Skip to main content

Cardiotocography for Fetal Monitoring: Technical and Methodological Aspects

  • Chapter
  • First Online:
Innovative Technologies and Signal Processing in Perinatal Medicine

Abstract

In this chapter, the basic principles of the computerized cardiotocography are illustrated. After a short historical reconstruction of this fetal monitoring technique, the hardware and software solutions adopted for measuring the fetal heart rate and the toco signals in current commercial cardiotocographs are briefly summarized. A major focus is dedicated to the methodologies for FHR analysis, starting from the extraction of classical morphological and time domain parameters, going through frequency analysis and concluding with advanced nonlinear indices, more recently proposed and adopted by researchers in the field. The chapter has been written taking into account our experience acquired in about 20 years of research in fetal monitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hammacher, K., Werners, P.H.: über die auswertung und dokumentation von ctg-ergebnissen. Gynecol. Obstet. Investig. 166(5), 410–423 (1968)

    Article  Google Scholar 

  2. Alfirevic, Z., Devane, D., Gyte, G., Cuthbert, A.: Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst. Rev. 2, CD006066 (2017). https://doi.org/10.1002/14651858.CD006066.pub3. ISSN 1469-493X. PMC 6464257. PMID 28157275.

    Article  Google Scholar 

  3. Ayres-de-Campos, D., Bernardes, J.: FIGO Subcommittee. Twenty-five years after the FIGO guidelines for the use of fetal monitoring: time for a simplified approach? Int. J. Gynaecol. Obstet. 110, 1):1–1):6 (2010)

    Article  Google Scholar 

  4. Figueras, F., Albela, S., Bonino, S., et al.: Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome. J. Perinat. Med. 33, 241–245 (2005)

    Google Scholar 

  5. Grivell, R.M., Alfirevic, Z., Gyte, G., Devane, D.: Antenatal cardiotocography for fetal assessment. Cochrane Database Syst. Rev. (9), CD007863 (2015). https://doi.org/10.1002/14651858.CD007863.pub4. PMC 6510058. PMID 26363287

  6. Lawson, C.W., Belcher, R., Dawes, G.S., Redman, C.W.G.: A comparison of an ultrasound (with autocorrelation) and direct electrocardiogram fetal heart rate detector system. Am. J. Obstet. Gynecol. 147, 721–722 (1983)

    Article  Google Scholar 

  7. Hewlett-Packard, G.H.: Fetal Monitor Test – a brief summary. Hewlett-Packard Technical Notes, Germany, pp. 1–6 (1995)

    Google Scholar 

  8. Chang, A., Sahota, D.S., Reed, N.N., James, D.K., Mohajer, M.P.: Computerised fetal heart rate analysis in labour-effect of sampling rate. Eur. J. Obstet. Gynecol. Reprod. Biol. 59(2), 125–129 (1995)

    Article  Google Scholar 

  9. Signorini, M.G., Magenes, G., Cerutti, S., Arduini, D.: Linear and nonlinear parameters for the analysis of Fetal heart rate signal from Cardiotocographic recordings. IEEE Trans Biom Eng. 50(3), 365–374 (2003). https://doi.org/10.1109/TBME.2003.808824

    Article  Google Scholar 

  10. Lowery, C.L., Russell Jr., W.A., Baggot, P.J., Wilson, J.D., Walls, R.C., Bentz, L.S., Murphy, P.: Time quantified detection of fetal movements using a new fetal movement algorithm. Am. J. Perinatol. 14(1), 7–12 (1997)

    Article  Google Scholar 

  11. Magenes, G., Signorini, M.G., Ferrario, M., Lunghi, F.: 2CTG2: A new system for the antepartum analysis of fetal heart rate. In: 11th Mediterr. Conf. Med. Biomed. Eng. Comput. 2007, pp. 781–784. Springer Berlin Heidelberg, Berlin, Heidelberg (2007). https://doi.org/10.1007/978-3-540-73044-6_203

    Chapter  Google Scholar 

  12. Macones, G.A., Hankins, G.D.V., SpongCY, H.J., Moore, T.: The 2008 National Institute of Child Health and Human Development workshop report on electronic Fetal monitoring. Obstet. Gynecol. 112(3), 661–666 (2008). https://doi.org/10.1097/AOG.0b013e3181841395. PMID 18757666

