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Wu W, Wang H, Zhao P, Talcott M, Lai S, McKinstry RC, Woodard PK, Macones GA, Schwartz AL, Cahill AG, Cuculich PS, Wang Y. Noninvasive high-resolution electromyometrial imaging of uterine contractions in a translational sheep model. Sci Transl Med 2020; 11:11/483/eaau1428. [PMID: 30867320 DOI: 10.1126/scitranslmed.aau1428] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/09/2018] [Accepted: 02/20/2019] [Indexed: 12/20/2022]
Abstract
In current clinical practice, uterine contractions are monitored via a tocodynamometer or an intrauterine pressure catheter, both of which provide crude information about contractions. Although electrohysterography/electromyography can measure uterine electrical activity, this method lacks spatial specificity and thus cannot accurately measure the exact location of electrical initiation and location-specific propagation patterns of uterine contractions. To comprehensively evaluate three-dimensional uterine electrical activation patterns, we describe here the development of electromyometrial imaging (EMMI) to display the three-dimensional uterine contractions at high spatial and temporal resolution. EMMI combines detailed body surface electrical recording with body-uterus geometry derived from magnetic resonance images. We used a sheep model to show that EMMI can reconstruct uterine electrical activation patterns from electrodes placed on the abdomen. These patterns closely match those measured with electrodes placed directly on the uterine surface. In addition, modeling experiments showed that EMMI reconstructions are minimally affected by noise and geometrical deformation. Last, we show that EMMI can be used to noninvasively measure uterine contractions in sheep in the same setup as would be used in humans. Our results indicate that EMMI can noninvasively, safely, accurately, robustly, and feasibly image three-dimensional uterine electrical activation during contractions in sheep and suggest that similar results might be obtained in clinical setting.
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Affiliation(s)
- Wenjie Wu
- Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University, St. Louis, MO 63110, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hui Wang
- Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Physics, Washington University, St. Louis, MO 63110, USA
| | - Peinan Zhao
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Talcott
- Division of Comparative Medicine, Washington University, St. Louis, MO 63110, USA
| | - Shengsheng Lai
- Department of Medical Devices, Guangdong Food and Drug Vocational College, Guangzhou, Guangdong Province, P.R. China
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - George A Macones
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alan L Schwartz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Phillip S Cuculich
- Department of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Yong Wang
- Center for Reproductive Health Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA. .,Department of Biomedical Engineering, Washington University, St. Louis, MO 63110, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Saleem S, Saeed A, Usman S, Ferzund J, Arshad J, Mirza J, Manzoor T. Granger causal analysis of electrohysterographic and tocographic recordings for classification of term vs. preterm births. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vullings R, van Laar JOEH. Non-invasive Fetal Electrocardiography for Intrapartum Cardiotocography. Front Pediatr 2020; 8:599049. [PMID: 33363064 PMCID: PMC7755891 DOI: 10.3389/fped.2020.599049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
Fetal monitoring is important to diagnose complications that can occur during pregnancy. If detected timely, these complications might be resolved before they lead to irreversible damage. Current fetal monitoring mainly relies on cardiotocography, the simultaneous registration of fetal heart rate and uterine activity. Unfortunately, the technology to obtain the cardiotocogram has limitations. In current clinical practice the fetal heart rate is obtained via either an invasive scalp electrode, that poses risks and can only be applied during labor and after rupture of the fetal membranes, or via non-invasive Doppler ultrasound technology that is inaccurate and suffers from loss of signal, in particular in women with high body mass, during motion, or in preterm pregnancies. In this study, transabdominal electrophysiological measurements are exploited to provide fetal heart rate non-invasively and in a more reliable manner than Doppler ultrasound. The performance of the fetal heart rate detection is determined by comparing the fetal heart rate to that obtained with an invasive scalp electrode during intrapartum monitoring. The performance is gauged by comparing it to performances mentioned in literature on Doppler ultrasound and on two commercially-available devices that are also based on transabdominal fetal electrocardiography.
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Affiliation(s)
- Rik Vullings
- Biomedical Diagnostics Lab Eindhoven, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Nemo Healthcare, Veldhoven, Netherlands
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Allahem H, Sampalli S. Automated uterine contractions pattern detection framework to monitor pregnant women with a high risk of premature labour. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Benalcazar-Parra C, Garcia-Casado J, Ye-Lin Y, Alberola-Rubio J, Lopez Á, Perales-Marin A, Prats-Boluda G. New electrohysterogram-based estimators of intrauterine pressure signal, tonus and contraction peak for non-invasive labor monitoring. Physiol Meas 2019; 40:085003. [PMID: 31370050 DOI: 10.1088/1361-6579/ab37db] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Uterine activity monitoring is an essential part of managing the progress of pregnancy and labor. Although intrauterine pressure (IUP) is the only reliable method of estimating uterine mechanical activity, it is highly invasive. Since there is a direct relationship between the electrical and mechanical activity of uterine cells, surface electrohysterography (EHG) has become a noninvasive monitoring alternative. The Teager energy (TE) operator of the EHG signal has been used for IUP continuous pressure estimation, although its accuracy could be improved. We aimed to develop new optimized IUP estimation models for clinical application. APPROACH We first considered enhancing the optimal estimation of IUP clinical features (maximum pressure and tonus) rather than optimizing the signal only (continuous pressure). An adaptive algorithm was also developed to deal with inter-patient variability. For each optimizing signal feature (continuous pressure, maximum pressure and tonus), individual (single patient), global (full database) and adaptive models were built to estimate the recorded IUP signal. The results were evaluated by computing the root mean square errors (RMSe): continuous pressure error (CPe), maximum pressure error (MPe) and tonus error (TOe). MAIN RESULTS The continuous pressure global model yielded IUP estimates with Cpe = 14.61 mm Hg, MPe = 29.17 mm Hg and Toe = 7.8 mm Hg. The adaptive models significantly reduced errors to CPe = 11.88, MPe = 16.02 and Toe = 5.61 mm Hg. The EHG-based IUP estimates outperformed those from traditional tocographic recordings, which had significantly higher errors (CPe = 21.93, MPe = 26.97, and TOe = 13.96). SIGNIFICANCE Our results show that adaptive models yield better IUP estimates than the traditional approaches and provide the best balance of the different errors computed for a better assessment of the labor progress and maternal and fetal well-being.
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Affiliation(s)
- Carlos Benalcazar-Parra
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Edif. 8B, Camino de Vera SN, 46022 Valencia, Spain
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Kahankova R, Martinek R, Jaros R, Behbehani K, Matonia A, Jezewski M, Behar JA. A Review of Signal Processing Techniques for Non-Invasive Fetal Electrocardiography. IEEE Rev Biomed Eng 2019; 13:51-73. [PMID: 31478873 DOI: 10.1109/rbme.2019.2938061] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fetal electrocardiography (fECG) is a promising alternative to cardiotocography continuous fetal monitoring. Robust extraction of the fetal signal from the abdominal mixture of maternal and fetal electrocardiograms presents the greatest challenge to effective fECG monitoring. This is mainly due to the low amplitude of the fetal versus maternal electrocardiogram and to the non-stationarity of the recorded signals. In this review, we highlight key developments in advanced signal processing algorithms for non-invasive fECG extraction and the available open access resources (databases and source code). In particular, we highlight the advantages and limitations of these algorithms as well as key parameters that must be set to ensure their optimal performance. Improving or combining the current or developing new advanced signal processing methods may enable morphological analysis of the fetal electrocardiogram, which today is only possible using the invasive scalp electrocardiography method.
