Abstract:
A computer readable storage medium storing a program element for execution by a computer to implement a user interface. The user interface conveys fetal condition information to a user. The user interface has a first section showing one or more vital signs of a fetus. The first section includes at least one tracing associated with a vital sign of the fetus and a marker to visually highlight an area of the tracing corresponding to an event of interest. The first section also has a control component that can be activated by the user to deliver additional information about the event of interest.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims the benefit under 35 USC §120 of U.S. provisional patent application Ser. No. 60/996,935 filed Dec. 11, 2007 by E. Hamilton and which is presently pending. The contents of the above-mentioned patent application are incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The invention relates to information delivery and more particularly to a user interface to show FHR variations and contraction information during labor. 
       BACKGROUND 
       [0003]    During labor, uterine contractions push the baby through the birth canal. Uterine contractions can also reduce oxygen delivery to the baby by causing compression of the umbilical cord or by reducing maternal blood flow through the uterus and placenta. These intermittent stresses are usually mild and well tolerated by the baby. However, under certain conditions the baby will be subject to excessive oxygen deprivation. If this is sufficiently prolonged or severe it can lead to fetal brain injury or death. 
         [0004]    Fetal Heart Rate (FHR) and maternal contraction monitoring is performed in approximately 90% of labors. The pattern of the FHR response to contractions reflects in part the in-utero mechanism producing the FHR change as well as the ability of the fetus to respond and compensate. Other aspects of the FHR recording, such as the heart beat to heart beat variation in the FHR reflect the ability of the central nervous system to modulate the fetal heart. Professional bodies have defined the size and shape characteristics of several deceleration and acceleration patterns. 
         [0005]    Clinicians visually review these monitor recordings, including the trends in patterns over time, and integrate this with other pertinent clinical information to assess fetal tolerance to labor and risk of hypoxic injury. Although deceleration patterns are defined, numerous studies show inconsistent labeling by clinicians especially when the patterns are mixed and tracings are neither completely normal nor highly abnormal. Visual inspection of the tracing is an imprecise way to measure these fluctuations in the FHR. Integrating information consistently over many hours is a challenging task for humans and well known to be further exacerbated by fatigue, distraction and inexperience. Several reviews of hypoxic fetal death or brain injury confirm a high rate of medical error ranging from 40 to 60%, centering most often on failure to appreciate the degree and duration of abnormality. 
         [0006]    Therefore, a need exists in the industry to provide improved FHR information delivery mechanisms allowing the physician during labor to identify at a glance periods of FHR changes, without the need to browse through lengthy recordings in an attempt to spot trends. 
       SUMMARY 
       [0007]    As embodied and broadly described herein the invention provides a computer readable storage medium holding a program element for execution by a computer to implement a user interface conveying fetal condition information to a user, the user interface comprising a section showing one or more vital signs of a fetus, said first section including:
       a) at least one tracing associated with a vital sign;   b) a marker to visually highlight an area of the tracing corresponding to an event of interest;   c) a control component that can be activated by the user to deliver additional information about the event of interest.       
 
         [0011]    Other aspects and features of the present invention will become apparent to those ordinarily skilled in the art upon review of the following description of specific embodiments of the invention in conjunction with the accompanying figures. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]    A detailed description of examples of implementation of the present invention is provided hereinbelow with reference to the following drawings, in which: 
           [0013]      FIG. 1  shows a high-level functional block diagram of a system including an apparatus  100  for monitoring an obstetrics patient in accordance with a specific example of implementation of the present invention; 
           [0014]      FIG. 2  shows a block diagram of the apparatus  100  depicted in  FIG. 1  in accordance with a specific example of implementation of the present invention; 
           [0015]      FIG. 3  show a specific example of implementation of a graphical user interface implemented by the system shown in  FIG. 1  for providing fetal condition information in accordance with a first non-limiting example of implementation of the invention; 
           [0016]      FIG. 4  is a block diagram of an apparatus for providing fetal condition information in accordance with a specific example of implementation of the present invention; 
           [0017]      FIG. 5  is a high level conceptual block diagram of a program element for implementing a graphical user interface of the type shown in  FIG. 3  in accordance with a specific example of implementation of the present invention; 
           [0018]      FIG. 6  shows a functional block diagram of a client-server system for providing fetal condition information in accordance with an alternative specific non-limiting example of implementation of the present invention. 
