Abstract
Background:Indirect fetal electrocardiography is preferable to direct fetal electrocardiography because of being noninvasive and is applicable also during the end of pregnancy, besides labor. Still, the former is strongly affected by noise so that even R-peak detection (which is essential for fetal heart-rate evaluations and subsequent processing procedures) is challenging. Some fetal studies have applied the Pan-Tompkins’ algorithm that, however, was originally designed for adult applications. Thus, this work evaluated the Pan-Tompkins’ algorithm suitability for fetal applications, and proposed fetal adjustments and optimizations to improve it. Method: Both Pan-Tompkins’ algorithm and its improved version were applied to the “Abdominal and Direct Fetal Electrocardiogram Database” and to the “Noninvasive Fetal Electrocardiography Database” of Physionet. R-peak detection accuracy was quantified by computation of positive-predictive value, sensitivity and F1 score. Results:When applied to “Abdominal and Direct Fetal Electrocardiogram Database”, the accuracy of the improved fetal Pan-Tompkins’ algorithm was significantly higher than the standard (positive-predictive value: 0.94 vs. 0.79; sensitivity: 0.95 vs. 0.80; F1 score: 0.94 vs. 0.79; P<0.05 in all cases) on indirect fetal electrocardiograms, whereas both methods performed similarly on direct fetal electrocardiograms (positive-predictive value, sensitivity and F1 score all close to 1). Improved fetal Pan-Tompkins’ algorithm was found to be superior to the standard also when applied to “Noninvasive Fetal Electrocardiography Database” (positive-predictive value: 0.68 vs. 0.55, P<0.05; sensitivity: 0.56 vs. 0.46, P=0.23; F1 score: 0.60 vs. 0.47, P=0.11).Conclusion:In indirect fetal electrocardiographic applications, improved fetal Pan-Tompkins’ algorithm is to be preferred over the standard, since it provides higher R-peak detection accuracy for heart-rate evaluations and subsequent processing.
Highlights
Fetal electrocardiography (FECG) provides important information on fetal well-being and allows diagnosis of cardiac abnormalities, especially in early stages of heart development [1 - 3]
Improved fetal Pan-Tompkins' algorithm (IFPTA) performed better than Pan-Tompkins’ algorithm (PTA) in all indirect FECG (IFECG) recordings, whereas the two methods performances were compared when applied to Direct FECG (DFECG) (Table 1)
This is mainly due to the fact that signal-to-noise ratio (SNR) associated to DFECG was significantly grater than that associated to IFECG ([3.3 [1.6;4.8] dB vs. -2.3 [-7.4;0.6] dB, P=3.9∙10-3, as previously found in [7])
Summary
Fetal electrocardiography (FECG) provides important information on fetal well-being and allows diagnosis of cardiac abnormalities, especially in early stages of heart development [1 - 3]. Direct FECG (DFECG) is typically characterized by a good signal quality but its applicability is. Indirect FECG (IFECG) is typically corrupted by a significant amount of noise, but the procedure can be applied from the 37th-38th week of pregnancy. Given its noninvasiveness and the wider period of applicability, IFECG is considered preferable over DFECG. Indirect fetal electrocardiography is preferable to direct fetal electrocardiography because of being noninvasive and is applicable during the end of pregnancy, besides labor. Still, the former is strongly affected by noise so that even R-peak detection (which is essential for fetal heart-rate evaluations and subsequent processing procedures) is challenging. This work evaluated the PanTompkins’ algorithm suitability for fetal applications, and proposed fetal adjustments and optimizations to improve it
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