Non-invasive fetal monitoring: Fetal Heart Rate multimodal estimation from abdominal electrocardiography and phonocardiography.

Background: Fetal cardiac well-being is essential during labor as the delivery is at risk for fetal distress. Continuous monitoring by cardiotocography (CTG) is daily used to record the fetal heart rate (FHR) but this technique has important drawbacks in clinical use.
Objectives: We propose to monitor FHR with a non-invasive technique, using multimodal recordings of the fetus cardiac activity, associating electrocardiographic (ECG) and phonocardiographic (PCG) sensors. The aim of this study is to evaluate the quality of these multimodal FHR estimations by comparison with CTG, based on clinical criteria.
Methods: A clinical protocol was established and a prospective open label study was carried out in the University Hospital of Grenoble. The objective was to record thoracic and abdominal PCG and ECG signals on pregnant women over 37 WG (weeks of gestation), simultaneously with CTG recordings. Adapted signal processing algorithms were then applied on abdominal PCG and ECG signals to extract FHR. Quantitative evaluation was carried out on FHR estimations compared with FHR extracted from CTG.
Results: A total of 40 recordings were performed. Due to technical mistakes the analysis was made possible for 38. 35 recordings allowed a FHR follow-up by ECG or PCG, 30 recordings allowed a FHR follow-up by PCG only, 25 recordings allowed a FHR follow-up by ECG only and 20 recordings allowed a FHR follow-up by both ECG and PCG.
Conclusion: Reliable multimodal recording of FHR associating ECG and PCG sensors is possible during the last month of pregnancy. These positive results encourage the study of multimodal FHR recording during labor and delivery.
(Copyright © 2022. Published by Elsevier Masson SAS.)