AMBULATORY FETAL MONITORING SYSTEM

Capstone Project by

Dana Hussein Hadid, 11736627

Malak Mohamad Mniemneh, 11730674

Submitted to the School of Engineering of the

International University of Beirut

Beirut, Lebanon

in partial fulfillment of the requirements for the degree of

BACHELOR OF ENGINEERING IN ELECTRONICS

ENGINEERING EMPHASIS ON BIOMEDICAL ENGINEERING

Summer 2020 - 2021

Approved By

Dr Mohammad HajjHassan

Supervisor Date Signature

Dr Hussein HajjHassan

Committee Member Date Signature

Miss Soumaya Berro

Committee Member Date Signature

 DEDICATION

This is a tremendous opportunity for us and all those involved in the care of

mothers and babies. Although having babies in hospitals is routine in this country, we

understand that there are unnecessary risks especially during the Covid pandemic

when we enter a complex healthcare system. Patient safety has to be our No. 1

priority. This dedication is for all the pregnant women who are struggling during their

pregnancy and want to make sure that their babies are in good health without having

to visit the Doctor frequently. We are proud to initiate this project that helps to fulfill

our goal to give every baby a healthy start in life.

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 ACKNOWLEDGEMENTS

It is our genuine gratefulness and warmest regard that we dedicate this work

to our higher university management, our project supervisor Dr. Mohammad Hajj

Hassan for his advice, and support. Despite the fact that this is an independent project

however we couldn’t have fulfilled it without the support and guidance of our advisor

Dr. Mohammad Hajj Hassan and Dr. Soumaya Berro. A special thanks to the

Biomedical Engineer Jad Masri for his continuous support and follow up, he provided

us with all the information we needed and more in order to complete our project.

Thanks to the hospital staff who were responsible of giving us proper training for the

testing tools and medical equipment. My deepest gratitude to my instructors and

teachers, they all gave us education that can least be said to be perfect, educating

students truly from their hearts.

Last but not least, most gratitude and appreciation to our dear families for their

unparalleled love and support all these years. We wouldn’t be who we are now

without them by our side.

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 ABSTRACT

Communication skills are critical to the delivery of high-quality maternity

services. There is a limitation on how often expectant mothers are able to check on

their baby's health since they rely on hospital equipment like ultrasound machines. A

baby’s heart rate can help doctors determine if pregnancy and labor are progressing

normally. Changes in the baby’s heart rate can be a sign of a potential problem. Fetal

monitoring during labor is especially helpful for high-risk pregnancies. It can help the

doctor to decide if there is a treatable problem. This is why we have developed an

ambulatory fetal monitoring system that will be worn continuously and track fetal

heart rate and contractions.

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 TABLE OF CONTENTS

DEDICATION............................................................................................................II

ACKNOWLEDGEMENTS......................................................................................III

ABSTRACT...............................................................................................................IV

TABLE OF CONTENTS............................................................................................V

LIST OF FIGURES................................................................................................VIII

LIST OF TABLES.....................................................................................................IX

LIST OF SYMBOLS AND ABBREVIATIONS......................................................X

CHAPTER 1. INTRODUCTION...............................................................................1

1.1. Background.......................................................................................................1

1.2. Problem Statement............................................................................................3

1.3. Objective...........................................................................................................3

1.4. Project Overview..............................................................................................4

1.5. Report Outline...................................................................................................4

CHAPTER 2. LITERATURE REVIEW...................................................................5

2.1. Novii Wireless Patch System............................................................................5

2.2. Avalon CL.........................................................................................................6

2.3. Comparison.......................................................................................................7

CHAPTER 3. PROJECT SPECIFICATIONS.........................................................8

3.1. Ambulatory Fetal Monitor Conception.............................................................8

3.2. Fetal Heart Rate................................................................................................9

CHAPTER 4. DESIGN..............................................................................................11

4.1. System Architecture........................................................................................11

4.1.1 AD8232 HR Sensor......................................................................................12

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 4.1.2 Arduino Uno..............................................................................................14

4.1.3 LCD Display.................................................................................................16

4.1.4 On/Off Switch............................................................................................19

4.1.5 LED............................................................................................................20

4.2 Assembly....................................................................................................22

CHAPTER 5. NON-TECHNICAL ASPECTS........................................................25

5.1 Introduction................................................................................................25

5.2 Economical/Financial................................................................................25

5.3 Project Management..................................................................................26

5.4 Ethical and Social......................................................................................27

5.5 Environmental and Sustainability..............................................................28

5.6 Standards....................................................................................................28

CHAPTER 6. TESTING AND RESULTS..............................................................30

6.1 Testing Setup.............................................................................................30

6.2 Testing........................................................................................................31

6.3 Results........................................................................................................33

CHAPTER 7. CONCLUSION..................................................................................36

7.1 Summary....................................................................................................36

7.2 Challenges........................................................................................................36

7.3 Lessons Learned.........................................................................................37

7.4 Future Work...............................................................................................37

APPENDIX A. TITLE OF APPENDIX A...............................................................39

REFRENCES..............................................ERROR! BOOKMARK NOT DEFINED.