       
    
    
       [0019]    In the drawings, embodiments of the invention are illustrated by way of example. It is to be expressly understood that the description and drawings are only for purposes of illustration and as an aid to understanding, and are not intended to be a definition of the limits of the invention. 
       DETAILED DESCRIPTION  
       [0020]    With reference to  FIG. 1 , there is shown a configuration of a system  150  for monitoring labor progress for an obstetrics patient comprising a fetal heart rate sensor  110 , a uterine activity sensor  120 , a user input device  118 , an apparatus  100  implementing a user interface for displaying labor related information and a display unit  114 . 
         [0021]    The user input device  118  is for receiving data from a user of the system. The user input device  118  may be used, for example, to enter information associated with the obstetrics patient and/or to manipulate the information displayed by the user interface implemented by the apparatus  100 . The type of data received through input device  118  may vary depending on the type of information that the apparatus  100  is adapted to process and interpret. Specific examples of the type of information that may be provided through input device  118  will be described later on in the specification. The user input device  118  includes any one or a combination of the following: keyboard, pointing device, touch sensitive surface, actuator/selection switches or speech recognition unit. 
         [0022]    The fetal heart rate sensor  110  is for detecting a fetal heart rate of a fetus in-utero, also referred to as a fetus in the womb. The fetal heart rate sensor  110  samples the fetal heart rate at a certain pre-determined frequency to generate the signal indicative of the fetal heart rate. Fetal heart rate sensors are well known in the art to which this invention pertains and any suitable sensor for detecting a fetal heart rate may be used without detracting from the spirit of the invention and as such will not be described further here. 
         [0023]    The uterine activity sensor  120  is for monitoring uterine activity (TOCO). The sensor samples the contraction pattern at a certain pre-determined frequency to generate the signal indicative of uterine activity. Sensors for monitoring uterine activity are well known in the art to which this invention pertains and any suitable sensor may be used without detracting from the spirit of the invention and as such will not be described further here. 
         [0024]    Optionally, the monitoring system  150  may include other sensors (not shown) for measuring labor progress and the fetus&#39; tolerance to labor. Such sensors may include for example:
       a sensor for measuring the maternal oxygen saturation   a sensor for measuring the fetal oxygen saturation   a sensor for measuring maternal blood pressure       
 
         [0028]    Suitable sensors other than the ones described above may also be used without detracting from the spirit of the invention. 
         [0029]    The display unit  114  is coupled to the apparatus  100  and receives a signal causing the display unit  114  to display a graphical user interface module implemented by apparatus  100 . The display unit  114  may be in the form of a display screen, a printer or any other suitable device for conveying to the physician or other health care professional the progression of labor related information. In a non-limiting implementation, the display unit  114  includes one or more display screens to display the graphical user interface. The display unit  114  may also include a printer device for providing a paper print out of the graphical user interface implemented by apparatus  100 . In embodiments where the display unit  114  is in the form of a display screen, it may be part of any suitable type of apparatus including, without being limited to, a desktop/laptop computing apparatus, a personal digital assistant (PDA), a telephone equipped to video display capability, a TV monitor or any other suitable device equipped with a display screen for visually conveying information to a user. 
         [0030]    Optionally, the monitoring system  150  may further include a data output module  130 . The data output module  130  is in communication with the apparatus  100  and is suitable for receiving signals generated by the apparatus  100 . In a first specific example of implementation, the data output module  130  includes an audio module for releasing audio signals on the basis of signals received from the apparatus  100 . In a second specific example of implementation, the data output module  130  includes a data communication entity suitable for transmitting messages to remote devices causing the latter to convey to a user of the monitoring system  150  fetal condition information and, optionally, maternal condition information. Examples of remote devices include, without being limited to, PDAs, telephones, pagers and computing terminals. 
