U.S. patent number 3,703,168 [Application Number 05/023,737] was granted by the patent office on 1972-11-21 for fetal heart monitor with particular signal conditioning means.
Invention is credited to Richard D. Frink.
United States Patent |
3,703,168 |
Frink |
November 21, 1972 |
FETAL HEART MONITOR WITH PARTICULAR SIGNAL CONDITIONING MEANS
Abstract
A fetal heart monitor capable of detecting fetal heart activity
in a non-invasive manner and in the presence of noise and
substantially stronger maternal heart signals. The system is also
operative to simultaneously monitor labor contractions in a
non-invasive substantially noise free manner, and additionally
provides means for selectively displaying the rhythm ECG.
Inventors: |
Frink; Richard D. (Westwood,
MA) |
Family
ID: |
21816911 |
Appl.
No.: |
05/023,737 |
Filed: |
March 30, 1970 |
Current U.S.
Class: |
600/511; 333/175;
327/552 |
Current CPC
Class: |
A61B
5/4362 (20130101); A61B 5/344 (20210101); A61B
5/4356 (20130101) |
Current International
Class: |
A61B
5/0444 (20060101); A61B 5/0402 (20060101); A61B
5/03 (20060101); A61b 005/04 () |
Field of
Search: |
;128/2.6B,2.6F,2.6G,2.6R,2S ;333/7G ;330/69 ;307/233 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Claims
What is claimed is:
1. A non-invasive fetal heart monitor comprising:
an amplifier having low input impedance and adapted for connection
to a plurality of surface electrodes attached to a mother's
skin;
filter means coupled to said amplifier and operative to
substantially eliminate 60-cycle signal components;
high-Q critically damped active filter means responsive to the
fetal complex and operative to provide an enhanced fetal R-wave and
to substantially reject spurious signals;
said active filter means including first switching means operative
to alter the bandwidth of said active filter means to provide
relatively wideband operation for detection of rhythm ECG;
baseline correction circuitry coupled to said active filter means
and operative to maintain the output signal of said active filter
means at a stable reference level; and
second switching means for bypassing said baseline correction
circuitry when said first switching means is operative;
said output signal being adapted for application to utilization
means.
2. A non-invasive fetal heart monitor according to claim 1
including
active bandpass filter means coupled to said amplifier and having a
passband of approximately 0.1 to 1.0 Hz for providing a signal
representative of labor contractions simultaneously with the output
signal of said high-Q active filter means.
3. A non-invasive fetal heart monitor comprising:
an amplifier having low input impedance and adapted for connection
to a plurality of surface electrodes attached to a mother's
skin;
filter means coupled to the output of said amplifier and operative
to substantially eliminate power line noise frequencies;
multistage variable bandwidth active filter means each stage being
a high-Q critically damped active filter operative to provide
maximum response to the fetal complex and to discriminate against
other waveforms;
said active filter means being operative in a narrowband mode to
provide a first output signal representing an enhanced fetal R-wave
and to substantially reject spurious signals, and operative in a
relatively wideband mode to provide a second output signal
representing a rhythm ECG;
first switching means coupled to said active filter means and
operative to select said narrow band or wideband mode;
baseline correction circuitry coupled to the output of said active
filter means and operative to maintain the output signals of said
active filter means at a stable reference level; and
second switching means cooperative with said first switching means
for bypassing said baseline correction circuitry when said wideband
mode is selected by said first switching means.
4. A non-invasive fetal heart monitor according to claim 3
including
a contraction detector coupled to the output of said amplifier and
operative to detect labor contractions simultaneously with
detection of fetal heart activity, said contraction detector
comprising
an active bandpass filter having a low frequency narrow passband in
the vicinity of 1.0 Hz for providing a signal representing labor
contractions and to substantially reject spurious signals.
Description
FIELD OF THE INVENTION
This invention relates to electrocardiographs and more particularly
to electrocardiographs for detecting fetal heart signals in the
presence of maternal signals and noise.
