Fetal electrocardiography (fECG) is a promising alternative to cardiotocography continuous fetal monitoring. Robust extraction of the fetal signal from the abdominal mixture of maternal and fetal electrocardiograms presents the greatest challenge to effective fECG monitoring. This is mainly due to the low amplitude of the fetal versus maternal electrocardiogram and to the non-stationarity of the recorded signals. In this review, we highlight key developments in advanced signal processing algorithms for non-invasive fECG extraction and the available open access resources (databases and source code). In particular, we highlight the advantages and limitations of these algorithms as well as key parameters that must be set to ensure their optimal performance. Improving or combining the current or developing new advanced signal processing methods may enable morphological analysis of the fetal electrocardiogram, which today is only possible using the invasive scalp electrocardiography method.

Non-adaptive signal processing methods have been successfully applied to extract fetal electrocardiograms (fECGs) from maternal abdominal electrocardiograms (aECGs); and initial tests to evaluate the efficacy of these methods have been carried out by using synthetic data. Nevertheless, performance evaluation of such methods using real data is a much more challenging task and has neither been fully undertaken nor reported in the literature. Therefore, in this investigation, we aimed to compare the effectiveness of two popular non-adaptive methods (the ICA and PCA) to explore the non-invasive (NI) extraction (separation) of fECGs, also known as NI-fECGs from aECGs. The performance of these well-known methods was enhanced by an adaptive algorithm, compensating amplitude difference and time shift between the estimated components. We used real signals compiled in 12 recordings (real01–real12). Five of the recordings were from the publicly available database (PhysioNet-Abdominal and Direct Fetal Electrocardiogram Database), which included data recorded by multiple abdominal electrodes. Seven more recordings were acquired by measurements performed at the Institute of Medical Technology and Equipment, Zabrze, Poland. Therefore, in total we used 60 min of data (i.e., around 88,000 R waves) for our experiments. This dataset covers different gestational ages, fetal positions, fetal positions, maternal body mass indices (BMI), etc. Such a unique heterogeneous dataset of sufficient length combining continuous Fetal Scalp Electrode (FSE) acquired and abdominal ECG recordings allows for robust testing of the applied ICA and PCA methods. The performance of these signal separation methods was then comprehensively evaluated by comparing the fetal Heart Rate (fHR) values determined from the extracted fECGs with those calculated from the fECG signals recorded directly by means of a reference FSE. Additionally, we tested the possibility of non-invasive ST analysis (NI-STAN) by determining the T/QRS ratio. Our results demonstrated that even though these advanced signal processing methods are suitable for the non-invasive estimation and monitoring of the fHR information from maternal aECG signals, their utility for further morphological analysis of the extracted fECG signals remains questionable and warrants further work.

This paper is focused on the design, implementation and verification of a novel method for the optimization of the control parameters (such as step size μ and filter order N) of LMS and RLS adaptive filters used for noninvasive fetal monitoring. The optimization algorithm is driven by considering the ECG electrode positions on the maternal body surface in improving the performance of these adaptive filters. The main criterion for optimal parameter selection was the Signal-to-Noise Ratio (SNR). We conducted experiments using signals supplied by the latest version of our LabVIEW-Based Multi-Channel Non-Invasive Abdominal Maternal-Fetal Electrocardiogram Signal Generator, which provides the flexibility and capability of modeling the principal distribution of maternal/fetal ECGs in the human body. Our novel algorithm enabled us to find the optimal settings of the adaptive filters based on maternal surface ECG electrode placements. The experimental results further confirmed the theoretical assumption that the optimal settings of these adaptive filters are dependent on the ECG electrode positions on the maternal body, and therefore, we were able to achieve far better results than without the use of optimization. These improvements in turn could lead to a more accurate detection of fetal hypoxia. Consequently, our approach could offer the potential to be used in clinical practice to establish recommendations for standard electrode placement and find the optimal adaptive filter settings for extracting high quality fetal ECG signals for further processing. Ultimately, diagnostic-grade fetal ECG signals would ensure the reliable detection of fetal hypoxia.

This study focuses on the design, implementation and subsequent verification of a new type of hybrid extraction system for noninvasive fetal electrocardiogram (NI-fECG) processing. The system designed combines the advantages of individual adaptive and non-adaptive algorithms. The pilot study reviews two innovative hybrid systems called ICA-ANFIS-WT and ICA-RLS-WT. This is a combination of independent component analysis (ICA), adaptive neuro-fuzzy inference system (ANFIS) algorithm or recursive least squares (RLS) algorithm and wavelet transform (WT) algorithm. The study was conducted on clinical practice data (extended ADFECGDB database and Physionet Challenge 2013 database) from the perspective of non-invasive fetal heart rate variability monitoring based on the determination of the overall probability of correct detection (ACC), sensitivity (SE), positive predictive value (PPV) and harmonic mean between SE and PPV (F1). System functionality was verified against a relevant reference obtained by an invasive way using a scalp electrode (ADFECGDB database), or relevant reference obtained by annotations (Physionet Challenge 2013 database). The study showed that ICA-RLS-WT hybrid system achieve better results than ICA-ANFIS-WT. During experiment on ADFECGDB database, the ICA-RLS-WT hybrid system reached ACC > 80 % on 9 recordings out of 12 and the ICA-ANFIS-WT hybrid system reached ACC > 80 % only on 6 recordings out of 12. During experiment on Physionet Challenge 2013 database the ICA-RLS-WT hybrid system reached ACC > 80 % on 13 recordings out of 25 and the ICA-ANFIS-WT hybrid system reached ACC > 80 % only on 7 recordings out of 25. Both hybrid systems achieve provably better results than the individual algorithms tested in previous studies. INDEX TERMS Noninvasive fetal electrocardiography, independent component analysis (ICA), adaptive neuro fuzzy inference system (ANFIS), recursive least squares (RLS), wavelet transform (WT), ICA-ANFIS-WT, ICA-RLS-WT, hybrid methods, fetal heart rate variability monitoring, extraction systems.

Fetal electrocardiography is among the most promising methods of modern electronic fetal monitoring. However, before they can be fully deployed in the clinical practice as a gold standard, the challenges associated with the signal quality must be solved. During the last two decades, a great amount of articles dealing with improving the quality of the fetal electrocardiogram signal acquired from the abdominal recordings have been introduced. This article aims to present an extensive literature survey of different non-adaptive signal processing methods applied for fetal electrocardiogram extraction and enhancement. It is limiting that a different non-adaptive method works well for each type of signal, but independent component analysis, principal component analysis and wavelet transforms are the most commonly published methods of signal processing and have good accuracy and speed of algorithms.