Research and Development of Personal Technologies for Prenatal Care and Prevention of Preterm Birth
Date Issued
2012
Date
2012
Author(s)
Chen, Chen-Yu
Abstract
Fetal compromise and preterm birth are two of the important problems in obstetrics. Cardiotocography (CTG), also known as electronic fetal monitoring, is a prevalent tool for recording fetal heart rates (FHRs) and uterine contractions (UCs) to evaluate fetal conditions and uterine activities during pregnancy. High risk pregnancies (such as gestational hypertension, preeclampsia, gestational diabetes mellitus, preterm labor, oligohydramnios, intrauterine growth restriction, and postdatism) are the indications of CTG.
A complete interpretation of a cardiotocogram includes both qualitative and quantitative descriptions of FHR (baseline, baseline variability, acceleration, early deceleration, late deceleration, variable deceleration, prolonged deceleration, recurrent deceleration, and sinusoidal pattern) and UC (baseline uterine tone, contraction frequency, duration, and strength), which can diagnose non-reassuring fetal heart rate and predict preterm birth.
In general, CTG was performed at hospitals and diagnosed by obstetricians. Before prenatal telemedicine, the CTG surveillance often required pregnant women to visit and stay in the hospital, and it was especially stressful for patients who reside far from hospitals.
Preterm birth is the main cause of perinatal morbidity and mortality with an incidence of 5 to 13% in developed countries, and accounts for nearly 70% of neonatal deaths and 50% of neurologic disabilities. However, early detection of preterm birth is difficult because the initial signs and symptoms are often obscure and may be mimicked by normal pregnancies.
Fetal fibronectin (fFN), which is a type of glycoprotein, is a major ingredient of the extracellular matrix originated in the interface between the maternal and fetal components of the choriodecidual junction. Preterm uterine contractions or cervical change is related to disruption of the choriodecidual junction, which leads fFN to release in the ectocervix or posterior vaginal fornix. fFN is the strongest biomarker to predict the risk of spontaneous preterm birth.
This dissertation includes two main sections: The first section is prenatal telemedicine with a novel CTG analysis program; the second section is biosensors for fFN detection to predict the risk of preterm birth.
Telemedicine with self-monitoring (such as blood pressure, blood sugar, and blood oxygen monitoring) is widely applied to provide clinical health care remotely. It can supply comparable health care, provide more convenience to patients, and may be cost-effective. In this dissertation we developed a prenatal telemedicine system with a novel objective and quantitative CTG analysis program based on the Laboratory Virtual Instrumentation Engineering Workbench (LabVIEW) graphical software to monitor FHRs and UCs at home. The results of CTG were then sent to the hospital via Bluetooth and WiFi networks.
The development of biosensors provides an efficient, effective and accurate method of clinical examination, drug test, biochemical analysis, and environmental monitoring. Biosensors have been used to study a variety of biomolecules such as proteins, enzymes, and nucleic acids. Surface plasmon resonance (SPR) is an electromagnetic reaction of surface plasmons at the metal–dielectric interface of biosensors. In theory, when the analyte binds the ligand on the metal film, the interfacial architecture changes, and surface plasmons are excited by the light beam. We can measure the change of the resonant angle and determine the concentration of biomolecules of interest; Immunomagnetic reduction (IMR) is a technology developed to measure the reduction in the alternative-current (ac) magnetic susceptibility of magnetic reagents and detects the association between bio-functionalized magnetic nanoparticles and targeted bio-molecules. By way of the binding antibodies on the shell surface, magnetic nanoparticles connect the targeted bio-molecules and become either larger or clustered. The larger/clustered magnetic nanoparticles oscillate much less than that of initially individual magnetic nanoparticles, and we can analyze the targeted bio-molecules by measuring the diminution in ac magnetic susceptibility of the magnetic reagent.
In Taiwan, the commercial fFN ELISA kit is not widely used because of its higher cost. In this dissertation, we developed the biosensors based on SPR and IMR to predict the risk of preterm birth. The biosensor is a promising method with quantitative detection, high sensitivity, high specificity, easy operation, and low cost. Pregnant women monitor FHRs and UCs at home and the high risk groups of fetal compromise or preterm birth are suggested to go to the hospital for further evaluation and management. In the hospital we use the biosensor to predict the risk of preterm birth in order to reduce the perinatal morbidity and mortality.
Subjects
Fetal compromise
preterm birth
telemedicine
cardiotocography
fetal fibronectin
biosensor
surface plasmon resonance
immunomagnetic reduction
SDGs
Type
thesis
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