BACKGROUND OF THE INVENTION
Indirect fetal heart monitoring can be accomplished by means of
electrodes attached to the skin of the mother to detect the fetal
heartbeat and provide signals to an electrocardiograph. Presently
known systems for fetal heart monitoring are not, however, wholly
satisfactory since the fetal signal is usually masked in background
noise caused, for example, by abdominal movement and labor
contractions and masked by the substantially stronger maternal
heartbeat. Indirect heart monitoring systems have generally
employed rather complex signal averaging techniques to minimize
spurious signals and such systems often depend upon critical
placement of electrodes and require considerable skill in
utilization of the apparatus and interpretation of the output
display. Signal averaging systems also suffer from loss of heart
rate information.
In order to detect fetal heart activity in a manner less subject to
noise, invasive monitoring has been employed by means of electrodes
attached directly to the fetus. Such invasive techniques can
usually be employed only during the last stages of pregnancy prior
to delivery. There has heretofore been no convenient means for
reliable non-invasive monitoring of fetal heart activity from early
stages of pregnancy through delivery.
SUMMARY OF THE INVENTION
In accordance with the present invention, a non-invasive fetal
heart monitor is provided in which fetal heart activity is easily
and reliably detected in the presence of background noise and
considerably stronger maternal heart signals. A plurality of low
noise surface electrodes are attached at selected positions on the
skin of the mother's body and are connected by low noise shielded
cable to signal processing circuitry which is of low input
impedance to match the source impedance and which employs
narrowband filtering to discriminate between the intended fetal
signals and unwanted signals. The system also includes automatic
baseline correction for the display of the detected fetal complex
at a stable reference level.
The invention employs high-Q active filter means which is
responsive to the fetal complex and which is operative to provide
an enhanced fetal R-wave and to discriminate against other
waveforms. The complete fetal electrocardiograph is not displayed;
rather, the invention provides accurate detection and display of
the R-wave which contains necessary information for obstetrical
monitoring to determine presence or absence of electrocardiograph
activity, fetal heart rate, multiple pregnancy and fetal
distress.
The novel system, which can also be employed to monitor the heart
activity of newborn infants, includes bandwidth control circuitry
for selectively providing narrowband operation for R-wave detection
and display, and wideband operation for detection and display of
the rhythm ECG. The invention further includes means for detecting
labor contractions non-invasively and simultaneously with heart
activity to provide a display of labor contraction signals
correlative with display of fetal heart signals and useful in
obstetrical monitoring.
DESCRIPTION OF THE DRAWINGS
The invention will be more fully understood from the following
detailed description taken in conjunction with the accompanying
drawings in which:
FIG. 1 is a block diagram of a fetal heart monitor according to the
invention;
FIG. 2 is a pictorial view, partly in section, of an electrode of a
type useful in practicing the invention;
FIG. 3 is a schematic diagram of a fetal heart monitor according to
the invention;
FIG. 4 is a schematic diagram of the labor contraction detector
according to the invention;
FIG. 5 is an electrocardiogram of fetal and maternal heart signals
provided in accordance with the invention;
FIG. 6 is an electrocardiogram provided by the invention and
indicating the fetal heart activity of twins;
FIG. 7 is an electrocardiogram of fetal and maternal heart signals
and labor contraction signals provided in accordance with the
invention; and
FIG. 8 is a plot of contraction and heart rate signals provided in
accordance with the invention.
DETAILED DESCRIPTION OF THE INVENTION
A fetal heart monitor according to the invention is illustrated in
diagrammatic form in FIG. 1. Signals are detected from the skin of
the mother's body by surface electrodes 10, three of which are
generally employed to provide a differential signal input and an
electrical ground connection. Signals detected by the electrodes
are applied to an amplifier 12 having low input impedance,
typically 10,000 ohms, and a gain sufficient to achieve a signal
level suitable for subsequent signal processing. The output signals
from amplifier 12 are applied to a 60-cycle filter 14 which
substantially eliminate any 60-cycle components in the processed
signal due for example to power line noise. The signal is next
applied to an active filter 16 which is a high-Q, critically damped
filter operative to provide maximum response to the fetal complex
and to discriminate against other waveforms. The output of active
filter 16 is applied to a like active filter 18 to provide an
additional stage of filter processing, and increased rejection of
unwanted signals.
