Medical Engineering and Physics 88 (2021) 78–85

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Medical Engineering and Physics

journal homepage: www.elsevier.com/locate/medengphy

Differentiation of fluctuations in uterine contractions associated with

Term pregnancies using adaptive fractal features of electromyography
signals
P. Vardhini∗, N. Punitha, S. Ramakrishnan
Non-Invasive Imaging and Diagnostics Laboratory, Biomedical Engineering Group, Department of Applied Mechanics, Indian Institute of Technology Madras,
Chennai, 600036, India

a r t i c l e i n f o a b s t r a c t

Article history: Analysis of uterine contractions using electromyography signals is gaining importance due to its capabil-
Received 10 May 2020 ity to measure the dynamics of uterus. Uterine electromyography (uEMG) provides information on the
Revised 23 October 2020
nature of uterine contractions non-invasively. In this study, the fluctuations in uEMG signals associated
Accepted 17 December 2020
with Term pregnancies are analyzed. For this, Term uEMG signals corresponding to second (T1) and third
(T2) trimesters are considered. The signals are subjected to Adaptive Fractal Analysis (AFA), wherein a
Keywords: global trend is obtained by using overlapping windows of three orders namely, 25%, 50% and 75%. The
Uterine electromyography signals are detrended and the fluctuation function is estimated. Two Hurst exponent features computed
Adaptive fractal analysis at short range (Hs) and long range (Hl) are extracted and statistically analyzed. Results show that AFA
Term condition
is able to characterize variations in the fluctuations of Term delivery signals. The feature values are ob-
Fluctuation function
served to vary significantly during different weeks of gestation. It is found that features of T2 signals are
Hurst exponent
higher than that of T1 signals for all the considered overlaps, indicating that T2 signals possess smoother
characteristics than T1 signals. Further, coefficient of variation is observed to be low, indicating that these
features are able to handle the inter-subject variations in Term signals. Therefore, it appears that the pro-
posed approach could aid in investigation of progressive changes in uterine contractions during Term
pregnancies.
© 2021 IPEM. Published by Elsevier Ltd. All rights reserved.

1. Introduction rate. Hence, monitoring uterine contractions is essential for analyz-

Women during pregnancy undergo physiological and emotional
changes to nurture and accommodate the developing fetus [1].
Pregnancy is a natural process, but various health related compli-
cations may occur. These complications lead to a higher rate of ma-
ternal and neonatal mortality and morbidity. According to World
Health Organization report, 80% of newborn deaths are a result
of complications during delivery, infections and premature birth,
and approximately 810 women die each day from various prob-
lems during pregnancy and labor. India is one among the top na-
tions for the highest number of fetal deaths [2]. Early diagnosis of
such complications enables appropriate and effective medical in-
tervention, which is vital to reduce the mortality and morbidity
Abbreviations: AFA, adaptive fractal analysis; CV, coefficient of variation; DFA,
detrended fluctuation analysis; IUPC, intrauterine pressure catheter; Toco, tocody-
namometry; uEMG, uterine electromyography.
∗
Corresponding author.
E-mail address: niidvardhini@gmail.com (P. Vardhini).
ing the women’s adaptations to various physiological changes and
development of fetus [3].
Currently, the clinically available methods for evaluating uter-
ine contractions are manual palpation, use of Intrauterine Pressure
Catheter (IUPC) and Tocodynamometry (Toco). In manual palpa-
tion, an experienced clinician identifies a contraction by palpating
the parturient’s abdomen over the uterus. It is harmless, does not
require any special equipment, and there is no risk of infections.
However, this is subjective and there is a need for a constant pres-
ence of a trained observed by the bedside [4].
In IUPC, a catheter is placed transvaginally into the uterus to
measure the pressure within amniotic space during contractions.
This technique allows the physician to evaluate frequency, intensity
and duration of the contractions. However, IUPC is invasive, and
it is associated with increased incidence of intrapartum infections,
placental abruption and uterine perforation. As it requires rupture
of membranes prior to insertion of the catheter, it cannot be used
in early stages of pregnancy [1,4].