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vii
 LIST OF FIGURES

Figure 1-1:Traditional fetal monitoring device [4]........................................................2

Figure 1-2: Portable fetal monitoring device [5]...........................................................2

Figure 1-3: Monitor pregnant women from home [6]...................................................3

Figure 2-1: Novii wireless patch system [7]..................................................................5

Figure 2-2: ACL beltless fetal monitor [8]....................................................................6

Figure 3-1: Electronic fetal monitoring [2]....................................................................9

Figure 4-2: AD8232 sensor chip [12]..........................................................................13

Figure 4-3: AD8232 sensor package [13]....................................................................14

Figure 4-4: Arduino Uno chip [15]..............................................................................16

Figure 4-5: LCD pins [17]...........................................................................................17

Figure 4-6: On/off switch [18].....................................................................................19

Figure 6-1: ECG and LCD system [25].......................................................................31

Figure 6-2: Led blinking according to beats [24]........................................................32

Figure 6-3: Circuit connection [17].............................................................................32

Figure 6-4: LCD setup.................................................................................................33

Figure 6-5: Beat comparison........................................................................................34

Figure 6-6: Setting neonatal heart rate ranges.............................................................35

Figure 6-7: Ambulatory fetal monitor connected to and ECG stimulator...................35

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 LIST OF TABLES

Table 2-1: Advantages, disadvantages and prices of similar systems [9]......................7

Table 3-1:Fetal heart rate ranges [12]..........................................................................10

Table 4-1:On/off switch pins [3]..................................................................................19

Table 4-2:Pins of SIM900A [22].................................................................................21

Table 5-1: Components prices [22]..............................................................................25

Table 5-2: Work organization......................................................................................27

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 LIST OF SYMBOLS AND ABBREVIATIONS

o WHD: Wearable Belt Devices.

o FHR: Fetal Heart Rate

o MHR: Maternal Heart Rate

o UA: Uterine Activity

o FEG: Fetal Electro Cardiogram

o EMG: Electromyography

o NBP: Noninvasive Blood Pressure

o SPO2: Oxygen saturation

o LCD: liquid crystal display

o AD8232: Heart Rate Monitor

o LO-: = Lead is Off – Left Arm

o LO+ = Lead is Off – Right Arm

o SND = Shutdown. Pull LOW to put into low power mode

o IDE3: Arduino Software

o ISCP: In-circuit system programming header.

o GSM/GPRS: Wireless communication

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 CHAPTER 1. INTRODUCTION

1.1. BACKGROUND

Wearable Health Devices (WHDs) are an emerging technology that enables

continuous ambulatory monitoring of human vital signs during daily life (during

work, at home, during sport activities, etc.) or in a clinical environment, with the

advantage of minimizing discomfort and interference with normal human activities.

The use of WHDs allows the ambulatory acquisition of vital signs and health status

monitoring over extended periods (days/weeks) and outside clinical environments.

This feature allows acquiring vital data during different daily activities, ensuring a

better support in medical diagnosis and/or helping in a better and faster recovering

from a medical intervention or body injury [1].

In the last two decades, research has been very active in developing wearable devices

and systems for medical-oriented applications, often aimed at continuously

monitoring patients in their environment and during daily life activities. The need is a

sustainable health system that can manage acute care (in hospital or emergency

departments), and care of outpatients (mainly chronic), including healthy citizens

during their normal life, in order to prevent possible diseases by means of tele-

monitoring. Despite significant improvements in antenatal care, the rate of stillbirth

deliveries has remained static in the United Kingdom, at approximately 5 per 1000

births, over the past two decades [2]. Thus, continuous fetal monitoring of

physiological signals is of particular importance for early detection of complexities

related to the fetus or the mother's health. The available conventional methods of

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monitoring mostly perform off-line analysis and restrict the mobility of subjects

within a hospital or a room and requires the supervision of expert personnel, as shown

in figure 1-1. For this reason, a wearable system able to continuously monitor Fetal

Heart Rate (FHR) would be a noticeable step towards a personalized and remote

pregnancy care [3]. Figure 1-2 shows a portable device for fetal monitoring.

Figure 1-1:Traditional fetal monitoring device [4].

Figure 1-2: Portable fetal monitoring device [5].

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1.2. PROBLEM STATEMENT

As biomedical engineering students having engineering background

combined with medical background, we saw that there is a limitation on how often

expectant mothers are able to check on their baby's health since that doctor visits are

limited to once a month at the early stages of pregnancy, to once a week at the later

stages. Meanwhile, mother purely rely on perception of their baby's movement for

months as indication of health status, all these circumstances may not result in optimal

fetal well-being. Figure 1-3 shows the facility provided by the portable fetal

monitoring system.

Figure 1-3: Monitor pregnant women from home [6].

1.3. OBJECTIVE

The main objective of this project is to develop a wearable, comfortable, and

lightweight device that can be worn continuously and track fetal heart rate and

contractions which are the parameters needed to indicate the health status of a baby.

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1.4. PROJECT OVERVIEW

The current project consists of a set of sensors that continuously track the

fetal heart rate and contractions. Moreover, it consists of an alert system responsible

for giving an alarm once identifying unusual patterns that are not confirmed to the

expected behavior where an SMS message will be sent to the maternal partner once a

contraction is conducted.

1.5. REPORT OUTLINE

The following report consists of seven chapters where chapter 2 includes an

overview about similar devices that serve the same purpose of our project. Chapter 3

shows the methodology followed and the design of this project. Moving on to chapter

4 which includes the diagram and schematic of the circuit as well as for the

components used where we mentioned in details their data sheets and functions. The

economic studies about the Ambulatory fetal monitor will be represented in details in

chapter 5 as well as for the main financial aim and benefits in consuming in this

system Ethical studies and standards are also settled in chapter 5. In chapter 6, circuit

testing is performed and results are formed. Finally, in chapter 7, a summary about the

monitor is presented provoking the challenges faced and the future expectation or

enhancement that must be done to improve the system.