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Huber C, Shazly SA, Ruano R. Potential use of electrohysterography in obstetrics: a review article. J Matern Fetal Neonatal Med 2019; 34:1666-1672. [PMID: 31303075 DOI: 10.1080/14767058.2019.1639663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Monitoring the uterine contraction during pregnancy is necessary to monitor labor progress, fetal and maternal well-being, and uterine activity. The aim of this review was to evaluate the performance of electrohysterography and to analyze the nature of uterine contraction. A search was undertaken using PubMed, Embase, and ClinicalTrials.gov database from 1 January 1950 to 1 November 2018. Search terms include: "Uterine" or "Uterus" or "Labor" or "Labour" and "electrical activity" or "electrohysterogram" or "electrohysterograph". Reviewing the literature, electrohysterography showed a higher sensitivity for uterine contraction detection and was independent of body mass index, abdominal wall thickness, or maternal position enabling monitoring obese patients as well. Electrohysterography can enhance uterine monitoring throughout labor because of its noninvasiveness, adhesive properties, and reduced obesity sensitiveness. Electrohysterography should be available to safely improve intrapartum monitoring instead of the invasive intrauterine pressure catheter.
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Affiliation(s)
- Carola Huber
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sherif A Shazly
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo Ruano
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN, USA
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58
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Characterization of the effects of Atosiban on uterine electromyograms recorded in women with threatened preterm labor. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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59
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Hao D, Qiu Q, Zhou X, An Y, Peng J, Yang L, Zheng D. Application of decision tree in determining the importance of surface electrohysterography signal characteristics for recognizing uterine contractions. Biocybern Biomed Eng 2019; 39:806-813. [PMID: 31787794 PMCID: PMC6876647 DOI: 10.1016/j.bbe.2019.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022]
Abstract
The aims of this study were to apply decision tree to classify uterine activities (contractions and non-contractions) using the waveform characteristics derived from different channels of electrohysterogram (EHG) signals and then rank the importance of these characteristics. Both the tocodynamometer (TOCO) and 8-channel EHG signals were simultaneously recorded from 34 healthy pregnant women within 24 h before delivery. After preprocessing of EHG signals, EHG segments corresponding to the uterine contractions and non-contractions were manually extracted from both original and normalized EHG signals according to the TOCO signals and the human marks. 24 waveform characteristics of the EHG segments were derived separately from each channel to train the decision tree and classify the uterine activities. The results showed the Power and sample entropy (SamEn) extracted from the un-normalized EHG segments played the most important roles in recognizing uterine activities. In addition, the EHG signal characteristics from channel 1 produced better classification results (AUC = 0.75, Sensitivity = 0.84, Specificity = 0.78, Accuracy = 0.81) than the others. In conclusion, decision tree could be used to classify the uterine activities, and the Power and SamEn of un-normalized EHG segments were the most important characteristics in uterine contraction classification.
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Affiliation(s)
- Dongmei Hao
- College of Life Science and Bioengineering, Beijing University of Technology, Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Qian Qiu
- College of Life Science and Bioengineering, Beijing University of Technology, Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Xiya Zhou
- Department of Obstetrics, Peking Union Medical College Hospital, Beijing, China
| | - Yang An
- College of Life Science and Bioengineering, Beijing University of Technology, Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Jin Peng
- College of Life Science and Bioengineering, Beijing University of Technology, Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Lin Yang
- College of Life Science and Bioengineering, Beijing University of Technology, Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Dingchang Zheng
- Health and Wellbeing Academy, Faculty of Medical Science, Anglia Ruskin University, Chelmsford, United Kingdom
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60
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Vlemminx MWC, Rabotti C, van der Hout-van der Jagt MB, Oei SG. Clinical Use of Electrohysterography During Term Labor: A Systematic Review on Diagnostic Value, Advantages, and Limitations. Obstet Gynecol Surv 2018; 73:303-324. [PMID: 29850920 DOI: 10.1097/ogx.0000000000000560] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Real-time electrohysterography (EHG)-based technologies have recently become available for uterine monitoring during term labor. Therefore, obstetricians need to be familiar with the diagnostic value, advantages, and limitations of using EHG. Objective The aims of this study were to determine the diagnostic value of EHG in comparison to (1) the intrauterine pressure catheter (IUPC), (2) the external tocodynamometer (TOCO), and (3) in case of maternal obesity; (4) to evaluate EHG from users' and patients' perspectives; and (5) to assess whether EHG can predict labor outcome. Evidence Acquisition A systematic review was performed in the MEDLINE, EMBASE, and Cochrane library in October 2017 resulting in 209 eligible records, of which 20 were included. Results A high sensitivity for contraction detection was achieved by EHG (range, 86.0%-98.0%), which was significantly better than TOCO (range, 46.0%-73.6%). Electrohysterography also enhanced external monitoring in case of maternal obesity. The contraction frequency detected by EHG was on average 0.3 to 0.9 per 10 minutes higher compared with IUPC, which resulted in a positive predictive value of 78.7% to 92.0%. When comparing EHG tocograms with IUPC traces, an underestimation of the amplitude existed despite that patient-specific EHG amplitudes have been mitigated by amplitude normalization. Obstetricians evaluated EHG tocograms as better interpretable and more adequate than TOCO. Finally, potential EHG parameters that could predict a vaginal delivery were a predominant fundal direction and a lower peak frequency. Conclusions and Relevance Electrohysterography enhances external uterine monitoring of both nonobese and obese women. Obstetricians consider EHG as better interpretable; however, they need to be aware of the higher contraction frequency detected by EHG and of the amplitude mismatch with intrauterine pressure measurements.
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Affiliation(s)
- Marion W C Vlemminx
- Resident, Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands; PhD Candidate
| | - Chiara Rabotti
- Assistant Professor, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Postdoctoral Researcher, Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands; Postdoctoral Researcher, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S Guid Oei
- Gynecologist-Perinatologist, Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands; and Professor Fundamental Perinatology, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Mas-Cabo J, Ye-Lin Y, Garcia-Casado J, Alberola-Rubio J, Perales A, Prats-Boluda G. Uterine contractile efficiency indexes for labor prediction: A bivariate approach from multichannel electrohysterographic records. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thijssen KMJ, Vlemminx MWC, Westerhuis MEMH, Dieleman JP, Van der Hout-Van der Jagt MB, Oei SG. Uterine Monitoring Techniques from Patients' and Users' Perspectives. AJP Rep 2018; 8:e184-e191. [PMID: 30250758 PMCID: PMC6138467 DOI: 10.1055/s-0038-1669409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/21/2018] [Indexed: 02/08/2023] Open
Abstract
Objective To evaluate preferences from patients and users on 3 uterine monitoring techniques, during labor. Study Design Women in term labor were simultaneously monitored with the intrauterine pressure catheter, the external tocodynamometer, and the electrohysterograph. Postpartum, these women filled out a questionnaire evaluating their preferences and important aspects. Nurses completed a questionnaire evaluating users' preferences. Results Of all 52 participating women, 80.8% preferred the electrohysterograph, 17.3% the intrauterine pressure catheter and 1.9% the external tocodynamometer. For these women, the electrohysterograph scored best regarding application and presence during labor ( p < 0.001). Most important aspects were "least likely to harm" and "least discomfort". Of 57 nurses, 40.4% preferred the electrohysterograph, 35.1% the external tocodynamometer, and 24.6% had no preference, or replied that their preference is subject to situation and patient. Conclusion Patients prefer the electrohysterograph over the external tocodynamometer and the intrauterine pressure catheter, while healthcare providers report ambiguous results.
