-called punctum maximum. To do that, the loudspeaker 29 and/or earphones 30 may be connected to the output of the power amplifier 28 connected to the output of the bandpass filter 25.
[0054]
[0055] The structure and functioning mechanism of the demodulator 31 and the intermediary storage medium 32 are known to those skilled in the art, so their detailed presentation is not necessary here. Cross-correlation between the incoming signal and a pre-recorded and stored short foetal heartbeat sample is calculated in peak detector 33. The energy associated with the points of the correlated signal are received e.g., by a Teager energy operator known to those skilled in the art from the work of Kvedalen, Eivind entitled “Signal processing using the Teager energy operator and other nonlinear operators” Master University of Oslo Department of Informatics 21, 2003. The heartbeats appear on the energy curve of the correlated signal as peaks, easy to detect by level-intersecting algorithm.
[0056] Foetal heart rate (FHR) is determined by the frequency-defining stage 34 so that the foetal heart rate curve associated with the recording is obtained by subtracting the time of a respective previous heartbeat from the time of the heartbeats obtained during peak detections.
[0057] The processing stage 35 is used to define the baseline, calculate the variability of the heartbeat, i.e. oscillation, amplitude, and look for heart frequency acceleration and deceleration. One can also record special circumstances of the heartbeat recording here, e.g. listening to music, presence of the father; set periodic heartbeat recordings that can be stored for reference, e.g. 20-minute measurement made at 06:00 a.m.; do continuous heart sound monitoring, within which the actual recording can be saved within a given time window; awaken the sleeping foetus by a vibration function—although that is a so-called load test recommended only for pregnant mothers in weeks 38-41.
[0058] In case of continuous monitoring, the basic rhythm of the heart is analysed by the processing stage 35, where slower heart rhythm is likely to mean sleep and faster heart rhythm movement. Inferences can be drawn as to the sleep-wakefulness-movement periods; periodic foetal heart rhythm changes associated with contractions, recorded regularly by the pregnant mother, can be analysed. Conclusions can be drawn as to the special movement of the foetus upon measuring a heart rhythm that is different from the basic one e.g. when listening to music, in the presence of the father, and the movements of the foetus, e.g. the quantity of movement over a given time period, can also be analysed.
[0059] The recordings and other data to be recorded are stored by the storage stage 36, of known structure and operation mechanism, and said storage stage 36 ensures data retrieval and sharing.
[0060] The display stage 37 provides for intuitive, smooth use by the user. It is possible to display a guide for placement, to provide feedback if the recording is not adequate, e.g. only the heartbeat of the pregnant mother can be detected or the background noise is excessive, for example, a Short Message Service, in short SMS, can be sent about temporary abrupt heart rhythm decline, permanently low (bradycardia: foetal heart frequency under 120/minute) or permanently high (tachycardia: foetal heart frequency in excess of 160/minute) foetal heart rhythm.
[0061] Although not indicated in the figure, those skilled in the art will understand that the device can also be designed so as to make the pregnant mother able to indicate subjectively by a handling element, e.g. by operating a push-button, the movement of the foetus and the contractions.
[0062] The safety of the exemplary device embodying the method according to the invention is to be given high priority: the power supply of the electronic circuits is provided by (rechargeable) batteries, and the whole device is electrically insulated, so that neither the pregnant mother, nor the foetus can be exposed to any electric effect. The device can be provided with the known polarity protection, with battery charge indicator, and with protection against splashing water.
[0063] Let us mention among the main advantages of the method according to the invention that it is suitable for home use, and makes it possible to conduct observation without the presence of a professional, even over a longer time. Its advantages include, furthermore, raising the chances of live birth, providing reassuring and reliable feedback to the pregnant mother and the physician, respectively, on the status of the foetus; easy and effective use by the pregnant mother and the physician, respectively; alarm in case of complication; exclusion of false alarm in the same context; fast feedback and, last but not least, ease of wearing that does not hinder movement. Since the device used for the method is non-invasive (PCG-based) and provides for easy wear, heartbeat detection and heart rhythm measurement can take place over a longer period, continuously.
[0064] It is possible to conduct measurements for tens of minutes, to obtain medically relevant information from the measured data, based on which feedback can be provided on information characterising the condition of the foetus—inferences concerning the special movement of the foetus upon the measurement of heart rhythm differing from the basic one, inference as to the daily sleep-wakefulness-movement period—on the basis of which the condition of the foetus be assessed in a reliable way. The measurement results can be stored and searched, that may be a great advantage for medical diagnostics; they can be included optionally into the decision-making process of the specialist physician.
[0065] The phonocardiography method requires no professional assistance, keeping in mind that obtaining a signal of adequate quality depends on the relative position of the detection head and the foetal heart. Since the examination of the foetus is completely passive, the foetus is not subject to any energy radiation or other external effect, the examination can be conducted for as long time and as frequently as desired, preferably at home, in a monitoring-type of way.
[0066] Based on the regular measurements, the method provides for the analysis of trends, rhythmic changes. Collecting the data so received makes it feasible to analyse population dynamic or launch other medical research.
LIST OF USED REFERENCE SIGNS
[0067] 1-9 step [0068] 11 measuring unit [0069] 12 foetal heart [0070] 13 detector head [0071] 21 communication device [0072] 22 electro-acoustic transducer stage [0073] 23 filtering and signal conditioning stage [0074] 24 pre-amplifier [0075] 25 bandpass filter [0076] 26 amplifier [0077] 27 frequency modulator [0078] 28 power amplifier [0079] 29 loudspeaker [0080] 30 earphone [0081] 31 demodulator [0082] 32 intermediary storage medium [0083] 33 peak detection stage [0084] 34 frequency-defining stage [0085] 35 processing stage [0086] 36 storage stage [0087] 37 display stage