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 CHAPTER 2. LITERATURE REVIEW

In this section we will compare two different Ambulatory Fetal Monitoring

system that seems to be similar to our project. Each one represents a technique to

safely record the baby's heart rate.

2.1. NOVII WIRELESS PATCH SYSTEM

The Novii Wireless Patch System shown in figure 2-1 is an intrapartum

Maternal/Fetal Monitor that non-invasively measures and displays fetal heart rate

(FHR), maternal heart rate (MHR) and uterine activity (UA) [7]. The Novii acquires

and displays the FHR tracing from abdominal surface electrodes (Novii Patch) that

pick up the fetal ECG (fECG) signal. Using the same surface electrodes, the Novii

also acquires and displays the UA tracing from the uterine electromyography (EMG)

signal and the MHR tracing from the maternal ECG signal (mECG). Novii detects the

Fetal ECG and Maternal ECG rather than fetal heart rate through ultrasound Doppler

and a separate device for maternal heart rate.

Figure 2-4: Novii wireless patch system [7].

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2.2. AVALON CL

The Avalon CL shown in figure 2-2 is a beltless fetal monitoring which

measures the fetal heart rate of twins and triplets along with maternal NBP and SpO2

and uterine activity from the abdomen. Built-in Avalon Smart Pulse provides a

convenient source for maternal pulse, enabling constant coincidence detection and

provides reliable information on the patient’s state [8]. The beltless solution uses ECG

and EMG signals to extract fetal and maternal heart rates and uterine activity from the

mother’s abdomen.

Figure 2-5: ACL beltless fetal monitor [8].

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2.3. COMPARISON

The comparison table 2-1 shows the advantages and disadvantages of each

system, the Novii Wireless Patch System and the Avalon CL in addition to their costs.

Table 2-1: Advantages, disadvantages and prices of similar systems [9].

Advantages Disadvantages COST

Novii a) Mobility a) Short range (via 5932.56$ [9]
Wireless bluetooth)
Patch System b) Acquires reliable
tracings on high b) Signal
BMI patients restriction

c) Allows for c) Monitoring

continuous wont work
monitoring of when fully
MHR, FHR, and submerged in
UA water

Avalon CL a) Mobility a) Low data 72950$ [10]

storage
b) Suited for high-
BMI patients b) Low humidty
range tolerance
c) Wide range
solution extends
cableless
measurements to
the full reach of
your
WiFi/WLAN

d) Monitors twins,
triplets and mom

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 CHAPTER 3. PROJECT SPECIFICATIONS

3.1. AMBULATORY FETAL MONITOR CONCEPTION

Most babies who measure small during pregnancy are born healthy.

However, some are small because they are not growing as expected, usually because

the placenta (the baby's 'life support' system) is not working properly [11]. These

babies are at greatly increased risk of dying before birth, and need to be delivered

before they become poorly. Scans and electronic heart rate monitoring are currently

used to monitor these babies. But they can only be used for short periods and don't

always provide enough information to show when to deliver the baby. A small light

monitor has been developed that safely records the baby's heart rate by measuring

electrical activity through sticky patches on the mum's skin (like a normal ECG). The

woman carries on with her daily activities while wearing it. Monitoring the heart rate

over a longer time may help with decisions about the timing of the delivery and could

prevent stillbirth. The customer requirements for our device is that it should be

comfortable and lightweight in order to be wearable. It should be also battery operated

and rechargeable to maintain continuous monitoring for the patient and baby’s health.

Two parameters will be represented the heart rate and contractions as well as

implementing an alert system for situations where the baby could be in distress so the

it will be connected directly through the application and inform the healthcare

provisions. Figure 3-1 shows the electronic monitoring of the fetus.

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 Figure 3-6: Electronic fetal monitoring [2].

3.2. FETAL HEART RATE

The electronics of the ambulatory fetal monitoring system is based on

Arduino microcontroller and heart rate sensor AD8232. The electrical signals are

picked up from the electrodes which are transported through the leads and then go to

the heart rate sensor directly into the Arduino Uno which will analog the reading from

the sensor. The code of Arduino is able to extract the ECG signal from sensor and

convert them into heart rate readings. The average fetal heart rate is between 110 and

160 beats per minute. It can vary by 5 to 25 beats per minute. The fetal heart rate may

change as your baby responds to conditions in your uterus as shown in table 3-1. An

abnormal fetal heart rate may mean that your baby is not getting enough oxygen or

that there are other problems.

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 Table 3-2:Fetal heart rate ranges [12].

Weeks Fetal Heart Rate

6 weeks 103-126 bpm

7 weeks 126-149 bpm

8 weeks 149-172 bpm

9 week 155-195 ( average 175 bpm)

12 week 120-160 bpm

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 CHAPTER 4. DESIGN

4.1. SYSTEM ARCHITECTURE

This chapter presents the design itself in terms: block diagrams in figure 4-1,

detailed architecture, and calculation.

Figure 4-1: Block diagram of the system.

3D Foam ECG AD8232

Electrodes Cable Sensor

Arduino
SIM 900A LCD
Uno

LED

This device is powered by a 9 volts’ rechargeable lithium battery and it

consists of an On/Off switch so that the device can be powered as needed. The system

also includes 3M foam electrodes to be able to detect the electrical activity of the

heart of the baby, it also includes one LED and an LCD screen to display the heart

rate readings as well as the contractions that need to be detected. The device also

consists of an Arduino Uno microcontroller connected to the AD8232 HR sensor. The

11
electrical signals are collected from the foam electrodes which are transported through

the leads and then pass to the HR sensor directly to the Arduino Uno. Then the

Arduino Uno is connected to the LCD display so we can display the analog readings

from the sensor. For the coding we used the Arduino IDE software. This code is able

to extract the ECG signals from the sensor and convert them into heart rate readings.