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Affiliation(s)
- Kirsten M. J. Thijssen
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Marion W. C. Vlemminx
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | | | - M. Beatrijs Van der Hout-Van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S. Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Could electrohysterography be the solution for external uterine monitoring in obese women? J Perinatol 2018; 38:580-586. [PMID: 29467514 DOI: 10.1038/s41372-018-0065-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/03/2018] [Accepted: 01/18/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the influence of maternal obesity on the performance of external tocodynamometry and electrohysterography. STUDY DESIGN In a 2-hour measurement during term labor, uterine contractions were simultaneously measured by electrohysterography, external tocodynamometry, and intra-uterine pressure catheter. The sensitivity was compared between groups based on obesity (non-obese/obese/morbidly obese) or uterine palpation (good/moderate/poor), and was correlated to maternal BMI and abdominal circumference. RESULT We included 14 morbidly obese, 18 obese, and 20 non-obese women. In morbidly obese women, the median sensitivity was 87.2% (IQR 74-93) by electrohysterography and 45.0% (IQR 36-66) by external tocodynamometry (p < 0.001). The sensitivity of electrohysterography appeared to be non-influenced by obesity category (p = 0.279) and uterine palpation (p = 0.451), while the sensitivity of tocodynamometry decreased significantly (p = 0.005 and p < 0.001, respectively). Furthermore, the sensitivity of both external methods was negatively correlated with obesity parameters, being non-significant for electrohysterography (range p-values 0.057-0.088) and significant for external tocodynamometry (all p-values < 0.001). CONCLUSIONS Electrohysterography performs significantly better than external tocodynamometry in case of maternal obesity.
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Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Detection rate of fetal distress using contraction-dependent fetal heart rate variability analysis. Physiol Meas 2018; 39:025008. [PMID: 29350194 DOI: 10.1088/1361-6579/aaa925] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Monitoring of the fetal condition during labor is currently performed by cardiotocograpy (CTG). Despite the use of CTG in clinical practice, CTG interpretation suffers from a high inter- and intra-observer variability and a low specificity. In addition to CTG, analysis of fetal heart rate variability (HRV) has been shown to provide information on fetal distress. However, fetal HRV can be strongly influenced by uterine contractions, particularly during the second stage of labor. Therefore, the aim of this study is to examine if distinguishing contractions from rest periods can improve the detection rate of HRV features for fetal distress during the second stage of labor. APPROACH We used a dataset of 100 recordings, containing 20 cases of fetuses with adverse outcome. The most informative HRV features were selected by a genetic algorithm and classification performance was evaluated using support vector machines. MAIN RESULTS Classification performance of fetal heart rate segments closest to birth improved from a geometric mean of 70% to 79%. If the classifier was used to indicate fetal distress over time, the geometric mean at 15 minutes before birth improved from 60% to 72%. SIGNIFICANCE Our results show that combining contraction-dependent HRV features with HRV features calculated over the entire fetal heart rate signal improves the detection rate of fetal distress.
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Affiliation(s)
- G J J Warmerdam
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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65
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Benalcazar-Parra C, Monfort-Orti R, Ye-Lin Y, Prats-Boluda G, Alberola-Rubio J, Perales A, Garcia-Casado J. Comparison of labour induction with misoprostol and dinoprostone and characterization of uterine response based on electrohysterogram. J Matern Fetal Neonatal Med 2017; 32:1586-1594. [PMID: 29251182 DOI: 10.1080/14767058.2017.1410791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study is to compare the uterine activity response between women administered dinoprostone (prostaglandin E2) and misoprostol (prostaglandin E1) for induction of labour (IOL) by analysing not only the traditional obstetric data but also the parameters extracted from uterine electrohysterogram (EHG). METHODS Two cohorts were defined: misoprostol (25-µg vaginal tablets; 251 women) and dinoprostone cohort (10 mg vaginal inserts; 249 women). All the mothers were induced by a medical indication of a Bishop Score < = 6. RESULTS The misoprostol cohort was associated with a shorter time to achieve active labour (p = .017) and vaginal delivery (p = .009) and with a higher percentage of vaginal delivery in less than 24 h in mothers with a very unfavourable cervix score (risk ratio (RR): 1.41, IC95% 1.17-1.69, p = .002). Successful inductions with misoprostol showed EHG parameter values significantly higher than basal state for amplitude and pseudo Montevideo units (PMU) 60' after drug administration, while spectral parameters significantly increased after 150'. This response was not observed in failed inductions. In the successful dinoprostone group, the duration and number of contractions increased significantly after 120', PMU did so after 180', and no significant differences were found for spectral parameters, possibly due to the slower pharmacokinetics of this drug. CONCLUSION Successful inductions of labour by misoprostol are associated with earlier effective contractions than in labours induced by dinoprostone.
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Affiliation(s)
- Carlos Benalcazar-Parra
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
| | - Rogelio Monfort-Orti
- b Servicio de Obstetricia y Ginecología , Hospital Universitario y Politécnico La Fe de Valencia , Valencia , España
| | - Yiyao Ye-Lin
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
| | - Gema Prats-Boluda
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
| | - Jose Alberola-Rubio
- b Servicio de Obstetricia y Ginecología , Hospital Universitario y Politécnico La Fe de Valencia , Valencia , España
| | - Alfredo Perales
- b Servicio de Obstetricia y Ginecología , Hospital Universitario y Politécnico La Fe de Valencia , Valencia , España
| | - Javier Garcia-Casado
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
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Comparison of electrohysterogram characteristics during uterine contraction and non-contraction during labor. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2924-2927. [PMID: 29060510 DOI: 10.1109/embc.2017.8037469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Uterine contraction is one of the most important indication in the labor progression. Electrohysterogram (EHG) is a promising method for monitoring uterine contraction and discriminating efficient and inefficient contractions. This study aims to analyze the difference of EHG signals between two groups. EHG signals are recorded with abdominal electrodes from 20 pregnant women, including 10 in term labor group and 10 in non-labor group. Typical linear and nonlinear characteristics of EHG signals, including root mean square (RMS), peak frequency (PF), median frequency (MDF), mean frequency (MNF), parameters from wavelet decomposition (W4, W5) and time reversibility (Tr) are extracted. These characteristics are compared between contraction and non-contraction in term labor group and non-labor group. The result shows that RMS, W4 and W5 of contraction are significantly larger than non-contraction both within term labor group and between two groups (all p<;0.001). However, MDF and MNF are significantly smaller (all p<;0.05). Furthermore, all characteristics of non-contraction show no significant difference between two groups, except MNF. The variability of RMS, W4, W5 and Tr of contraction are significantly larger than non-contraction both within term labor group and between two groups (all p<;0.05, with p<;0.001 for W5 and Tr). However, the variability of MDF, PF and MNF are significantly smaller (all p<;0.05). Moreover, the variability of all characteristics of non-contraction shows no significant difference between two groups, except MNF. We have shown that characteristics of EHG signals and their variability during contraction are quite different from non-contraction. Therefore, it is feasible to separate uterine contractions and monitor uterine activity with EHG signals.
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YANG ZIDUO, YANG RENHUAN, LU YAOSHENG. ESTIMATION OF INTRAUTERINE PRESSURE FROM ELECTROHYSTEROGRAPHY USING HILBERT PHASE SLIPS AND STATISTICS METHOD. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prognostic information during pregnancy can be obtained by monitoring maternal uterine activity. Tocodynamometry (TOCO) is widely used to assess the uterine activity today but it has been found that it has very low sensitivity. Another method to assess the uterine activity is intrauterine pressure catheter (IUPC) which is accurate but highly invasive. Electrohysterogram (EHG) measured from abdominal surface is a noninvasive method to detect uterine contractions. To reduce motion artifacts of intrauterine pressure (IUP) estimated from EHG signal and further improve the accuracy of contractions detected by IUP estimation, we propose a method to divide the EHG signal into segments by using Hilbert phase slips. Standard deviation (STD) was used to estimate IUP from each EHG signal segment and median filter was used to remove the motion artifacts. The method we proposed was compared with other four methods from literatures. The proposed method results in a higher contractions detection accuracy of EHG-based IUP estimation and a higher correlation coefficient with the IUPC signals compared to other methods which demonstrated the capabilities of the proposed method in reducing motion artifacts of IUP estimation based on abdominal EHG.
