The high-tech device, nicknamed SARA (SQUID Array for Reproductive Assessment), relies on an array of 151 sensors that detect and record extremely weak signals generated from naturally occurring magnetic fields in the body. The system provides a graph that shows the changes in fetal heart rate, brain activity, and other vital functions as well as changes in the mother’s uterus.
Over the last two decades researchers have used SQUID arrays to assess adult brain activity. The technique of recording magnetic signals from the brain is called magnetoencephalography (MEG). Signals captured by the arrays are superimposed over images produced from imaging modalities such as computed tomography and magnetic resonance to give a complete picture of the adult brain and neuromuscular system.
Understanding Signal Patterns
In their research with SARA, Dr. Curtis Lowery, director, division of Maternal-Fetal Medicine, University of Arkansas for Medical Sciences and his colleague Hari Eswaran, director of the SARA Laboratory, University of Arkansas for Medical Sciences, found that the brain and heart signal patterns of healthy fetuses are far more complex than those of fetuses with problems. They have followed 70 patients since they began their fetal MEG research in 2005. "In theory high-risk fetuses produce less complex and more predictable signals than a healthy fetus," explains Lowery. "We now have some evidence that healthy fetuses produce very complex signals."
NIBIB support has allowed the researchers to fine tune SARA’s signal processing capabilities to produce a more complete picture of maternal/fetal heart/brain activity and their relation to uterine activity. "Normally [researchers] record brain and heart activity separately and then correlate it," says Lowery. "With SARA we record both activities on the same computer system so the correlation is easier."
Tracking Brain and Heart Activity
SARA has the potential to provide an array of monitoring capabilities. For instance, the researchers have mapped fetal brain function in response to sound and light stimuli. Early results show that normal fetuses produce responses to these stimuli from a small area of the cortex while spontaneous brain activity involves the whole brain. The investigators also discovered that healthy fetuses can discriminate between two different sound frequencies while neurologically impaired fetuses cannot.
The system’s ability to track heart function has enabled the researchers to study cardiac development as well as to monitor therapeutic drug interventions. A popular drug used to treat abnormal fetal heart rhythms is administered to the mother and crosses the placenta. One of the drug’s drawbacks is widening of a critical heart interval. With SARA, clinicians can monitor the mother and fetus and, if the complication arises, quickly stop the drug.
Because SARA permits simultaneous monitoring of heart and brain activity, the researchers are developing a screening tool to detect early neurological damage in high-risk fetuses. Termed SARA Neurological Assessment Protocol, or SNAP, the screening tool provides multiple observations of heart and brain activity including visual and auditory response with the hope that by cross correlating the information over time, a more complete picture of a fetus’s condition will emerge.
"SNAP will help clinicians better predict how high-risk babies will do once they are delivered because it looks at the heart and brain with multiple parameters," explains Lowery. Early detection of impairment could also lead to interventions that may improve fetal survival.
What Causes Labor?
In addition to monitoring fetal activity, SARA allows the researchers to track uterine activity. Other research groups have shown that close to term, electrical junctions form in the uterus. When contractions begin, the junctions synchronize and provide the energy to expel a fetus. Research with SARA may enable investigators to identify how cells are recruited when labor begins. These insights may help clinicians determine which mothers are at risk for pre-term labor before it occurs as well as to actually predict when term labor will begin. "If we can track the electrical signals related to labor, we can better treat labor," explains Eswaran.
From Research Lab to Clinic
The researchers have completed recording data on normal mothers and fetuses and have turned their attention to mothers at high risk including those with pre-eclampsia, diabetes, and those who smoke. A key goal of the project is to extract three-dimensional data for both mother and fetus using ultrasound and electrical signaling. "Ultimately we would like to combine both structural and functional information," says Eswaran. "It seems simple but it means mapping two different coordinate systems." To produce a 3D image, the researchers must develop new algorithms or mathematical formulas so that the ultrasound and electrical signals can be combined in the same spatial dimension.
Lowery notes that a SARA system will be installed in Tuebingen, Germany in 2007 and he anticipates more widespread use in the next three years as SARA gains attention in the research community. "This is a research tool with clinical applications but we need multiple applications for widespread use," he says. Other potential applications include noninvasive bladder and digestive tract studies as well as reproductive studies in nonpregnant women.
In addition to support from NIBIB, the research is supported by the National Institute of Neurological Diseases and Stoke.