The data collected from the sensor will be analyzed and calculated hence displayed on

the LCD as Heart Rate and identifying the contractions set as well. Besides, an SMS

message will be sent to the mother partner in case of an irregular heart rate or

contractions. A switch will be also placed to reset the program and send a message in

case of a false alarm.

4.1.1 AD8232 HR SENSOR

The AD8232 Spark Fun single lead heart rate monitor is a cost-effective

board used to measure the electrical activity of the heart. This electrical activity can

be charted as an ECG or Electrocardiogram and output as an analog reading. ECGs

can be extremely noisy, the AD8232 single lead heart rate monitor acts as an op amp

to help obtain a clear signal from the PR and QT Intervals easily. The key feature of

this sensor is that it has a built-in signal filtering and amplification, it also breaks out

nine connections from the IC that you can solder pins, wires, or other connectors to

SDN, LO+, LO-, OUTPUT, 3.3V, GND provide essential pins for operating this

monitor with an Arduino or other development board. Also provided on this board are

RA (Right Arm), LA (Left Arm), and RL (Right Leg) pins to attach and use your own

custom sensors.

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 GND = Ground

 3.3V = Connect to 3.3V

 OUTPUT = Sensor analog output – connect to analog input A0

 LO- = Lead is Off – Left Arm

 LO+ = Lead is Off – Right Arm

 SND = Shutdown. Pull LOW to put into low power mode

Additionally, there is a LED indicator light that will pulsate the rhythm of a heartbeat.

These pins are shown in figure 4-1. The package of the sensor includes AD8232 heart

rate monitor module, 3 cable leads, and 3 adhesive foam electrodes as shown in figure

4-2. The measurements of electrical activities are done through sticky patches on the

mom's skin, these activities are then carried to our sensor by the cable leads.

Figure 4-7: AD8232 sensor chip [12].

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 Figure 4-8: AD8232 sensor package [13].

4.1.2 ARDUINO UNO

The Arduino Uno is a microcontroller board based on the ATmega328. As

shown in figure 4-3, it has 20 digital input/output pins (of which 6 can be used as

PWM outputs and 6 can be used as analog inputs), a 16 MHz resonator, a USB

connection, a power jack, an in-circuit system programming (ICSP) header, and a

reset button. It contains everything needed to support the microcontroller; simply

connect it to a computer with a USB cable or power it with an AC-to-DC adapter or

battery to get started. You can tell your board what to do by sending a set of

instructions to the microcontroller on the board. To do so you use the Arduino

programming language (based on Wiring), and the Arduino Software (IDE), based on

Processing [14]. The key features for the Arduino Uno are:

 Inexpensive: Arduino boards are relatively inexpensive compared to other

microcontroller platforms.

14
 Cross-platform: The Arduino Software (IDE) runs on Windows, Macintosh OSX,

and Linux operating systems. While most microcontroller systems are limited to

Windows.

 Simple, clear programming environment: The Arduino Software (IDE) is easy-to-

use for beginners, yet flexible enough for advanced users to take advantage of as

well.

 Open source and extensible software: The Arduino software is published as open

source tools, available for extension by experienced programmers. The language

can be expanded through C++ libraries, and people wanting to understand the

technical details can make the leap from Arduino to the AVR C programming

language on which it's based. Similarly, you can add AVR-C code directly into

your Arduino programs if you want to.

 Open source and extensible hardware: The plans of the Arduino boards are

published under a Creative Commons license, so experienced circuit designers can

make their own version of the module, extending it and improving it. Even

relatively inexperienced users can build the breadboard version of the module in

order to understand how it works and save money [14].

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 Figure 4-9: Arduino Uno chip [15].

4.1.3 LCD DISPLAY

An LCD (Liquid Crystal Display) screen is an electronic display module and

has a wide range of applications. 16×2 LCD has two registers like data register and

command register. The RS (register select) is mainly used to change from one register

to another. When the register set is ‘0’, then it is known as command register.

Similarly, when the register set is ‘1’, then it is known as data register. The main

function of the command register is to store the instructions of command which are

given to the display. So that predefined tasks can be performed such as clearing the

display, initializing, set the cursor place, and display control. Here commands

processing can occur within the register. The main function of the data register is to

store the information which is to be exhibited on the LCD screen. Here, the ASCII

value of the character is the information which is to be exhibited on the screen of

LCD. Whenever we send the information to LCD, it transmits to the data register, and

16
then the process will be starting there. When register set =1, then the data register will

be selected. Figure 4-4 shows the pins of the 16*2 LCD [16].

Figure 4-10: LCD pins [17].

 Pin1 (Ground/Source Pin): This is a GND pin of display, used to connect the

GND terminal of the microcontroller unit or power source.

 Pin2 (VCC/Source Pin): This is the voltage supply pin of the display, used to

connect the supply pin of the power source.

 Pin3 (V0/VEE/Control Pin): This pin regulates the difference of the display, used

to connect a changeable POT that can supply 0 to 5V.

 Pin4 (Register Select/Control Pin): This pin toggles among command or data

register, used to connect a microcontroller unit pin and obtains either 0 or 1(0 =

data mode, and 1 = command mode).

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 Pin5 (Read/Write/Control Pin): This pin toggles the display among the read or

writes operation, and it is connected to a microcontroller unit pin to get either 0 or

1 (0 = Write Operation, and 1 = Read Operation).

 Pin6 (Enable/Control Pin): This pin should be held high to execute Read/Write

process, and it is connected to the microcontroller unit & constantly held high.