The active filters 16 and 18 each exhibit a narrow bandpass
characteristic having a half power passband of approximately 20-30
Hz. The filter characteristic is non-symmetrical, having a more
gradual low frequency slope of typically 18 db/octave, as compared
to a relatively steep high frequency cutoff of typically 50-60
db/octave. The more gradual low frequency cutoff reduces tendencies
toward oscillation.
The output of filter 18 is applied to a baseline correction circuit
20 which is operative to maintain the detected fetal signal at a
substantially constant reference level and to discriminate against
signal variations near the baseline level. The output signal from
circuitry 20 is then applied to suitable utilization apparatus such
as an electrocardiograph recorder 22 and/or a display 24 such as a
cathode ray tube. The output signal may also be applied to alarm
circuitry 26 for indicating an abnormal signal condition, which may
signify abnormal heart activity.
In obstetrical monitoring, it is often useful to simultaneously
monitor labor contractions which can be for example, displayed on a
separate channel of recorder 22, which in this case can be a
multi-channel electrocardiograph recorder. Contraction monitoring
is useful for example in detecting umbilical cord compression which
may occur during a contraction and which may endanger the child. As
seen in FIG. 1, a contraction detector 15 is coupled to the output
of amplifier 12, the output of detector 15 being coupled to
recorder 22. The contraction detector 15 is operative in response
to the signals derived from surface electrodes 10 to provide a
substantially noise-free representation of labor contractions. It
is significant that labor contractions can be monitored
non-invasively and an accurate signal provided even in the presence
of noise generated by abdominal muscle activity. The detector 15
will be described in detail hereinafter.
In practicing the invention it is preferable to minimize, so far as
practical, surface noise at the electrode locations and in
accordance with the invention electrodes are employed of a
construction to minimize such surface effects. Such an electrode is
illustrated in FIG. 2 and includes a cylindrical ring 28 of
electrically insulative material such as Nylon, with a solid silver
electrode plate 30 mounted within the annular space of ring 28 and
removed from the surface 32 which is to be attached to the
patient's skin. A coaxial cable 34 is disposed within an opening
provided in the ring with its center conductor 36 soldered or
otherwise connected to electrode plate 30. The coaxial cable is of
low noise construction to further reduce system noise. In
operation, a conductive jelly is placed in the space defined by
ring 28 and electrode plate 30. As is well known, the conductive
jelly melts at body temperature, and electrical signals are
conducted through this medium from the skin surface to the
electrode plate. Electrical noise generated by movement of the skin
surface against an electrode surface is substantially reduced by
this electrode construction. Low noise wire and gold plated
contacts further decrease interface noise. The electrode is
typically secured to the patient's skin with an adhesive surgical
tape.
In general, the electrodes are placed along the midline of the
mother's body. The largest fetal R-wave is usually obtained when
one electrode is over the head of the fetus while the other is over
the buttocks of the fetus; therefore, one electrode is usually
placed above the pubis of the patient, with the second electrode
being placed above the umbilicus in late pregnancy or below the
umbilicus in early pregnancy. The ground electrode typically is
placed on the thigh. In particular cases, it may be necessary to
adjust the placement of the electrodes to achieve desired signal
detection. Electrode placement, however, is not as critical as in
conventional monitoring schemes. Fine adjustment of the electrode
placement can be accomplished simply by moving the electrodes while
observing the fetal monitor display for the desired waveform. Once
a satisfactory signal is obtained, further adjustment is not
generally needed even in the presence of changes in fetal position
and/or vigorous maternal movement, such as occurs during labor. It
will be appreciated that the invention provides clear detection of
a fetal signal even during the extreme electrical activity
exhibited during labor.