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Affiliation(s)
- ZIDUO YANG
- Department of Electronic Engineering, Jinan University, Guangzhou 510632, P. R. China
| | - RENHUAN YANG
- Department of Electronic Engineering, Jinan University, Guangzhou 510632, P. R. China
| | - YAOSHENG LU
- Department of Electronic Engineering, Jinan University, Guangzhou 510632, P. R. China
- Science and Technology Bureau of Meizhou, Meizhou 514021, P. R. China
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Cohen WR. Clinical assessment of uterine contractions. Int J Gynaecol Obstet 2017; 139:137-142. [DOI: 10.1002/ijgo.12270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/26/2017] [Accepted: 07/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Wayne R. Cohen
- Department of Obstetrics and Gynecology; University of Arizona College of Medicine; Tucson AZ USA
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Vlemminx MW, Thijssen KM, Bajlekov GI, Dieleman JP, Van Der Hout-Van Der Jagt MB, Oei SG. Electrohysterography for uterine monitoring during term labour compared to external tocodynamometry and intra-uterine pressure catheter. Eur J Obstet Gynecol Reprod Biol 2017. [DOI: 10.1016/j.ejogrb.2017.05.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang Y, Gao P, Qiu Q, An Y, Hao D, Yang F, Zhou X, Yang L, Yang Y, Li X, Zhang S, Zheng D. Comparison of the onset of uterine contractions determined from tocodynamometry and maternal perception. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1376-1379. [PMID: 29060133 DOI: 10.1109/embc.2017.8037089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate the time difference (TD) between the onset of uterine contraction (UC) determined from tocodynamometry (TOCO) and identified by maternal perception. The online available Icelandic database was used to calculate TD, which was defined as the difference between when it was felt by a pregnant woman and the starting point on the UC signal recorded by a TOCO. A total of 295 TDs from 78 recordings (from a total of 33 participants; among them, 13 participants included at least 3 recordings from different gestational weeks) were analyzed with the overall mean±SD of TD calculated. For each individual participant with at least 3 recordings, regression analysis was then performed to investigate the relationship between the mean TD from each recording with gestational week, with their overall slope calculated. The results showed that 85.4% of TDs was within [-40, 40] s, with an overall mean TD of 3.04 s (p>0.05), indicating that there was no significant difference between the UC onset determined from TOCO and maternal perception. It was also noticed that 61.5% recordings (48 out of 78 recordings) had all positive or negative TD for all the UCs analyzed within a recording. Furthermore, the regression analysis showed that the regression line slope was negative for 10 out of the 13 participants with at least 3 recordings from different gestational weeks, resulting in that the overall slope (-2.85±5.58) was significantly negative (p<;0.05), and indicating that UC onset TD decreased with gestational weeks. In summary, this study quantitatively investigated the TD between the onset of UCs determined from TOCO and maternal perception, providing scientific evidence for future studies to understand the underlying mechanism of the time sequence of UC activity determined from different techniques.
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The Identification and Tracking of Uterine Contractions Using Template Based Cross-Correlation. Ann Biomed Eng 2017; 45:2196-2210. [PMID: 28660431 DOI: 10.1007/s10439-017-1873-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this paper is to outline a novel method of using template based cross-correlation to identify and track uterine contractions during labour. A purpose built six-channel Electromyography (EMG) device was used to collect data from consenting women during labour and birth. A range of templates were constructed for the purpose of identifying and tracking uterine activity when cross-correlated with the EMG signal. Peak finding techniques were applied on the cross-correlated result to simplify and automate the identification and tracking of contractions. The EMG data showed a unique pattern when a woman was contracting with key features of the contraction signal remaining consistent and identifiable across subjects. Contraction profiles across subjects were automatically identified using template based cross-correlation. Synthetic templates from a rectangular function with a duration of between 5 and 10 s performed best at identifying and tracking uterine activity across subjects. The successful application of this technique provides opportunity for both simple and accurate real-time analysis of contraction data while enabling investigations into the application of techniques such as machine learning which could enable automated learning from contraction data as part of real-time monitoring and post analysis.
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Maeder AB, Vonderheid SC, Park CG, Bell AF, McFarlin BL, Vincent C, Carter CS. Titration of Intravenous Oxytocin Infusion for Postdates Induction of Labor Across Body Mass Index Groups. J Obstet Gynecol Neonatal Nurs 2017; 46:494-507. [PMID: 28528810 DOI: 10.1016/j.jogn.2017.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate whether oxytocin titration for postdates labor induction differs among women who are normal weight, overweight, and obese and whether length of labor and birth method differ by oxytocin titration and body mass index (BMI). DESIGN Retrospective cohort study. SETTING U.S. university-affiliated hospital. PARTICIPANTS Of 280 eligible women, 21 were normal weight, 134 were overweight, and 125 were obese at labor admission. METHODS Data on women who received oxytocin for postdates induction between January 1, 2013 and June 30, 2013 were extracted from medical records. Oxytocin administration and labor outcomes were compared across BMI groups, controlling for potential confounders. Data were analyzed using χ2, analysis of variance, analysis of covariance, and multiple linear and logistic regression models. RESULTS Women who were obese received more oxytocin than women who were overweight in the unadjusted analysis of variance (7.50 units compared with 5.92 units, p = .031). Women who were overweight had more minutes between rate changes from initiation to maximum than women who were obese (98.19 minutes compared with 83.39 minutes, p = .038). Length of labor increased with BMI (p = .018), with a mean length of labor for the normal weight group of 13.96 hours (standard deviation = 8.10); for the overweight group, 16.00 hours (standard deviation = 7.54); and for the obese group, 18.30 hours (standard deviation = 8.65). Cesarean rate increased with BMI (p = .001), with 4.8% of normal weight, 33.6% of overweight, and 42.4% of obese women having cesarean births. CONCLUSION Women who were obese and experienced postdates labor induction received more oxytocin than women who were non-obese and had longer length of labor and greater cesarean rates.
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Vasak B, Graatsma EM, Hekman-Drost E, Eijkemans MJ, Schagen van Leeuwen JH, Visser GH, Jacod BC. Identification of first-stage labor arrest by electromyography in term nulliparous women after induction of labor. Acta Obstet Gynecol Scand 2017; 96:868-876. [DOI: 10.1111/aogs.13127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Blanka Vasak
- Department of Obstetrics; University Medical Center; Utrecht the Netherlands
| | | | - Elske Hekman-Drost
- Department of Obstetrics; The Sykehuset Telemark HF Hospital; Skien Norway
| | - Marinus J. Eijkemans
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Gerard H.A. Visser
- Department of Obstetrics; University Medical Center; Utrecht the Netherlands
| | - Benoit C. Jacod
- Department of Obstetrics; University Medical Center; Utrecht the Netherlands
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Gonçalves H, Morais M, Pinto P, Ayres-de-Campos D, Bernardes J. Linear and non-linear analysis of uterine contraction signals obtained with tocodynamometry in prediction of operative vaginal delivery. J Perinat Med 2017; 45:327-332. [PMID: 27564692 DOI: 10.1515/jpm-2016-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/25/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether linear and non-linear analysis of uterine contraction (UC) signals obtained with external tocodynamometry can predict operative vaginal delivery (OVD). MATERIALS AND METHODS The last 2 h before delivery (H1 and H2) of 55 UC recordings acquired with external tocodynamometry in the labour ward of a tertiary care hospital were analysed. Signal processing involved the quantification of UCs/segment (UCN), and the linear and non-linear indices: Sample Entropy (SampEn) measuring signal irregularity; interval index (II) measuring signal variability, both of which may be associated with uterine muscle fatigue, and high frequency (HF), associated with maternal breathing movements. Thirty-two women had normal deliveries and 23 OVDs. Statistical inference was performed using 95% confidence intervals (95% CIs) for the median, and areas under the receiver operating curves (auROCs), with univariate and bivariate analyses. RESULTS A significant association was found between maternal body mass index (BMI) and UC signal quality in H1, with moderate/poor signal quality being more frequent with higher maternal BMI. There was an overall increase in contraction frequency (UCN), signal regularity (SampEn), signal variability (II), and maternal breathing (HF) from H1 to H2. The OVD group exhibited significantly higher values of signal irregularity and variability (SampEn and II) in H1, and higher contraction frequency (UCN) and maternal breathing (HF) in H2. Modest auROCs were obtained with these indices in the discrimination between normal and OVDs. CONCLUSIONS The results of this exploratory study suggest that analysis of UC signals obtained with tocodynamometry, using linear and non-linear indices associated with muscle fatigue and maternal breathing, identifies significant changes occurring during labour, and differences between normal and OVDs, but their discriminative capacity between the two types of delivery is modest. Further refinement of this analysis is needed before it may be clinically useful.
