The way to diagnose the condition of the fetus during pregnancy and device for its implementation

 

The invention relates to medicine, obstetrics. Register joint ECG mother and fetus. Analyze its second derivative. Allot of joint electrocardiogram QRS-complexes of the fetus, comparing them with the parameters of the reference QRS-complexes of the fetus and the mother. Measure the RMS value of the cardiac rhythm of the fetus in the full frequency range of its fluctuations and in the range of fluctuations with a center frequency of 0.075 Hz. The fetus is diagnosed the ratio of RMS values of the fluctuations. A device for implementing the method comprises a series-connected electrodes and the amplifier cardiomegaly. In addition, it contains a device for fixing a reference QRS-complexes, a selector device for measuring cardiac intervals fruit, bandpass filter, the first and second measures the RMS value, the processing unit of the diagnostic parameter and sequentially connected first and second differentiator. The method and apparatus allow for a better assessment of the status of the fetus, to detect the initial signs of hypoxia and can be used both in the hospital and in the antenatal clinic. 2 S. p. f-crystals, 6 ill.

Izopet the sticky condition of the fetus during pregnancy by analyzing the state of the circulatory system of the fetus.

There is a method of diagnosing the condition of the fetus during pregnancy, which is the most available and widely used method for monitoring the functional status of the fetus during pregnancy and is in direct instantaneous heart rate (HR) fetal ultrasonic sensing, based on the Doppler effect, the abdominal placement of an ultrasonic transducer within a certain interval of monitor observations (20...60 min) (1).

The disadvantage of this method of measurement variation is superimposed on the signal (HR) interference caused by motor activity of the fetus, as well as variable interference with methodological nature (1). As a result the heart rate of the fetus in time often is fragmented, not allowing to analyze the full spectrum of HR in the entire frequency range of its change. The analysis of the spectral composition of the variation is reduced to the visual selection and classification of some of the most common and visually manifested features of the cardiac rhythm of the fetus: the fundamental frequency (basal level), temporal changes in heart rate ranging from 15 s to 10 min, resulting motor Akti is the frequency (1), (2). In particular, the pathological condition of the fetus particular, a rare type of oscillations, the so-called "sinus rhythm", representing waves with a frequency of 3-5 cycles per minute and an amplitude of from 5 to 70 beats/min (1), (2).

Modern methods of assessment of fetal status based on this method, the different treatment combinations of these features heart rate of the fetus and low reliability of the diagnosis of pathology in the early stages of its development. A marked disadvantage of measuring the heart rate of the fetus ultrasonic sensing is not possible to conduct a full spectral analysis of the oscillations of the heart rate of the fetus and to develop more sophisticated methods of evaluation.

There is also known a method of assessing the state of the circulatory system of the fetus during pregnancy, most similar to that proposed, which consists in registration of joint electrocardiogram (ECG) of the fetus and the mother, then the analysis and making of the diagnosis (1), (3).

In the known method, the registration of the joint ECG of the fetus and the mother is from the anterior abdominal wall of the mother (abdominal ECG) (1).

This method also allows you to get information about the heart rate of the fetus F=60/T, where T is the duration of cardiointervals between R-teeth QRS-amego time failed to create device for efficient extraction of QRS-complexes of the fetus from the abdominal ECG, measuring intervals between adjacent R-teeth and thereby obtain ramagrama heartbeat of the fetus.

Known to be closest to the intended device to diagnose the condition of the circulatory system of the fetus during pregnancy, containing series-connected electrodes and the amplifier cardiomegaly (1).

The disadvantage of this device is that the output information is a joint ECG mother and fetus, and not the heart rate of the fetus.

The proposed invention solves the problem of improving the accuracy of diagnosing the condition of the fetus during pregnancy by detecting the state of the circulatory system of the fetus during pregnancy, namely compensated hypoxia on preclinical stage of its development. Regardless of the etiology of the disorders of the circulatory system of the fetus, it leads to oxygen suffering hypoxia. Hypoxia is called compensated until such time as the circulatory system mother - placenta - fetus-placental system, it is possible to compensate for the lack of oxygen.

The problem is solved by the formation of a continuous sampling of the R-interval fruit of joint electrocardiogram of the fetus and the mother and evaluation of SOS.