 Pins7-14 (Data Pins): These pins are used to send data to the display. These pins

are connected in two-wire modes like 4-wire mode and 8-wire mode. In 4-wire

mode, only four pins are connected to the microcontroller unit like 0 to 3, whereas

in 8-wire mode, 8-pins are connected to microcontroller unit like 0 to 7.

 Pin15 (+ve pin of the LED): This pin is connected to +5V.

 Pin16 (-ve pin of the LED): This pin is connected to GND.

The main features of the 16*2 LCD are:

 The operating voltage of this LCD is 4.7V-5.3V.

 It includes two rows where each row can produce 16-characters.

 The utilization of current is 1mA with no backlight.

 Every character can be built with a 5×7-pixel box.

 Capable of displaying 224 different characters and symbols.

 Its display can work on two modes like 4-bit & 8-bit.

 Low power consumption and low cost [16].

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 4.1.4 ON/OFF SWITCH

The On/Off switch is an electrical component that can disconnect or connect

the conducting path in an electrical circuit. It consists of 3 pins as shown in figure 4-5.

Moreover, table 4-1 defines the function of each pin.

Figure 4-11: On/off switch [18].

Table 4-3:On/off switch pins [3].

Electrical Connections Function

Power This is the pin where the switch receives its voltage

Accessories This is the pin that connects to the load of the circuit,

whatever the switch turns on when it's switched on.

Ex: lights, motor, etc.

Ground This is the pin that connects to the ground of the

circuit

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 4.1.5 LED

The light-emitting diode (LED) shown in figure 4-7 is a semiconductor light

source that emits light when current flows through it, so as the device is turned on it

starts blinking [19].

Figure 4-7: Light-emitting diode [20].

4.1.6 SIM900

The GSM-900 GSM/GPRS module shown in figure 4-8 is a readily

available GSM/GPRS module, which can provide the network connectivity. It can do

all the work as the mobile phone would do like making a call, receive a call, send a

message, connect to the internet using GPRS. SIM900A GSM Module is a dual-band

GSM/GPRS engine that works on frequencies EGSM 900MHz and DCS 1800MHz.

SIM900A features GPRS multi-slot class 10/ class 8 (optional) and supports the

GPRS coding schemes CS-1, CS-2, CS-3 and CS-4. This module can be used in your

IoT based projects and embedded systems. This is used in Automobiles, robotics,

servers, etc.

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 Figure 4-8: GSM SIM 900A pin configuration [21].

The physical interface to the mobile application is a 68-pin SMT pad, which provides

all hardware interfaces between the module and customers’ boards.

The SIM900A is designed with power saving technique so that the current

consumption is as low as 1.5mA in SLEEP mode.

The SIM900A is integrated with the TCP/IP protocol; extended TCP/IP AT

commands are developed for customers to use the TCP/IP protocol easily, which is

very useful for those data transfer applications. Table 4-2 the symbolization of the

RTS, TXD, and RXD pins of the SIM900A.

Table 4-4:Pins of SIM900A [22].

RT Request to send [Serial

1 S port ]

TX
2 D Transmit data [Serial port ]

RX
3 D Receive data [Serial port ]

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4.2 ASSEMBLY

The system contains three main components the Arduino Uno, AD8232, and

SIM900A. The output calculated which is the heart rate and contractions is

represented on the LCD.

 Connections of LCD on the Arduino Uno:

 Place the LCD on a Breadboard where shield pins are plugged into the LCD

 Connect pins (rs, en, d4, d5, d6, d7) of LCD to pins (12, 11, 16, 17, 18, 19)

respectively.

 A resistor of 2.7 k is connected between the anode pin of LCD and 5v pin of

Arduino in order to the backlight of the LCD while the cathode pin is connected to

ground.

 The VDD pin of the LCD is connected to +5v of the Arduino board and RW to

ground.

 VO (LCD Contrast) controls the contrast and brightness of the LCD. Using a

simple voltage divider with a potentiometer (5K ohm), we can make fine

adjustments to the contrast.

 Connection of AD8232 sensor to the Arduino:

 Connect the ground pin of AD8232 to ground pin of Arduino.

 Supply the AD8232 with 3.3 V through the Arduino pin (3.3 V).

 Connect the output pin of AD8232 to the analog pin A0 of Arduino.

22
 Connect the red led to pin 13 (built-in led of Arduino board) in order to blink

according to the Heart beat that has been identified by AD8232 sensor. The red

led is also connected to a resistor of 100 ohms.

Figure 4-9 illustrates the connection of the AD8232 sensor to the Arduino Uno board.

Figure 4-9: Connections of AD8232 sensor [23].

 Connection of Sim900A to Arduino:

 The ground pin and 5V pin to the Arduino board.

 The +5vr pin of SIM900A is connected to digital pin of Arduino 10.

 The +5vt pin is connected to digital pin 9.

 Connect a green led to resistor 220 ohm and then to digital pin 3 of Arduino board

which represents the SMS indicator.

Figures 4-10 and 4-11 show the SIM900A and switch connections respectively.

The circuit is powered by a 9V lithium battery which is connected to a switch where

positive terminal connected to switch and then to Arduino board and the negative pin

to the switch.

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Figure 4-10: SIM900A connections [24].

Figure 4-11: Connections of switch [25].

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 CHAPTER 5. NON-TECHNICAL ASPECTS

5.1 INTRODUCTION

Every Capstone Project report must include sections that cover non-technical aspects.