    Article  Google Scholar 

  13. Dawes, G.S., Houghton, C.R.S., Redman, C.W.G.: Baseline in human fetal heart rate records. Br J Obstet Gynecol. 89, 270–275 (1982)

    Article  Google Scholar 

  14. Mantel, R., Van Geijn, H.P., Caron, F.J.M., Swartijes, J.M., van Worden, E.E., Jongsma, H.W.: Computer analysis of antepartum fetal heart rate: I. Baseline determination. Int. J. Biomed. Comput. 25, 262–272 (1990)

    Google Scholar 

  15. Bailey, R.E.: Intrapartum fetal monitoring. Am. Fam. Phys. 80(12), 1388–1396 (2009). PMID 20000301.

    Google Scholar 

  16. Arduini, D., Rizzo, G., Piana, G., Bonalumi, A., Brambilla, P., Romanini, C.: Computerized analysis of fetal heart rate: I. Description of the system (2CTG). J. Matern. Fetal Invest. 3, 159–163 (1993)

    Google Scholar 

  17. Task Force of the Europ. Soc. of Cardiol. & North Am. Soc.of Pacing and Electrophys: Heart rate variability, standard of measurement, physiological interpretation and clinical use. Circulation. 93, 1043–106521 (1996)

    Article  Google Scholar 

  18. Cerutti, S., Civardi, S., Bianchi, A., Signorini, M.G., Ferrazzi, E., Pardi, G.: Spectral analysis of antepartum heart rate variability. Clin. Phys. Physiol. Meas. 10 Suppl B, 27–31 (1989)

    Article  Google Scholar 

  19. Kristal-Boneh, E., Rafeil, M., Froom, P., Ribak, J.: Heart rate variability in health and disease. Scand. J. Work Environ. Health. 21, 85–89 (1995)

    Article  Google Scholar 

  20. Divon, M.Y., Zimmer, E.H., Yeh, S.Y., Vilensky, A., Sarna, E.Z., Paldi, E., Platt, L.D.: Modulation of foetal heart rate patterns by foetal breathing: the effect of maternal intravenous glucose administration. Am. J. Perinatol. 2, 292–295 (1985)

    Article  Google Scholar 

  21. Giuliano, N., Annunziata, M.L., Esposito, F.G., Tagliaferri, S., Di Lieto, A., Magenes, G., Signorini, M.G., Campanile, M., Arduini, D.: Computerised analysis of antepartum foetal heart parameters: new reference ranges. J. Obstet. Gynaecol. 37(3), 296–304 (2017)

    Article  Google Scholar 

  22. Magenes, G., Signorini, M.G., Arduini, D., Cerutti, S.: Fetal heart rate variability due to Vibroacoustic stimulation: linear and nonlinear contribution. Methods Inf. Med. 43, 47–51 (2004)

    Article  Google Scholar 

  23. Lecanuet, J.P., Schaal, B.: Fetal sensory competencies. Eur. J. Obstet. Gynecol. 68, 1–23 (2006)

    Article  Google Scholar 

  24. Marple, L.: Digital Spectral Analysis with Applications, pp. 264–285. Prentice-Hall, Englewood Cliffs (1971)

    Google Scholar 

  25. Pincus, S.M.: Approximate entropy (ApEn) as a complexity measure. Chaos. 5, 110–117 (1995)

    Article  Google Scholar 

  26. Richman, J.S., Moorman, J.R.: Physiological time-series analysis using approximate entropy and sample entropy. Am. J. Physiol. Heart Circ. Physiol. 278, 2039–2049 (2000)

    Article  Google Scholar 

  27. Costa, M., Goldberger, A.L., Peng, C.K.: Multiscale entropy analysis of complex physiologic time series. Phys. Rev. Lett. 89, 068102 (2002)

    Article  Google Scholar 

  28. Ferrario, M., Signorini, M.G., Magenes, G., Cerutti, S.: Comparison of entropy-based regularity estimators: application to the fetal heart rate signal for the identification of fetal distress. I.E.E.E. Trans. Biomed. Eng. 53(1), 119–125 (2006)