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Affiliation(s)
- Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto
| | - Mariana Morais
- Department of Obstetrics and Gynecology, Medical School, University of Porto
| | - Paula Pinto
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto
| | | | - João Bernardes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto
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Monitoring Fetal Heart Rate during Labor: A Comparison of Three Methods. J Pregnancy 2017; 2017:8529816. [PMID: 28392944 PMCID: PMC5368359 DOI: 10.1155/2017/8529816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 02/08/2017] [Accepted: 02/12/2017] [Indexed: 11/17/2022] Open
Abstract
The purpose of the study was to compare the accuracy of a noninvasive fetal heart rate monitor with that of ultrasound, using a fetal scalp electrode as the gold standard, in laboring women of varying body habitus, throughout labor and delivery. Laboring women requiring fetal scalp electrode were monitored simultaneously with the investigational device (noninvasive fetal ECG), ultrasound, and fetal scalp electrode. An algorithm extracted the fetal heart rate from the noninvasive fetal ECG signal. Each noninvasive device recording was compared with fetal scalp electrode with regard to reliability by positive percent agreement and accuracy by root mean squared error. Seventy-one women were included in this analysis. Positive percent agreement was 83.4 ± 15.4% for noninvasive fetal ECG and 62.4 ± 26.7% for ultrasound. The root mean squared error compared with fetal scalp electrode-derived fetal heart rate was 4.8 ± 2.0 bpm for noninvasive fetal ECG and 14.3 ± 8.2 bpm for ultrasound. The superiority of noninvasive fetal ECG was maintained for stages 1 and 2 of labor and increases in body mass index. Compared with fetal scalp electrode-derived fetal heart rate, noninvasive fetal ECG is more accurate and reliable than ultrasound for intrapartum monitoring for stages 1 and 2 of labor and is less affected by increasing maternal body mass index. This confirms the results of other workers in this field.
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Chetlur Adithya P, Sankar R, Moreno WA, Hart S. Trends in fetal monitoring through phonocardiography: Challenges and future directions. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Degbedzui DK, Mills GA, Kaufmann EE. DEVELOPMENT OF UTERINE CONTRACTION MONITORING SYSTEM FOR RESOURCE-LIMITED SETTINGS. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2016. [DOI: 10.4015/s1016237216500459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A need assessment exercise at various resource-limited hospitals in Ghana revealed that a conventional method of monitoring uterine contractions is employed. This method is time consuming and ineffective with a likelihood of misrepresenting data on uterine contractions. There is therefore a need for a system that can potentially overcome the identified challenges. In this paper, the authors present the proof of concept for development of an automated uterine contraction monitoring system designed for use in resource-limited settings. Following the engineering design process, data were gathered to draft product specifications. Various concepts were evaluated and a mathematical model of chosen concept was built and simulated. A functional prototype was constructed to test the system’s ability to measure the frequency and average duration of muscle contractions over a specified interval. The results indicate the capability of the chosen concept to meet design specifications. The design can also be enhanced to provide the intensity of contractions.
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Affiliation(s)
- Derek Kweku Degbedzui
- Department of Biomedical Engineering, School of Engineering Sciences, University of Ghana, Legon, Accra, Ghana
| | - Godfrey A. Mills
- Department of Computer Engineering, School of Engineering Sciences, University of Ghana, Legon, Accra, Ghana
| | - Elsie Effah Kaufmann
- Department of Biomedical Engineering, School of Engineering Sciences, University of Ghana, Legon, Accra, Ghana
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Olgan S, Celiloglu M. Contraction-based uterine artery Doppler velocimetry: novel approach for prediction of preterm birth in women with threatened preterm labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:757-764. [PMID: 26823022 DOI: 10.1002/uog.15871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/17/2016] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate whether uterine artery (UtA) Doppler velocimetry during peak uterine contraction is a useful marker for the prediction of preterm delivery. METHODS In this prospective cohort study, 172 patients admitted with preterm (24-35 weeks' gestation) uterine contractions were evaluated by UtA Doppler velocimetry during peak uterine contraction and by common obstetric measurements including cervical length. For UtA Doppler velocimetry, flow-velocity waveforms during peak uterine contraction (determined visually on tocodynamometry) were recorded during three consecutive heart cycles, and the mean UtA pulsatility index (UtA-PI) was calculated. RESULTS UtA-PI during the peak of contractions was significantly higher in patients who delivered within 7 days than in those who did not (P < 0.001). On receiver-operating characteristics curve analysis of UtA-PI on contraction, the areas under the curve for prediction of delivery within 48 h, 7 days or 14 days, ≤ 35 weeks and ≤ 37 weeks were 0.92, 0.88, 0.81, 0.83 and 0.74, respectively. Multiple regression analysis identified UtA-PI on contraction (P < 0.001) and cervical length (P < 0.001) as predictors of admission-to-delivery interval. The corresponding adjusted odds ratios for delivery within 7 days were 16.5 (95% CI, 5.7-47.2) for UtA-PI on contraction ≥ 1.32, and 14.7 (95% CI, 5.2-41.8) for cervical length ≤ 28 mm. CONCLUSION Use of UtA Doppler velocimetry during peak uterine contraction for patients exhibiting symptoms of preterm labor might be effective for the identification of pregnant women at risk of preterm delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Olgan
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - M Celiloglu
- Department of Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Hiersch L, Salzer L, Aviram A, Hadar E, Yogev Y, Ashwal E. Uterine electrical activity at labor: is there a correlation between labor stages? J Matern Fetal Neonatal Med 2016; 30:2620-2625. [DOI: 10.1080/14767058.2016.1259309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Liran Hiersch
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Salzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Aviram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Ashwal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Masuzawa Y, Yaeko K. Uterine activity during the two hours after placental delivery among low-risk pregnancies: an observational study. J Matern Fetal Neonatal Med 2016; 30:2446-2451. [DOI: 10.1080/14767058.2016.1253057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yuko Masuzawa
- Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan and
| | - Kataoka Yaeko
- Department of Women's Health and Midwifery, St. Luke’s International University, Tokyo, Japan
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Tocogram characteristics of uterine rupture: a systematic review. Arch Gynecol Obstet 2016; 295:17-26. [PMID: 27722806 PMCID: PMC5225169 DOI: 10.1007/s00404-016-4214-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/27/2016] [Indexed: 10/25/2022]
Abstract
PURPOSE Timely diagnosing a uterine rupture is challenging. Based on the pathophysiology of complete uterine wall separation, changes in uterine activity are expected. The primary objective is to identify tocogram characteristics associated with uterine rupture during trial of labor after cesarean section. The secondary objective is to compare the external tocodynamometer with intrauterine pressure catheters. METHODS MEDLINE, EMBASE, and the Cochrane library were systematically searched for eligible records. Moreover, clinical guidelines were screened. Studies analyzing tocogram characteristics of uterine rupture during trial of labor after cesarean section were appraised and included by two independent reviewers. Due to heterogeneity, a meta-analysis was only feasible for uterine hyperstimulation. RESULTS Thirteen studies were included. Three tocogram characteristics were associated with uterine rupture. (1) Hyperstimulation was more frequently observed compared with controls during the delivery (38 versus 21 % and 58 versus 53 %), and in the last 2 h prior to birth (19 versus 4 %). Results of meta-analysis: OR 1.68 (95 % CI 0.97-2.89), p = 0.06. (2) Decrease of uterine activity was observed in 14-40 % and (3) an increasing baseline in 10-20 %. Five studies documented no changes in uterine activity or Montevideo units. A direct comparison between external tocodynamometer and intrauterine pressure catheters was not feasible. CONCLUSIONS Uterine rupture can be preceded or accompanied by several types of changes in uterine contractility, including hyperstimulation, reduced number of contractions, and increased or reduced baseline of the uterine tonus. While no typical pattern has been repeatedly reported, close follow-up of uterine contractility is advised and hyperstimulation should be prevented.