These sections can form one chapter or can be explicitly embedded in the report

chapters. The following sections present the recommended aspects with brief

descriptions, where it includes: economics and finance, project management, ethics,

environment, and finally standards

5.2 ECONOMICAL/FINANCIAL

Compared to the facilities offered by our project, the total cost shown in

table 5-1 is considered to be unassuming. Since that the pregnant woman will be

saving her time, transportation cost, examination cost. Moreover, as we all know in

the past two years the world has been facing the pandemic of coronavirus disease, and

by going to hospitals or clinics the pregnant woman will be more exposed to

infections and diseases. By using the portable fetal monitoring system, only in urgent

cases the woman will have to go to see her consultant, otherwise she will be checking

on her baby’s health at home and contacting her doctor by phone.

Table 5-5: Components prices [22].

Component Number of Price per Total ($)

Pieces One Piece
($)
1 Resistor (2.7 K – 100 ohm ) 2 0.1 0.2

25
 2 Variable resistor (5 k ohm) 1 0.5 0.5

3 Led ( green – red ) 2 0.1 0.2

4 Ad8232 sensor 1 12 12

5 ECG Cable Leads 1 10 10

6 Switch On/Off 1 0.5 0.5

7 Arduino Uno 1 15 15

8 Wire male to female Set(1) 2 2

9 Deposable Leads Set (1) 4 4

10 SIM900A 1 17 17

11 LCD (liquid Crystal ) 1 3 3

12 Rechargeable lithium battery 1 4 4

(9V)

Total 68.4

5.3 PROJECT MANAGEMENT

The scope of our project is characterized by delivering an ambulatory fetal

monitoring system that monitors the baby’s health by measuring the heart rate and

contractions. This project should be delivered within 11 weeks from the starting time.

In order to deliver it on time, hardware implementation along with a detailed report

should be successfully made and tested. Based on this, we organized our work as

shown in table 5-2.

26
Regarding our stakeholders, this project is mainly for pregnant women in order to

facilitate their pregnancy period and to ensure a continuous tracking for the baby’s

health.

Table 5-6: Work organization.

Week 1 Finding an idea

Week 2 Searching for the availability of components

Week 3 Writing chapter 1 and 2

week 4 Writing chapter 3 and 4

Week 5 Buying all the components

Week 6 Writing the Arduino code

Week 7 Continue with writing the Arduino code

Week 8 Soldering the components together and testing the functionality

Week 9 Finishing all the report and the poster

Week 10 Making the PowerPoint and printing the CDs

Week 11 Meetings to prepare ourselves for the presentation

27
5.4 ETHICAL AND SOCIAL

When talking about ethics and social in research report it should include the

importance of publishing findings in a transparent way, not plagiarizing other’s work,

and not falsifying work. Where every sentence or picture copied from an article,

website or even a pdf, is attached to a reference indicating author’s name, name of

web page, date published, and date accessed. This project uses concepts and ideas

developed from numerous research papers and resources.

Moreover, all the data and results found in this report are written honestly,

objectively, and with integrity. Taking into consideration the safety of patient as

priority, where all components used are safe and isolated. The aim of this project was

to create an ambulatory fetal monitoring system which is portable and can be used

daily by the mother in order to track her baby’s heart rate and contractions.

5.5 ENVIRONMENTAL AND SUSTAINABILITY

The environment is something to be both cared for and enjoyed by society at

large. Our aim is to help mothers track their baby’s heart rate and apply safety for the

mother and baby with best ethical and safe way. Where we aim to have a safe

prototype for patient and environment therefore, all the components’ material used are

environmentally friendly besides, there is no waste product or pollution and energy is

conserved

28
5.6 STANDARDS

According to licensing and restrictions of the Arduino platform, even though

the Arduino platform is open source, and is legal to commercially sell in a product,

such as this home automation system, there are still a few licensing issues that need to

take into consideration. If the device is a derivative of the Arduino platform (i.e.

deriving an Arduino microcontroller specific to this project), the files must be

released to Arduino under the “Creative Commons Attribution Share-Alike license”

[26].

Moreover, in reference to the ISO 13485 standards, each organization should

apply certain standards and norms to their products in order to be approved. Our

project has been restricted to obey those standards by achieving the following:

1. For the product realization and customer requirements, we have determined

the quality objectives, requirements, validation, verification, resources, and

testing prior to developing the “Smart Aiding Spoon”.

2. As for the design and development stage, we have taken into consideration the

safety measures required by the standards. In addition, we made sure that our

output has matched the development input put in the beginning by applying

certain regulations when needed, and benefiting from information taken from

similar devices.

3. Finally, when problems were detected upon testing proper changes were made

to improve the functioning of the device.

Therefore, we successfully completed our project by looking up to the standards

executed by the ISO and to licensing and restrictions of the Arduino platform.

29
 CHAPTER 6. TESTING AND RESULTS

6.1 TESTING SETUP

As mentioned previously our project consists of an ECG system, indicators,

Transmitter and receiver (Alarm) system and LCD.

 ECG system: After connecting the AD8232 board to the Arduino the ECG leads

will be connected to disposable pads through the patient. A code will be se for the

ECG sensor in order to calculate the heart rate and identify the contractions.

 Indicator System: Two indicators are set in the circuit. First indicator is the red

led which will be blinking according to the beats of the baby. The second

indicator is the green led which indicates whenever an SMS message is sent to the

partner as an alarm in case of low/high rate or in case of contractions. Both

indicators are identified through the Arduino code.

 Transmitter and Receiver system: A SIM900A is designed for wireless

radiation monitoring through Short Messaging Service (SMS). An Arduino code

will be designated for the functionality of the module including its library.

