DeviceEFM: Implementation for Fetal Heart Monitor

[tanjera]

The next device I'd like to implement is DeviceEFM - the external fetal heart monitor (abbreviated as EFM- "external fetal monitor", also known as cardiotocography...). It is a monitoring device used in hospitals to monitor pregnant women in labor to track the fetus's heart rate and ensure it is healthy (with a healthy heart rate). The machine tracks two waveforms: fetal heart rate and uterine contractions. The framework for the code, both WPF and C#, is mainly copy/pasted from DeviceECG and adapted.

The screen and the printout both look like this:

The top waveform strip is the fetal heart rate, measured in beats per minute (y axis) plotted over time (x axis), with normal heart rates hovering around 130-160 beats per minute. The bottom waveform strip is uterine contractions, measured more subjectively as 0-100% (y axis) plotted over time (x axis).

Steps to do for implementation (non-medical!):

• Implement EFMTracing.xaml and EFMTracing.xaml.cs as the control for visualizing the graphs (unassigned)

  • Note: EFMTracing.xaml & EFMTracing.xaml.cs are pretty much copy/pasted versions of other Controls that are adapted to specific uses for specific devices/look/feel.
  • Expected outcome: A control much like ECGTracing except with a white background, red grid lines similar to the picture above, with measurement units mimicking the picture above. Lines and labels can either be added programmatic (as WPF items), as Resources (as vector image .svg imported as background image, able to scale with different screen resolutions/window sizes).
  • It would be okay to create TWO controls, one for fetal heart rate and one for uterine contractions. Would prefer names EFMTracingFHR (fetal heart rate) and EFMTracingToco (tocometer- name of device that reads uterine contractions).

• Implement DeviceEFM.xaml and DeviceEFM.xaml.cs as the actual device screen. (unassigned)

  • Expected outcome: Would be the window containing the EFMTracing controls, arranged like the waveform strip pictured above, able to display waveform strips in the control. Would function and act like other devices (e.g. ECG window), would be spawned by clicking on WPF button on PatientEditor.xml (currently disabled... needs enabling and possibly needs mouse-click trigger event implemented to spawn window).

• Patient modeling for populating waveform strips in Strip.cs (not medical specific, but integrates with medical-specific functionality) (unassigned)

  • Add_Beat__Obstetric_Baseline - to be used for populating baseline strip waveform, timer event for triggering contractions and decelerations
  • Add_Beat__Obstetric_Contraction - used for populating tocometer and triggering start/end of contraction; triggers FHR decelerations based on contractions
  • Add_Beat__Obstetric_Deceleration - used for triggering unique FHR decelerations

• Then, implementing medical-specific functionality (assigned: Tanjera)

  • Creating waveforms for EFMTracing in Waveforms.cs
    • EFM_FHR: fetal heart rate rhythm
    • EFM_Toco: tocometer rhythm
  • Display the rhythm strip in EFMTracing...
  • Tie in obstetric patient parameters from Patient.cs
    • FHR, uterine frequency/strength, decelerations

[tanjera]

Miscellaneous notes from "To Do.md"

• DeviceEFM layout

• EFMTracing control

• Rhythms (Rhythms.cs)

  • FHR, UA

• References

  • Perinatology EFM: http://perinatology.com/Fetal%20Monitoring/Intrapartum%20Monitoring.htm
  • 3-Tier FHR Interpretation: https://perinatalweb.org/themes/wapc/assets/docs/three%20tiered,%20three%20category%20fhr%20interpretation%20system%20_july,%202010_.pdf

[tanjera]

• Implement Patient parameters via PatientEditor

• Implement Device
  • Modeled off of ECG device re: background image, controls drawn over

• Implement Tracings
  • EFMTracing.xaml
  • EFMTracing.xaml.cs

• Patient timers
  • Beat propagation timers

• Implement Waveforms
  • EFM_FHR: fetal heart rate rhythm
  • EFM_Toco: tocometer rhythm

• Bugfix: Changing vital signs (e.g. FHR) triggers contraction on Toco (Changing vital signs (e.g. FHR) triggers immediate contraction on Toco #117)

• Implement plotted waveform for fetal heart rate variability
  • Absent, mild, moderate, severe

• Test basic rhythm (category 1)
  • Including:
    • Varying fetal heart rates
    • Varying contraction rates and lengths

• Implement variances
  • Accelerations
  • Decelerations
    • Early
    • Late
    • Variable

• Localization, language translations
  • Initial entries (English, for testing)
  • Complete translations

[tanjera]

DeviceEFM implemented in 6ef10eb, tested, working as expected. Only remaining features to implement are accelerations/decelerations. In progress. Closing issue.