There are 24,000 stillbirths per year in the United States, and 2.6 million stillbirths per year worldwide, with no
significant decrease in the last decade. Abnormal fetal heart rhythms, such as long QT syndrome, are thought
to play an important role in these deaths, and may cause 3-10% of unexplained stillbirths. This is in addition to
known fetal arrhythmias, which affect 1-3% of pregnancies per year. A magnetocardiogram is the gold
standard to detect these disorders, but is not portable or practical for widespread use. Other available tools
such as ultrasound and cardiotocography cannot measure the intervals needed to diagnose and guide
management of life threatening arrhythmias. The ideal tool for diagnosing and guiding therapy for arrhythmias
is an electrocardiogram (ECG). Unfortunately, clinicians do not widely use the existing fetal electrocardiogram
(fECG) devices for a variety of reasons: they do not work throughout all of gestation, can miss brief
arrhythmias, have a delay between the actual rhythm and displayed rhythm, do not work in multiple gestations,
and lack resolution of important intervals.
Our team is developing a methodology to detect a continuous, time-resolved fECG using a novel
implementation of adaptive interference cancellation (AIC). This proposal will build on our preliminary work to
create a fECG clinical prototype and evaluate its performance in maternal patients at our pediatric hospital.
This device is designed to generate an fECG regardless of gestational age, position, or pregnancies involving
multiple fetuses. In this proposal, we aim to:
1. Transition an engineering prototype fECG to a clinical prototype by modifying the signal processing
algorithm and user interface using existing datasets.
2. Measure cardiac time intervals in 16-40 week gestation fetuses and assess the reproducibility of these
measurements between two readers.
If successful, fetal cardiologists could use this tool to diagnose and treat known and latent fetal arrhythmias
with existing anti-arrhythmic therapies. Globally, it could serve as a low cost tool to screen for arrhythmias that
lead to stillbirth and to monitor fetuses for compromise during surgery, maternal medication use, and fetal
interventions. Clinically implementing this critical diagnostic tool will be a landmark in the field of fetal