       Apparatus  100   
       [0031]    A specific example of implementation of apparatus  100  will now be described with reference to  FIG. 2 . The apparatus  100  includes a first input  202 , a second input  203 , a processing unit  206  and an output  208 . The first input  202  is for receiving a contraction signal originating from the uterine activity sensor  120  (shown in  FIG. 1 ) and conveying information related to occurrences of uterine contractions over time. The second input  203  is for receiving a fetal heart rate signal as generated by fetal heart rate sensor ( 110 ). It will be readily appreciated that, although the fetal heart rate signal and the uterine activity signal are received at different inputs in the embodiment illustrated in  FIG. 2 , these signals may be provided to processing unit  206  through a same input without detracting from the spirit of the invention. Optionally, as shown in  FIG. 2 , the apparatus further includes a third input  204  for receiving data from a user through input device  118  (shown in  FIG. 1 ). 
         [0032]    The processing unit  206  processes the signals received at inputs  202  and  203  as well as the user data received at input  204  and to derive various information elements including fetal condition information and, optionally, maternal condition information. The processing unit  206  also implements a graphical user interface module for displaying the device information elements. The output  208  is for releasing a signal for causing display unit  114  to display the graphical user interface module implemented by processing unit  206 . 
         [0033]    The output  208  is for releasing a signal for causing the display unit  114  (shown in  FIG. 1 ) to display the graphical user interface implemented by processing unit  206 . Optionally still, the apparatus further includes a data interface  210  for exchanging signals with the data output module  130  (shown in  FIG. 1 ) for causing the latter to convey fetal condition information and, optionally, maternal condition information to a user of the labor monitoring system  150  (shown in  FIG. 1 ). 
       Processing Unit  206   
       [0034]    The processing unit  206  receives data from the fetal heart rate sensor  110 , the uterine activity sensor  120  and the input device  118  and processes that data to derive therefrom various information elements including fetal condition information and, optionally, maternal condition information. 
         [0035]    In a specific example of implementation, the processing unit  206  includes functionality for deriving fetal heart rate feature measurements. Fetal heart rate feature measurements include, for example, mean baseline, mean baseline variability, decelerations and accelerations amongst others. Any suitable algorithm for identifying fetal heart rate feature measurements may be used. Any suitable pattern recognition technique may be used for identifying the occurrence of acceleration/deceleration events and for calculating the baseline for the fetal heart rate. Such techniques are well known in the art of signal processing and as such will not be described further here. The processing unit  206  also includes functionality for processing the contraction signal received at second input  203  to detect the occurrence of contraction events. Any suitable pattern recognition technique may be used for identifying the occurrence of contraction events. Such techniques are well known in the art of signal processing and as such will not be described further here. 
         [0036]      FIG. 3  shows an example of a user interface, as it would appear on the display unit  114  while an obstetrics patient is in labor. The user interface  300  delivers visual information to the user and, at the same time, accepts user inputs via the user input device  118 . The inputs via user input device help further refine the usefulness and accuracy of the information displayed on the display unit  114 . 
         [0037]    In the non-limiting example depicted, an upper section  304  of the user interface  300  is used primarily to display fetal heart rate information and, optionally, maternal heart rate information. A lower section  306  of the user interface is used primarily to display maternal uterine contraction information and, optionally maternal and/or fetal oxygen saturation information. 
         [0038]    Specifically, the user interface  300  has a top information bar  302  that contains basic information about the ongoing procedure, in particular the date of the procedure, the identification of the patient and the physician identification among others. Below the information bar  302 , the display is divided into two separate sections  304  and  306 . The sections  304  and  306  are synchronized with respect to time; in other words they share a common time line. Accordingly, an event in the upper section  304  that is aligned with an event in the lower section  306  occurs at the same point in time. 
         [0039]    The drawings show sections  304 ,  306  aligned horizontally. This is a useful disposition of the information since it mimics the way a chart is laid on a sheet and is well suited for computer monitors set in a landscape orientation. However the information can also be presented differently, especially on devices that are not intended to be used in a landscape orientation, such as portable devices that have screens oriented portrait wise. In this instance, the sections  304 ,  306  can run vertically, instead of running horizontally. 
         [0040]    Also note that while the time synchronization between the sections  304  and  306  is considered to be an advantageous feature, it is not absolutely required and may be dispersed without departing from the spirit of the invention. Specifically, the each one of the sections  304 ,  306  can be shown on two different display units  114 , which may be located side by side. 
