EP0000504B1 - Circuit de commutation électrique pour la détection et l'enregistrement de l'activité de la matrice - Google Patents

Circuit de commutation électrique pour la détection et l'enregistrement de l'activité de la matrice Download PDF

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Publication number
EP0000504B1
EP0000504B1 EP78100372A EP78100372A EP0000504B1 EP 0000504 B1 EP0000504 B1 EP 0000504B1 EP 78100372 A EP78100372 A EP 78100372A EP 78100372 A EP78100372 A EP 78100372A EP 0000504 B1 EP0000504 B1 EP 0000504B1
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EP
European Patent Office
Prior art keywords
signals
circuit arrangement
signal
arrangement according
activity
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
EP78100372A
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German (de)
English (en)
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EP0000504A1 (fr
Inventor
Joachim Nagel
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Biotronik SE and Co KG
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Biotronik Mess und Therapiegeraete GmbH and Co
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Publication of EP0000504A1 publication Critical patent/EP0000504A1/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/43—Detecting, measuring or recording for evaluating the reproductive systems
    • A61B5/4306—Detecting, measuring or recording for evaluating the reproductive systems for evaluating the female reproductive systems, e.g. gynaecological evaluations
    • A61B5/4343—Pregnancy and labour monitoring, e.g. for labour onset detection
    • A61B5/4362—Assessing foetal parameters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/344—Foetal cardiography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/389—Electromyography [EMG]
    • A61B5/391—Electromyography [EMG] of genito-urinary organs

