Comparison of non-invasive electrohysterographic recording techniques for monitoring uterine dynamics

Non-invasive recording of uterine myoelectric activity (electrohysterogram, EHG) could provide an alternative to monitoring uterine dynamics by systems based on tocodynamometer (TOCO). Laplacian recording of bioelectric signals has been shown to give better spatial resolution and less interference than mono and bipolar surface recordings. The aim of this work was to study the signal quality obtaines from monopolar, bipolar and Laplacian techniques in EHG recordings, as well as to assess their ability to detect uterine contractions. Twenty-two recording sessions were carried out on singleton pregnant women during the active phase of labour. In each session the following simultaneous recordings were obtained: internal uterine pressure (IUP), external tension of abdominal wall (TOCO) and EHG signals (5 monopolar and 4 bipolar recordings, 1 discrete aproximation to the Laplacian of the potential and 2 estimates of the Laplacian from two active annular electrodes). The results obtained show that EHG is able to detect a higher number of uterine contractions than TOCO. Laplacian recordings give improved signal quality over monopolar and bipolar techniques, reduce maternal cardiac interference and improve the signal-to-noise ratio. The optimal position for recording EHG was found to be the uterine median axis and the lower centre-right umbilical zone.Research partly supported by the Spanish Ministerio de Ciencia y Tecnologia (TEC2010-16945) and the Universitat Politecnica de Valencia (PAID 2009/10-2298). The translation of this paper was funded by the Universitat Politecnica de Valencia, Spain.Alberola Rubio, J.; Prats Boluda, G.; Ye Lin, Y.; Valero, J.; Perales Marin, AJ.; Garcia Casado, FJ. (2013). Comparison of non-invasive electrohysterographic recording techniques for monitoring uterine dynamics. Medical Engineering and Physics. 35(12):1736-1743. https://doi.org/10.1016/j.medengphy.2013.07.008S17361743351

Comparison of electrohysterogram signal measured by surface electrodes with different designs: A computational study with dipole band and abdomen models

Non-invasive measurement of uterine activity using electrohysterogram (EHG) surface electrodes has been attempted to monitor uterine contraction. This study aimed to computationally compare the performance of acquiring EHG signals using monopolar electrode and three types of Laplacian concentric ring electrodes (bipolar, quasi-bipolar and tri-polar). With the implementation of dipole band model and abdomen model, the performances of four electrodes in terms of the local sensitivity were quantifed by potential attenuation. Furthermore, the efects of fat and muscle thickness on potential attenuation were evaluated using the bipolar and tri-polar electrodes with diferent radius. The results showed that all the four types of electrodes detected the simulated EHG signals with consistency. That the bipolar and tri-polar electrodes had greater attenuations than the others, and the shorter distance between the origin and location of dipole band at 20dB attenuation, indicating that they had relatively better local sensitivity. In addition, ANOVA analysis showed that, for all the electrodes with diferent outer ring radius, the efects of fat and muscle on potential attenuation were signifcant (all p<0.01). It is therefore concluded that the bipolar and tri-polar electrodes had higher local sensitivity than the others, indicating that they can be applied to detect EHG efectively

Feasibility and analysis of bipolar concentric recording of Electrohysterogram with flexible active electrode