The signal processing circuitry is illustrated in FIG. 3. Signals
detected by the two active electrodes are applied via input
resistors R40 and R42 to the differential input terminals of an
operational amplifier 44. A resistor R46 is connected between the
positive input of amplifier 44 and a source of reference potential
such as ground. A resistor R44 is connected between the output of
amplifier 44 and the negative input thereof, and a bypass capacitor
C42 is connected across resistor R44. The output of amplifier 44 is
coupled via a series resistor R45 and shunt capacitor C40 to a
parallel-T notch filter operative to eliminate 60-cycle noise. This
filter includes series connected capacitors C44 and C46 and a
resistor R48 connected between the junction of capaci-tors C44 and
C46 and ground. A pair of series connected resistors R50 and R52
are connected in shunt across capacitors C44 and C46, with a
capacitor C48 connected between the junction of resistors R50 and
R52 and ground.
The output of the 60-cycle filter is connected via series resistor
R54 and shunt capacitor C58 to the resistive input of operational
amplifier 46, which with its associated circuitry functions as a
high-Q filter, such as described hereinabove. The negative input of
amplifier 46 is connected via resistor R55 and capacitor C51 and an
FET transistor switch Q1 to ground. A critically damped parallel-T
filter network is provided between the negative input and the
output of operational amplifier 46 and includes series connected
capacitors C50 and C52 and resistor R56 between the common junction
of C50 and C52 and through an FET switch Q3 to ground.
Series connected resistors R58 and R60 are connected in parallel
across capacitors C50 and C52, with a capacitor C54 connected
between the common resistor junction to the junction between
resistor R56 and transistor switch Q3. A resistor R62 is connected
across resistors R58 and R60 to limit the Q of the circuit to
prevent oscillation. A capacitor C55 is connected across resistor
R62. A resistor R57 and capacitor C57 are series connected between
the negative input of amplifier 46 and an FET switch Q2 which, in
turn, is connected to ground. The gate electrodes of switches Q1
and Q3 are connected together and are also connected via a resistor
R64 to ground and to a switch contact 2 of a switch 80. The gate
electrode of FET switch Q2 is connected to contact 1 of switch 80
and is also connected via a resistor R65 to ground. A source of
negative potential -V is applied to the common terminal of switch
80 via a resistor R66. As will be described, the FET switches are
operative to alter the bandwidth of the active filter to permit
narrow band operation for monitoring the fetal heart rate and
relatively wideband operation for monitoring the fetal rhythm
ECG.
The output of the active filter is coupled to circuitry 47 which
includes a like 60-cycle notch filter and active filtering as just
described. The additional notch filter provides further
discrimination against 60-cycle noise, while the additional active
filter provides further discrimination between the fetal R-wave and
noise. The output of filter circuitry 47 is coupled via a capacitor
C60 to a potentiometer R70, which functions as a level control, the
output of the potentiometer being applied to an amplifier 70. The
output of amplifier 70 is applied to a pair of oppositely poled
diodes D40 and D42. The output from the diode network is coupled
via a capacitor C62 to an amplifier 72, the output of which is the
system output for application to utilization apparatus, such as an
electrocardiogram recorder or cathode ray tube display.
The output from amplifier 72 is also applied to rate circuitry 74
operative to provide an output signal proportional to the fetal
heart rate signals applied thereto. Rate circuitry 74 is operative
to drive a suitable rate meter 76 for providing a visual indication
of fetal heart rate, and is also operative to provide fetal heart
rate signals for the electrocardiogram recorder. A switch 81
connected across the diode network has its switch arm mechanically
linked to the switch arm of switch 80 such that the switches are
operative in tandem. Switch 80 is employed together with FET
switches described above to provide narrowband and wideband
operation of the circuitry in a manner to be described in detail
hereinafter.
As discussed, the invention is also operative to simultaneously
detect labor contractions and to provide a substantially noise free
signal representative of these contractions which can be displayed
concurrently with display of the fetal heart signals. The labor
contraction detector 15 is illustrated in greater detail in FIG. 4
and includes an input filter network comprising series connected
resistors R80 and R82 connected to the positive input of an
operational amplifier R85 and shunt capacitors C80 and C82
connected to ground. The negative input of operational amplifier 75
is coupled via series connected resistor R86 and capacitor C86 to
ground and is also connected via the parallel combination of
resistor R84 and capacitor C84 to the output of amplifier 75. The
amplifier output is coupled via a potentiometer R88 and capacitor
C88, to the electrocardiograph recorder 22 or other suitable output
utilization apparatus.