         [0041]    The upper section  304  is provided with two sets of grid lines. The horizontal set of gridlines  308  provide reference to a heart beat axis  310 , which in the example shown ranges from 30 beats per minute to 240 beats per minute. The vertical set of gridlines  312  is associated with a time scale  314  which is shown at the bottom of the upper section  304 . The time scale  314  appears as a bar showing the actual time of day. 
         [0042]    Below the upper section  304 , which is used primarily to display fetal heart rate information, appears the lower section  306 . The lower section  306 , which is used primarily to convey maternal uterine contraction information, is similarly arranged to the upper section  304  in that it has vertical grid lines  316  that refer to the time scale  314 , which is common to both sections  304  and  306 . 
         [0043]    Horizontal grid lines  318  are also provided but they refer to the contractions strength axis  320 . In the example shown the contractions strength axis  320  ranges from 0 to 100. 
         [0044]    The upper section includes a tracing  322  showing the variation of the fetal heart beat with respect to time. While this tracing provides very useful information to the physician, it may be difficult to interpret sometimes as the minute variations in the tracing make longer terms trends less obvious to see. As an assist to FHR tracing  322  interpretation the upper section  304  includes markers that visually indicate the occurrence of FHR significant events. One such event is an FHR downward or upward change of significant size and duration. 
         [0045]    In the example shown, the markers are in the form of windows (several such windows are shown in the drawing denoting several events of interest). For the purpose of the example consider the window  324   a.  That window is laid over the tracing  322  and is rendered in a color that is different from the background of the chart such to make it stand out visually. The coloring of the window  324   a  is translucent. In this fashion the tracing  322  remains visible within the frame of the window  324   a.  The horizontal size of the window denotes the duration of the event of interest, in this case a reduction of the FHR. Indeed, it can be clearly noted that the tracing  322  dips below the 140 beats per minute line. 
         [0046]    The window  324   a  shows a deceleration of the FHR. Windows that show acceleration, such as the window  324   b  appear in a different color. In the example shown the window  324   b  is in green, which by convention is normally associated to a “safe” event, while the amber color used in the case of the window  324   a  denotes an “unsafe” event. The reader will appreciate that the particular color chosen for the window is a matter of design and many different color schemes can be used without departing from the spirit of the invention. 
         [0047]    In addition to using color to highlight the windows  324   a,    324   b,  other techniques can also be employed such as causing the window to flash to further attract the physician&#39;s attention. Audible alarms can be also be employed in extreme circumstances. 
         [0048]    To reduce clutter on the display, windows, such as windows  324   a  and  324   b,  can initially appear in the form of bars  326  and  328  having a color that denotes the nature of the event to the reported, namely green for FHR increase and amber for FHR decrease. The length of a bar denotes the duration of the event to report. In the example of the window  324   a,  the length of the bar spans an interval of about 1 minute. Above the bar  326  is provided a control  330  that can be invoked to obtain more information on the event that the window denotes. The control also shows, in color and textually, the nature of the event, such as a late deceleration (L), a variable deceleration (V) or an acceleration (A) of the FHR amongst others. In addition, controls of different color intensities and containing letters other than the ones mentioned above may also be used to draw attention to events signalling potentially problematic situations. The control can be activated in different ways to show the additional information. One is to simply “click” with a pointing device on, or near, the control  330 . In the case of a touch sensitive display  114 , the physician can touch the area of the display  114  where the control  330  is shown to activate it. Yet another possibility is to activate the control  330  when the pointer of the pointing device hovers over, or near, the control  330 . In this case there is no necessity to actually “click” on the control  330 . As soon as the pointer is brought in proximity to the control  330 , the activation occurs. 