The conduction velocity and propagation patterns of Electrohysterogram (EHG) provide fundamental information about uterine electrophysiological condition. The accuracy of these measurements can be impaired by both the poor spatial selectivity and sensitivity to the relative direction of the contraction propagation associated with conventional disc electrodes. Concentric ring electrodes could overcome these limitations the aim of this study was to examine the feasibility of picking up surface EHG signals using a new flexible tripolar concentric ring electrode (TCRE), and to compare it with conventional bipolar recordings. Simultaneous recording of conventional bipolar signals and bipolar concentric EHG (BC-EHG) were carried out on 22 pregnant women. Signal bursts were characterized and compared. No significant differences among channels in either duration or dominant frequency in the Fast Wave High frequency range were found. Nonetheless, the high pass filtering effect of the BC-EHG records resulted in lower frequency content within the range 0.1 to 0.2 Hz than the bipolar ones. Although the BC-EHG signal amplitude was about 5-7 times smaller than that of bipolar recordings, similar signal-to-noise ratio was obtained. These results suggest that the flexible TCRE is able to pick up uterine electrical activity and could provide additional information for deducing uterine electrophysiological condition.The authors are grateful to the Obstetrics Unit of the Hospital Universitario La Fe de Valencia (Valencia, Spain), where the recording sessions were carried out. The work was supported in part by the Ministerio de Ciencia y Tecnologia de Espana (TEC2010-16945), by the Universitat Politecnica de Valencia (PAID SP20120490) and Generalitat Valenciana (GV/2014/029) and by General Electric Healthcare.Ye Lin, Y.; Alberola Rubio, J.; Prats Boluda, G.; Perales Marin, AJ.; Desantes, D.; Garcia Casado, FJ. (2015). 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Enhancement of Non-Invasive Recording of Electroenterogram by Means of a Flexible Array of Concentric Ring Electrodes

Monitoring intestinal myoelectrical activity by electroenterogram (EEnG) would be of great clinical interest for diagnosing gastrointestinal pathologies and disorders. However, surface EEnG recordings are of very low amplitude and can be severely affected by baseline drifts and respiratory and electrocardiographic (ECG) interference. In this work, a flexible array of concentric ring electrodes was developed and tested to determine whether it can provide surface EEnG signals of better quality than bipolar recordings from conventional disc electrodes. With this aime, sixteen healthy subjects in a fasting state (>8h) underwent recording. The capabiltiy of detecting intestinal pacemaker activity (slow wave) and the influence of physiological interferences were studied. The signals obtained from the concentric ring electrodes proved to be more robust to ECG and respiratory interference than those from conventional disc electrodes. The results also show that intestinal EEnG components such as the slow wave can be more easily identified by the proposed system based on a flexible array of concentric ring electrodes. The developed active electrode array could be a very valuable tool for non-invasive diagnosis of disease states such as ischemia and motility disorders of the small bowel which are known to alter the normal enteric slow wave activity.Research supported in part by the Ministerio de Ciencia y Tecnologia de Espana (TEC 2010-16945). The proof-reading of this paper was funded by the Universitat Politecnica de Valencia, Spain.Garcia Casado, FJ.; Zena Giménez, VF.; Prats Boluda, G.; Ye Lin, Y. (2014). Enhancement of Non-Invasive Recording of Electroenterogram by Means of a Flexible Array of Concentric Ring Electrodes. Annals of Biomedical Engineering. 42(3):651-660. https://doi.org/10.1007/s10439-013-0935-yS651660423Abo, M., J. Liang, L. Qian, and J. D. Chen. 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Active flexible concentric ring electrode for non-invasive surface bioelectrical recordings

Bioelectrical surface recordings are usually performed by unipolar or bipolar disc electrodes even though they entail the serious disadvantage of having poor spatial resolution. Concentric ring electrodes give improved spatial resolution, although this type of electrode has so far only been implemented in rigid substrates and as they are not adapted to the curvature of the recording surface may provide discomfort to the patient. Moreover, the signals recorded by these electrodes are usually lower in amplitude than conventional disc electrodes. The aim of this work was thus to develop and test a new modular active sensor made up of concentric ring electrodes printed on a flexible substrate by thick-film technology together with a reusable battery-powered signal-conditioning circuit. Simultaneous ECG recording with both flexible and rigid concentric ring electrodes was carried out on ten healthy volunteers at rest and in motion. The results show that flexible concentric ring electrodes not only present lower skin electrode contact impedance and lower baseline wander than rigid electrodes but are also less sensitive to interference and motion artefacts. We believe these electrodes, which allow bioelectric signals to be acquired non-invasively with better spatial resolution than conventional disc electrodes, to be a step forward in the development of new monitoring systems based on Laplacian potential recordings.This research was supported in part by the Ministerio de Ciencia y Tecnologia de Espana (TEC2010-16945) and by the Universitat Politecnica de Valencia (PAID 2009/10-2298). The proof-reading of this paper was funded by the Universitat Politecnica de Valencia, Spain.Prats Boluda, G.; Ye Lin, Y.; García Breijo, E.; Ibáñez Civera, FJ.; Garcia Casado, FJ. (2012). Active flexible concentric ring electrode for non-invasive surface bioelectrical recordings. 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Characterization of the effects of Atosiban on uterine electromyograms recorded in women with threatened preterm labor