Definitions

  • the invention relates to a circuit arrangement for the detection and registration of uterine activity by means of electrical signals as specified in the preamble of claim 1.
  • the monitoring and evaluation of uterine activity which enables an assessment of labor, is important in perinatal medicine to observe the course of pregnancy and to assess the condition of the fetus.
  • a so-called "open-end catheter” filled with liquid is inserted into the amniotic cavity or between the amniotic sac and the uterine wall to determine the pressure. After performing a zero adjustment, this procedure can be used to determine the absolute pressure of the uterus.
  • the external tokenography is based on a method already given by Rech in 1934.
  • a pressure transducer which is usually designed as a strain gauge, is attached to the abdomen of the pregnant woman with an elastic strap. Due to the stroke changes caused by uterine contractions of a stylus, which acts mechanically on the strain gauges, an electrical signal is obtained that represents a measure of the labor activity and the temporal course of which is evaluated by the attending physician.
  • the method of external tokenography has the disadvantage that the indirect method of taking up pressure is exposed to numerous interferences which falsify the measurement result. Such disturbances already represent, for example, the changes in stroke associated with breathing.
  • the non-invasive method is based on the assumption that the pressure detected and registered on the abdomen by means of the stylus is a sufficient approximation of the intrauterine pressure. With this measurement, however, it is not possible to obtain sufficiently precise information about the course of the uterine activity.
  • the aforementioned method has the disadvantage that a large number of electromyographic leads leading to intrauterine electrodes must be provided in order to record the individual activity centers and to obtain clarity about the activity of the entire uterus by means of a statement about the spread of stimuli.
  • the object of the invention specified in claim 1 is to provide a device of the type mentioned which does not bother the patient and which provides the doctor with a reliable result in a reproducible and easily interpretable manner.
  • the invention is based on the fact that the intrauterine pressure changes are also caused directly by muscle contractions, and the electrical fields associated with these contractions can be measured electromyographically on the surface of the skin.
  • a measure of the intensity of the contractions is not directly the measured voltage curve, but, as was found with the invention, an average of the pulse-shaped AC voltage components of the measured signals in a very specific frequency interval, which is compared to the frequency interval previously used for electrical measurement of uterine activity is shifted above.
  • Intensity is understood to mean a value that is representative of the magnitude of the amplitude of the alternating voltage component and can be obtained, for example, by rectifying the alternating voltage component or squaring in the sense of a power determination.
  • the output signal thus runs essentially at least similar to an envelope of the electro-myographically recorded signal.
  • the output signal does not form a measure of a size determined on the basis of one-dimensionally directed forces, but instead uses the intrauterine pressure to establish a relationship to a phenomenon which is based on a three-dimensional mechanical state of tension with muscle forces acting in all spatial directions.
  • a medical examination device based on the device according to the invention that, owing to its simple operability and reliable detection of the signals to be emitted, it is particularly suitable for routine examinations, so that there is a wide field of application not only in the clinical field. Since the measurement result is comparable to that of the conventional mechanically working tocopograph, there are no difficulties for the treating doctor in interpreting the results. It is also advantageous that the maternal and fetal heart signals are contained in the abdominally derived electromyogram as interference signals, but these can, if necessary, be filtered out and evaluated separately.
  • the information contained in the measurement and thus accessible to the doctor is more extensive than is the case when pressure sensors are used. Since the attachment of skin electrodes is much easier to carry out than the attachment of mechanical pressure transducers, the determination of uterine activity is made considerably easier for the doctor. The reduction in the examination time to be spent per patient is also associated with a reduction in treatment costs.
  • the device according to the invention it is possible to record the activity of the entire uterus and the abdominal muscles by placing the electrodes accordingly.
  • the shape of the averaged and displayed contractions can be used to draw conclusions about the excitation and spread of contractions. In this way, the doctor can also recognize motility disorders, such as incoordination, at an early stage.
  • the evaluation of the myo signals can be carried out in an advantageous manner by using an appropriate bandpass filter in a frequency range of approximately 150 to 250 Hz. It is favorable that the signal components of the fetal and maternal electrocardiogram that are disturbing when the uterine motility is detected are smaller in amplitude in this frequency range than the myopotentials to be evaluated and therefore have little influence on the result.
  • Another possibility in determining the uterine activity of reducing the effect of interfering signals is to select a sufficiently large time constant used for averaging (by low-pass filtering) the rectified or squared signal. In this case (with a time constant of several seconds) even that frequency range of the myographically recorded signal of approximately 15 to 40 Hz can be used in which the heart signals have their maximum.
