Fetal Electrocardiography

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Author: E. Malcolm Symonds
Published: December 2001
Publisher: Imperial College Press
ISBN: 1860941710
Hardcover Book
Number of Pages: 200

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Fetal Electrocardiography

This important book summarises a century of research and practical applications in fetal electrocardiography. Although fetal ECG is most commonly used for the calculation of fetal heart rates, other parameters have been employed in the prediction of fetal acidons. The book presents new approaches to the interpretation and analysis of the fetal ECG signal and discusses possible new approaches to the clinical exploitation of the electrical activity of the fetal heart. The authors have made numerous contributions to the study of fetal electrocardiography over the last three decades. This volume summarizes research and practical applications in fetel electrocardiography (ECG). In the nine chapters, Symonds (U. of Nottingham) and Daljit Sahota and Allan Chang (The Chinese U. of Hong Kong) review the history and current status of the field, present new approaches to the interpretation and analysis of the fetal ECG signal, and discuss possible new approaches to the clinical exploitation of the electrical activity of the fetal heart. Geared toward both medical and engineering researchers. Distributed by World Scientific.

Table of Contents
Introduction
1 Historical Development 1
Early Observations 1
Early Observations of the P & T Waves 4
The P Wave and the QRS Complex 6
Observations on the FECG Waveform in the 1970s with Appropriate Filtering 10
New Methods of Signal Processing in the 1980s 12
Clinical Trials and Observations in Recent Studies 14
The QRS Complex 18
Vectorcardiography 22
Fetal Cardiac Arrythmias 23
Tachyarrhythmias 24
The Use of Abdominal Electrodes 25
The R-R' Interval and Fetal Heart Rate 29
2 Fetal Adaptation 31
What is Fetal Distress? 31
Fetal Physiological Response to Hypoxia 33
Cellular Effects of Hypoxia 36
A Model for Fetal Distress 39
3 Research Models and Prediction 41
The Statistical Evaluation of Discrete Predictors 41
The Statistical Evaluation of Continuous Predictors 43
The Validation of Predictive Tests by Observational Studies 44
The Validation of Predictive Tests by Clinical Trials 45
The Inclusion of Both Intervention and Morbidity in a Clinical Trial of Predictive Tests 46
The Hawthorne Effect 46
Animal and Clinical Models of Study 47
4 The Electrical Signal, its Acquisition and Measurement 49
The Biophysics - How is the Fetal Electrocardiogram Produced? 49
Acquisition of the Signal 53
Signal Detection and Enhancement 58
Morphology and Time Measurement of the Enhanced Waveform 65
5 The R-R' Interval and the Cardiotocograph 69
Physiology of Fetal Heart Rate Regulation 69
Regulation by the Autonomic Nervous System 70
Regulation by Baroreceptors and Chemoreceptors 70
Fetal Heart Rate Variability 71
Short-Term Variability 71
Long-Term Variability 72
Fetal Behavioural States 73
High Fetal Heart Rate Variability 73
Low Fetal Heart Rate Variability 73
Accelerations and Decelerations of the Fetal Heart Rate 74
Interpretation of the CTG 77
Computerised Assessment of the RR Interval - New Definitions 78
Computerised Systems for the Interpretation of Antepartum Fetal Heart Rate 81
Computerised Systems for the Interpretation of Intrapartum Fetal Heart Rate 83
6 Time Intervals and Morphology of the Fetal ECG 89
Analysis of the FECG 90
Development of an Analyser of the FECG 90
The PR Interval and the PR/FHR Relationship 92
P Wave Morphology and Area 92
The PR/FHR Relationship 93
The Application of PR/FHR to Clinical Trials 98
Prospective Trials 99
The QRS Complex 102
The R/S Ratio and Fetal Vector Cardiography 102
The QT Interval and the ST Segment 103
The T/QRS Ratio 104
7 Fetal Cardiac Arrhythmias 108
Disorders of Cardiac Rhythms in the Fetus 108
Extrasystoles 109
Supraventricular Extrasystoles 110
Escape Rhythms - The Bradycardias 111
Sinus Bradycardia 111
Blocked Atrial Premature Beats 112
Complete Heart Block 112
The Tachycardias 113
Supraventicular Tachycardias 113
Atrial Flutter and Atrial Fibrillation 115
Ventricular Tachycardia 116
8 Information Interpretation and Transformation 117
The Transformation of Data 117
Neural networks 122
Organisation of the information 125
Object orientated structure of the data and algorithm 126
Presentation 129
9 Conclusions 132
Monitoring Methods Currently in Use 132
Problems with the Present Systems 135
Has the Fetal ECG Analysis Enhanced the Specificity of Fetal Monitoring? 136
The Way Forward 138
References 141

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