[EN] Although research studies using electrohysterography on women without tocolytic therapy have shown its potential for preterm birth diagnosis, tocolytics are usually administered in emergency rooms at the first sign of threatened preterm labor (TPL). Information on the uterine response during tocolytic treatment could prove useful for the development of tools able to predict true preterm deliveries under normal clinical conditions. The aim of this study was thus to analyze the effects of Atosiban on Electrohysterogram (EHG) parameters and to compare its effects on women who delivered preterm (WDP) and at term (WDT). Electrohysterograms recorded in different Atosiban therapy stages (before, during and after drug administration) on 40 WDT and 27 WDP were analyzed by computing linear, and non-linear EHG parameters. Results reveal that Atosiban does not greatly affect the EHG signal amplitude, but does modify its spectral content and reduces the energy associated with the fast wave high component in both WDP and WDT, with a faster response in the latter. EHG signal complexity remained constant in WDT, while it increased in WDP until it reached similar values to WDT during Atosiban treatment. The spectral and complexity parameters were able to separate (p < 0.05) WDT and WDP prior to and during tocolytic treatment and before and after treatment, respectively. The results pave the way for developing better and more reliable medical decision support systems based on EHG for preterm delivery prediction in TPL women in clinical scenarios.This work received financial support from the Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund (DPI2015-68397-R), VLC/Campus (UPV-FE-2018-B03) and by Conselleria de Educación, Investigación, Cultura y Deporte, Generalitat Valenciana (GV/2018/104).Mas-Cabo, J.; Prats-Boluda, G.; Ye Lin, Y.; Alberola Rubio, J.; Perales, A.; Garcia-Casado, J. (2019). Characterization of the effects of Atosiban on uterine electromyograms recorded in women with threatened preterm labor. Biomedical Signal Processing and Control. 52:198-205. https://doi.org/10.1016/j.bspc.2019.04.001S1982055

Estudio electrofisiológico del útero humano durante el embarazo a partir de registros no invasivos del electrohisterograma

Título: “Estudio electrofisiológico del útero humano durante el embarazo a partir de registros no invasivos del electrohisterograma” La actividad uterina se monitoriza durante el embarazo y el parto con el objetivo de obtener información sobre las contracciones uterinas, para ayudar a la estimación del inicio y el progreso del trabajo de parto y para evaluar el estado de salud del conjunto materno-fetal. Actualmente, las tocografía externa e interna, son las técnicas más extendidas para la monitorización de la actividad uterina. Éstas técnicas manométricas de uso clínico habitual se limitan a monitorizar las contracciones uterinas a partir de resultante mecánica de la actividad bioeléctrica contráctil. Además, la tocografía externa aporta información poco fiable y dependiente de la subjetividad del examinador. Recientemente, el análisis de la actividad mioeléctrica uterina captada en superficie (electrohisterograma, EHG) ha demostrado ser uno de los marcadores biofísicos más prometedores no sólo de la dinámica uterina sino también del estado electrofisiológico del útero. Sin embargo, a pesar de haberse demostrando que el EHG aporta información muy valiosa, no ha habido una traslación de esta técnica al uso clínico. Introducir el EHG en la práctica clínica requiere atender las principales demandas de los obstetras, como son: simplificar los protocolos y sistemas de adquisición de señal, facilitar la interpretación de la información adquirida y verificar su utilidad en escenarios clínicos. Por ello, en esta Tesis Doctoral se ha comparado la capacidad de detección de la actividad contráctil uterina de los sistemas utilizados en la práctica clínica habitual, respecto de diferentes configuraciones de registros de EHG en superficie abdominal y con el objetivo de acercar lo máximo posible la electrohisterografía a la clínica, se ha desarrollado electrodos más cómodos y de mejor contacto, un monitor obstétrico de EHG amigable en entorno clínico, se ha estudiado la generación de señales fácilmente interpretables por el personal clínico, se han implementado sistemas automáticos de detección de artefactos para así evitar la confusión en la interpretación de las mismas y sistemas de diagnóstico automáticos para la predicción de parto en menos de 24h

Evaluation of Respiratory Muscle Activity by Means of Concentric Ring Electrodes

© 2021 IEEE. Personal use of this material is permitted. Permissíon from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertisíng or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.[EN] Surface electromyography (sEMG) can be used for the evaluation of respiratory muscle activity. Recording sEMG involves the use of surface electrodes in a bipolar configuration. However, electrocardiographic (ECG) interference and electrode orientation represent considerable drawbacks to bipolar acquisition. As an alternative, concentric ring electrodes (CREs) can be used for sEMG acquisition and offer great potential for the evaluation of respiratory muscle activity due to their enhanced spatial resolution and simple placement protocol, which does not depend on muscle fiber orientation. The aim of this work was to analyze the performance of CREs during respiratory sEMG acquisitions. Respiratory muscle sEMG was applied to the diaphragm and sternocleidomastoid muscles using a bipolar and a CRE configuration. Thirty-two subjects underwent four inspiratory load spontaneous breathing tests which was repeated after interchanging the electrode positions. We calculated parameters such as (1) spectral power and (2) median frequency during inspiration, and power ratios of inspiratory sEMG without ECG in relation to (3) basal sEMG without ECG (R-ins/noise), (4) basal sEMG with ECG (R-ins/cardio) and (5) expiratory sEMG without ECG (R-ins/exp). Spectral power, R-ins/noise and R-ins/cardio increased with the inspiratory load. Significantly higher values (p < 0.05) of R-ins/cardio and significantly higher median frequencies were obtained for CREs. R-ins/noise and R-ins/exp were higher for the bipolar configuration only in diaphragm sEMG recordings, whereas no significant differences were found in the sternocleidomastoid recordings. Our results suggest that the evaluation of respiratory muscle activity by means of sEMG can benefit from the remarkably reduced influence of cardiac activity, the enhanced detection of the shift in frequency content and the axial isotropy of CREs which facilitates its placement.This work was supported in part by the CERCA Program/Generalitat de Catalunya, in part by the Secretaria d'Universitats i Recerca de la Generalitat de Catalunya under Grant GRC 2017 SGR 01770, in part by the Spanish Grants RTI2018-098472-B-I00, RTI2018-094449-A-I00-AR (MCIU/AEI/FEDER, UE) and DPI2015-68397-R (MINECO/FEDER), and in part by the Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN, Instituto de Salud Carlos III/FEDER). The first author was supported by the IFARHU-SENACYT Scholarship Program from the Panama Government under Grant 270-2012-273.Estrada-Petrocelli, L.; Torres, A.; Sarlabous, L.; Ràfols-De-Urquía, M.; Ye Lin, Y.; Prats-Boluda, G.; Jané, R.... (2021). Evaluation of Respiratory Muscle Activity by Means of Concentric Ring Electrodes. IEEE Transactions on Biomedical Engineering. 68(3):1005-1014. https://doi.org/10.1109/TBME.2020.3012385S1005101468

Uterine contractile efficiency indexes for labor prediction: a bivariate approach from multichannel electrohysterographic records