         [0049]    When the control  330  is activated, the window expands to take the shape shown in  324   a.  The entire area is then colored amber but remains translucent to keep the tracing  322  visible. In addition, a secondary window  332  pops up adjacent the primary window  324   a,  in which additional information appears. The additional information relates to the event of interest and can help the physician determine the relevance of the event denoted by the primary window  324   a.  Recall that the windows are actually generated by an algorithm which tracks the raw data, such as the FHR generated by the sensor  110 . While most of the time the algorithm accurately identifies in the raw data the events of interest, it may occur that some events that are reported by a window are of little clinical relevance or even wrongly identified. A purpose of the secondary window  332  is to expose to the physician the raw data that has been used as a basis for the identification of the event, to allow the physician to validate the event. Specifically, the secondary window may convey the following type of information:
       1. The type of event. In the examples shown the event can be a (late or variable) deceleration of the FHR or an acceleration of the FHR.   2. The duration of the event.   3. The magnitude of the rise or fall in the FHR within the event compared to the ambient baseline FHR value for instance a 16 Beats Per Minute (BPM) drop relative to the baseline BPM value that was observed before the event was triggered.   4. While not shown in the drawings, another element of information that can be used is the degree of confidence, reported by the algorithm in connection with the event recognition. This can be expressed as a percentage where the higher the percentage the higher the degree of confidence that the event is a real occurrence and not the result of an artifact in the raw data.       
 
         [0054]    The window  324   a  is also associated with a second control, namely control  340 , which allows editing the window  324   a.  In the example shown, the control is in the form of an “X” appearing near the bottom of the window  324   a  and when activated erases the window from the display  114 . This option is used in instances where the window  324   a  is of little clinical relevance and may be removed to de-clutter the user interface  300 . The control  340  is activated by “clicking” on it via a pointing device, such as a mouse, trackball or touch sensitive display surface. 
         [0055]    Other editing options can be used as well. For example, the actuation of the control  340  can allow the physician to enter comments. This can be done by opening a text box in which comments can be typed. The comments are then stored and can be retained permanently as part of the records produced by the apparatus  100 . Yet another editing option is to change the window size which corresponds to the duration of the event. That can occur when the algorithm has determined an event duration to be less than what it truly is and the physician can correct the duration by “dragging” the left or the right vertical line boundaries of the window to increase or decrease the duration. When the window  324   a  is edited in this fashion, the associated information that would appear in the secondary window  332  would also change. Specifically, the duration shown for the event will be corrected accordingly along with magnitude if the rise or fall in FHR within the event. 
         [0056]    Yet another possible edit to the window  324   a  is to merge it with another adjacent window such that both windows are jointed into a single window. 
         [0057]    As discussed earlier, the lower section  306 , which primarily displays contractions rate information, is provided below the upper section  304 , which is used primarily to display fetal heart rate information. Both sections are time synchronized. This allows correlating events reported in the upper section  304  to events occurring in the lower section  306 . Specifically, window  324   a  has vertical bars  360  and  380  that delimit the window  324   a  horizontally. The bars  360  and  380  extend down up to the lower section  306  and intersect the tracing of the contraction rate. Therefore, the bars  360  and  380  show that the FHR deceleration event occurred somewhat before a contraction peak and dissipated shortly after the contraction ceased. 
         [0058]    Below the lower section  306  are also provided a series of markers in the form of bars  400  that identify the occurrence of individual contractions. The bars  400  show the beginning and the end of each contraction and thus make the interpretation of the tracing easier. Specifically, one of the extremities of the bars  400  corresponds to the area of the tracing where a contraction begins and the opposite end of the bar  400  corresponds to the end of the contraction. 
         [0059]    The use of the bars  400  is useful when the image is reduced in size, which can occur when the user interface is rendered on a small screen, such as a mobile computing device as a PDA. In such instances, the loss of resolution may be such as to make the tracing difficult to interpret and the bars  400  can be very useful to the user to spot where the contractions are. 
         [0060]    Those skilled in the art should appreciate that in some embodiments of the invention, all or part of the functionality previously described herein with respect to the apparatus implementing a user interface for displaying labour related information may be implemented as pre-programmed hardware or firmware elements (e.g., application specific integrated circuits (ASICs), electrically erasable programmable read-only memories (EEPROMs), etc.), or other related components. 
         [0061]    In other embodiments of the invention, all or part of the functionality previously described herein with respect to the apparatus for implementing a graphical user interface module for displaying labour related information may be implemented as software consisting of a series of instructions for execution by a computing unit. The series of instructions could be stored on a medium which is fixed, tangible and readable directly by the computing unit, (e.g., removable diskette, CD-ROM, ROM, PROM, EPROM or fixed disk), or the instructions could be stored remotely but transmittable to the computing unit via a modem or other interface device (e.g., a communications adapter) connected to a network over a transmission medium. The transmission medium may be either a tangible medium (e.g., optical or analog communications lines) or a medium implemented using wireless techniques (e.g., microwave, infrared or other transmission schemes). 