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Batista AG, Najdi S, Godinho DM, Martins C, Serrano FC, Ortigueira MD, Rato RT. A multichannel time–frequency and multi-wavelet toolbox for uterine electromyography processing and visualisation. Comput Biol Med 2016; 76:178-91. [DOI: 10.1016/j.compbiomed.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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Aina-Mumuney A, Hwang K, Sunwoo N, Burd I, Blakemore K. The Impact of Maternal Body Mass Index and Gestational Age on the Detection of Uterine Contractions by Tocodynamometry: A Retrospective Study. Reprod Sci 2016; 23:638-43. [PMID: 26499394 PMCID: PMC5933158 DOI: 10.1177/1933719115611754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the impact of maternal body mass index (BMI) and gestational age (GA) on uterine contraction detection by tocodynamometry. METHODS Gravidas with preterm labor (PTL) complaints who were evaluated by tocodynamometry, discharged from Labor and Delivery triage, and subsequently readmitted for preterm delivery were studied. Forty-six patients in whom contractions were detected (group 1) were compared to 49 women in whom contractions were not detected (group 2) with respect to BMI and GA at both evaluation and delivery. Multivariable logistic regression was used to adjust for confounders. RESULTS Group 2 had a higher mean BMI (31.7 vs 26.1, P < .001), were more likely to be obese (57.1% vs 19.6%, P < .001), and were more likely to have been evaluated in the mid-trimester (36.7% vs 17.4%, P = .04) compared to group 1. Independent risk factors for the inability of the tocodynamometer to detect contractions were obesity (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.07-0.46) and evaluation in the mid-trimester (OR 0.33, 95% CI 0.13-0.84). CONCLUSION Our study provides evidence that the effectiveness of tocodynamometry diminishes with increasing maternal BMI. Efficacy of tocodynamometry is also decreased at earlier GA, most pronounced below 25 weeks. To evaluate women with PTL symptoms in the mid-trimester or symptomatic obese women at any GA, a modality other than tocodynamometry could be valuable to more accurately assess uterine activity.
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Affiliation(s)
- A Aina-Mumuney
- Division of Maternal Fetal Medicine, Department of Gynecology/Obstetrics, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - K Hwang
- Department of Biomedical Engineering, Johns Hopkins University Baltimore, MD, USA
| | - N Sunwoo
- Department of Biomedical Engineering, Johns Hopkins University Baltimore, MD, USA
| | - I Burd
- Division of Maternal Fetal Medicine, Department of Gynecology/Obstetrics, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - K Blakemore
- Division of Maternal Fetal Medicine, Department of Gynecology/Obstetrics, Johns Hopkins University School of Medicine Baltimore, MD, USA
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Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor. Physiol Meas 2016; 37:387-400. [PMID: 26862891 DOI: 10.1088/0967-3334/37/3/387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During labor, uterine contractions can cause temporary oxygen deficiency for the fetus. In case of severe and prolonged oxygen deficiency this can lead to asphyxia. The currently used technique for detection of asphyxia, cardiotocography (CTG), suffers from a low specificity. Recent studies suggest that analysis of fetal heart rate variability (HRV) in addition to CTG can provide information on fetal distress. However, interpretation of fetal HRV during labor is difficult due to the influence of uterine contractions on fetal HRV. The aim of this study is therefore to investigate whether HRV features differ during contraction and rest periods, and whether these differences can improve the detection of asphyxia. To this end, a case-control study was performed, using 14 cases with asphyxia that were matched with 14 healthy fetuses. We did not find significant differences for individual HRV features when calculated over the fetal heart rate without separating contractions and rest periods (p > 0.30 for all HRV features). Separating contractions from rest periods did result in a significant difference. In particular the ratio between HRV features calculated during and outside contractions can improve discrimination between fetuses with and without asphyxia (p < 0.04 for three out of four ratio HRV features that were studied in this paper).
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Affiliation(s)
- G J J Warmerdam
- Faculty of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
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86
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Radomski DS. Reprint of 'A nonlinear parameterization of multivariate electrohysterographical signals'. Comput Biol Med 2016; 69:254-60. [PMID: 26832964 DOI: 10.1016/j.compbiomed.2016.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 10/05/2015] [Indexed: 11/17/2022]
Abstract
Electrohysterography is a technique which measures a bioelectrical activity of a uterus. This paper presents an application of a nonlinear parameterization of multivariate electrohysterographical signals for a uterine activity assessment to improve unsatisfactory a labor prediction accuracy by methods published in literature. A multivariate sample entropy used for differentiated 4-channel electrohysterographical signals, general Spearman's correlation and a combined index being the sum of them, were tested. These nonlinear measures use joint information contained in a multivariate signal. The results confirm that the combined index provides the best assessment of uterine contractions: 87% sensitivity and 50% specificity of labor prediction in the studied data. These results should be verified in a prospective study.
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Affiliation(s)
- Dariusz S Radomski
- Institute of Radioelectronics, Warsaw University of Technology, Nowowiejska 15/19 00-665 Warsaw, Poland.
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87
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Early diagnosis of threatened premature labor by electrohysterographic recordings – The use of digital signal processing. Biocybern Biomed Eng 2016. [DOI: 10.1016/j.bbe.2015.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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88
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Eswaran H, Wilson JD, Murphy P, Siegel ER, Lowery CL. Comparing the performance of a new disposable pneumatic tocodynamometer with a standard tocodynamometer. Acta Obstet Gynecol Scand 2015; 95:319-28. [PMID: 26660622 DOI: 10.1111/aogs.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 11/13/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The goal was to test a newly developed pneumatic tocodynamometer (pTOCO) that is disposable and lightweight, and evaluate its equivalence to the standard strain gauge-based tocodynamometer (TOCO). MATERIAL AND METHODS The equivalence between the devices was determined by both mechanical testing and recording of contractile events on women. The data were recorded simultaneously from a pTOCO prototype and standard TOCO that were in place on women who were undergoing routine contraction monitoring in the Labor and Delivery unit at the University of Arkansas for Medical Sciences. In this prospective equivalence study, the output from 31 recordings on 28 pregnant women that had 171 measureable contractions simultaneously in both types of TOCO were analyzed. The traces were scored for contraction start, peak and end times, and the duration of the event was computed from these times. RESULTS The response curve to loaded weights and applied pressure were similar for both devices, indicating their mechanical equivalence. The paired differences in times and duration between devices were subjected to mixed-models analysis to test the pTOCO for equivalence with standard TOCOs using the two-one-sided tests procedure. The event times and duration analyzed simultaneously from both TOCO types were all found to be significantly equivalent to within ±10 s (all p-values ≤0.0001). CONCLUSION pTOCO is equivalent to the standard TOCO in the detection of the timing and duration of uterine contractions. pTOCO would provide a lightweight, disposable alternative to commercially available standard TOCOs.