https://doi.org/10.1016/j.medengphy.2020.12.010
1350-4533/© 2021 IPEM. Published by Elsevier Ltd. All rights reserved.
P. Vardhini, N. Punitha and S. Ramakrishnan
Figure 1. Pipeline of the proposed methodology.
Toco is a non-invasive method, in which a belt transducer is
used to detect changes in the abdominal wall tension. In this
method, frequency and duration of the contractions can be as-
sessed, but contraction intensity cannot be evaluated. This tech-
nique is also reported to have poor sensitivity in identifying the
contractions. Further, there is a need for constant repositioning of
the transducer [1]. Considering all these techniques, due to the
need of a trained clinician for palpation, poor sensitivity of Toco
and invasive nature of IUPC, these methods are not favourable for
examining and characterizing the uterine contractions [4].
One of the alternate methods to record uterine contractions
non-invasively from the abdominal surface is uterine electromyo-
graphy (uEMG). This technique entails an objective evaluation of
uterine activity by measuring electrical potentials underlying the
uterine contractions. This method is reported to have higher sen-
sitivity for detecting uterine contractions than Toco. In addition,
uEMG is found to be more precise without additional risks as com-
pared to IUPC [5]. Several studies have provided a quantitative
comparison of these methods and demonstrated the advantages of
uEMG technique [1,5]. The sensitivity of uEMG to detect the uter-
ine contractions is reported to be in the range of 86–98%, while for
Toco, it is in the range of 46–73.6% [5]. Therefore, this technique is
suggested as a potential method for monitoring pregnancy [3].
The uEMG signals reflects the changes in uterine muscle con-
tractions that precede labor [4]. These signals can provide infor-
mation about frequency and intensity of the contractions [6]. How-
ever, due to complications in inferring the signal information, this
technique is not in clinical practice yet [7]. Hence, there is a need
for automated analysis of these signals.
In the literature, various signal processing approaches have
been performed for uEMG signal analysis. Linear methods assume
the signals to have a stationary behavior, and thus fail to charac-
terize subtle variations in the signal. As uterus comprises of vari-
ous interconnected cells, it possesses non-linear characteristics. In
addition, a quantitative comparison on the performance of linear
and non-linear methods has been carried out, and it has been con-
cluded that non-linear approaches are effective in analyzing uEMG
signals [8].
Many physiological systems have been reported to exhibit frac-
tal dynamics, which is one of the non-linear methods. Fractal anal-
ysis provides a statistical measure of complexity of a signal [9]. In
addition, measures that are obtained from fractals quantitatively,
could be essential for characterizing the variations in signal fluc-
tuations. By analyzing this, the normal and abnormal behavior of
physiological systems can be studied [10]. Hence, fractal analysis is
stated to be a potential method in physiological signal processing.
Various biosignals such as heart rate variability, electroen-
cephalography and inter-breath interval in human respiration pos-
sess fractal characteristics [11]. A comparative study of ten fractal
methods performed on intrauterine pressure signals has reported
that the fractal dimension values could be used for classifying uter-
ine contractions [12].
Detrended Fluctuation Analysis (DFA), which is a fractal algo-
rithm, have been applied on uEMG signals. It has been reported
that fractal dimension using DFA is computed from uEMG signals
for determining the onset of labor [13], and to analyze signal cor-
relations recorded from pregnant and labor women [14]. However,
79
Medical Engineering and Physics 88 (2021) 78–85
in conventional DFA method, the local trends are reported to be
discontinuous piecewise fits, that are computed by fitting a poly-
nomial function using non-overlapping segments of data [9]. More-
over, the results obtained by DFA are influenced by non-linear fil-
ters [15] and non-stationarities [16].
In Adaptive Fractal Analysis (AFA), which is another frac-
tal algorithm, a globally continuous and smooth fit of data is
identified using overlapping segments [17]. Also, AFA is reported
to handle arbitrary non-linear trends [19]. This technique has been
previously employed in sunspot time series [18], and several phys-
iological time series namely, electroencephalography for epileptic
seizure detection [17], analysis of cognitive task performance [9],
center of pressure time series for analyzing the underlying neuro-
muscular dynamics [19], analysis of heart rate variability on task
performance [20] and stride time data to differentiate healthy and
Parkinson’s disease [21].
In this work, Term delivery uEMG signals obtained during dif-
ferent weeks of gestational ages are comprehensively analyzed us-
ing AFA. The fluctuations associated with these signals are charac-
terized. The applicability of adaptive fractal features for analyzing
the progression of pregnancy is established. The features computed
using AFA are compared with corresponding features obtained us-
ing conventional DFA algorithm for validation.
2. Materials and Methods
The pipeline of methodology is represented in Figure 1. Term
signals used in this study were considered from a publicly avail-
able database, and further grouped as T1 and T2 signals, based on
the recording time. These signals were subjected to AFA to obtain
a global trend. This global trend was removed from the original
signal to form the detrended signal. The fluctuation function was
then estimated from the detrended signal with respect to window
size. The adaptive fractal features obtained for the two considered
groups (T1 and T2) were further statistically analyzed.
2.1. Description of uEMG signals [8]
The uEMG signals from Term-Preterm ElectroHysteroGram
database were considered in this study [8,22]. These signals were
recorded by Fele-Žorž and co-workers [8] using four surface elec-
trodes positioned on the abdomen, from three channels in bipolar
configuration. The electrodes were placed on a symmetric axis in
two horizontal rows surrounding the navel, each at a distance of
7 cm. The sampling frequency of the uEMG signals was 20 Hz.
Term condition signals (gestational age of pregnancy is greater
than 37 weeks) were considered for this work. The third chan-
nel signals (recorded between two lowermost electrodes) with fre-
quency range (0.3–3 Hz) was used, as it has been reported to have
artefact free characteristics [8]. The Term condition signals were di-
vided into two groups, according to the recording time, as T1 and
T2. T1 signals were recorded prior to gestational age of 26 weeks
and consist of 143 signals. T2 group contains 119 signals, and were
recorded during or after 26 weeks of gestation.
P. Vardhini, N. Punitha and S. Ramakrishnan Medical Engineering and Physics 88 (2021) 78–85