30
 LCD system: Messages are displayed on the screen upon writing the Arduino

code. The Arduino code must include the library of the lcd and all pins must be

identified “const int rs = 12, en = 11, d4 = 16, d5 = 17, d6 = 18, d7 = 19”

6.2 TESTING

 ECG system: Upon writing the Arduino code for the sensor, an ECG stimulator

will be connected to the leads in order to adjust the accuracy of the sensor and

make sure that the code is error-free. The BPM equation must be calculated

precisely “BPM = (1.0/Pulse Interval) * 60.0 * 1000;”as well as for the upper

threshold and lower threshold which has been set according to the analog values

represented for the ECG values. The small bi-potential signal will be detected

representing the baby’s heartbeat. This small signal will be integrated, amplified

and filtered through the chip of the AD8232 chip transmitted through the Arduino

as analog values. Through this signal we are able to find the Heart rate of the baby

and compare with the reference range. These connections are shown in figure 6-1.

Figure 0-12: ECG and LCD system [25].

31
 Indicator System: Both leads are tested. As shown in figure 6-2, the red led

represents the heart beats depends on the functionality of the AD8232 sensor.

Hence if the AD8232 code and sensor are working then the Led will be set high

blinking according to the beats. However, the green lead functionality depends on

the SIM900A where it will be set high if the code is precise.

Figure 0-13: Led blinking according to beats [24].

 Transmitter and Receiver system: The SIM900A code will send a message only

in case of an alarm. This module will receive serial data from monitoring devices

which is the Arduino with ECG sensor and transmit the data as text SMS to a host

server which is the phone of her partner. This message is sent whenever a low

heart rate value is detected for five repetitive times and similarly in case of a high

rate and contractions.

 LCD system: Once the switch is set on, the LCD code must represent the title of

the monitor and it will later print the values of the Heart Rate after calculating the

BPM. It will also represent if there is contraction by displaying “Yes/No

“message.

The overall circuit connection is shown in figure 6-3 below.

32
 Figure 0-14: Circuit connection [17].

6.3 RESULTS

After connecting all the system, the LCD code shown in figure 6-4 will first

display the title “Fetal Heart Rate Monitor”.

Figure 0-15: LCD setup.

Then, the AD8232 sensor will transmit the signal which is integrated to through the

Arduino. Few beats are counted to display only 1 every 5 beats. Each pulse rate is

compared with the upper and lower threshold before moving on to the second pulse

33
interval. The red led will also blink upon each beat. The code written is shown in

figure 6-5.

Figure 0-16: Beat comparison.

After, comparing the beats with the ECG analog thresholds, the heart rate will be

displayed on the LCD and the AD8232 will compare it with the ranges of the neonatal

BPM which must be between 110 and 160. In case it was below 110 and SMS alarm

message will be sent. Similarly, an SMS message will be sent indicate high rate and

34
thus leading to contraction. The code written to set the ranges is represented in figure

6-6 below.

Figure 0-17: Setting neonatal heart rate ranges.

Once an SMS message is sent the green led will turn on and the SMS will be sent only

after 5 repetitive values. Figure 6-7 shows how our project was designed and

finalized.

35
 Figure 0-18: Ambulatory fetal monitor connected to and ECG stimulator.

CHAPTER 7. CONCLUSION

7.1 SUMMARY

During late pregnancy and labor, the physician may recommend monitoring

the fetal heart rate and other functions. The average fetal heart rate is between 110 and

160 beats per minute, and can vary five to 25 beats per minute [27]. The fetal heart

rate may change as the fetus responds to conditions in the uterus. An abnormal fetal

heart rate or pattern may indicate that the fetus is not getting enough oxygen or that

there are other problems. Here comes the purpose of our project which is designed to

monitor passively the well-being of the fetus in the antenatal period. Our system is a

portable, battery powered device, developed using Arduino Uno board and attached

via a cable assembly which in turn is attached to three standard disposable electrodes

placed on the abdomen of a pregnant woman.

36
The systems was developed and tested successfully, using different testing techniques.

By that, the design is ready to function properly and serve the user at its best.

7.2 CHALLENGES

Several challenges have been encountered in this project. Concerning the

coding part, it was really challenging to write a code for two modules that we barely

found any similar codes on internet. Besides, we had to search for the ECG limited

threshold of the analog values. As for the hardware part, at first, we struggled to find a

heart sensor able to give us and amplified and filtered ECG signal. Besides the

AD8232 sensor is very sensitive to humidity therefore setting the accurate heart rate

was a challenge and it won’t also work in such medium; hence, we had to check

continuity, short circuit, and current of the sensor. Moreover, the connections between

the Arduino and SIM boards and all the components distributed in the system was

very risky to avoid detaching any wire or unplugging any pin from the boards.

7.3 LESSONS LEARNED

After conducting this project, new skills have been gained. Finalizing this

project required time management especially that we were really limited in time. It

allowed as to work as a team. A clear role distribution based on each individual’s

skills and abilities. The project has turned out into success. Furthermore, dealing with

a sensitive sensor like the AD8232 module has allowed us to gain more skills in

troubleshooting and in testing the tools as well as enlightening us to accuracy testing

37
system. Upon connecting the monitor to a GSM module and using new equipment, we

have improved our coding and network skills.

7.4 FUTURE WORK

A lot of improvements could be done for the ambulatory fetal monitor

system. One of our aims is to make an application that could show the ECG rhythm

and the values and it could be remotely connected through the doctor’s clinic as well

as her beloved ones. Another aim is having the ability to collect the signal at different

stage of pregnancy and a sounding system to the beats instead a blinking led. This will

help the mother to improve her communication with her baby and keep her in peace.

