JP4364138B2 - Delivery monitoring device, delivery monitoring method, delivery monitoring program, recording paper - Google Patents

Description

  The present invention relates to a labor monitoring device, a labor monitoring method, a labor monitoring program, and a recording sheet for the labor monitoring device.

  The following are known as conventional labor monitoring devices.

(1) A fetal heart rate curve, labor intensity curve, and fetal oxygen saturation curve are recorded on a delivery chart (for example, Patent Document 1).

(2) The fetal heart rate curve, labor pain intensity curve, and fetal oxygen saturation curve are recorded on the delivery chart, and the fetal oxygen saturation curve is recorded together with the scale of the labor pain intensity curve, and the fetal oxygen saturation curve. Is drawn so as to be clearly separated from the labor intensity curve (for example, Patent Document 2).

(3) Labor pain waveform, fetal heart rate information, and pulse wave velocity information are displayed in a graph on the same time axis, and changes in these labor pain waveform, fetal heart rate information, and pulse wave velocity information can be easily determined. (For example, patent document 3).

  Various parameters related to labor monitoring are described in Non-Patent Documents 1 and 2.

JP-A-8-000629 JP-A-8-000630 JP 2003-325464 A Japan Society of Obstetrics and Gynecology, Perinatal Committee “Proposal Proposal”, Journal of Japanese Society of Obstetrics and Gynecology 54, No. 4, p23-27, April 1, 2002 Japanese Society of Obstetrics and Gynecology Perinatal Committee Terminology and Definition Subcommittee for Fetal Heart Rate Chart “Revised”, Journal of Japanese Society of Obstetrics and Gynecology 55 vol.8, p1205-1216, August 2003 1 day

  In the delivery monitoring devices of Patent Documents 1 to 3, the doctor visually interprets the fetal heartbeat curve and labor pain intensity curve and makes a comprehensive judgment to judge the health condition of the fetus. However, interpretation of the fetal heart rate curve and labor intensity curve requires a high degree of skill, and there is a possibility that correct judgment may not be made depending on the skill level and skill of the doctor.

In addition, the delivery monitoring devices of Patent Documents 1 to 3 require a doctor to continuously observe for a long time in order to immediately respond to a sudden change in the state of the fetus. In particular, in the late pregnancy and parturition, the fetal state changes abruptly. For example, if the fetus suddenly falls into a hypoxic state and the state persists for a long time, the brain is hypoxic.
However, the burden of the doctor constantly monitoring the labor monitoring device is extremely large and practically impossible.

  The present invention was devised to solve such conventional problems, and it is an object of the present invention to eliminate the need for advanced interpretation work for determining the health condition of a fetus.

  According to the present invention, it is possible to make a highly accurate determination without requiring an advanced interpretation work for determining the health condition of a fetus.

  The labor monitoring device according to the present invention represents a fetal heart rate detecting means for detecting a signal representative of fetal heart rate, a labor intensity detecting means for detecting a signal representative of maternal labor intensity, and the fetal heart rate. A fetal heart rate calculating means for calculating a fetal heart rate based on the signal; a labor intensity calculating means for calculating labor intensity based on a signal representative of the labor intensity; and a fetal heart rate based on the fetal heart rate Average calculating means for calculating a global average value, display means for displaying the fetal heart rate, labor intensity, and global average value, and alarm means for issuing an alarm regarding the health condition of the fetus based on the global average value Prepare. As a result, it is possible to make a highly accurate determination without requiring an advanced interpretation work for determining the health condition of the fetus.

  The delivery monitoring device according to the present invention further comprises fine fluctuation calculation means for calculating the fine fluctuation of the global average value, and further displays the fine fluctuation by the display means, and the warning means further includes the fine fluctuation. Based on the above, a warning regarding the health condition of the fetus may be issued. As a result, more information can be displayed, and an alarm based on more information can be issued.

  The delivery monitoring device according to the present invention includes a tachycardia determination means for determining tachycardia when the global average value is larger than a first predetermined value, and the global average value is smaller than a second predetermined value. Bradycardia determining means for sometimes determining bradycardia, wherein the display means further displays the bradycardia and tachycardia, and the alarm means further provides a fetus based on the determination of the bradycardia and tachycardia. An alarm regarding the health condition of the child may be issued. As a result, more information can be displayed, and an alarm based on more information can be issued.

  The delivery monitoring device according to the present invention further includes a transient bradycardia determining unit that classifies the decrease pattern of the fetal heart rate, and the display unit further displays the classification of the transient bradycardia determination, The alarm means may further issue an alarm regarding the health condition of the fetus based on the decrease pattern of the fetal heart rate. As a result, more information can be displayed, and an alarm based on more information can be issued.

In the delivery monitoring device according to the present invention, the global average value is, for example, a fetal heart rate baseline, and the fine variation of the global average value is, for example, a heart rate baseline fine variation.
In the delivery monitoring device according to the present invention, the warning means is provided in the display means, for example.

  The delivery monitoring device according to the present invention may further comprise a recording means for recording an alarm relating to the fetal heart rate, labor intensity, and the health condition of the fetus on a recording sheet. As a result, information and warnings regarding the health condition of the fetus can be recorded on the recording paper.

In the delivery monitoring method according to the present invention, a fetal heart rate detecting step of detecting a signal representative of the fetal heart rate by the fetal heart rate detecting means, and a signal representative of the labor intensity of the mother is detected by the labor intensity detecting means. and labor intensity detecting step, by the processing unit, and the fetal heart rate calculation step of calculating the fetal heart rate on the basis of a signal representative of the fetal heart rate, by the processing unit, based on a signal representative of the labor intensity A labor intensity calculating step for calculating labor intensity, an average calculating step for calculating a global average value of the fetal heart rate based on the fetal heart rate by the calculation processing unit, and a display step for displaying the global average value; And an alarm sending step for issuing an alarm concerning the health condition of the fetus based on the global average value. As a result, it is possible to make a highly accurate determination without requiring an advanced interpretation work for determining the health condition of the fetus.

