Non-invasive fetal electrocardiography (NI-FECG) is an emerging technology that demonstrates potential for providing novel physiological information compared to traditional ultrasound-based cardiotocography (CTG). However, few studies have investigated the reliability of signal features derived via this technique for diagnostic use. One feature of NI-FECG recordings proposed for the purpose of identifying fetal distress is the T/QRS ratio, which has been indicated to change in response to fetal hypoxia. As the T/QRS ratio measures characteristics of the heart's electrical activity in 3D space (represented as the vectorcardiogram), it is critical to understand how changes in the vectorcardiogram orientation may influence the reliability of this feature. To study this influence, this work simulates NI-FECG recordings using eight finite element models of the maternal-fetal anatomy and calculates the T/QRS ratio for a range of vector-cardiogram orientations and sensor positions. To quantify the potential for T/QRS ratio estimation error in real world data, these results are compared to those observed in a homogeneous volume conductor model, as assumed by many existing signal processing techniques. Our results demonstrate that the fetal vectorcardiogram orientation has a significant influence on the reliability of the T/QRS ratio obtained via NI-FECG. Varying the vectorcardiogram orientation through a range of -30 to +30 degrees along each coordinate axis results in the potential for the T/QRS ratio to be underestimated by up to 94% and overestimated by up to 240% if a homogeneous volume conductor model is assumed. Furthermore, we find that the sensor positioning on the maternal abdomen strongly affects the range of the T/QRS ratio estimation error. These results confirm that further study must be undertaken to determine the relationship between the physiological and signal processing domains before utilizing the T/QRS ratio obtained via NI-FECG for diagnostic purposes.
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