To achieve this result, the register of joint electrocardiogram of the mother and fetus, measure the second derivative of the joint ECG, fix the second derivative and the duration of the reference QRS-complexes of the fetus and the mother, separated from the joint ECG remaining QRS-complexes of the fetus by comparing them with the parameters of the reference QRS-complexes of the fetus and the mother, and recording the values of the selected R-interval fruit, measure the RMS value of the cardiac rhythm of the fetus in the full frequency range of its fluctuations and in the accepted range of frequency fluctuations with a center frequency of 0.075 Hz, and the making of the diagnosis is done according to the ratio of the RMS value of the fluctuations of the cardiac rhythm of the fetus.

Distinctive features of the proposed method consists in measurement of the second derivative of the ECG, fixing the second derivative and the duration of the reference QRS-complexes of the fetus and the mother, the allocation of joint electrocardiogram remaining QRS-complexes of the fetus by comparing them with the parameters of the reference QRS-complexes of the fetus and the mother, fixing the values of the selected R-R-interval of the fetus, measuring RMS values of the cardiac rhythm of the fetus in the full frequency range of its fluctuations and in the accepted range is edeclarations values of fluctuations of the cardiac rhythm of the fetus.

To achieve the mentioned technical result of the proposed device comprises a series-connected electrodes and the amplifier cardiomegaly. In contrast to the known proposed device contains a device for fixing a reference QRS-complexes of series-connected first and second differentiator, the device measuring the duration and amplitude of the QRS-complexes, a selector device for measuring cardiac intervals fruit, bandpass filter, the first and second measures the RMS value of and device for generating diagnostic parameter. When this locking device reference QRS-complexes, the first and second differentiator connected to the output of amplifier cardiomegaly, devices for measuring the amplitude and duration of the reference QRS-complexes and the first input of the selector through its informational inputs connected to the output of the second differentiator, the output device fixing the reference QRS-complexes connected to control inputs of the device measuring the duration and amplitude of the reference QRS-complexes, and the outputs of the measuring devices of the amplitude and duration of the reference QRS-complexes are connected respectively to the second and third inputs of the selector, the output select the first meter RMS, the output of bandpass filter connected to the second meter RMS, and to the outputs of the measure of the RMS value of the connected device for generating diagnostic parameter.

The invention is illustrated by drawings, which depict:

in Fig.1 - fragment of joint electrocardiogram of the mother and fetus;

in Fig.2 is an example of "sinusoidal" heart rate of the fetus and heart rate of the mother, received from joint ECG;

in Fig.3 - normalized spectral density sine heart rate of the fetus shown in Fig.2;

in Fig.4 is an example of records the heart rate of the fetus and the mother received from joint ECG corresponding boundary occasion;

in Fig.5 - normalized spectral density of the cardiac rhythm of the fetus shown in Fig.4 and the corresponding boundary occasion;

in Fig. 6 is a functional diagram of the device.

The proposed method is carried out in the following sequence.

At a joint ECG cardiocomplex fruit 1 appears QRS-complex amplitude (of the order of 10...40 Áv), usually considerably smaller than the amplitude of a QRS-complex of the mother of 2 and close to the level of measurement noise. QRS-complexes of the fruit near the x ECG, including QRS-complexes of the same fruit, recorded at different times. Factor in enabling them to implement the proposed method and to highlight the QRS-complexes of the fruit of joint electrocardiogram of the mother and fetus, is fixed by the operator of the reference QRS complex fruit and a QRS-complex of the mother. For example, on the screen of the video display.

Thus the identification of the remaining QRS-complexes of the fruit is brought additional a priori information - the parameters of a QRS-complex of the fetus and the QRS-complex of the mother from the same ECG.

Measuring first and second derivatives of the ECG in the double differentiation allows us to separate QRS-complexes of the fetus and the mother from slowly changing evolutions of the middle line of the ECG and fix the beginning and the end of all observed peaks, including QRS-complexes of the fetus and the mother. Obstetrician, fixing on one or more ECG QRS-complexes of fruit and QRS-complexes mother as a reference, thus captures the temporal location of the peaks in the second derivative of the ECG corresponding to the time reference QRS-complexes of the fetus and the mother. The parameters of the reference peaks are compared with the similar parameters of all other peaks in the second derivative of the ECG. The peaks correspond to the selection criteria, are accepted in quality(R-interval) and is formed rhythmogram fetus 3 and 5 the dependence of the instantaneous values of the R-interval variation (or variation) of fruit from time to time.