  The recording paper for the labor monitoring device according to the present invention is provided in the fetal heart rate recording area for recording the fetal heart rate, the labor intensity recording area for recording labor intensity, and the fetal heart rate recording area, Provided with a tachycardia region for recording the fetal heart rate and a bradycardia region provided in the fetal heart rate recording region for recording the fetal heart rate of bradycardia. As a result, it is possible to make a highly accurate determination without requiring an advanced interpretation work for determining the health condition of the fetus.

  Next, preferred embodiments of the delivery monitoring device, delivery monitoring method, delivery monitoring program, and recording paper according to the present invention will be described with reference to the drawings.

[Laboratory monitoring device]
FIG. 1 is a block diagram showing a first embodiment of a delivery monitoring device according to the present invention, FIG. 2 is a block diagram showing an arithmetic processing unit in the delivery monitoring device of FIG. 1, and FIG. 3 is a diagram in the delivery monitoring device of FIG. It is a front view which shows a display part.

  In FIG. 1, the delivery monitoring apparatus includes a delivery monitoring apparatus main body 100, an electrocardiographic electrode 110 connected to the delivery monitoring apparatus main body 100, an ultrasonic transducer 112, an internal pressure transducer 114, and a labor pain transducer 116. The recording paper 162 is output.

  The delivery monitoring device main body 100 includes an electrocardiographic electrode 110, an ultrasonic transducer 112, an internal pressure transducer 114, an electrocardiographic amplifier unit 120, an ultrasonic amplifier unit 122, an internal pressure amplifier unit 124, and a labor pain respectively connected to the labor pressure transducer 116. The analog detection signals of the electrocardiogram electrode 110, the ultrasonic transducer 112, the internal pressure transducer 114, and the labor pain transducer 116 are the electrocardiographic amplifier unit 120, the ultrasonic amplifier unit 122, the internal pressure amplifier unit 124, The labor amplifiers 126 amplify the analog signals to appropriate levels.

  A / D converters 130, 132, 134, and 136 are connected to the electrocardiographic amplifier unit 120, the ultrasonic amplifier unit 122, the internal pressure amplifier unit 124, and the labor amplifier unit 126, respectively. The output signals of the ultrasonic amplifier 122, the internal pressure amplifier 124, and the labor amplifier 126 are converted into digital signals S11, S12, S13, and S14 in the A / D converters 130, 132, 134, and 136, respectively. Are input to the arithmetic processing unit 140.

  The electrocardiogram electrode 110 and the ultrasonic transducer 112 are used for detection of the heart rate system, and the internal pressure transducer 114 and the labor pain transducer 116 are used for detection of the labor pain system. The electrocardiogram electrode 110 and the ultrasonic transducer 112 function as a fetal heart rate detection unit, and the internal pressure transducer 114 and the labor pain transducer 116 function as a labor intensity detection unit.

There are two methods for detecting heart rate and labor system: internal measurement and external measurement.
In the detection of the heart rate system, in the internal measurement method, the electrocardiogram of the fetus is detected by the electrocardiographic electrode 110 mounted on the head of the fetus after the rupture, and in the external measurement method, the ultrasonic transducer 112 mounted on the maternal abdomen surface is used. It detects the movement of the fetal heart valve.

  On the other hand, in the detection of the labor pain system, in the internal measurement method, the intrauterine pressure is detected by the internal pressure transducer 114 inserted into the uterus after rupture, and in the external measurement method, the labor pain transducer 116 attached to the uterus corresponding position on the surface of the mother's abdomen. By detecting uterine muscle hardness. Uterine muscle hardness corresponds to labor intensity. Signals S13 and S14 are an internal pressure signal and a labor signal, respectively.

  A display unit (display unit) 142, an external input / output unit 150, and a recording unit 160 are connected to the arithmetic processing unit 140, and various information necessary for labor monitoring is displayed on the display unit 142.

  The external input / output unit 150 receives heartbeat or labor signals from the arithmetic processing unit 140, and the external input / output unit 150 outputs these signals as an external output signal S15 (FIG. 2). The external input / output unit 150 also receives a heartbeat or labor signal measured by an external device as an external input signal S16 (FIG. 2).

  A fetal heartbeat drawing signal S17, a maternal labor drawing signal S18, an analysis result signal S19, and an alarm signal S20 are input from the arithmetic processing unit 140 to the recording unit (recording unit) 160. The recording unit 160, based on these signals, The fetal heart rate curve L40 and the maternal labor pain curve L41 (FIG. 4) are recorded on the recording paper 162. The recording unit 160 is, for example, a thermal array type recording unit.

  In FIG. 2, an arithmetic processing unit 140 includes an electrocardiogram heart rate calculation unit 210 to which a signal S11 is input, an autocorrelation heart rate calculation unit 220 to which S12 is input, and an intra / external measurement to which signals S13 and S14 are input. A switching processing unit 230 is included. The electrocardiogram heart rate calculation unit 210 and the autocorrelation heart rate calculation unit 220 are connected to the intra-beat / external measurement switching processing unit 240, and the in-labor / external measurement switching processing unit 230 is connected to the labor intensity calculating unit 250.

  The electrocardiogram heart rate calculator 210 calculates an instantaneous heart rate S21 based on the signal S11, and the autocorrelation heart rate calculator 220 calculates a Doppler heart rate signal S22 based on the signal S12.

  The intra-heartbeat / external measurement switching processing unit 240 selectively outputs the instantaneous heart rate S21 or the Doppler heartbeat signal S22, and inputs it to the fetal heartbeat rendering processing unit 270 and the heartbeat labor analysis processing unit 290 as the fetal heartbeat signal S23. Regarding the generation of the fetal heart rate signal S23, the electrocardiogram heart rate calculator 210 and the autocorrelation heart rate calculator 220 function as a fetal heart rate calculator.