The filter of FIG. 4 is a bandpass filter having a passband of
approximately 0.1 to 1 Hz. The filter has a low frequency roll-off
of approximately 6 db per octave and a high frequency roll-off of
approximately 18 db per octave. The high frequency characteristics
of the amplifier are essentially determined by resistor R86,
capacitor C86 and coupling capacitor C88. The remaining resistive
and capacitive elements essentially determine the low frequency
characteristics of the filter.
The invention also provides means for varying the bandwidth of the
active filter circuitry in order to selectively provide narrowband
operation for enhanced detection of the fetal R-wave, even in the
presence of noise and the stronger maternal heart signals, and
relatively wideband operation to detect the P, QRS and T waves of
the fetal complex to determine the presence or absence of normal
sinus rhythm. The FET switches shown in FIG. 3 provide the
bandwidth control. Referring to FIG. 3, with switches 80 and 81 in
position 1, as illustrated, FET switch Q2 is biased off, while
switches Q1 and Q3 are conductive. In this mode of operation, the
active filter provides narrowband operation for discrimination
between the fetal R-wave and noise. In this mode of operation,
diodes D40 and D42 are in circuit to provide the intended baseline
correction. With switches 80 and 81 in switch position 2, the FET
switches Q1 and Q3 are biased off while switch Q2 is conducting to
alter the filter characteristics such that relatively wideband
operation is achieved to process the PQRST fetal complex. In this
wideband mode of operation, the active filter has a bandwidth of
approximately 1 to 30 Hz. The diode network, in the wideband mode,
is shunted out of circuit, with a result that no baseline
correction is employed to permit processing of the rhythm
complex.
The illustrated embodiment provides signal sensitivity down to one
microvolt to easily detect fetal heart signals which are typically
in the 3-5 microvolt range. Maternal heart signals are generally in
the 600-700 microvolt range and are also efficiently processed to
provide accurate indication of maternal heart activity.
For purposes of illustrating the greatly enhanced signal
discrimination provided by the invention, there is shown in FIG. 5
an electrocardiogram of fetal and maternal heart signals provided
in accordance with the invention. As seen in FIG. 5, a normal fetal
R-wave, labeled f, is displayed along with the maternal complexes,
labeled M. It is evident that the fetal heart signal is clearly
distinguishable from the maternal heart signal and provides an
accurate and easily analyzed representation of fetal heart
activity.
The enhanced detection of fetal heart activity provided by the
invention also permits the early detection of twins, and the heart
activity of each twin can be easily detected and monitored in
accordance with the invention. An electrocardiogram of the fetal
heart activity of twins is depicted in FIG. 6. The waveform labeled
f.sub.1 indicates the heart activity of one twin, while the
waveform labeled f.sub.2 indicates the heart activity of the second
twin. The maternal heart complex, labeled M, is also clearly
evident. It will be noted that the fetal complex of each twin is of
opposite polarity to the other, denoting that the twins are in
opposite disposition one in a vertex position, the other in a
breech position. The position of the fetus is easily determined in
accordance with the invention since the polarity of the enhanced
fetal R-wave provides accurate indication of fetal position.
The simultaneous display of fetal heart signals and labor
contraction signals is shown in FIG. 7. The upper waveform
represents the fetal R-wave, labeled f, along with the maternal
complex, M, while the lower waveform shows the periodic signal
caused by the uterine contractions and derived from contraction
detector 15.
It is also useful in obstetrical monitoring to simultaneously
display labor contractions and fetal heart rate. Such a display is
shown in FIG. 8, in which the upper plot represents a contraction,
while the lower plot depicts heart rate, as derived from rate
circuitry 74. As illustrated, the heart rate is decreased during a
contraction, as would occur for example when the umbilical cord is
compressed. Such an indication would signal a possibly dangerous
situation which should be corrected.
Various modifications and alternative implementations will occur to
those versed in the art without departing from the spirit and true
scope of the invention. For example, in instances where only fetal
R-wave detection is desired, the invention can be practiced without
the contraction monitor and bandwidth selection means. Accordingly,
it is not intended to limit the invention by what has been
particularly shown and described.
* * * * *