Figure 2. Representative uEMG signals in (a, b) T1 and (c, d) T2 conditions.

Figure 3. Computation of polynomial fits for a representative T1 uEMG signal using (a) DFA and (b) AFA.

2.2. Adaptive fractal analysis (AFA) where,

AFA employs an algorithm based on adaptive detrending by (w − 1 )

which a global smooth trend is obtained. In this method, overlap- n= ,
2
ping windows were used for computation [9]. This was done to  
obtain continuous fits of the data to analyze the scaling behavior l−1
[23]. .The uEMG signals were processed using an AFA algorithm w1 = 1 − ,
n
based on that of Riley et al. [9] as follows.  
Step I: The uEMG signal u(i), i = 1,2…N, where N is the length l−1
of the signal, was divided into overlapping segments of length w, w2 = and
n
with the orders of overlap of 25%, 50% and 75%. The choice of three
 
orders of overlap was empirically made to analyze the influence of 1, 2, ... n2 + 1 , for 25% overlap
these overlaps on the nature of obtained global trend. l = 1, 2, ...(n + 1 ), for 50% overlap
Step II: In each window w, the data was fit using a fitting poly- 1, 2, ... 32n + 1 , for 75% overlap
nomial function of order K.
Step III: A globally smooth trend v(i) was obtained by consider-
ing a weighted combination of the fits from two consecutive win- This indicates that the weights decrease linearly with respect to
dows, and mathematically given as: distance of the points from center of the segment. This weighted
combination ensures that there are no discontinuities around the
v(i ) = w1 y(i) (l + n) + w2 y(i+1) (l ) (1) neighbouring segment boundaries [17].

80
P. Vardhini, N. Punitha and S. Ramakrishnan Medical Engineering and Physics 88 (2021) 78–85

Figure 4. Plot of variance of residual data versus order of fitting polynomial for 25% overlap, with various window sizes in logscale (a) 6.1, (b) 6, (c) 5.9 and (d) 5.8.

Figure 5. Double log plot of F(w) vs w for 25% overlap for representative signals in (a, b) T1 and (c, d) T2 groups.