  The labor internal / external measurement switching processing unit 230 selectively outputs the input signals S13 and S14, and the labor intensity calculating unit 250 calculates labor intensity based on the input signal (S13 or S14). The intensity signal S24 is input to the labor intensity drawing processing unit 280 and the heartbeat labor analysis processing unit 290. Regarding the generation of the labor intensity signal S24, the labor intensity calculator 250 functions as a labor intensity calculator.

  The fetal heartbeat rendering processing unit 270 generates a signal S17 for recording a heartbeat signal in the recording unit.

  The labor intensity drawing processing unit 280 generates a signal S18 for recording a labor-related signal in the recording unit.

  The heartbeat labor analysis processing unit 290 performs waveform analysis based on the fetal heartbeat signal S23 and the labor intensity signal S24, and outputs an analysis result signal S19 and an alarm signal S20.

  Regarding the detection of the heart rate system, the electrocardiogram electrode 110, the electrocardiogram amplifier 120, the A / D converter 130, the electrocardiogram heart rate calculator 210, the ultrasonic transducer 112, the ultrasonic amplifier 122, the A / D converter 132, the autocorrelation heart rate calculation unit 220, and the intra / external measurement switching processing unit 240 constitute fetal heart rate measurement means. A configuration in which one set of the ultrasonic transducer 112, the ultrasonic amplifier unit 122, the A / D conversion unit 132, and the autocorrelation heart rate calculation unit 220 is added to perform twin fetal heart rate measurement may be employed.

  Regarding the detection of labor system, internal pressure transducer 114, internal pressure amplifier unit 124, A / D conversion unit 134, labor pain transducer 116, labor force amplifier unit 126, A / D conversion unit 136, internal / external measurement switching processing unit 230 The labor intensity calculating unit 250 constitutes labor intensity measuring means.

  In FIG. 3, the display unit 142 includes a fetal heart rate display unit 410, a labor intensity display unit 420, a fetal heart rate baseline display unit 430, display units 440, 442, 444 and 446 related to transient bradycardia, a heart rate baseline. Display portions 450, 452, 454, 456 and warning signs 460, 462 regarding fine fluctuations are provided. The display unit 142 receives the fetal heart rate signal S23, labor intensity signal S24, fetal heart rate baseline information, transient bradycardia, and heart rate baseline fine variation information to be displayed on these display units. Information on fetal heart rate baseline, transient bradycardia, and heart rate baseline fine fluctuation will be described later.

  The fetal heart rate display unit 410 displays the fetal heart rate digitally (153 in FIG. 3), the labor intensity display unit 420 displays the labor intensity digitally (38 in FIG. 3), and the fetal heart rate baseline display unit 430 displays the fetal heart rate. The fetal heart rate baseline is digitally displayed (150 in FIG. 3), and alarm indications 432 and 434 are provided when the fetal heart rate baseline is tachycardia or bradycardia.

  Display units 440, 442, 444, 446 related to transient bradycardia indicate early, late, fluctuation, and prolonged transient bradycardia, respectively, and display units 450, 452, 454, related to heart rate baseline fine fluctuations. Reference numeral 456 indicates disappearance, decrease, moderate, and increase, respectively.

  The warning signs 460, 462 are lamps, and only the lamp 460 is lit in the first stage of urgency level (for example, the urgency level to call a doctor), and the lamps at higher urgency levels (for example, urgency level to call a doctor immediately). Both 460 and 462 are lit.

  In this way, if the main information such as the fetal heart rate baseline and the alarm such as the urgency level are displayed on the display unit 142, advanced interpretation work for determining the health condition of the fetus is unnecessary and the burden on the doctor is reduced. It is reduced.

{Parameter definition}
The parameters calculated and processed in the labor monitoring device are as follows.
(1) Fetal heart rate baseline As shown in FIG. 9, in the fetal heart rate curve L40 in which the fetal heart rate signal S23 is recorded for a predetermined time (for example, 10 minutes), the fetal heart rate is determined for each predetermined heart rate (for example, 5 bpm). Dividing into groups, the median value (median value) in the mode group is called the fetal heart rate baseline. When there are multiple mode values, the group with the higher heart rate is used. Also, when the fetal heart rate sampling value of three times changes continuously more than a predetermined value (for example, 15 heartbeats), the central sampling value of the three times is removed. The fetal heart rate baseline is a global average that represents the fetal heart rate globally and characteristically, and can accurately determine information regarding the health status of the fetus. In some cases, global average values representing other fetal heart rates, such as median values and average values, can be used. The fetal heart rate baseline is calculated by the heartbeat labor analysis processor 290, and the heartbeat labor analysis processor 290 functions as an average calculator for this calculation.

  Tachycardia when the fetal heart rate baseline is greater than a first predetermined value (eg, 160 bpm), normal arrhythmia when it is within a predetermined range (eg, 110-160 bpm), and bradycardia when less than a second predetermined value (eg, 110 bpm) For example, an urgency level for reporting a tachycardia to a doctor and a higher urgency level for reporting a bradycardia to a doctor immediately are set. Regarding the determination of tachycardia and bradycardia, the heartbeat labor analysis processing unit 290 functions as a tachycardia determination unit and a bradycardia determination unit.

(2) Heart rate baseline fine variation As shown in FIG. 9, in the fetal heart rate curve L40 obtained by calculating the fetal heart rate baseline, within a predetermined range DH (for example, -20 to +20 bpm) centered on the fetal heart rate baseline The average value of the amplitude LTV (increased amplitude) over time is called heart rate baseline fine fluctuation. The heart rate baseline fine fluctuation is calculated by the heartbeat labor analysis processor 290, and the heartbeat labor analysis processor 290 functions as a fine fluctuation calculator with respect to this calculation.