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Affiliation(s)
- Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James D Wilson
- Graduate Institute of Technology, University of Arkansas, Little Rock, AR, USA
| | - Pam Murphy
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curtis L Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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89
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Radomski DS. A nonlinear parameterization of multivariate electrohysterographical signals. Comput Biol Med 2015; 67:13-20. [DOI: 10.1016/j.compbiomed.2015.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 08/26/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022]
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90
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Sunwoo N, Hwang K, Blakemore KJ, Aina-Mumuney A. Vaginal electrohysterography: the design and preliminary evaluation of a novel device for uterine contraction monitoring in an ovine model (.). J Matern Fetal Neonatal Med 2015; 29:2742-7. [PMID: 26458732 DOI: 10.3109/14767058.2015.1107538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Tocodynamometry is the most common method of labor evaluation but most clinicians would agree it has limited utility before 26 weeks of gestation. The obesity epidemic has further reduced our ability to accurately detect uterine contractions using the tocodynamometer at any gestational age. We sought to design and test a novel contraction monitor that bypasses the maternal abdomen. METHODS An optimized version of an intravaginal electrohysterographic ring device was tested in an ovine model. The device and its methodology as well as the tocodynamometer were validated against the current gold standard uterine activity monitor, the intrauterine pressure catheter in six sheep at varying gestational ages. RESULTS Both the intravaginal ring device and the tocodynamometer correlated well with IUPC, r = 0.69 and 0.73, respectively (p < 0.001). The number of contractions detected by each monitor remained similar even after accounting for confounders. CONCLUSIONS These results suggest that uterine activity can be monitored from the vaginal interface in an ovine model and offers an alternative clinical tool for the detection of contractions in situations, in which tocodynamometry would be ineffective or intrauterine monitoring inappropriate.
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Affiliation(s)
- Nate Sunwoo
- a Johns Hopkins University School of Biomedical Engineering , Baltimore , MD , USA and
| | - Karin Hwang
- a Johns Hopkins University School of Biomedical Engineering , Baltimore , MD , USA and
| | - Karin J Blakemore
- b Department of GYN/OB , Division of Maternal Fetal Medicine, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Abimbola Aina-Mumuney
- b Department of GYN/OB , Division of Maternal Fetal Medicine, Johns Hopkins School of Medicine , Baltimore , MD , USA
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91
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Bajlekov GI, Rabotti C, Oei SG, Mischi M. Electrohysterographic detection of uterine contractions in term pregnancy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:5851-5854. [PMID: 26737622 DOI: 10.1109/embc.2015.7319722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Uterine-contraction detection is a fundamental component of pregnancy monitoring. Electrohysterography (EHG) provides a non-invasive and accurate alternative to intrauterine pressure (IUP) measurements, and several techniques provide an estimated IUP (eIUP) based on the EHG alone. Commonly, EHG contraction detection is based on amplitude thresholding of the eIUP. We aim at improving the reliability of contraction detection, such that automatic contraction detection can be realized. An algorithm for template-matching of the eIUP signal is proposed. This method is based on Bayesian evidence using a Gaussian likelihood function to classify uterine activity. Gaussian templates are matched to the input signal, with weights obtained empirically from manually-annotated contraction events in a training data-set. The results show an improvement in contraction detection accuracy compared to threshold-based methods. The template-matching method is adaptable to relevant features in the input training data, and is thus less sensitive to differences in eIUP derivation or measurement variability. The method allows for improved automatic uterine contraction detection in labor EHG data, while being extensible to e.g. preterm contraction detection.
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92
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Ren P, Yao S, Li J, Valdes-Sosa PA, Kendrick KM. Improved Prediction of Preterm Delivery Using Empirical Mode Decomposition Analysis of Uterine Electromyography Signals. PLoS One 2015; 10:e0132116. [PMID: 26161639 PMCID: PMC4498691 DOI: 10.1371/journal.pone.0132116] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/04/2015] [Indexed: 01/28/2023] Open
Abstract
Preterm delivery increases the risk of infant mortality and morbidity, and therefore developing reliable methods for predicting its likelihood are of great importance. Previous work using uterine electromyography (EMG) recordings has shown that they may provide a promising and objective way for predicting risk of preterm delivery. However, to date attempts at utilizing computational approaches to achieve sufficient predictive confidence, in terms of area under the curve (AUC) values, have not achieved the high discrimination accuracy that a clinical application requires. In our study, we propose a new analytical approach for assessing the risk of preterm delivery using EMG recordings which firstly employs Empirical Mode Decomposition (EMD) to obtain their Intrinsic Mode Functions (IMF). Next, the entropy values of both instantaneous amplitude and instantaneous frequency of the first ten IMF components are computed in order to derive ratios of these two distinct components as features. Discrimination accuracy of this approach compared to those proposed previously was then calculated using six differently representative classifiers. Finally, three different electrode positions were analyzed for their prediction accuracy of preterm delivery in order to establish which uterine EMG recording location was optimal signal data. Overall, our results show a clear improvement in prediction accuracy of preterm delivery risk compared with previous approaches, achieving an impressive maximum AUC value of 0.986 when using signals from an electrode positioned below the navel. In sum, this provides a promising new method for analyzing uterine EMG signals to permit accurate clinical assessment of preterm delivery risk.
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Affiliation(s)
- Peng Ren
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Biomedicine, University of Electronic Science and Technology of China, Chengdu, China
- * E-mail: (PR); (KMM)
| | - Shuxia Yao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Biomedicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingxuan Li
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu, China
| | - Pedro A. Valdes-Sosa
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Biomedicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Keith M. Kendrick
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Biomedicine, University of Electronic Science and Technology of China, Chengdu, China
- * E-mail: (PR); (KMM)
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93
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Ye Y, Song X, Liu L, Shi SQ, Garfield RE, Zhang G, Liu H. Effects of Patient-Controlled Epidural Analgesia on Uterine Electromyography During Spontaneous Onset of Labor in Term Nulliparous Women. Reprod Sci 2015; 22:1350-7. [PMID: 25824008 DOI: 10.1177/1933719115578926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effect of patient-controlled epidural analgesia (PCEA) on uterine electromyography (EMG) activity in term pregnant women during labor. METHODS Nulliparous pregnant women in spontaneous term labor (N = 30) were enrolled (PCEA group, n = 20 and control group, n = 10). Five time periods (30 minutes each) were defined for noninvasive abdominal recordings and analysis of uterine EMG activity, that is, period I: before PCEA treatment with 2-cm cervical dilation; periods II to IV: each period successively at 30, 60, and 120 minutes after PCEA; and period V: second stage of labor with cervix at 10 cm dilation. Control patients without PCEA were monitored during the same times. The number of bursts/30 min, power density spectrum peak frequency, mean amplitude, and duration of uterine EMG bursts were measured to assess uterine EMG activity. Maternal, fetal, and labor characteristics were also recorded. Data were analyzed by analysis of variance followed by other tests. RESULTS Electromyography parameters are significantly lower (P < .001) after PCEA (periods II to IV) compared to controls but similar between groups by period V (P > .05). Also, patients with PCEA have a slower rate of cervical dilation (P < .003, period IV only) and longer labor in both stage 1 and stage 2 (P < .05). All patients have similar (P > .05) positive labor outcomes. CONCLUSIONS Patient-controlled epidural analgesia initially suppresses uterine EMG and slows cervical dilation thereby prolonging labor. However, the EMG activity recovers with labor progress with no effects on delivery outcomes.
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Affiliation(s)
- Yuanjuan Ye
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xingrong Song
- Department of Anesthesia, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lei Liu
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shao-Qing Shi
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Robert E Garfield
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Guozheng Zhang
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huishu Liu
- Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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94
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Patwardhan M, Hernandez-Andrade E, Ahn H, Korzeniewski SJ, Schwartz A, Hassan SS, Romero R. Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications. Gynecol Obstet Invest 2015; 80:26-37. [PMID: 25634647 PMCID: PMC4536955 DOI: 10.1159/000370001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate dynamic changes in myometrial thickness during the third stage of labor. METHODS Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n = 30), postpartum hemorrhage (n = 4), preterm delivery (n = 7) and clinical chorioamnionitis (n = 4). Differences between myometrial thickness of the uterine segments and as a function of time were evaluated. RESULTS There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p < 0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p < 0.0001). In women with postpartum hemorrhage, preterm delivery, and clinical chorioamnionitis, an uncoordinated pattern among the uterine segments was observed. CONCLUSION A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk of postpartum hemorrhage.