Rhythmogram is a random stationary process for which the Fourier transform can be found spectral density describing the distribution of variance of heart rhythm frequency f

where Rx- autocorrelation function of heart rate,

where Xk(tk)- the heart rate at time tk.

Cardiac activity of the fetus during pregnancy is characterized by more frequent 3 and 5 compared with the parent 4 and 6 and is constantly oscillating rhythm. The change of rhythm is one of the most important compensatory-adaptive reactions of the circulatory system.

In response to hypoxia, the fetus responds universal adaptive reaction - rearrangement of the cardiovascular system to a new level and redistribution of blood flow. The result of it is the new distribution of the amplitudes of the oscillations on the frequency scale in comparison with the distribution corresponding to the physiological condition of the fruit.

According to the three-component theory of regulation serdechnaya oscillators. In the spectrum of heart rhythm usually distinguish three zones of frequency modulation period of the cardiac cycle: metabolic (0.05 Hz), vascular (0,11 0,05... Hz) and respiratory (higher of 0.11 Hz).

As we experimentally found that, in contrast to the human spectral density of the cardiac rhythm of the fetus 3 and 5 are determined mainly by the first two zones of frequencies. In the mid-frequency area of the spectral density we found a peak at a frequency of 0.075 Hz. The peak at the frequency of 0.075 Hz, as shown by our research, is observed in the mother before birth, and then disappears. All this allows to associate it with fetoplacental circulation unified system mother - placenta - fetus. Confirmation of this assumption was the increase in the peak at the frequency of 0.075 Hz 7 and 8 of the normalized spectral density of heart rhythm fetal hypoxia as a result of activation of a compensatory mechanism and, as a consequence, the corresponding adjustment of the cardiovascular system. Redistribution of blood flow when the compensated hypoxia leads to an increase in the relative values of the peak spectral density at the frequency of 0.075 Hz and the more, the more severe the degree of hypoxia.

Therefore, the previously mentioned reckonability peak normirovannoi spectral density at the frequency of 0.075 Hz high amplitude 7.

The weaker the degree of hypoxia visually on the heart beat of the fetus to observe, it is not because manifest and other harmonic oscillations of heart rhythm 5.

But it can be identified by the proposed method. The factor that has diagnostic value in this way, are not the absolute value of the oscillations, and their relative performance. In the proposed method, this indicator is the ratio of the RMS values of the cardiac rhythm of the fetus in the full frequency range of its fluctuationsand in the accepted rangef frequency fluctuationsfwith a center frequency of 0.075 Hz, which is determined by the basis of the above peak

The above standard attitude can be found in one of the following ways:

where Xf- oscillations of heart rhythm in the accepted frequency rangef=f2-f1;

The highest value of the ratio corresponds to a sinusoidal rhythm. Attitude, since it is by experimentally on birth outcomes. In our case, was determined according to the Apgar scale. The spectral density of 8 heart rhythm fruit 5 corresponds to the ratio of characteristic boundary case.

The proposed device for diagnosing the condition of the fetus during pregnancy contains the electrodes and the amplifier cardiomegaly 9, the locking device etalonnage QRS-complex fruit 10 sequentially included the first 11 and second differentiator 12, the device measuring the amplitude of 13 and duration 14 QRS-complexes, the selector 15, a measuring device of the R-interval fruit 16, band-pass filter 17, the first 18 and second 19 meters RMS and device for the formation of a diagnostic parameter of 20, with the locking device of the reference QRS-complexes 10, the first 11 and second 12 differentiator connected to the output of amplifier cardiomegaly 9, devices for measuring the amplitude of 13 and duration of 14 reference QRS-complexes and the first input of the selector 15 through its informational inputs connected to the output of the second differentiator 12, to the output device fixing the reference QRS-complexes 10 connected to the control inputs of the device measuring the amplitude of 13 and duration of 14 reference QRS-complexes, and the outputs of the devices measuring the amplitude of 13 and d is yhou selector 15 is connected a device to measure R-R-interval of the fetus 16, the output of which is connected band-pass filter 17 and the first meter of srednekvadraticheskogo values 18, the output of the band pass filter 17 is connected to the second meter RMS 19, and to the outputs of the meters RMS 18 and 19 connected device forming a diagnostic parameter of 20.