    Google Scholar 

  29. Signorini, M.G., Magenes, G., Ferrario, M., Lucchini, M.: Complex and nonlinear analysis of heart rate variability in the assessment of fetal and neonatal wellbeing. In: Complexity and Nonlinearity in Cardiovascular Signals, Springer international Publishing AG, Cham, Switzerland pp. 427–450 (2017)

    Google Scholar 

  30. Lempel, A., Ziv, J.: On the complexity of finite sequences. IEEE Trans. Inf. Theory. 22, 75–81 (1976)

    Article  MathSciNet  Google Scholar 

  31. Ferrario, M., Signorini, M.G., Magenes, G.: Comparison between fetal heart rate standard parameters and complexity indexes for the identification of severe intrauterine growth restriction. Methods Inf. Med. 46, 186–190 (2007). doi:07020186

    Article  Google Scholar 

  32. Bauer, A., Bunde, A., Barthel, P., Schneider, R., Malik, M., Schmidt, G.: Phase rectified signal averaging detects quasi-periodicities in nonstationary data. J. Phys. A. 364, 423–434 (2006)

    Google Scholar 

  33. Fanelli, A., Magenes, G., Campanile, M., Signorini, M.G.: Quantitative assessment of fetal well-being through ctg recordings: a new parameter based on phase-rectified signal average. IEEE J. Biomed. Heal. Inform. 17(5), 959–966 (2013)

    Article  Google Scholar 

  34. Signorini, M.G., Fanelli, A., Magenes, G.: Monitoring fetal heart rate during pregnancy: contributions from advanced signal processing and wearable technology. Comput. Math. Methods Med. 2014, 707581 (2014)

    Article  Google Scholar 

  35. Ferrario, M., Signorini, M.G., Magenes, G.: Complexity analysis of the fetal heart rate variability: early identification of severe intrauterine growth-restricted fetuses. Med. Biol. Eng. Comput. 47(9), 911–919 (2009)

    Article  Google Scholar 

  36. Ferrario, M., Signorini, M.G., Magenes, G.: Complexity analysis of the fetal heart rate for the identification of pathology in fetuses. In: Computers in Cardiology, 32, art. no. 1588275, IEEE Publisher, Piscataway, USA. pp. 989–992 (2005)

    Google Scholar 

  37. McCullagh, P., Nelder, J.A.: Generalized Linear Models. Chapman and Hall, Chapman & Hall/CRC, Boca Raton, Florida, USA(1989)

    Google Scholar 

  38. Bursac, Z., Gauss, C.H., Williams, D.K., Hosmer, D.W.: Purposeful selection of variables in logistic regression. Source Code Biol. Med. 3, 17 (2008). https://doi.org/10.1186/1751-0473-3-17

    Article  Google Scholar 

  39. Hand, D.J., Yu, K.: Idiot’s Bayes – not so stupid after all? Int. Stat. Rev. 69, 385–398 (2001). https://doi.org/10.1111/j.1751-5823.2001.tb00465.x

    Article  Google Scholar 

  40. Kotsiantis, S.B.: Decision trees: a recent overview. Artif. Intell. Rev. 39, 261–283 (2013). https://doi.org/10.1007/s10462-011-9272-4

    Article  Google Scholar 

  41. Breiman, L., Friedman, J.H., Olshen, R.A., Stone, C.J.: Classification and Regression Trees. Chapman & Hall/CRC, Boca Raton, Florida, USA (1984)

    Google Scholar 

  42. Zhang, Y.: Support Vector Machine Classification Algorithm and its Application, vol. 2012, pp. 179–186. Springer, Berlin, Heidelberg (2012). https://doi.org/10.1007/978-3-642-34041-3_27.35

    Book  Google Scholar 

  43. Signorini, M.G., Pini, N., Malovini, A., Bellazzi, R., Magenes, G.: Integrating machine learning techniques and physiology based heart rate features for antepartum fetal monitoring. Comput. Methods Prog. Biomed. 185, 105015 (2020)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giovanni Magenes .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Magenes, G., Signorini, M.G. (2021). Cardiotocography for Fetal Monitoring: Technical and Methodological Aspects. In: Pani, D., Rabotti, C., Signorini, M.G., Burattini, L. (eds) Innovative Technologies and Signal Processing in Perinatal Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-54403-4_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-54403-4_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-54402-7

  • Online ISBN: 978-3-030-54403-4

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics