Antepartum Fetal Monitoring through a Wearable System and a Mobile Application

Prenatal monitoring of Fetal Heart Rate (FHR) is crucial for the prevention of fetal pathologies and unfavorable deliveries. However, the most commonly used Cardiotocographic exam can be performed only in hospital-like structures and requires the supervision of expert personnel. For this reason, a wearable system able to continuously monitor FHR would be a noticeable step towards a personalized and remote pregnancy care. Thanks to textile electrodes, miniaturized electronics, and smart devices like smartphones and tablets, we developed a wearable integrated system for everyday fetal monitoring during the last weeks of pregnancy. Pregnant women at home can use it without the need for any external support by clinicians. The transmission of FHR to a specialized medical center allows its remote analysis, exploiting advanced algorithms running on high-performance hardware able to obtain the best classification of the fetal condition. The system has been tested on a limited set of pregnant women whose fetal electrocardiogram recordings were acquired and classified, yielding an overall score for both accuracy and sensitivity over 90%. This novel approach can open a new perspective on the continuous monitoring of fetus development by enhancing the performance of regular examinations, making treatments really personalized, and reducing hospitalization or ambulatory visits. Keywords: tele-monitoring; wearable devices; fetal heart rate; telemedicin

Monitoring Fetal Heart Rate during Pregnancy: Contributions from Advanced Signal Processing and Wearable Technology

Monitoring procedures are the basis to evaluate the clinical state of patients and to assess changes in their conditions, thus providing necessary interventions in time. Both these two objectives can be achieved by integrating technological development with methodological tools, thus allowing accurate classification and extraction of useful diagnostic information. The paper is focused on monitoring procedures applied to fetal heart rate variability (FHRV) signals, collected during pregnancy, in order to assess fetal well-being. The use of linear time and frequency techniques as well as the computation of non linear indices can contribute to enhancing the diagnostic power and reliability of fetal monitoring. The paper shows how advanced signal processing approaches can contribute to developing new diagnostic and classification indices. Their usefulness is evaluated by comparing two selected populations: normal fetuses and intra uterine growth restricted (IUGR) fetuses. Results show that the computation of different indices on FHRV signals, either linear and nonlinear, gives helpful indications to describe pathophysiological mechanisms involved in the cardiovascular and neural system controlling the fetal heart. As a further contribution, the paper briefly describes how the introduction of wearable systems for fetal ECG recording could provide new technological solutions improving the quality and usability of prenatal monitoring. © 2014 Maria G. Signorini et al

Fetal heart rate monitoring and neonatal outcome in a population of early- and late-onset intrauterine growth restriction

AIM: The early-onset intrauterine growth restriction (IUGR) is associated with severe placental insufficiency and Doppler abnormalities. The late-onset IUGR is associated with mild placental insufficiency and normal Doppler velocimetry. The computerized cardiotocographic (cCTG) monitoring is used to evaluate the fetal well-being in pregnancies complicated by IUGR. Our aim was to investigate the cardiotocographic characteristics of IUGR fetuses and to identify every cCTG difference between Healthy and IUGR fetuses. METHODS: Four hundred thirty pregnant women were enrolled starting from the 28th week of gestation until the time of delivery: 200 healthy and 230 IUGR fetuses. Fetal heart rate (FHR) baseline (FHR), short-term variability (STV), long-term irregularity (LTI), delta, interval index (II), approximate entropy (ApEn), high frequency (HF), low frequency (LF), movement frequency (MF), LF/(HF + MF) ratio (LF/(HF + MF)) and number of decelerations were examined. Newborn baby data were also collected. RESULTS: The parameters of short- and medium-term variability discriminate between IUGR and healthy fetuses before 36 weeks including FHR, STV, LTI and delta discriminate between each subgroup of IUGR were compared to each one of the other two (P < 0.05). CONCLUSION: cCTG is a useful tool for the evaluation of chronic hypoxemia, which causes a delay in the maturation of all components of the autonomic and central nervous system. However, cCTG requires integration with fetal ultrasound and Doppler vessels evaluation to improve the ability to predict the neonatal outcome

Characterization of cardiorespiratory phase synchronization and directionality in late premature and full term infants

Objective: Though the mutual influence of cardiovascular and respiratory rhythms in healthy newborns has been documented, its full characterization is still pending. In general, the activity of many physiological subsystems has a well-expressed rhythmic character, and often an interdependency between physiological rhythms emerges early in development. Traditional methods of data analysis only address the quantification of the strength of subsystem interactions. In this work, we will investigate system interrelationships in terms of the possible presence of causal or directional interplays. Approach: In this paper, we propose a methodological application that quantifies phase coupling and its directionality in a population of newborn infants born between 35 and 40 weeks of gestational age (GA). The aim is to assess whether GA at birth significantly influences the development of phase synchronization and the directionality of the coupling between the cardiovascular and respiratory system activity. Several studies indicating irregular cardiorespiratory coupling as a leading cause of several pathologies underscore the need to investigate this phenomenon in this at-risk population. Main results: Results from our investigation show a different directionality profile as a function of GA and sleep state. Significance: These findings are a contribution to the understanding of higher risk for the documented negative outcomes in the late preterm population. Moreover, these parameters could provide a tool for the development of early markers of cardiorespiratory dysregulation in infants

Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA "search and isolate" strategy in a hospital in Italy with hyperendemic MRSA

Abstract OBJECTIVE: To evaluate the secular trends in MRSA BSIs after the introduction of a nosocomial MRSA control intervention. DESIGN: Before-after study. SETTING: An 850-bed community hospital with an ICU and vascular surgery, neurosurgery, bone marrow transplantation, and AIDS units. MRSA is endemic at this hospital; the prevalence of methicillin resistance among patients with S. aureus infection is greater than 50%. PATIENTS: Among all inpatients, MRSA BSI was identified, its origin defined, and incidence rates calculated by ward and origin. INTERVENTION: A MRSA control program was implemented based on active surveillance cultures to identify MRSA-colonized patients, followed by isolation using contact precautions. Incidence rates of MRSA BSI during the intervention (i.e., July 1, 1997, to December 31, 2001) and preintervention (i.e., January 1, 1996, to June 30, 1997) periods were compared. RESULTS: Sixty-nine MRSA BSIs were identified. When compared with the preintervention period, the incidence rate of MRSA BSI was reduced from 0.64 to 0.30 per 1000 admissions (RR, 0.46; CI95, 0.25-0.87; P = .02) during the intervention period. The impact was greater in the ICU, with an 89% reduction (RR, 0.11; CI95, 0.01-0.98; P = .03), and for CVC-associated MRSA BSIs, with an 82% decrease (RR, 0.17; CI95, 0.05-0.55; P = .002). Methicillin resistance among S. aureus blood isolates decreased from 46% to 17% (RR, 0.36; CI95, 0.22-0.62; P = .0002). CONCLUSION: A reduction in MRSA bacteremia is achievable through use of the MRSA "search and isolate" intervention even in a hospital with high rates of endemic MRSA

Dioxin Exposure, from Infancy through Puberty, Produces Endocrine Disruption and Affects Human Semen Quality

BACKGROUND: Environmental toxicants are allegedly involved in decreasing semen quality in recent decades; however, definitive proof is not yet available. In 1976 an accident exposed residents in Seveso, Italy, to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). OBJECTIVE: The purpose of this study was to investigate reproductive hormones and sperm quality in exposed males. METHODS: We studied 135 males exposed to TCDD at three age groups, infancy/prepuberty (1-9 years), puberty (10-17 years), and adulthood (18-26 years), and 184 healthy male comparisons using 1976 serum TCDD levels and semen quality and reproductive hormones from samples collected 22 years later. RESULTS: Relative to comparisons, 71 men (mean age at exposure, 6.2 years; median serum TCDD, 210 ppt) at 22-31 years of age showed reductions in sperm concentration (53.6 vs. 72.5 million/mL; p = 0.025); percent progressive motility (33.2% vs. 40.8%; p < 0.001); total motile sperm count (44.2 vs. 77.5 x 10(6); p = 0.018); estradiol (76.2 vs. 95.9 pmol/L; p = 0.001); and an increase in follicle-stimulating hormone (FSH; 3.58 vs. 2.98 IU/L; p = 0.055). Forty-four men (mean age at exposure, 13.2 years; median serum TCDD, 164 ppt) at 32-39 years of age showed increased total sperm count (272 vs. 191.9 x 10(6); p = 0.042), total motile sperm count (105 vs. 64.9 x10(6); p = 0.036), FSH (4.1 vs. 3.2 UI/L; p = 0.038), and reduced estradiol (74.4 vs. 92.9 pmol/L; p < 0.001). No effects were observed in 20 men, 40-47 years of age, who were exposed to TCDD (median, 123 ppt) as adults (mean age at exposure, 21.5 years). CONCLUSIONS: Exposure to TCDD in infancy reduces sperm concentration and motility, and an opposite effect is seen with exposure during puberty. Exposure in either period leads to permanent reduction of estradiol and increased FSH. These effects are permanent and occur at TCDD concentrations < 68 ppt, which is within one order of magnitude of those in the industrialized world in the 1970s and 1980s and may be responsible at least in part for the reported decrease in sperm quality, especially in younger men