The device operates as follows.

Using electrodes and amplifier cardioidal continuously for 5...10 min register joint ECG mother and fetus. The midwife using a fixation device of the reference QRS complex records (for example, by using the pointing device on the screen of the video display) typical in his opinion QRS-complexes of the fetus and the mother (at least one of a QRS-complex of fruit and one of a QRS-complex of the mother), taking them as a reference, and devices for measuring the amplitude and duration simultaneously record the corresponding time reference QRS-complexes of the fetus and the mother of the amplitude and duration of the peaks in the second derivative of the ECG. obtained from the output of the second differentiator. The selector selects the second derivative of the ECG peaks corresponding to the remaining QRS-complexes of the fetus, by comparing them with the parameters of the reference QRS-complexes of the fetus and the mother, and the device is the fetch-R-interval (ramagrama) adopted frequency band, the first and second measures the RMS value of the form of primary and transformed samples of the RMS value of the cardiac rhythm of the fetusaccording to one of the expressions

where

The forming device diagnostic parameter generates a diagnostic parameter, the ratio of the RMS values of the second value to the first and makes a diagnosis of the condition of the circulatory system of the fetus, comparing the diagnostic parameter boundary value.

Shown in Fig.1...5 print obtained using the proposed device.

As shown by the test, the inventive method and device can reliably determine the physiological condition of the fetus in 90,5% (▒5%, p<0.05) of the cases and to detect the initial signs of hypoxia in 80% (9,4%, p<0.05) and can be applied in a maternity home, and in the antenatal clinic.

Sources used:

1. Markin, L. B., Pawlowski M. P. and others Monitor system in obstetrics. - Kiev: Health, 1992, 13, 127, 25, 109-112,114, 23, 30, 31, 56 C.

2. 86, 16-19, 40 S.

3. Pilipenko, N. In., Beletsky Y. C. Method of evaluating the condition of blood circulation of the fetus. A. C. the USSR # 624602, 1978.

Claims

1. The way to diagnose the condition of the fetus during pregnancy, which consists in the removal of joint electrocardiogram of the mother and fetus, in its subsequent analysis and rendering diagnosis of the condition of the fetus, characterized in that in the analysis additionally measure the second derivative of the joint ECG, fix the second derivative and the duration of the reference QRS-complexes of the fetus and the mother, separated from the joint ECG QRS-complexes of the fetus by comparing them with the parameters of the reference QRS-complexes of the fetus and the mother, and recording the values of the selected R-interval fruit, measure the RMS value of the cardiac rhythm of the fetus in the full frequency range of its fluctuations and in the accepted frequency range fluctuations, which is determined by the base peak with a center frequency of 0.075 Hz, and the making of the diagnosis is done according to the ratio of RMS values of the cardiac rhythm of the fetus.

2. A device for implementing the method according to p. 1, containing series-connected electrodes and the amplifier cardiomegaly, characterized in that it further comprises a second filter, the first and second measures the RMS value, the processing unit of the diagnostic parameter and sequentially connected first and second differentiator, with locking device reference QRS-complexes and the first differentiator connected to the output of amplifier cardiomegaly, devices for measuring the amplitude and duration of the reference QRS-complexes and the first input of the selector through its informational inputs connected to the output of the second differentiator, the output device fixing the reference QRS-complexes connected to control inputs of the device measuring the amplitude and duration of the reference QRS-complexes, and the outputs of the measuring devices of the amplitude and duration of the reference QRS-complexes are connected respectively to the second and to the third input of the selector, to the output of the selector is connected a device to measure R-R-interval of the fetus, the output of which is connected band-pass filter and the first meter RMS, the output of bandpass filter connected to the second meter RMS, and to the outputs of measuring the RMS value of the connected device for generating diagnostic parameter.

 

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