  • the selection of the narrower frequency range to be evaluated and its width within a total range of approximately 10 to 300 Hz depends on whether the static or dynamic parts of the muscle contractions should be given preference and to what extent the influence of the abdominal muscles (tension during compression) in the result should appear.
  • the frequency range is limited to that of the heart signals by appropriate filter means during signal acquisition, these signals can be used both for determining the labor activity and for evaluating the heart signals.
  • the output of the averaged signals which form a measure of the intrauterine pressure, can advantageously take place in a logarithmic representation, for example via a connected recorder, so that a large amplitude range is recorded.
  • the gain factor and the zero line do not have to be readjusted, so that ease of use is guaranteed.
  • the signal processing can be carried out in a particularly simple manner by means of analog modules such as operational amplifiers. If the device according to the invention is combined with one for determining cardiac activity, the signal processing is advantageously carried out digitally, preferably by means of microprocessors.
  • the device according to the invention exhibits its particular advantages in the event that signals affecting the uterus as well as the fetal (or maternal) cardiac activity are derived simultaneously by means of abdominally attached electrodes or the recorded signals are evaluated in a common device. It is thus possible to obtain extensive data within the scope of perinatal examinations with a single measurement which is not very stressful for the patient, which enables the doctor to quickly obtain an accurate picture of the condition of the fetus and the patient so that he can get the necessary measures can be initiated immediately.
  • the frequency range to be evaluated is selected by choosing a correspondingly large time constant for the averaging so that it covers the range of the frequencies taken up by the heart signals, no further filter means are required to filter the signals for the Detect uterine activity from those for determining heart activity.
  • FIG. 1 shows a representation of the signal recording.
  • Various electrodes 301, 302 and 303 are attached to the body of a patient 304 for recording measured values, whose contractions are to be recorded.
  • the cardiac activity of a fetus 305 is examined at the same time.
  • the signal from the heart 307 of the fetus is superimposed on the signal from the heart 308 of the mother and various interference components in the signal course 306 recorded electromyographically by means of the skin electrodes 301 to 303.
  • the fetal or maternal heart signal is repeatedly identified in the signal course 306 with "f" or "m".
  • the signals representing the contraction are not directly recognizable in the recorded signal and can only be represented as a curve by the device according to the invention.
  • the first embodiment of the device according to the invention shown in FIG. 2 enables the determination and recording of uterine activity by the detection and evaluation of muscle contractions in the abdominal area.
  • the input of an amplifier 1, which is shown in circuit terms in detail in FIG. 3, is connected via its inputs 2 to the electrodes, not shown here.
  • the signal from the output 7 of the amplifier 1 is fed to an input 8 of a processing part 3, by means of which the signal components relating to uterine activity are processed such that the signal of the processing part 3 fed to an output 4 represents a measure of the uterine motility.
  • a recording device (not shown) which records the course of the intensity of the labor activity as a function of time, so that the doctor can draw conclusions about the labor activity from the resulting characteristic curve developments, if necessary by comparison with curve developments listed in a directory can pull.
  • the circuit of the processing part 3 is shown in detail in FIG. 4.
  • the signal at the output 7 of the amplifier 1 is branched off to a processing part 5 for heart signals.
  • the fetal electrocardiogram or a signal as a measure of the heart rate are available at the output 6 of the processing part 5 and can, for example, be reproduced in their time-dependent curve profile.
  • the representation of the fetal heart signals can be summarized with that of the uterine activity in a cardiotocogram, which can be represented by a single graphic output device.
  • FIG. 3 shows the complete circuit diagram of the amplifier for the abdominal signal (1 in FIG. 2).
  • the signals from the abdominal electrodes reach a separation amplifier T 1, which serves for the potential separation of the patient and the measuring device.
  • the outputs of the isolation amplifier T 1 are connected to the inputs of a differential amplifier, which consists of an operational amplifier OP 1, which is connected to a number of resistors and capacitors.
  • the resistors R 1 and R 3 or R2 and R 4 each form an input low-pass filter with the capacitors C 2 and C 3, while the resistor-capacitor combinations C 1 / R 5 and C 4 / R 6 and the capacitor C 5 provide a drop in gain towards high frequencies.
  • the subsequent stage which contains the operational amplifier OP 2 is connected in the usual way as a selective filter, the values of the resistors R 7 to R 10 and that of the capacitors C 6 to C 9 being selected in the exemplary embodiment shown so that the circuit is preferred cuts the low frequencies of the abdominal signal.
  • the last stage containing an operational amplifier OP 3 works as a pure AC-coupled amplifier circuit, the gain factor being determined by the ratio of the resistors R 11 and R 13 and the output signal can be zero-balanced via the resistor R 12 by means of a variable resistor R 15.
  • the overall circuit of the amplifier for the abdominal signal brings about a first trimming of the frequencies which interfere with the subsequent signal processing.
  • the first two stages with the operational amplifiers OP 4 and OP 5 perform bandpass filtering of the signal appearing at the input of the processing part 3.