Step IV: The signal u(i) was detrended to obtain a residual, by where, H represents the Hurst exponent.
removing the resultant global trend v(i). The fluctuation function
F(w) was then computed as
2.3. Feature extraction

1 
N
F (w ) = 2
[u(i ) − v(i )] ∼ wH (2) Hurst exponent denotes the fractal dimension and represents
N correlation properties of the time series [24]. It is computed as the
i=1

81
P. Vardhini, N. Punitha and S. Ramakrishnan Medical Engineering and Physics 88 (2021) 78–85

Figure 6. Separation of scaling regions for a representative T2 signal for 25% overlap (a) whole signal (b) first scaling region and (c) second scaling region.

Table 1
Statistical measures of Hurst exponent features for T1 and T2 groups.

Amount of overlap Hurst exponent T1 T2 p-value

feature
Mean Standard Deviation CV Mean Standard Deviation CV

25% Hs 1.400 0.24 0.17 1.548 0.24 0.15 0.0188∗

Hl 0.496 0.18 0.36 0.639 0.22 0.34 0.0002∗ ∗
50% Hs 1.413 0.23 0.16 1.538 0.21 0.13 0.0510
Hl 0.561 0.16 0.28 0.701 0.21 0.29 0.0001∗ ∗
75% Hs 1.359 0.21 0.15 1.483 0.20 0.13 0.0388∗
Hl 0.555 0.15 0.27 0.700 0.19 0.27 0.0003∗ ∗
∗ ∗∗
Statistically significant (p-value < 0.05) Highly statistically significant (p-value < 0.01).

slope obtained from linear fit of bi-logarithmic plot of fluctuation
function F(w) with respect to window size w.
In this work, two features namely, Hurst exponent at short
range (Hs) and Hurst exponent at long range (Hl) were extracted.
These features were computed for distinct scaling regions from the
obtained log-log plots. Hs was obtained for lower values of w or
faster time scales, and Hl for higher values of w or slower time
scales [9]. These features were estimated based on the values of
coefficient of determination (R2 ) and standard error of the slope.
Initially, a regression line was fit to the entire range of log2 (w)
from the obtained log-log plots. For this fit, R2 and standard error
values were calculated. The procedure was repeated by removing
data points from the end, and this process was terminated when
R2 > 0.95 and standard error < 0.08 were obtained. This was de-
noted as the first scaling region, and corresponding slope value
was represented as Hs. Further, the regression line was fit to the
remaining set of points in log2 (w), and the same procedure was
followed. The obtained region was the second scaling region, and
respective slope value was referred to as Hl.
2.4. Statistical analysis
The normality test for the data was performed using the
Quantile-Quantile plot. Based on normality characteristics of the
data, Student’s t-test was performed on the extracted Hs and Hl
features of T1 and T2 signals for the three considered orders of
overlap namely, 25%, 50% and 75%. Further, Coefficient of Variation
(CV) was calculated to quantify the inter-subject variability in the
considered Term signals. It was computed as the ratio of standard
deviation by average value of the feature. If the CV value is found
to be less, then the feature is said to have less variability among
the subjects.
3. Results and Discussion
The representative uEMG signals from T1 group are shown in
Figure 2 (a, b). The amplitude of the signal in Figure 2(a) varies
between −13.1 μV and 15 μV, and for the signal in Figure 2(b), the
range of amplitude is from −14.5 μV to 18.5 μV. It is observed that
no specific pattern could be identified based on visual inspection,
and the signals are random and complex in nature. Two represen-
tative T2 group signals are depicted in Figure 2 (c, d). The ampli-
tude range of these two signals is from −40.1 μV to 38.1 μV and
between −37.7 μV and 45.4 μV respectively. The amplitude of the
signals is found to vary among the subjects.
Further, amplitude values of T2 signals are found to be higher
than T1 signals. This could be due to increase in the intensity of
uterine muscle contractions towards the progression of pregnancy.
Figure 3 shows the polynomial fits computed for a representa-
tive T1 signal, using DFA and AFA algorithms. For representation