Heart rate baseline variability is classified into four stages: disappearance, decrease, moderate, and increase, and disappearance, decrease, moderate, and increase are heart rate baseline variability of 0 bpm, 5 bpm or less, 6-25 bpm, 26 bpm or more, respectively. Point to. For disappearance, decrease, and increase, for example, a high degree of urgency that is reported to the doctor immediately is set.
The heart rate baseline fine variation is a fine variation that globally and characteristically expresses a change in fetal heart rate, and information on the health condition of the fetus can be judged personally. In some cases, a variation value representative of other fetal heart rate variations such as variance, standard deviation, etc. can be used.

(3) Transient bradycardia
In the fetal heart rate curve L40 in FIG. 9, a portion CP where the fetal heart rate continuously falls below the fetal heart rate baseline for a period of time equal to or longer than a predetermined time TTP (for example, 15 seconds) is referred to as transient bradycardia.

Transient bradycardia is classified as early, late, variable, or prolonged.
Early and late onset is a bradycardia in which the fetal heart rate gradually decreases with the contraction of the uterus, and it takes 30 seconds or more from the start of the decrease to the lowest point. The lowest point coincides with the strongest point of the uterine contraction. Those that do are called early, and those whose lowest point lags behind the strongest point of uterine contraction are called late. After reaching the lowest point, the fetal heart rate returns to normal as the uterine contraction disappears.
The fluctuation is a bradycardia that is less than 30 seconds from the start of decrease of the fetal heart rate to the lowest point, and it is a time from 15 seconds to less than 2 minutes from the start of decrease to the return. Prolongation refers to the time from the start of the decrease in fetal heart rate to the return to 2 to 10 minutes. Note that a change of 10 minutes or more from the start of reduction to the return is treated as a change in fetal heart rate baseline.
Detection and classification of transient bradycardia are executed by the heartbeat labor analysis processing unit 290, and the heartbeat labor analysis processing unit 290 functions as a transient bradycardia determination unit.
For late departure, fluctuation, and delay, for example, a high degree of urgency to be reported to a doctor immediately is set.

[Recording paper]
4 is a plan view showing the recording paper in the delivery monitoring apparatus of FIG. 1, and FIG. 5 is a plan view showing the recording paper in the conventional delivery monitoring apparatus.

  In FIG. 4, on the recording paper 162, a recording area A40 for recording a fetal heart rate curve L40 indicating temporal changes in fetal heart rate, and a recording area A41 for recording a maternal labor pain curve L41 indicating temporal changes in labor intensity. Is provided. The recording area A40 includes a normal arrhythmia area A401 (eg, fetal heart rate 110 to 160 bpm) at the center in the vertical direction, and a tachycardia area A402 above and below the normal arrhythmia area A401 (eg, larger than the fetal heart rate 160 bpm: along the time axis) And a bradycardia region A403 (for example, fetal heart rate less than 110 bpm: shown with a right-handed hatching along the time axis), tachycardia, slow Pulses can be easily detected. The colors of the areas A401, A402, and A403 are, for example, green, yellow, and pink.

Furthermore, in the tachycardia region A402, analysis results D421 and D422 and alarm signs D441 and D442 indicating that the degree of urgency is high are displayed, and it is possible to know the emergency state of the fetal health simply by observing the recording paper. .
The display of the alarm signs 460, 462, D441, D442 is defined as shown in Table 1, for example.

  On the other hand, as shown in FIG. 5, in the conventional recording paper, only the fetal heart rate curve L40 and the maternal labor pain curve L41 are recorded in the recording areas A40 and A41, respectively, and the fetal heart rate baseline, bradycardia, and tachycardia are recorded. Interpretation is performed by doctors themselves, and the accuracy of the interpretation results may vary, and it is extremely difficult to always perform the interpretation work.

  That is, according to the recording paper 162 of the first embodiment, advanced interpretation work for determining the health condition of the fetus is unnecessary, and the burden on the doctor is reduced.

[Laboratory monitoring method]
Next, a delivery monitoring method in the delivery monitoring device of FIG. 1 will be described based on the drawings.
6 is a flowchart showing a delivery monitoring method in the delivery monitoring apparatus of FIG. 1, FIG. 7 is a flowchart showing processing of fetal heart rate baseline calculation in the delivery monitoring method of FIG. 6, and FIG. 8 is a delivery monitoring method of FIG. FIG. 9 is a graph showing the concept of heart rate baseline fine variation processed in FIG. 8, and FIG. 10 is a transient bradycardia in the delivery monitoring method of FIG. It is a flowchart which shows the process of determination.

  In FIG. 6, the delivery monitoring method is executed by the following steps, for example.

  Step S601: The fetal heartbeat signal S23 and labor intensity signal S24 are taken into the heartbeat labor analysis processing unit 290 every 1 second, and the process proceeds to step S602.

  Step S602: It is determined whether or not the fetal heart rate signal S23 for a predetermined period (for example, 10 minutes) for calculating the fetal heart rate baseline has been captured, that is, whether or not the predetermined period has elapsed. If 10 minutes or more have elapsed, the process proceeds to step S603, and if not, the process ends.

  Step S603: It is determined whether it is time to execute the processes of steps S604 to S607. When the processes of steps S604 to S607 are to be executed, the process proceeds to step S604, and when not, the process ends.

  Step S604: Calculate fetal heart rate baseline and heart rate baseline fine variation, and proceed to step S605. The calculated fetal heart rate baseline and heart rate baseline fine variation are recorded in a random access memory (not shown) or the like and sequentially updated to new data.

  Step S605: Transient bradycardia is detected and classified, and the process proceeds to Step S606.

  Step S606: Based on the results of steps S604 and S606, the health condition of the fetus is determined, and it is determined whether or not to display the warning signs 460 and 462, the warning signs D441 and D442, and the like.

  Step S607: Display of warning signs 460 and 462, warning signs D441 and D442, and the like based on the determination in step S606.

