Department of Obstetrics and Gynaecology, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands.
Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600, MB, Eindhoven, The Netherlands.
BMC Pregnancy Childbirth. 2020 Apr 15;20(1):215. doi: 10.1186/s12884-020-02918-8.
Twin pregnancy is associated with increased perinatal mortality. Close foetal monitoring is therefore warranted. Doppler Ultrasound cardiotocography is currently the only available method to monitor both individual foetuses. Unfortunately, the performance measures of this method are poor and erroneous monitoring of the same twin with both transducers may occur, leaving the second twin unmonitored. In this study we aimed to determine the feasibility of monitoring both foetuses simultaneously in twin gestation by means of non-invasive foetal electrocardiography (NI-fECG), using an electrode patch on the maternal abdomen.
A NI-fECG recording was performed at 25 + 3 weeks of gestation on a multiparous woman pregnant with dichorionic diamniotic twins. An electrode patch consisting of eight adhesive electrodes was applied on the maternal abdomen, yielding six channels of bipolar electrophysiological measurements. The output was digitized and stored for offline processing. The recorded signals were preprocessed by suppression of high-frequency noise, baseline wander, and powerline interference. Secondly, the maternal ECG was subtracted and segmentation into individual ECG complexes was performed. Finally, ensemble averaging of these individual ECG complexes was performed to suppress interferences.
Six different recordings were obtained from each of the six recording channels. Depending on the orientation and distance of the fetal heart with respect to each electrode, a distinction could be made between each fetus based on the morphology of the signals. Yielding of the fetal ECGs was performed manually based on the QRS complexes of each fetus.
NI-fECG with multiple electrodes allows for monitoring of the fetal heart rate and ECG of both individual fetuses in twin pregnancies.
双胞胎妊娠与围产期死亡率增加有关。因此，有必要进行密切的胎儿监测。多普勒超声胎心监护是目前唯一可用于监测两个胎儿的方法。不幸的是，这种方法的性能指标较差，并且可能会在两个换能器上对同一双胞胎进行错误监测，从而导致第二个胎儿未被监测。在这项研究中，我们旨在通过在 25+3 孕周的多胎妊娠孕妇的腹部使用电极片，通过非侵入性胎儿心电图（NI-fECG）来同时监测双胞胎胎儿的可行性。
在一名双绒毛膜双羊膜双胞胎的多胎妊娠妇女的腹部应用由 8 个粘性电极组成的电极片，进行 NI-fECG 记录，从而获得 6 个双极电生理测量通道。输出信号被数字化并存储以供离线处理。记录的信号经过预处理，包括抑制高频噪声、基线漂移和电源线干扰。其次，减去母体心电图并对其进行个体心电图复合波的分段。最后，对这些个体心电图复合波进行集合平均以抑制干扰。
从每个 6 个记录通道中获得了 6 个不同的记录。根据胎儿心脏相对于每个电极的方向和距离，可以根据信号的形态来区分每个胎儿。基于每个胎儿的 QRS 复合物手动进行胎儿心电图的获取。
多电极的 NI-fECG 可用于监测双胞胎妊娠中两个胎儿的心率和心电图。