82
P. Vardhini, N. Punitha and S. Ramakrishnan
Figure 7. Comparison of Hurst exponent features computed using AFA (a) Hs and (c) Hl, and using DFA (b) Hs and (d) Hl.
Table 2
Comparison of performance measures of Hurst exponent features.
Method CV
T1
Hs Hl
DFA 0.18 0.31
AFA 0.15 0.27
purpose, a window size of 50 is considered. As DFA uses non-
overlapping segments, from Figure 3(a), it is observed that piece-
wise discontinuous fits are present. In Figure 3(b), the fits are com-
puted for the same window size with 50% order of overlap. It is
evident from the figure that adaptive detrending could recognize
the arbitrary trend present in the signal, and readily addresses the
non-stationarity in biosignals [17].
Figure 4 compares the variance of residual data with respect
to different orders of the fitting polynomial K, for various window
sizes w, at 25% overlap. From the figure, it is observed that the
variance decreases gradually with increase in the order of polyno-
mial.
For window size in logscale 6.1, as shown in Figure 4(a), differ-
ence in the variance between orders 1 and 2 is 16.8%, and between
orders 2 and 3 is 10%, while there is a 7.4% difference between the
orders 3 and 4. From Figure 4(b), for logscale 6, there is 15% change
in the variance between 1st and 2nd orders of the polynomial, 9.4%
difference between 2nd and 3rd orders, and there is a 5% difference
between 3rd and 4th orders.
For logscale 5.9, as depicted in Figure 4(c), the differences in
the variance among orders 1 to 2, 2 to 3, and 3 to 4, are 12%, 6%
and 2% respectively. As represented in Figure 4(d), for logscale 5.8,
between 1st and 2nd orders, 2nd and 3rd orders and 3rd and 4th or-
ders, the corresponding changes in the variance are 11.3%, 4.44%
and 1.08%. For all the considered window sizes, the decrease in
variance of residual after K = 3 is comparatively low.
Medical Engineering and Physics 88 (2021) 78–85
Mean percentage difference
T2
Hs Hl Hs Hl
0.24 0.37 12.41 14.55
0.13 0.27 14.51 15.51
In addition, when w is less than logscale 5.9, there is no signif-
icant decrease in the variance. It is reported in the literature that
optimal choices of polynomial order and window size are identi-
fied based on the variance of residual [18]. Upon increasing K than
a certain value, and/or upon reducing w, there is no significant de-
crease in the variance of residual [18]. Hence, in this study, K was
chosen as 3 and w in logscale was 5.9. The same behavior is ob-
tained for 50% and 75% overlaps.
The log-log plots for two representative T1 and T2 signals are
depicted in Figure 5. In this plot, window size w in logscale is
taken along the abscissa, and log value of the detrended fluctua-
tion function F(w) is considered along the ordinate axis. It is ob-
served from the plots that more than one scaling region is present
for each signal. The slopes obtained from these distinct scaling re-
gions may be considered as short range and long range scaling in-
dicators [24]. It is observed that F(w) for T2 signals varies over a
wider range, when compared to T1 signals for the considered win-
dow size. This also indicates that F(w) varies slowly with respect to
w for T1 group when compared to T2 group, suggesting that there
are more rapid fluctuations in T1 group signals [25].
For a representative T2 signal for 25% overlap, the obtained
scaling regions are shown in Figure 6. The log-log plot for the
whole segment of the signal is represented in Figure 6(a), and
the first and second scaling regions for that signal are denoted in
Figure 6 (b, c) respectively. From Figure 6(a), it is observed that
log2 (F(w)) ranges from −11.9 to −8.8 for this representative sig-
83
P. Vardhini, N. Punitha and S. Ramakrishnan
nal. Figure 6(b) illustrates the first scaling region obtained with
R2 = 0.994, standard error of 0.05 and the corresponding slope Hs
is 1.905. The second scaling region is determined with R2 = 0.981,
standard error of 0.016 and the respective slope Hl is 0.505, as
shown in Figure 6(c).
Based on the test for normality, the extracted Hurst exponent
features are found to be normally distributed. The statistical mea-
sures of Hs and Hl features computed for T1 and T2 signals for 25%,
50% and 75% overlaps are listed in Table 1. It can be observed that
Hs and Hl features for T2 group signals are found to be higher than
the T1 signals for all three considered overlaps, indicating that T2
signals possess smoother fluctuations than the signals in T1 group
[25]. This could be due to synchrony in the generated action po-
