Real-time intrapartum fetal electrocardiogram analysis
The research within this thesis concerns the monitoring of the fetus during labour, using the fetal electrocardiogram (FECG). A versatile FECG analysis system was developed for the Microsoft Windows environment, to allow various FECG parameters to be extracted. Algorithms, currently used in other FECG analysis systems, were implemented using Object Oriented Programming, thus allowing new algorithms to be easily added at a later stage. Although these current algorithms have been demonstrated by several authors, it was felt that they had been used with only partial investigation of their limitations, and with failure to fully determine their accuracy in controlled conditions. These factors are fully addressed within this thesis. By developing a FECG simulator, in which heart-rate, morphology, and noise levels could be varied, the ability of the analysis algorithms to extract the parameters, and the accuracy of these parameters under different noise conditions, were thoroughly checked. Both ability and accuracy were shown to be very good in ideal noiseless conditions; but, with the addition of noise, there exists a compromise between parameter accuracy when the morphology is static, and parameter accuracy when the morphology is changing. The accuracies of the most common indices in this field (the Conduction Index, and the T/QRS ratio) were determined for different levels of simulated noise, and their values demonstrated for data previously recorded from the fetal scalp. Errors as large as 0.3 in the CI and 0.05 in the T/QRS suggested that in the clinical environment, an indication of the accuracy of each index ought to be displayed, and this may be estimated from the measured level of noise. Furthermore, this analysis system allows the direct comparison of both indices. Finally, in order to design a more effective front-end filter, it is important to be aware of the frequency content of the underlying FECG. The Integral Pulse Frequency Modulation (IPFM) model, combined with Pulse Amplitude Modulation (PAM), was used to estimate realistic frequency components within the FECG signal. The effects of filtering could then easily be modelled to show the distortion of both the FECG and any parameters taken from it. For a FECG frontend filter, distortion was found to be insignificant provided that, above 1 Hz, both the gain remained constant and there was no phase-distortion.