Surgery – Diagnostic testing – Measuring anatomical characteristic or force applied to or...
Patent
1997-05-23
1998-10-06
Jaworski, Francis
Surgery
Diagnostic testing
Measuring anatomical characteristic or force applied to or...
600500, A61B 502
Patent
active
058170359
DESCRIPTION:
BRIEF SUMMARY
FIELD OF THE INVENTION
The present invention relates to a foetal monitor adapted to report on foetal activity in the womb and to a process for reporting on such foetal activity.
BACKGROUND ART
Foetal development is currently measured in a variety of ways by the midwives and clinicians supervising pregnancy. Current routine measures of foetal development include simple manual methods, such as physical examination by palpation, and auscultation of foetal heart noise; the mother's history, such as date of last menstrual period; the presence or absence of foetal movement ("quickening"); the size of the uterine enlargement; and total maternal weight gain. These have now been supplemented by advanced technological methods. In particular, diagnostic ultrasound provides a high level of information about the foetus providing a "photographic" like real-time image of the foetus which allows the detection of gross physical abnormality. Ultrasound is semi-invasive in that a high frequency soundwave is transmitted into the foetus and the reflected waves are recorded according to how much is absorbed into the foetus or reflected back to the sensor. Although considered safe, there is some uncertainty about potential adverse effect of the ultrasound passing into the foetus.
Ultrasound use has now been extended to develop a clinical "biophysical profile" in which the heart rate is measured, the presence of foetal breathing movements is sought, and then the presence of spontaneous, or evoked (e.g. by manual probing or by externally applied auditory stimuli) foetal body movements. By examining a foetus in this way the attending clinicians are reassured that it is developing normally, or in other cases is identified to be at risk, for example, of placental insufficiency. Although the level of information generated by ultrasound is highly useful and valuable, it provides only, at best a "snapshot" (typically the longest duration being about 20 minutes) of foetus activity in any one day. Such abnormalities as bradycardia and absent foetal breathing movements are used as a guide to the presence of foetal distress, for example from placental insufficiency. In more extreme conditions, the lack of body movements may indicate the possibility of more severe foetal compromise, or even foetal death. The presence of foetal breathing movements are a sign of well-being. At an early stage of any foetal distress, breathing movements cease. The detection of such movements is an important clinical measure of foetal function. However it is known that the foetus has breathing movements in epochs which are usually associated with what is believed to be active wakefulness and in a particular form of sleep called rapid-eye-movement (REM) or "active" sleep. In contrast during quiet non-active wakefulness breathing movements cease, and in non-rapid-eye-movement (NREM) or quiet sleep, breathing movements also cease.
Breathing movements in the foetus do not provide the same function as occurs after birth (i.e. to provide oxygen), as the foetus receives oxygen from the placenta. However, the movements play an important role in the normal development of the lung, and in the training of the breathing muscles, which, after birth must be active continually. Epochs of breathing movement are seen early in the second trimester, when they are scattered throughout the 24 hours in each day. As the foetus matures, it begins to develop a 24 hour rest-activity cycle which is analogous to the infant and adult human sleep-wake cycle. Now, the breathing movements become clustered into epochs of REM sleep, and likely active wakefulness. As these clusterings occur, the epochs of breathing movements occur over longer periods, and the period of their normal absence increase. Thus, a part of the normal foetal maturation includes the development of longer cycle times of rest activity and sleep with consequently longer periods of foetal breathing movements and longer periods of absent breathing movements.
Because diagnostic ultrasound is done over brief periods e.g. 10-20
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Jaworski Francis
The Institute of Respiratory Medicine Ltd.
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