Objective: One dimensional (1D) Doppler ultrasound (DUS) is commonly used for fetal health assessment, during both regular prenatal visits and labor. It is used in preference to ECG and other modalities because of its simplicity and cost. To date, all analysis of such data has been confined to a smoothed, windowed heart rate estimation derived from the 1D DUS signal, reducing the potential of short-term variability information. A first step in improving the assessment of short-term variability of the fetal heart rate (FHR) is through implementing an accurate beat detector for 1D DUS signals.
Approach: This work presents an unsupervised probabilistic segmentation method enabled by a hidden semi-Markov model (HSMM). The proposed method employs envelope and spectral features for an online segmentation of fetal 1D DUS signal. The beat onsets and fetal cardiac beat-to-beat intervals are then estimated from the segmentations. For this work, two data sets were used, including 1D DUS recordings from five fetuses recorded in Germany, comprising 6521 beats and 45.06 minutes of data (dataset 1). Simultaneous fetal ECG (fECG) was used as the reference for beat timing. Dataset 2, comprising 4044 beats captured from 17 subjects in the UK was hand scored for beat location and was used as an independent held-out test set. Leave-one-out subject cross-validation was used for parameter tuning on dataset 1. No retraining was performed for dataset 2. To assess the performance of the beat onset detection, the root mean square error (RMSE), F1 score, sensitivity, positive predictivity (PPV) and the error in several standard common heart rate variability metrics were used. These metrics were evaluated on three fiducial points: (1) beat onset, (2) beat offset, and (3) middle of beat interval.
Main results: In dataset 1, the proposed method provided an RMSE of 20 ms, F1 score of 97.5 %, a Se of 97.6%, and a PPV of 97.3%. In dataset 2, the proposed method achieved an RMSE of 26 ms, an F1 score of 98.5 %, a Se of 98.0 % and a PPV of 98.9 %. It was also determined that the best beat-to-beat interval was derived from the onset of each beat. For the dataset 2, significant correlations were found in all short term heart rate variability metrics tested, both in the time and frequency domain. Only the proportion of successive normal-to-normal interval differences greater than 20 ms (pNN20) exhibited a significant absolute difference.
Significance: This work presents the first-ever description of an algorithm to identify cardiac beats with 1D DUS, closely matching the fetal ECG-derived beats, to enable short-term heart rate variability analysis. The novel algorithm proposed requires no human labeling of data, and could have applicability beyond 1D DUS to other similar highly variable time series.