  Step S608: A timer for detecting the timing for executing the processes of steps S604 to S607 is set to a predetermined value, and the process is terminated as it is for the next execution.

  In FIG. 7, the process of calculating the fetal heart rate baseline in step S604 is executed by the following steps after performing predetermined noise removal on the fetal heart rate signal, for example.

  Step S701: A counter i for identifying a fetal heart rate Pi (signal S23) in a fetal heart rate baseline calculation period (for example, 10 minutes) is initialized to zero.

  Step S702: The fetal heart rate Pi is calculated for a predetermined period and registered in a random access memory or the like. Here, the number of measurements of the fetal heart rate Pi during a predetermined period is N + 1.

  Step S703: It is determined whether i = 0, that is, whether the evaluation of the fetal heart rate Pi has already been started. If i = 0, the process jumps to step S705; otherwise, the process proceeds to step S704.

  Step S704: It is determined whether or not the absolute value of the difference between the previous fetal heart rate Pi-1 and the current fetal heart rate Pi is greater than a predetermined value TDP (for example, 15 bpm). If the absolute value of the difference in fetal heart rate Pi is greater than the predetermined value TDP, the process jumps to step S706, and if not, the process proceeds to step S705.

  Step S705: i is advanced by 1 and proceeds to step S710.

  Step S706: The next fetal heart rate Pi + 1 is calculated and registered in a random access memory or the like.

  Step S707: It is determined whether or not the absolute value of the difference between the next fetal heart rate Pi + 1 and the current fetal heart rate Pi is greater than a predetermined value TDP. If the absolute value of the difference in fetal heart rate is greater than the predetermined value TDP, the process proceeds to step S708, and if not, the process jumps to step S709.

  Step S708: The average of the previous fetal heart rate Pi-1 and the next fetal heart rate Pi + 1 is taken as the current fetal heart rate Pi, and the process proceeds to step S709.

  Step S709: i is advanced by 2 and proceeds to step S710.

  Step S710: It is determined whether i has reached N. If i = N, the process proceeds to step S711; otherwise, the process returns to step S702.

  Step S711: The fetal heart rate is classified into a plurality of groups, the mode value group of detection results is extracted, and the center value (median value) of the group is calculated. Thereafter, the process proceeds to step S712.

  Step S712: It is determined whether or not the mode value is one. If the mode value is one, the process is terminated as it is. Otherwise, the process proceeds to step S713. Step S713: The center value of the group with the largest fetal heart rate is selected as the fetal heart rate baseline, and the process is terminated as it is.

  In FIG. 8, the heart rate baseline fine variation calculation is executed by the following steps.

  Step S901: First, a counter i for a fetal heart rate Pi (i = 0 to imax) in a period (for example, 10 minutes) in which a fetal heart rate baseline is calculated, a counter j for specifying each increased amplitude portion, and an individual increase A counter ii that measures the amplitude of the amplitude portion is initialized to zero.

  Step S902: It is determined whether Pi is within a predetermined range (for example, -DH / 2 to + DH / 2) with respect to the fetal heart rate baseline, and whether BFHR-DH / 2 = <Pi <= BFHR + DH / 2. . If it is within the predetermined range, the process proceeds to step S903, and if not, the process proceeds to step S905.

  Step S903: It is determined whether or not Pi is increasing, that is, whether or not Pi + 1−Pi> 0. When it is increasing, the process proceeds to step S904, and when not, the process proceeds to step S905.

  Step S904: The counter ii for measuring the amplitude is increased by (Pi + 1−Pi), and the process proceeds to Step S907.

  Step S905: When Pi is not within the predetermined range, when it does not increase, or when the increase has ended, the amplitude measurement value ii so far is registered as the j-th increase amplitude LTVj. At the same time, j is the number jmax of the increased amplitude LTVj. Next, the process proceeds to step S906.

  Step S906: The counter ii is initialized to 0 and j is advanced by 1 to prepare for the next increase amplitude measurement. Next, the process proceeds to step S907.

  Step S907: It is determined whether or not all fetal heart rates Pi within the period in which the fetal heart rate baseline has been calculated have been evaluated, i.e., i = imax.

  Step S908: The average value is calculated for LPVj where j = 0 to jmax.

  In FIG. 10, the transient bradycardia determination process is executed by the following steps.

  Step S1001: First, a counter i for specifying the fetal heart rate in the transient bradycardia determination period is initialized to zero.

  Step S1002: It is determined whether or not the counter i is 0, that is, whether or not Pi-1 before the fetal heart rate Pi is unregistered. When the counter i is not 0, the process proceeds to step S1003, and it is determined whether or not a decrease in fetal heart rate Pi has occurred. When the counter i is 0, the decrease in fetal heart rate Pi cannot be determined, and the process jumps to step S1004.

  Step S1003: It is determined whether or not the fetal heart rate Pi is smaller than the previous fetal heart rate Pi-1, that is, whether or not the fetal heart rate Pi has decreased. When it is decreasing, the process proceeds to step S1004. Otherwise, the process proceeds to step S1009.

  Step S1004: When a decrease in the fetal heart rate Pi is detected in step S1003, the flag F1 indicating tracking of the decreased state is turned ON (status indicating tracking state), and the flag F2 indicating tracking of the increasing state is OFF (tracking) Status indicating that it is not in a state). Also, Pi is registered in the decrease start point Pini.

  Step S1005: It is determined whether or not the strongest point of uterine contraction is detected. When the uterine contraction strongest point is detected, the process proceeds to step S1006, and when it is not detected, the process jumps to step S1007.

  Step S1006: The timing i of the strongest point of uterine contraction is registered as Ft, and the process proceeds to Step S1007.

Step S1007: While i is incremented by 1, the decrease amount ii of the fetal heart rate Pi is increased by (Pi-1-Pi). Thereafter, the process proceeds to step S1008.
Step S1008: It is determined whether or not the transient bradycardia determination process should be terminated. When continuing, it returns to step S1002, and when it should complete | finish, a process is complete | finished as it is.