  • the circuitry of the operational amplifiers OP 4 and OP 5 with resistors R 16 to R 26 and capacitors C 12 to C 15 The function corresponds to that of the operational amplifier OP 2 in FIG. 3.
  • the values of the components are measured according to the rules valid for such active filter circuits.
  • the output level and the quality of the filter can be set by means of the variable resistor R 24.
  • the operational amplifiers OP 6 and OP 7 are connected as an integrating 'full-wave rectifier.
  • the output signal is a good approximation of the effective (RMS) value of the action potentials, the circuit used, in contrast to an analog square circuit, being simply constructed and operating reliably.
  • the first stage containing the operational amplifier OP 6 forms a half-wave rectifier, while the second stage with the operational amplifier OP 7 as an integrating adder to the input signal of the preceding stage which appears at its input via the resistor R 26 via the resistor R 30 the rectified half waves from the preceding stage with negative sign added.
  • the rectified signals form a measure of the intensity of the AC voltage components.
  • the rectifier circuit is replaced by a circuit for determining the power of the signals or for forming the effective value.
  • Such circuits are available as finished components in an analog or digital version.
  • the capacitor C 16 and the resistor R 31 give the circuit the low-pass character required for averaging.
  • the value of the time constant is a few seconds and determines on the one hand the reproduction of the temporal course of the uterine activity (a small time constant results in a large temporal resolution, while a larger time constant allows individual contractions to appear more clearly) and on the other hand the frequency range that can be evaluated.
  • a larger time constant selected greater than approximately 10 seconds
  • a stage following the rectifier circuit for digital or analog formation of the root mean square of the signals is inserted at this point.
  • the zero line of the output signal can be set by means of the variable resistor R 37. Otherwise, this stage serves as an amplifier with a gain factor which corresponds to the ratio of the values of the resistors R 35 and R 33.
  • the last stage containing the operational amplifier OP 9 forms a final amplifier for the output signal, the level being adjustable via the resistor R 39.
  • the capacitor C 17 brings about an additional lowering of the upper frequency range, so that a writing device connected to the output of the operational amplifier OP 9 is protected against sudden rashes.
  • EMG represents the portion of the electromyogram characteristic of uterine activity and N (t) represents an additive disturbance portion.
  • the time constant for the temporal averaging is chosen to be sufficiently large, then a frequency separation of signal components characteristic of the uterus and cardiac activity can be dispensed with, since with values of the time constant of more than approximately 10 seconds the cardiac signals when evaluating the uterine activity - as above mentioned-no longer appear disruptive.
  • the bandpass filter shown in the upper part of FIG. 4 can thus be omitted, while a corresponding filter for the frequency range of approximately 15 to 40 Hz, which is originally provided in the processing part 5, is assigned to the amplifier 1, so that only one band filter is required overall is.
  • Point 201 can either form the input of an electrical circuit or accordingly the starting point of a computer program.
  • the subsequent blocks can either form electrical circuit stages or suitable program blocks.
  • the circuit-based interpretation is to be used as a basis.
  • Step 202 includes all the steps that are related to the recording of the electromyographic signal.
  • the myographically recorded signal is freed from interfering signal components in a filter stage 203, the maternal heart signal being eliminated in the subsequent stage 204 by subtraction from the filtered input signal.
  • a signal curve is subtracted, which corresponds to a mean maternal EKG, the maternal EKG being recognized and its course being continuously improved or updated by averaging.
  • the mean maternal ECG is recorded in step 205. Subtraction adjusts the amplitude of the signal to be subtracted to the amplitude of the input signal.
  • the signal thus freed from interfering components serves as an input signal for a signal processing part 3 ', in which the processing of the signals relating to uterine activity is carried out, as described with reference to processing part 3.
  • the band filter assembly is omitted in the processing part 3 ', since the filtering is carried out jointly by the filter 203.
  • a logarithmic or potentiating distortion of the output amplitude values can take place in an evaluation part 209, which are graphically displayed as a function of time using a contraction chart 210.
  • the actual determination of the fetal ECG signal is carried out in a stage 206 following in the other signal path, the occurrence of a fetal heart signal being determined first by a maximum criterion, while then a second criterion for determining the occurrence of a fetal heart signal in accordance with the correspondence between the course of the input signal and the pattern signal stored in its amplitude course, which in turn is continuously adapted to the current signal shape by averaging.
  • the mean value of the fetal ECG (QRS complex) is recorded in step 206, while in step 208 the fetal heart rate is calculated and recorded from the time interval between the fetal heart signals.
  • FIGS. 3 and 4 The embodiment of the device according to the invention shown in FIGS. 3 and 4 is realized with analog components. This version is particularly cheap if it is to be used alone.
  • programs or program parts can be used for the necessary mathematical calculations (averaging, performance, RMS determination, logarithming, power generation) as they are contained, for example, in the program collections available for the corresponding data processing devices or microprocessors (eg LSI 11 or 8080).

