Hidden Markov model in nonnegative matrix factorization for fetal heart rate estimation using physiological priors

Objective. Fetal heart rate (fHR) analysis remains the most common technique for detecting fetal distress when monitoring the fetal well-being during labor. If cardiotocography (CTG) is nowadays the non-invasive clinical reference technique for fHR measurement, it suffers from several drawbacks, hence an increasing interest towards alternative technologies, especially around abdominal ECG (aECG). Approach. An original solution, using a single abdominal lead, was recently proposed to address both the feasibility in clinical routine and the challenging detection of temporal events when facing interfered signals from real life conditions. Based on a specification of the non-negative matrix factorization (NMF) algorithm, it exploits the semi-periodicity of fetal electrocardiogram (fECG) for fHR estimation. However, this method assumes temporal independence and therefore does not consider the continuity property of fHR values. It is thus proposed to add to the NMF framework a hidden Markov model (HMM) to include physiological information about fHR temporal evolution. Under a statistical setting, constraints have been added by accommodating regularization terms through Bayesian priors. Main results. The proposed method is evaluated on 23 real aECG signals from a new clinical database, according to CTG reference, and compared with the original NMF-only algorithm. The new proposed method improves performance, with an agreement with CTG increasing from 71% to 80%. Significance. This highlights the interest of a better modelization of the fHR characteristics for a more robust estimation.