  Step S1009: If no decrease in fetal heart rate Pi is detected in step S1003, it is determined whether F1 = ON, that is, whether the decrease state has been tracked until then. As a result, it is possible to detect when the decrease stops, that is, the lowest point of decrease in fetal heart rate. When F1 = ON, the process proceeds to step S1010. Otherwise, the process returns to step S1003.

  Step S1010: When the fetal heart rate decrease lowest point is reached, the flag F1 is set to OFF (status indicating that the tracking state is not set) and the flag F2 is set to ON (status indicating the tracking state) in order to track the subsequent increase. And

  Step S1011: It is determined whether or not the count number i from the fetal heart rate reduction start point to the lowest point is equal to or greater than a predetermined value Ttt1 (for example, a count number corresponding to a time of 30 seconds). When the count number i is equal to or greater than the predetermined value Ttt1, since it is an early departure or a late departure, the process proceeds to step S1012. When the count number i is less than the predetermined value Ttt1, the process proceeds to step S1015 because of step fluctuation or delay.

  Step S1012: It is determined whether i at the lowest fetal heart rate decrease point and the strongest uterine contraction point Ft are substantially equal, that is, whether the difference is smaller than a predetermined value TFt. In the early departure, i at the lowest fetal heart rate decrease point and the strongest uterine contraction point Ft substantially coincide with each other. Therefore, when the difference is smaller than the predetermined value TFt, the process proceeds to step S1013 and the early departure is determined. When the difference is greater than or equal to the predetermined value TFt, the process proceeds to step S1014, and the delay is determined.

  Step S1013: The early departure is determined and the process is terminated.

  Step S1014: The delay is determined and the process is terminated.

  Step S1015: It is determined whether or not the fetal heart rate Pi is greater than the previous fetal heart rate Pi-1, that is, whether or not the fetal heart rate Pi has increased. When it has increased, it progresses to step S1016, and when that is not right, it returns to step S1003.

  Step S1016: While i is advanced by 1, the decrease amount ii of the fetal heart rate Pi is decreased by (Pi-1-Pi). Thereafter, the process proceeds to step S1017.

  Step S1017: It is determined whether or not the fetal heart rate Pi has become a value equal to or greater than the decrease start point Pini, and whether or not the fetal heart rate Pi has returned to a value near Pini (the difference has become smaller than a predetermined value ΔP). That is, it is determined whether or not the fetal heart rate Pi has returned to the decrease start point Pini. When the fetal heart rate Pi returns to the decrease start point Pini, the process proceeds to step S1018. Otherwise, the process returns to step S1015.

  Step S1018: It is determined whether or not the count number i from the fetal heart rate reduction start point is equal to or greater than a predetermined value Ttt2 (for example, a count number corresponding to a time of 2 minutes). When the count number i is less than the predetermined value Ttt2, the process proceeds to step S1019 because of fluctuation. When the count number i is equal to or greater than the predetermined value Ttt2, the process is postponed, and the process proceeds to step S1020.

  Step S1019: A change is determined and the process is terminated.

  Step S1020: Judgment of postponement is made and the process is terminated as it is.

Next, a second embodiment of the labor monitoring device according to the present invention will be described with reference to the drawings.
FIG. 11 is a block diagram showing a second embodiment of the labor monitoring device according to the present invention, and FIG. 12 is a block diagram showing an arithmetic processing unit in the labor monitoring device of FIG. In addition, the same code | symbol is attached | subjected to the part which is the same as that of Example 1, or an equivalent in the figure, and description is abbreviate | omitted.
Example 2 employs only the external measurement method for both the heart rate system and the labor system.

  In FIG. 11, the labor monitoring device includes a labor monitoring device main body 100, an ultrasonic transducer 112, and a labor transducer 116, and the labor monitoring device main body 100 outputs a recording paper 162.

  The delivery monitoring apparatus main body 100 includes an ultrasonic amplifier unit 122 and a labor amplifier unit 126 connected to the ultrasonic transducer 112 and the labor pain transducer 116, respectively. The analog detection signals of the ultrasonic transducer 112 and the labor pain transducer 116 are The sound wave amplifier 122 and the labor amplifier 126 amplify the analog signals at appropriate levels.

  A / D converters 132 and 136 are connected to the ultrasonic amplifier unit 122 and the labor amplifier unit 126, respectively. The output signals of the ultrasonic amplifier unit 122 and the labor amplifier unit 126 are A / D converters 132, respectively. 136 are converted into digital signals S12 and S14, respectively, and input to the arithmetic processing unit 140.

  A display unit 142, an external input / output unit 150, and a recording unit 160 are connected to the arithmetic processing unit 140, and various information necessary for delivery monitoring is displayed on the display unit 142.

  Signals S <b> 17 to S <b> 20 are input from the arithmetic processing unit 140 to the recording unit 160, and a heart rate or labor signal S <b> 15 is input from the arithmetic processing unit 140 to the external input / output unit 150. In addition, the external input / output unit 150 inputs a heart rate or labor signal S16 measured by an external device to the arithmetic processing unit 140.

  In FIG. 12, the arithmetic processing unit 140 includes an autocorrelation heart rate calculation unit 220 to which S12 is input, and a labor intensity calculation unit 250 to which a signal S14 is input.

  The autocorrelation heart rate calculator 220 calculates a fetal heart rate signal S23 based on the signal S12.

  The labor intensity calculator 250 calculates labor intensity based on the signal S14 and inputs the labor intensity signal S24 to the labor intensity drawing processor 280 and the heartbeat labor analyzer 290.

  The heartbeat labor analysis processing unit 290 performs waveform analysis based on the fetal heartbeat signal S23 and the labor intensity signal S24, and outputs an analysis result signal S19 and an alarm signal S20.