Plants and traditional knowledge: An ethnobotanical investigation on Monte Ortobene (Nuoro, Sardinia)

<p>Abstract</p> <p>Background</p> <p>Most of the traditional knowledge about plants and their uses is fast disappearing as a consequence of socio-economic and land use changes. This trend is also occurring in areas that are historically exposed to very few external influences, such as Sardinia (Italy). From 2004 to 2005, an ethnobotanical investigation was carried out in the area of Monte Ortobene, a mountain located near Nuoro, in central Sardinia.</p> <p>Methods</p> <p>Data were collected by means of semi-structured interviews. All the records – defined as 'citations', i.e. a single use reported for a single botanical species by a single informant – were filed in a data base ('analytical table'), together with additional information: i.e. local names of plants, parts used, local frequencies, and habitats of plants, etc. In processing the data, plants and uses were grouped into general ('categories') and detailed ('secondary categories') typologies of use. Some synthetic indexes have also been used, such as Relative Frequency of Citation (RFC), Cultural Importance Index (CI), the Shannon-Wiener Index (H'), and Evenness Index (J).</p> <p>Results</p> <p>Seventy-two plants were cited by the informants as being traditionally used in the area. These 72 'ethnospecies' correspond to 99 botanical taxa (species or subspecies) belonging to 34 families. Three-hundred and one citations, 50 secondary categories of use, and 191 different uses were recorded, most of them concerning alimentary and medicinal plants.</p> <p>For the alimentary plants, 126 citations, 44 species, and 13 different uses were recorded, while for the medicinal plants, there were 106 citations, 40 species, and 12 uses. Few plants and uses were recorded for the remaining categories. Plants and uses for each category of use are discussed. Analyses of results include the relative abundance of botanical families, wild vs. cultivated species, habitats, frequency, parts of plant used, types of use, knowledge distribution, and the different cultural importance of the species in question.</p> <p>Conclusion</p> <p>The study provides examples of several interesting uses of plants in the community, which would seem to show that the custom of using wild plants is still alive in the Monte Ortobene area. However, many practices are no longer in use, and survive only as memories from the past in the minds of elderly people, and often only in one or just a few informants. This rapidly vanishing cultural diversity needs to be studied and documented before it disappears definitively.</p

Complexity analysis of the fetal heart rate variability: early identification of severe intrauterine growth-restricted fetuses

The main goal of this work is to suggest new indices for a correct identification of the intrauterine growth-restricted (IUGR) fetuses on the basis of fetal heart rate (FHR) variability analysis performed in the antepartum period. To this purpose, we analyzed 59 FHR time series recorded in early periods of gestation through a Hewlett Packard 1351A cardiotocograph. Advanced analysis techniques were adopted including the computation of the Lempel Ziv complexity (LZC) index and the multiscale entropy (MSE), that is, the entropy estimation with a multiscale approach. A multiparametric classifier based on k-mean cluster analysis was also performed to separate pathological and normal fetuses. The results show that the proposed LZC and the MSE could be useful to identify the actual IUGRs and to separate them from the physiological fetuses, providing good values of sensitivity and accuracy (Se = 77.8%, Ac = 82.4%)