tentials from uterine cells towards the progression of pregnancy
[26, 27].
The Hs feature is statistically significant (p-value < 0.05) be-
tween T1 and T2 groups for 25% and 75% overlaps. The Hl fea-
ture is highly statistically significant (p-value < 0.01) between T1
and T2 groups for all the three considered overlaps. Further, CV
values of Hs and Hl features are found to be lesser in 75% over-
lap, when compared to the considered overlaps. This suggests that
these features are able to handle the inter-subject variability in
Term signals. Hence, based on CV, p-value and standard deviation,
75% overlap is chosen to be able to better differentiate T1 and T2
group signals, among the considered overlaps.
Figure 7 illustrates the scatterplot of Hs and Hl features for T1
and T2 signals computed using AFA of 75% overlap and conven-
tional DFA algorithm. From Figure 7(a), it is observed that Hs is
separable between T1 and T2 groups. Figure 7(b) depicts that Hs
feature obtained using DFA exhibits higher level of overlap be-
tween the two groups. As illustrated in Figure 7(c), the Hl feature
shows separability between the considered groups. Figure 7 (d)
demonstrates that Hl tend to overlap for T1 and T2 signals. The
Hs and Hl features calculated using AFA are found to distinguish
T1 and T2 signals as seen in Figure 7(a, c).
In addition, the mean percentage difference and CV obtained
for Hs and Hl features using the two methods in T1 and T2 group
signals are listed in Table 2. It is observed that CV values are
less and the mean percentage difference is comparatively more for
the features when obtained using AFA. Hence, it is suggested that
the adaptive fractal features are able to characterize the Term sig-
nal fluctuations better than conventional fractal algorithm. How-
ever, the considered signals in T1 and T2 groups are from differ-
ent women as the database contains only one record per subject.
As uEMG signals recorded for the same subject are not available,
cross-sectional study is performed for analyzing the progression of
pregnancy in Term condition, rather than a longitudinal study.
4. Conclusions
Monitoring the uterine contractions during pregnancy is an es-
sential diagnostic tool. Analysis of uEMG signals provides quan-
titative information on the nature of uterine contractions. These
signals are non-stationary and non-linear in nature. Hence, a non-
linear measure such as fractals, could be suitable to analyze these
signals.
In this work, fluctuations in the uEMG signals associated with
Term delivery were analyzed using adaptive fractal features. The
signals obtained during the second (T1) and third trimester (T2)
were subjected to AFA. This technique is found to capture the frac-
tal behavior of the uEMG signals. A global trend for each signal was
calculated and the fluctuation function was estimated. The fluctu-
ations in the uterine contractions are found to be distinct during
different weeks of Term pregnancy. The fluctuations in T2 group
vary over a wider range when compared to T1 group. This indi-
84
Medical Engineering and Physics 88 (2021) 78–85
cates that there are comparatively more rapid fluctuations in the
signals during the second trimester (T1 group).
Further, adaptive fractal features namely, Hs and Hl were com-
puted and statistically analyzed. T2 signals are found to have
higher fractal dimension than T1 signals, indicating that the sig-
nals in T2 group possess smoother characteristics than T1 group.
This may be due to increase in the coordination of action poten-
tials generated from uterine muscle cells towards labor. Statistical
analysis reveals that Hs significantly differentiates T1 and T2 sig-
nals for 25% and 75% overlaps, while Hl is significant for all the
three overlaps. Thus, these two features could be used as biomark-
ers for analysing the fluctuations in uEMG signals.
As the adaptive fractal analysis investigated in this work shows
the ability to characterize the subtle fluctuations in uEMG signals,
it appears that this approach could be used to assess the progres-
sion of pregnancy in Term condition. The biomarkers identified in
this study can further be used to differentiate Term and Preterm
deliveries and other complexities associated with pregnancies.
Declaration of Competing Interest
The authors declare that there is no conflict of interest regard-
ing publication of this article.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Ethical Approval
Not required.
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