  The fetal heartbeat rendering processing unit 270 generates a signal S17 for recording a heartbeat signal in the recording unit, and the labor pain intensity rendering processing unit 280 generates a signal S18 for recording the laboring system signal in the recording unit.

  The heartbeat labor analysis processing unit 290 performs waveform analysis based on the fetal heartbeat signal S23 and the labor intensity signal S24, and outputs an analysis result signal S19 and an alarm signal S20.

  The second embodiment is simpler than the first embodiment, and has the same effects as the first embodiment with respect to the external measurement method.

Next, a third embodiment of the labor monitoring device according to the present invention will be described with reference to the drawings.
FIG. 13 is a block diagram showing a third embodiment of the labor monitoring device according to the present invention. In addition, the same code | symbol is attached | subjected to the part which is the same as that of Example 1, or an equivalent in the figure, and description is abbreviate | omitted.
In the third embodiment, an external analysis unit 900 is connected to the external input / output unit 150 in the delivery monitoring apparatus main body 100 as in the first embodiment.

  The external analysis unit 900 includes a heartbeat labor analysis processing unit 920 and an analysis display unit 940, and the fetal heartbeat signal S23 and the labor intensity signal S24 are input from the external input / output unit 150 to the heartbeat labor analysis processing unit 920 as an external output signal S90. Is done.

  The heartbeat labor analysis processing unit 920 performs waveform analysis on the fetal heartbeat signal S23 and the labor intensity signal S24, and appropriately displays the analysis result and warning sign on the analysis display unit 940 (for example, Table 1).

Next, a fourth embodiment of the labor monitoring device according to the present invention will be described with reference to the drawings.
FIG. 14 is a front view showing a fourth embodiment of the delivery monitoring apparatus according to the present invention, and FIG. 15 is a block diagram showing the delivery monitoring apparatus of FIG. In addition, the same code | symbol is attached | subjected to the part which is the same as that of Example 1, or an equivalent in the figure, and description is abbreviate | omitted.
In the fourth embodiment, a delivery monitoring device is configured by a general-purpose computer.

  14 and 15, an electrocardiogram electrode 110, an ultrasonic transducer 112, an internal pressure transducer 114, and a labor pain transducer 116 are connected to an interface 1100 attached to the general-purpose computer 1000. A delivery monitoring program including a computer readable program code for causing the general-purpose computer 1000 to execute the delivery monitoring method shown in FIG.

  A monitor 1010 and a general-purpose printer 1600 are connected to the general-purpose computer 1000 and have the functions of the display unit 142 and the recording unit 160 of the first embodiment. A recording paper 162 is set in the general-purpose printer 1600, and recording similar to that in the first embodiment is possible.

  The interface 1100 includes the functions of the electrocardiographic amplifier unit 120, the ultrasonic amplifier unit 122, the internal pressure amplifier unit 124, and the labor amplifier unit 126, and the functions of the A / D converters 130 to 136. A signal corresponding to the signals S11 to S14 can be input to the bus 1700 of the general-purpose computer 1000 including the A / D converter 1140 provided.

  The general-purpose computer 1000 includes a CPU (central processing unit) 1200, a frame memory 1400, and a system memory 1500 connected to a bus 1700. The interface 1100 is connected to the bus 1700.

  The delivery monitoring program is read into the general-purpose computer 1000 from a CD-ROM or other storage medium, or is read into the general-purpose computer 1000 from another computer by various communication means.

  By configuring the delivery monitoring device with the general-purpose computer 1000 in this way, work related to delivery monitoring or other work can be executed together with delivery monitoring, and the device can be easily diverted to work other than delivery monitoring.

It is a block diagram which shows Example 1 of the delivery monitoring apparatus which concerns on this invention. Example 1 It is a block diagram which shows the arithmetic processing part in the delivery monitoring apparatus of FIG. Example 1 It is a front view which shows the display part in the delivery monitoring apparatus of FIG. Example 1 It is a top view which shows the recording paper in the delivery monitoring apparatus of FIG. Example 1 It is a top view which shows the recording paper in the conventional delivery monitoring apparatus. (Conventional example) It is a flowchart which shows the delivery monitoring method in the delivery monitoring apparatus of FIG. Example 1 It is a flowchart which shows the process of fetal heart rate base line calculation in the delivery monitoring method of FIG. Example 1 It is a flowchart which shows the process of heart rate baseline fine fluctuation calculation in the delivery monitoring method of FIG. Example 1 It is a graph which shows the concept of the heart rate baseline fine variation processed in FIG. Example 1 It is a flowchart which shows the process of the transient bradycardia determination in the delivery monitoring method of FIG. Example 1 It is a block diagram which shows Example 2 of the delivery monitoring apparatus which concerns on this invention. (Example 2) It is a block diagram which shows the arithmetic processing part in the delivery monitoring apparatus of FIG. (Example 2) It is a block diagram which shows Example 3 of the delivery monitoring apparatus which concerns on this invention. (Example 3) It is a front view which shows Example 4 of the delivery monitoring apparatus which concerns on this invention. (Example 4) It is a block diagram which shows the delivery monitoring apparatus of FIG. (Example 4)