[EN] Labor prediction is one of the most challenging goals in obstetrics, mainly due to the poor understanding of the factors responsible for the onset of labor. The electrohysterogram (EHG) is the recording of the myoelectrical activity of myometrial cells and has been shown to provide relevant information on the electrophysiological state of the uterus. This information could be used to obtain more accurate labor predictions than those of the currently used techniques, such as the Bishop score, tocography or biochemical markers. Indeed, a number of efforts have already been made to predict labor by this method, separately characterizing the intensity, the coupling degree of the EHG signals and myometrial cell excitability, these being the cornerstones on which contraction efficiency is built. Although EHG characterization can distinguish between different obstetric situations, the reported results have not been shown to provide a practical tool for the clinical detection of true labor. The aim of this work was thus to define and calculate indexes from multichannel EHG recordings related to all the phenomena involved in the efficiency of uterine myoelectrical activity (intensity, excitability and synchronization) and to combine them to form global efficiency indexes (GEI) able to predict delivery in less than 7/14 days. Four EHG synchronization indexes were assessed: linear correlation, the imaginary part of the coherence, phase synchronization and permutation cross mutual information. The results show that even though the synchronization and excitability efficiency indexes can detect increasing trends as labor approaches, they cannot predict labor in less than 7/14 days. However, intensity seems to be the main factor that contributes to myometrial efficiency and is able to predict labor in less than 7/14 days. All the GEls present increasing monotonic trends as pregnancy advances and are able to identify (p < 0.05) patients who will deliver in less than 7/14 days better than single channel and single phenomenon parameters. The GEI based on the permutation cross mutual information shows especially promising results. A simplified EHG recording protocol is proposed here for clinical practice, capable of predicting deliveries in less than 7/14 days, consisting of 4 electrodes vertically aligned with the median line of the uterus. (C) 2018 Elsevier Ltd. All rights reserved.The authors are grateful to Zhenhu Liang, of the Yanshan University, who provided essential information for computing the PLV and NPCMI synchronization indexes. This work was supported by the Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund (DPI2015-68397-R, MINECO/FEDER).Mas-Cabo, J.; Ye Lin, Y.; Garcia-Casado, J.; Alberola Rubio, J.; Perales Marín, AJ.; Prats-Boluda, G. (2018). Uterine contractile efficiency indexes for labor prediction: a bivariate approach from multichannel electrohysterographic records. Biomedical Signal Processing and Control. 46:238-248. https://doi.org/10.1016/j.bspc.2018.07.018S2382484

A Flexible Multiring Concentric Electrode for Non-Invasive Identification of Intestinal Slow Waves

[EN] Developing new types of optimized electrodes for specific biomedical applications can substantially improve the quality of the sensed signals. Concentric ring electrodes have been shown to provide enhanced spatial resolution to that of conventional disc electrodes. A sensor with different electrode sizes and configurations (monopolar, bipolar, etc.) that provides simultaneous records would be very helpful for studying the best signal-sensing arrangement. A 5-pole electrode with an inner disc and four concentric rings of different sizes was developed and tested on surface intestinal myoelectrical recordings from healthy humans. For good adaptation to a curved body surface, the electrode was screen-printed onto a flexible polyester substrate. To facilitate clinical use, it is self-adhesive, incorporates a single connector and can perform dry or wet (with gel) recordings. The results show it to be a versatile electrode that can evaluate the optimal configuration for the identification of the intestinal slow wave and reject undesired interference. A bipolar concentric record with an outer ring diameter of 30 mm, a foam-free adhesive material, and electrolytic gel gave the best results.Grant from the Ministerio de Economia y Competitividad y del Fondo Europeo de Desarrollo Regional. DPI2015-68397-R (MINECO/FEDER).Zena-Giménez, VF.; Garcia Casado, FJ.; Ye Lin, Y.; Garcia-Breijo, E.; Prats-Boluda, G. (2018). A Flexible Multiring Concentric Electrode for Non-Invasive Identification of Intestinal Slow Waves. Sensors. 18(2):396-412. https://doi.org/10.3390/s18020396S39641218