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
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  • General Health & Medical Sciences (AREA)
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  • Gynecology & Obstetrics (AREA)
  • Reproductive Health (AREA)
  • Urology & Nephrology (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)

Claims (16)

1. Montage pour la détection et l'enregistrement de l'activité utérine au moyen de signaux recueillis extérieurement dans la région abdominale par voie électromyographique, comprenant des moyens de filtrage pour éliminer des composantes de tension alternative (OP 1, 2, 4, 5) en vue du traitement consécutif du signal, caractérisé en ce que les composantes de tension alternative éliminées par filtrage sont comprises dans la gamme de fréquences d'environ 10 à 300 Hz et en ce qu'un dispositif (3, 3') est prévu pour produire des signaux représentant une mesure de l'intensité des composantes de tension alternative éliminées par filtrage, ce dispositif comprenant un montage (OP 6 à 9 et C 16, R 31), pour la prise de lay moyenne dans le temps desdites composantes de tension afin d'obtenir un signal représentatif de la grandeur de la pression intra- utérine.
2. Montage selon la revendication 1, caractérisé en ce que le dispositif pour produire des signaux délivre des signaux qui représentent essentiellement une mesure de la puissance électrique de la composante de tension alternative du signal recueilli par voie électromyographique.
3. Montage selon la revendication 1, caractérisé en ce que des moyens sont prévus pour redresser les composantes de tension alternative (OP 6, OP 7).
4. Montage selon la revendication 3, caractérisé en ce que la prise de la moyenne s'effectue essentiellement par élévation au carré.
5. Montage selon la revendication 1, caractérisé en ce que le dispositif pour produire des signaux délivre des signaux qui correspondent essentiellement à la valeur effective (valeur RMS) de la composante de tension alternative des signaux recueillis par voie électromyographique.
6. Montage selon l'une des revendications précédentes, caractérisé en ce que le dispositif pour la prise de la moyenne dans le temps comporte un filtre passe-bas (OP 7 et 9).
7. Montage selon la revendication 6, caractérisé en ce que la constante de temps du filtre passe-bas est de plusieurs secondes.
8. Montage selon l'une des revendications précédentes, caractérisé en ce que la gamme de fréquences obtenue par élimination par filtrage est essentiellement comprise dans les limites de 150 et 250 Hz.
9. Montage selon l'une des revendications précédentes, caractérisé en ce que des moyens sont prévus pour délivrer la moyenne du signal sous une forme logarithmique.
10. Montage selon l'une des revendications 1 à 8, caractérisé en ce que des moyens sont prévus pour délivrer la moyenne du signal sous une forme élevée à une puissance plus haute.
11. Montage selon l'une des revendications précédentes, caractérisé en ce que des capteurs de valeur de mesure communs (électrodes 301 à 303) et/ou des moyens d'exploitation communs sont prévus pour recueillir par voie électromyographique des signaux de mesure servant à la détection et à l'enregistrement de l'activité utérine et de signaux cardiaques.
12. Montage selon la revendication 11, caractérisé en ce que les signaux recueillis par voie myographique par des capteurs communs sont, en vue de l'exploitation, limités essentiellement à une gamme de fréquences de 15 à 40 Hz par des moyens de filtrage passe-bande.
13. Montage selon la revendication 11 ou 12, caractérisé en ce que des moyens sont prévus pour reconnaître des signaux parasites répétitifs affectant l'exploitation du signal, pour retenir la variation de leur amplitude dans une mémoire et pour, à la détection d'un signal parasite dans le signal d'entrée, soustraire le signal parasite quant à son amplitude et avec la phase correcte du signal d'entrée.
14. Montage selon la revendication 13 pour la détermination de signaux cardiaques foetaux, caractérisé en ce que le signal parasite répétitif est le complexe QRS maternel.
15. Montage selon l'une des revendications 11 à 14, caractérisé en ce que, pour la dètec- tion de complexes QRS de signaux cardiaques foetaux dans le signal d'entrée séparé des signaux pour la détection et l'enrigistrement de l'activité utérine, une mémoire est prévue pour retenir la variation d'amplitude d'un complexe QRS foetal reconnu selon un premier critère et en ce que cette variation d'amplitude est utilisée comme modèle pour l'identification de complexes QRS suivants selon un second critère qui consiste dans le degré de concordance entre le signal appliqué chaque fois et la variation d'amplitude du complexe QRS foetal retenu comme modèle.
16. Montage selon la revendication 15, caractérisé en ce que des moyens sont prévus pour adapter continuellement la variation d'amplitude du complexe QRS foetal retenu comme modèle à la forme actuelle du complexe QRS foetal.
EP78100372A 1977-07-13 1978-07-12 Circuit de commutation électrique pour la détection et l'enregistrement de l'activité de la matrice Expired EP0000504B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE2732160 1977-07-13
DE2732160A DE2732160C3 (de) 1977-07-13 1977-07-13 Vorrichtung zur Detektion und Registrierung der Uterusaktivität

Publications (2)

Publication Number Publication Date
EP0000504A1 EP0000504A1 (fr) 1979-02-07
EP0000504B1 true EP0000504B1 (fr) 1982-05-19

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EP78100372A Expired EP0000504B1 (fr) 1977-07-13 1978-07-12 Circuit de commutation électrique pour la détection et l'enregistrement de l'activité de la matrice

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US (1) US4256118A (fr)
EP (1) EP0000504B1 (fr)
JP (1) JPS5419595A (fr)
DE (2) DE2732160C3 (fr)

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CN103637796A (zh) * 2013-12-26 2014-03-19 上海海事大学 基于广义特征值最大化的胎儿心电信号自适应盲提取方法

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EP0000504A1 (fr) 1979-02-07
DE2732160B2 (de) 1979-09-06
DE2732160A1 (de) 1979-01-18
DE2732160C3 (de) 1980-05-14
US4256118A (en) 1981-03-17
DE2861844D1 (en) 1982-07-08
JPS5419595A (en) 1979-02-14

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