Explanation of symbols

100 Labor monitoring device 110 ECG electrode
DESCRIPTION OF SYMBOLS 112 Ultrasonic transducer 114 Internal pressure transducer 116 Labor pain transducer 120 ECG amplifier part 122 Ultrasonic amplifier part 124 Internal pressure amplifier part 126 Labor pain amplifier part 130-136 A / D conversion part 140 Arithmetic processing part 142 Display part
150 External input / output unit 160 Recording unit
162 Recording paper
210 electrocardiogram heart rate calculator 220 autocorrelation heart rate calculator 230 intra-labor / external measurement switching processor 240 intra-heart / external measurement switching processor 250 labor intensity calculator 260 external input / output processor 270 fetal heart rate rendering processor 280 Labor intensity drawing processing unit 290 Heart rate labor analysis processing unit 410 Fetal heart rate display 420 Labor intensity display 430 Fetal heart rate baseline display 432 Tachycardia display
434 Bradycardia display
440 Transient bradycardia display (early onset)
442 Transient bradycardia display (delayed)
444 Transient bradycardia display (variation)
446 Transient bradycardia indication (prolonged)
450 Heart rate baseline fine fluctuation (disappearance)
452 Heart rate baseline fine fluctuation (decrease)
454 Heart rate baseline fine variation (moderate)
456 Heart rate baseline fine fluctuation (increase)
900 External analysis unit 920 Heartbeat labor analysis processing unit 940 Analysis display unit 1000 General-purpose computer 1010 Monitor
1100 Interface 1120 Amplifier section
1140 A / D converter 1200 CPU
1400 Frame memory 1500 System memory 1600 General-purpose printer 1700 Bus
S11, S12, S13, S14, S15, S16, S17, S18, S19, S20, S21, S22, S23, S24 signals

Claims (7)

A fetal heart rate detecting means for detecting a signal representative of the fetal heart rate;
Labor intensity detecting means for detecting a signal representative of the mother's labor intensity;
A fetal heart rate calculating means for calculating a fetal heart rate based on a signal representative of the fetal heart rate;
Labor intensity calculating means for calculating labor intensity based on a signal representative of the labor intensity;
An average calculating means for calculating a global average value of the fetal heart rate (fetal heart rate baseline) based on the fetal heart rate;
Tachycardia determination means for determining tachycardia when the global average value is greater than a first predetermined value;
Bradycardia determining means for determining bradycardia when the global average value is smaller than a second predetermined value;
A transient bradycardia determining means for classifying the decrease pattern of the fetal heart rate;
Fine fluctuation calculating means for calculating a fine fluctuation (heart rate baseline fine fluctuation) of the global average value;
Display means for displaying the fetal heart rate, the labor intensity, the global average, the bradycardia and tachycardia, the transient bradycardia classification, and the fine fluctuations ;
An alarm means for issuing an alarm regarding a fetal health condition based on the global average value, the bradycardia, tachycardia determination, the fine fluctuation, and the fetal heart rate reduction pattern ;
A delivery monitoring device comprising:
The first predetermined value is 160 bpm;
The second predetermined value is 110 bpm;
When there is one mode value group of the fetal heart rate, the average calculation means uses the center value in the group as a fetal heart rate baseline, and there are a plurality of mode values groups of the fetal heart rate. Sometimes the center value in the group with the highest heart rate is the fetal heart rate baseline,
The fine fluctuation calculating means calculates an average value of the amplitude of increase over time within a predetermined range centered on the fetal heart rate baseline of the fetal heart rate to obtain a heart rate baseline fine fluctuation,
Labor monitoring device.
The delivery monitoring apparatus according to claim 1 , wherein the warning means is provided in the display means.
The delivery monitoring apparatus according to claim 1 or 2 , further comprising recording means for recording an alarm relating to the fetal heart rate, labor intensity, and health condition of the fetus on a recording sheet.
Fetal heart rate detection means, labor intensity detection means, arithmetic processing unit, display means and alarm means operating method of the labor monitoring device comprising:
By the fetal heart rate detection unit, a fetal heart rate detection step of detecting a signal representative of the fetal heart rate,
By the labor intensity detecting means, and the labor intensity detecting step of detecting a signal representative of the labor intensity of the mother,
By the arithmetic processing unit, and the fetal heart rate calculation step of calculating the fetal heart rate on the basis of a signal representative of the fetal heart rate,
By the arithmetic processing unit, and the labor intensity calculation step of calculating the labor intensity based on the signal representative of the labor intensity,
By the arithmetic processing unit, and the average calculation step of calculating the fetal heart rate global mean value (fetal heart rate baseline) based on the fetal heart rate,
A tachycardia determination step for determining tachycardia when the global average value is larger than a first predetermined value by the arithmetic processing unit;
A bradycardia determining step for determining a bradycardia when the global average value is smaller than a second predetermined value by the arithmetic processing unit;
Transient bradycardia determination step for classifying the decrease pattern of the fetal heart rate by the arithmetic processing unit,
By the arithmetic processing unit, and a fine variation calculation step of calculating fine varying (heart rate baseline fine variation) of the global average value,
Displaying the fetal heart rate, the labor intensity, the global average value, the bradycardia and tachycardia, the classification of the transient bradycardia determination, and the fine fluctuations by the display means;
An alarm sending step for issuing an alarm about the health condition of the fetus based on the global average value, the bradycardia, tachycardia determination, the fine fluctuation, and the decrease pattern of the fetal heart rate by the alarm means ;
With
The first predetermined value is 160 bpm;
The second predetermined value is 110 bpm;
In the averaging step, when there is one mode value group of the fetal heart rate, a central value in the group is set as a fetal heart rate baseline, and a plurality of mode values of the fetal heart rate exist. Sometimes the center value in the group with the highest heart rate is the fetal heart rate baseline,
The fine variation calculation step calculates an average value of the amplitude of increase over time within a predetermined range centered on the fetal heart rate baseline of the fetal heart rate to obtain a heart rate baseline fine variation,
Method of operating the delivery monitoring device. A delivery monitoring program comprising computer-readable program code for causing a general-purpose computer to execute each step according to claim 4 .
A computer-readable storage medium in which the program according to claim 5 is stored.
A recording paper for the delivery monitoring device according to claim 3 ,
A fetal heart rate recording area for recording the fetal heart rate;
Labor intensity recording area for recording labor intensity,
Provided in the fetal heart rate recording region, a tachycardia region for recording the fetal heart rate of tachycardia,
Provided in the fetal heart rate recording region, a bradycardia region for recording the fetal heart rate of bradycardia,
With
The tachycardia region is set to 160 bpm as the lower limit,
The bradycardia region has an upper limit of 110 bpm,
Recording paper characterized by that.

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