         [0062]    The apparatus implementing a user interface for displaying labor related information may be configured as a computing unit  700  of the type depicted in  FIG. 4 , including a processing unit  702  and a memory  704  connected by a communication bus  708 . The memory  704  includes data  710  and program instructions  706 . The processing unit  702  is adapted to process the data  710  and the program instructions  706  in order to implement the functional blocks described in the specification and depicted in the drawings. In a non-limiting implementation, the program instructions  706  implement the functionality of processing unit  206  described above with reference to  FIG. 2 . The computing unit  700  may also comprise a number of interfaces  712   a,    712   b,    714 ,  716  for receiving or sending data elements to external devices. For example, interface  712   b  is used for receiving a data stream indicative of a fetal heart rate signal and interface  712   a  is for receiving a data stream indicative of a contraction signal. In addition, interface  714  is used for receiving a control signal from the user for controlling the information to be displayed on the graphical user interface implemented by the processing unit  702  when executing program instructions  706 . Interface  716  is for releasing a signal causing a display unit to display the user interface generated by the processing unit  702  when executing program instructions  706 . The computing unit shown in  FIG. 4  may be part of any suitable computing device including, but not limited to, a desktop/laptop computing device or a portable digital assistant device (PDA). 
         [0063]    It will be appreciated that the system for implementing a user interface for displaying labour related information may also be of a distributed nature where the contraction signal and FHR signal are collected at one location by a uterine activity sensor and fetal heart rate sensor and transmitted over a network to a server unit implementing the graphical user interface. The server unit may then transmit a signal for causing a display unit to display the graphical user interface. The display unit may be located in the same location as the uterine activity sensor, in the same location as the server unit or in yet another location.  FIG. 6  illustrates a network-based client-server system  900  for displaying uterine contraction information. The client-server system  900  includes a plurality of client systems  912 ,  914 ,  916 ,  918  connected to a server system  910  through network  920 . The communication links  950  between the client systems  912 ,  914 ,  916 ,  918  and the server system  910  can be metallic conductors, optical fibers or wireless, without departing from the spirit of the invention. The network  920  may be any suitable network including but not limited to a global public network such as the Intranet, a private network and a wireless network. The server  910  may be adapted to process and issue signals to display multiple heart rate and contraction signals originating from multiple sensors  926 ,  928  concurrently using suitable methods known in the computer related arts. 
         [0064]    The server system  910  includes a program element  960  for execution by a CPU. Program element  960  implements similar functionality as program instructions  706  (shown in  FIG. 4 ) and includes the necessary networking functionality to allow the server system  910  to communicate with the client systems  912 ,  914 ,  916 ,  918  over network  620 . In a non-limiting implementation, program element  960  includes a number of program element components, each program element components implementing a respective portion of the functionality of the user interface for displaying labor related information.  FIG. 5  shows a non-limiting example of the architecture of program element  960  at the server system. As shown, the program element  960  includes four (4) program element components:
       1. the first program element component  500  is executed on server system  910  and is for receiving signals conveying labor information;   2. the second program element component  502  is executed on server system  610  and is for sending messages to a client system, say client system  914 , for causing client system  914  to display the user interface as described in connection with  FIG. 3 ;   3. the third program element component  504  is executed on server system  910  and is for sending messages to client system  914  for causing client system  914  to display controls  330  and  340  (shown in  FIG. 3 );   4. the fourth program element component  506  is executed on server system  910  and is for receiving a message from client system  914  indicative of an actuation of anyone of the controls  330  and  340  (shown in  FIG. 3 ).       
 
         [0069]    Those skilled in the art should further appreciate that the program instructions may be written in a number of programming languages for use with many computer architectures or operating systems. For example, some embodiments may be implemented in a procedural programming language (e.g., “C”) or an object oriented programming language (e.g., “C++” or “JAVA”). 
         [0070]    Although various embodiments have been illustrated, this was for the purpose of describing, but not limiting, the invention. Various modifications will become apparent to those skilled in the art and are within the scope of this invention, which is defined more particularly by the attached claims.