Home / Transabdominal Fetal Oximetry

Transabdominal Fetal Oximetry

PROJECT OVERVIEW:

We are developing a Non-invasive, Transabdominal Fetal Oximetry system to provide worried mothers and obstetrician’s with needed information regarding fetal well-being during late-stage pregnancy/active labor.

We are developing a non-invasive, transabdominal fetal oximeter, to provide worried mothers and obstetricians needed information regarding fetal well-being, namely fetal oxygenation, to reduce the number of unnecessary emergency C-sections. This is done by transmitting light in the near-infrared spectrum through the maternal abdomen and fetus to measure the oxygen saturation in the fetal blood using pulse oximetry. Pulse oximetry is a technique that utilizes the light absorption spectra of oxy- and deoxy- hemoglobin and captures a photoplethysmograph (PPG) from the vascular pulsations of the cardiac cycle. This PPG signal can then be used to calculate the oxygen saturation of the blood based on how much light was detected per heartbeat. In our case, a mixed maternal-fetal PPG is captured since light is traversing both maternal and fetal tissue, to which the fetal contribution can be isolated through Fourier analysis and filtering.

Our Non-invasive, Transabdominal Fetal Oximetry system. It consists of our optical patch, optode control system, and custom software that provides real-time feedback and data visualization. [Published in Smart Health 2018]

MOTIVATION:

A screenshot of our custom software that provides real-time visual information to the clinicians of measurements taken from our system.

Cesarean section (C-section) is a major abdominal surgery which introduces significant risks to the mother and can have long-term effects on the respiratory health of the fetus [2][3]. While the World Health Organization has identified that an ideal C-section rate is between 10-15% to not be under- or overused, many countries report having rates much higher [4]. In 2014, the United States had an unacceptably high-rate of 32.2% [5]. This is in part due to the current paradigm used for monitoring fetal well-being.

Electronic fetal heart rate monitoring (EFM) was adopted in the 1970’s as a means of assessing fetal well-being during labor and delivery and decrease the incidence of cerebral palsy and neonatal death. However, the rates of cerebral palsy, neonatal death, low Apgar scores, and perinatal death remained unchanged with its introduction, while the rate of C-sections rose dramatically [6]. Despite the overwhelming evidence that EFM has not decreased adverse health outcomes, a high-proportion of C-sections are performed partly or fully in response to a non-reassuring EFM trace [7]. Current interpretations of such traces is that it is suggestive of inadequate blood flow to the fetal brain and, if left untreated, can lead to cerebral palsy, fetal acidosis, and other harmful conditions. However, studies have shown that interpretations of EFM traces are unreliable, produce a high rate of false-positives (99.8%), and may be related to a normal chemoreflex response of the fetus [8][9].

Pregnant ewe/fetal lamb models are often used to investigate pregnancy-related issues prior to clinical trials involving humans.

Clearly there is a need for new fetal well-being monitoring techniques. To address this issue and reduce the number of unnecessary emergency C-sections performed, we have developed a device that will non-invasively give physicians information on fetal oxygenation in utero, previously unattainable during critical stages of labor and delivery.

PUBLICATIONS:

Daniel D. Fong, André Knoesen, Mohammad Motamedi, Terry O’Neill, and Soheil Ghiasi. “Recovering the Fetal Signal in Transabdominal Fetal Pulse Oximetry“, Smart Health, Volumes 9–10, December 2018, Pages 23-36.

Daniel Fong, André Knoesen, Soheil Ghiasi. “Transabdominal Fetal Pulse Oximetry: The Case of Fetal Signal Optimization“, IEEE 19th International Conference on e-Health Networking, Applications and Services (HealthCom), October 2017.

ACKNOWLEDGMENTS:

This work was gratefully supported by a seed grant from CITRIS and the Banatao Institute at the University of California.

References:

  1. Y. Mendelson and B. D. Ochs. Noninvasive pulse oximetry utilizing skin reflectance photo- plethysmography. IEEE Transactions on Biomedical Engineering, 35(10):798–805, Oct 1988.
  2. Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk,” United States, 1998-2001 birth cohorts. Birth Sep;33(3):175-82, 2006.
  3. Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ 336(7635), 85–87, 2008.
  4. APPROPRIATE TECHNOLOGY FOR BIRTH. The Lancet, 326(8452):436 – 437, 1985.
  5. E. Hamilton, J. A. Martin, M. J. Osterman, S. C. Curtin, and T. J. Matthews. Births: final data for 2014. Natl Vital Stat Rep, 64(12):1–64, Dec 2015.
  6. Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD006066. DOI: 10.1002/14651858.CD006066.pub2.
  7. K. B. Nelson, T. P. Sartwelle, and D. J. Rouse. Electronic fetal monitoring, cerebral palsy, and caesarean section: assumptions versus evidence. BMJ, 355, 2016.
  8. Sabiani L, Le Dû R, Loundou A, et al. Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management. Am J Obstet Gynecol 2015;213:856.e1-8. doi:10.1016/j.ajog.2015.08. 066 pmid:26348383.
  9. Nelson KB, Dambrosia JM, Ting TY, Grether JK. Uncertain value of electronic fetal
monitoring in predicting cerebral palsy. N Engl J Med 1996;334:613-8. doi:10.1056/ 36 NEJM199603073341001 pmid:8592523.
Top