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Affiliation(s)
- Manasi Patwardhan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Hyunyoung Ahn
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Steven J Korzeniewski
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Alyse Schwartz
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Sonia S Hassan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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95
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Taralunga DD, Ungureanu M, Hurezeanu B, Gussi I, Strungaru R. Empirical mode decomposition applied for non-invasive electrohysterograhic signals denoising. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:4134-4137. [PMID: 26737204 DOI: 10.1109/embc.2015.7319304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The electrical activity of the uterus, i.e. the electrohysterogram (EHG), is one of the most prominent tool for preterm labour. There is no standard acquisition set up and often the EHG is corrupted with different types of noise: maternal and fetal electrocardiogram (mECG, fECG), electrical activity of the skeletal muscles, movement artifacts, power line interference (PLI) etc. Moreover, some of these noises overlap in frequency domain with the EHG. Thus, simple linear filtering approaches are not adequate. In this paper the empirical mode decomposition (EMD), a simple and data driven method, is proposed for EHG denoising. The method is evaluated on simulated data having different signal to noise ratios (SNRs) obtaining promising results.
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96
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Hadar E, Biron-Shental T, Gavish O, Raban O, Yogev Y. A comparison between electrical uterine monitor, tocodynamometer and intra uterine pressure catheter for uterine activity in labor. J Matern Fetal Neonatal Med 2014; 28:1367-74. [DOI: 10.3109/14767058.2014.954539] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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97
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de Lau H, Rabotti C, Oosterbaan HP, Mischi M, Oei GS. Study protocol: PoPE-Prediction of Preterm delivery by Electrohysterography. BMC Pregnancy Childbirth 2014; 14:192. [PMID: 24898548 PMCID: PMC4057931 DOI: 10.1186/1471-2393-14-192] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 05/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background Traditional methods used for prediction of preterm delivery are subjective and inaccurate. The Electrohysterogram (EHG) and in particular the estimation of the EHG conduction velocity, is a relatively new promising method for detecting imminent preterm delivery. To date the analysis of the conduction velocity has relied on visual inspection of the signals. As a next step towards the introduction of EHG analysis as a clinical tool, we propose an automated method for EHG conduction velocity estimation for both the speed and direction of single spike propagation. Methods/Design The study design will be an observational cohort study. 100 pregnant women, gestational age between 23 + 5 and 34 weeks, admitted for threatening preterm labor or preterm prelabor rupture of membranes, will be included. The length of the cervical canal will be measured by transvaginal ultrasound. The EHG will be recorded using 4 electrodes in a fixed configuration. Contractions will be detected by analysis of the EHG and using an estimation of the intra uterine pressure. In the selected contractions, the delays between channels will be estimated by cross-correlation, and subsequently, the average EHG conduction velocity will be derived. Patients will be classified as labor group and non-labor group based on the time between measurement and delivery. The average conduction velocity and cervical length will be compared between the groups. The main study endpoints will be sensitivity, specificity, and area under the ROC curve for delivery within 1,2,4,7, and 14 days from the measurement. Discussion In this study, the diagnostic accuracy of EHG conduction velocity analysis will be evaluated for detecting preterm labor. Visual and automatic detection of contractions will be compared. Planar wave propagation will be assumed for the calculation of the CV vector. Trial registration Current Controlled Trials ISRCTN07603227.
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Affiliation(s)
- Hinke de Lau
- Department of Electrical Engineering, University of Technology Eindhoven, Den Dolech 2, 5612 AZ Eindhoven, the Netherlands.
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98
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Rooijakkers MJ, Rabotti C, Oei SG, Aarts RM, Mischi M. Low-complexity intrauterine pressure estimation using the Teager energy operator on electrohysterographic recordings. Physiol Meas 2014; 35:1215-28. [PMID: 24853038 DOI: 10.1088/0967-3334/35/7/1215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Monitoring the progression of maternal uterine activity provides important prognostic information during pregnancy and parturition. Currently used methods for intrauterine pressure (IUP) measurement are unsuitable for long-term observation of uterine activity. The abdominally measured electrohysterogram (EHG) provides a non-invasive alternative to the existing methods for long-term ambulatory uterine contraction monitoring. A new low-complexity method for IUP estimation based on the Teager energy (TE) operator is proposed. The TE operator was used as it mimics the physiologic phenomena underlying the generation of the EHG signals. Several EHG signal analysis methods for IUP estimation from the literature are compared with the new TE method. The comparison is based on correlation and root mean square error of the IUP estimate with the gold standard internally measured IUP as well as their respective computational complexity. The proposed method results in a superior IUP estimation accuracy and complexity compared to state-of-the-art methods from the literature, with a complexity as much as 55 times lower. Therefore, the proposed method offers a valuable new option for long-term ambulatory uterine monitoring.
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Affiliation(s)
- Michael J Rooijakkers
- Faculty of Electrical Engineering, University of Technology Eindhoven, 5612 AZ Eindhoven, The Netherlands
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99
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Cohen WR, Hayes-Gill B. Influence of maternal body mass index on accuracy and reliability of external fetal monitoring techniques. Acta Obstet Gynecol Scand 2014; 93:590-5. [PMID: 24684703 DOI: 10.1111/aogs.12387] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/21/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the performance of external electronic fetal heart rate and uterine contraction monitoring according to maternal body mass index. DESIGN Secondary analysis of prospective equivalence study. SETTING Three US urban teaching hospitals. SAMPLE Seventy-four parturients with a normal term pregnancy. METHODS The parent study assessed performance of two methods of external fetal heart rate monitoring (abdominal fetal electrocardiogram and Doppler ultrasound) and of uterine contraction monitoring (electrohystero-graphy and tocodynamometry) compared with internal monitoring with fetal scalp electrode and intrauterine pressure transducer. Reliability of external techniques was assessed by the success rate and positive percent agreement with internal methods. Bland-Altman analysis determined accuracy. We analyzed data from that study according to maternal body mass index. MAIN OUTCOME MEASURES We assessed the relationship between body mass index and monitor performance with linear regression, using body mass index as the independent variable and measures of reliability and accuracy as dependent variables. RESULTS There was no significant association between maternal body mass index and any measure of reliability or accuracy for abdominal fetal electrocardiogram. By contrast, the overall positive percent agreement for Doppler ultrasound declined (p = 0.042), and the root mean square error from the Bland-Altman analysis increased in the first stage (p = 0.029) with increasing body mass index. Uterine contraction recordings from electrohysterography and tocodynamometry showed no significant deterioration related to maternal body mass index. CONCLUSIONS Accuracy and reliability of fetal heart rate monitoring using abdominal fetal electrocardiogram was unaffected by maternal obesity, whereas performance of ultrasound degraded directly with maternal size. Both electrohysterography and tocodynamometry were unperturbed by obesity.
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Affiliation(s)
- Wayne R Cohen
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, Arizona, USA
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100
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Automatic identification of motion artifacts in EHG recording for robust analysis of uterine contractions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:470786. [PMID: 24523828 PMCID: PMC3912778 DOI: 10.1155/2014/470786] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022]
Abstract
Electrohysterography (EHG) is a noninvasive technique for monitoring uterine electrical activity. However, the presence of artifacts in the EHG signal may give rise to erroneous interpretations and make it difficult to extract useful information from these recordings. The aim of this work was to develop an automatic system of segmenting EHG recordings that distinguishes between uterine contractions and artifacts. Firstly, the segmentation is performed using an algorithm that generates the TOCO-like signal derived from the EHG and detects windows with significant changes in amplitude. After that, these segments are classified in two groups: artifacted and nonartifacted signals. To develop a classifier, a total of eleven spectral, temporal, and nonlinear features were calculated from EHG signal windows from 12 women in the first stage of labor that had previously been classified by experts. The combination of characteristics that led to the highest degree of accuracy in detecting artifacts was then determined. The results showed that it is possible to obtain automatic detection of motion artifacts in segmented EHG recordings with a precision of 92.2% using only seven features. The proposed algorithm and classifier together compose a useful tool for analyzing EHG signals and would help to promote clinical applications of this technique.
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