As for its design, a smaller version could be created in order to provide ease and

comfort for the mother.

38
 APPENDIX A. TITLE OF APPENDIX A

#include <SoftwareSerial.h> // include library of sim

SoftwareSerial GPRS(9, 10); //include for sim900a

#include <LiquidCrystal.h>

int UpperThreshold = 518;// analog reading

int LowerThreshold = 490;

int reading = 0;// 1st pulse reading

float BPM = 0.0;// 1st bpm reading

bool IgnoreReading = false;

bool FirstPulseDetected = false;

unsigned long FirstPulseTime = 0;

unsigned long SecondPulseTime = 0;

unsigned long PulseInterval = 0;

const unsigned long delayTime = 10;

const unsigned long delayTime2 = 1000;

const unsigned long baudRate = 9600;

unsigned long previousMillis = 0;

unsigned long previousMillis2 = 0;

const byte interruptPin = 2; // assigning interrupt pin to pin 2

const int rs = 12, en = 11, d4 = 16, d5 = 17, d6 = 18, d7 = 19;

LiquidCrystal lcd(rs, en, d4, d5, d6, d7);

int count=0; //counting few beats to display only 1 every 5 beats.

39
int HighCount=0; //counter for delaying SMS (avoiding Spam)

int LowCount=0; //counter for delaying SMS (avoiding Spam)

void setup(){

GPRS.begin(9600); //begin sim900a

GPRS.println("AT+CMGF=1"); //set CMGF to 1 => SIM900A

GPRS.println("AT"); // cinfig of sim module

// Open serial communications:

Serial.begin(baudRate);

pinMode(3, OUTPUT); //SMS indicator

pinMode(LED_BUILTIN, OUTPUT);

digitalWrite(LED_BUILTIN, LOW);

lcd.begin(16, 2);

lcd.setCursor(0,0);

lcd.print("Fetal Heart Rate");

lcd.setCursor(0,1);

lcd.print(" Monitor <3");

delay(2000);

lcd.clear();

lcd.setCursor(0,0);

lcd.print("BPM: ");

lcd.setCursor(0,1);

lcd.print("Contractions:");

void loop(){

40
while(GPRS.available()) //make sure of comm of sim module

Serial.write(GPRS.read());

// Get current time

unsigned long currentMillis = millis();

// First event

if(myTimer1(delayTime, currentMillis) == 1){

reading = analogRead(0);

// Heart beat leading edge detected.

if(reading > UpperThreshold && IgnoreReading == false) // checking beats at millis

if(FirstPulseDetected == false)

FirstPulseTime = millis();

FirstPulseDetected = true;

else{

SecondPulseTime = millis();

PulseInterval = SecondPulseTime - FirstPulseTime;

FirstPulseTime = SecondPulseTime;

IgnoreReading = true;

digitalWrite(LED_BUILTIN, HIGH);

41
}

// Heart beat trailing edge detected.

if(reading < LowerThreshold && IgnoreReading == true){

IgnoreReading = false;

digitalWrite(LED_BUILTIN, LOW);

// Calculate Beats Per Minute.

BPM = (1.0/PulseInterval) * 60.0 * 1000;

// Second event

if(myTimer2(delayTime2, currentMillis) == 1){

Serial.print(reading);

Serial.print("\t");

Serial.print(PulseInterval);

Serial.print("\t");

Serial.print(BPM);

Serial.println(" BPM");

Serial.flush();

if((BPM>0)&&(BPM<300))//ignore incase of noise to prevent noise

Fetal(BPM, count++); // function to compare and print bpm

if(count==6){count=0;// each 5 beat print (set delay)

42
}

void Fetal (float BPM, int count){

if (count == 5){

lcd.setCursor(0,0);

lcd.print("BPM: ");

lcd.print(BPM);

if(BPM >= 160){

lcd.setCursor(13,1);

lcd.print("Yes");

if(HighCount == 0)// from 1st value send sms

SmsHigh(BPM);// Call SMS function for High HR

HighCount++;

if(HighCount==5){HighCount=0;}

else if(BPM <= 110){

lcd.setCursor(13,1);

lcd.print("No ");

if(LowCount == 0){

SmsLow(BPM);// Call SMS function for High HR

LowCount++;

if(LowCount==5){LowCount=0;}

43
}

else{

lcd.setCursor(13,1);

lcd.print("No ");

// First event timer

int myTimer1(long delayTime, long currentMillis){

if(currentMillis - previousMillis >= delayTime){previousMillis = currentMillis;return

1;}

else{return 0;}

// Second event timer

int myTimer2(long delayTime2, long currentMillis){

if(currentMillis - previousMillis2 >= delayTime2){previousMillis2 =

currentMillis;return 1;}

else{return 0;}

void SmsHigh(float BPM){

digitalWrite(3, HIGH); //indicator blink that SMS was sent

GPRS.println("AT+CMGS=\"+96176013438\"");

delay(500);

GPRS.print("contractions detected! Heart Rate: ");

44
GPRS.print(BPM);

GPRS.write( 0x1a ); // ctrl+Z character

digitalWrite(3,LOW); //indicator blink that SMS was sent

void SmsLow(float BPM){

digitalWrite(3, HIGH); //indicator blink that SMS was sent

GPRS.println("AT+CMGS=\"+96176013438\"");

delay(500);

GPRS.print("Low heart rate detected! Heart Rate: ");

GPRS.print(BPM);

GPRS.write( 0x1a ); // ctrl+Z character

digitalWrite(3,LOW); //indicator blink that SMS was sent

45
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49