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Anderson K, Wang S, Pizzella S, Wang Q, Wang Y, Ratts V. The use of transvaginal ultrasound alters physiologic uterine peristalsis in gynecologic participants. F S Rep 2024; 5:296-303. [PMID: 39381650 PMCID: PMC11456659 DOI: 10.1016/j.xfre.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 10/10/2024] Open
Abstract
Objective To study whether transvaginal ultrasound (TVUS) affected the uterine peristalsis (UP) patterns in nonpregnant participants. Design Institutional review board-approved, prospective observational cohort study. The noninvasive UP imaging (UPI) system uses electrode patches placed on the patient's skin just above the pubic bone and on the low back to quantify the 3-dimensional electrical activation pattern during UP by calculating peristalsis frequency, duration, magnitude, and activation ratio. A 20-minute UPI scan was completed without TVUS followed by a 10-minute UPI scan acquired simultaneously during TVUS examination as a comparison. Setting University medical center. Patients Twenty-eight participants with regular menstrual cycles not taking hormonal medication and with a normal uterus were included in analysis. Interventions Subjects were imaged longitudinally during the four phases of the menstrual cycle (menses, proliferative, periovulatory, and secretory) with a UPI scan followed by concurrent TVUS and UPI scan. Serum hormone levels (estradiol and progesterone) and TVUS evaluating follicular development were obtained during each visit to confirm menstrual cycle phase. Main Outcome Measures Duration, frequency, magnitude, and activation ratio of the UP waves. Results With the use of simultaneous TVUS, UP waves had a change in at least one of the outcomes measured in all visits. The frequency, magnitude, and duration were significantly higher with TVUS use in all phases of the menstrual cycle. The activation ratio was higher with TVUS during all phases except the periovulatory phase. Conclusions This study demonstrated that TVUS may inherently affect UP waves. Therefore, noninvasive technology may more accurately measure physiologic peristalsis waves.
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Affiliation(s)
- Kelsey Anderson
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Sicheng Wang
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Stephanie Pizzella
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Qing Wang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Yong Wang
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, Missouri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Valerie Ratts
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Young R, Marinescu P, Seligman N, Adair CD, Hern B. Directional Sensors for Recording Uterine EMG During Pregnancy. Reprod Sci 2023; 30:3190-3196. [PMID: 37217825 DOI: 10.1007/s43032-023-01268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Abstract
Multichannel uterine electromyography (uEMG) during pregnancy is traditionally performed with electrocardiography (ECG) sensors. Similar signals are often observed in two or more channels, suggesting the ECG sensors report activities originating from the same location on the uterus. To improve signal source localization, we designed a directional sensor or "Area Sensor". Here we compare Area Sensors with ECG sensors for source localization. Subjects were ≥ 38 wks experiencing regular contractions. 6 Area Sensors (n = 8) or 6 to 7 ECG sensors (n = 7) were used to record multichannel uEMG for 60 min. For each sensor type, the similarity of signals observed in pairs of channels during contractions was assessed by quantifying channel crosstalk. Since crosstalk depends on the separation between sensors, analyses were performed within distance groups: A 9-12 cm; B 13-16 cm; C 17-20 cm; D 21-24 cm; E ≥ 25 cm. For ECG sensors, crosstalk was 67.9 ± 14.4% in group A, decreasing to 27.8 ± 17.5% in group E. For Area Sensors, crosstalk was 24.6 ± 18.6% in Group A, decreasing to 12.5 ± 13.8% in group E. Area Sensors showed less crosstalk than ECG sensors in distance groups A, B, C and D, with all p < 0.002. Compared with ECG sensors, Area Sensors are more directional and report uterine activity from a smaller area of the uterine wall. Using 6 Area Sensors separated by at least 17 cm provides acceptably independent multichannel recording. This introduces the possibility of non-invasively evaluating uterine synchronization and the strength of individual uterine contractions in real time.
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Affiliation(s)
| | - Ponnila Marinescu
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Neil Seligman
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - C David Adair
- Department of Obstetrics and Gynecology, The University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Braxton Hern
- Vanderbilt University Medical Center, Nashville, TN, USA
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Li W, Xiao Z, Zhao J, Aono K, Pizzella S, Wen Z, Wang Y, Wang C, Chakrabartty S. A Portable and a Scalable Multi-Channel Wireless Recording System for Wearable Electromyometrial Imaging. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:916-927. [PMID: 37204963 PMCID: PMC10871545 DOI: 10.1109/tbcas.2023.3278104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Electromyometrial imaging (EMMI) technology has emerged as one of the promising technology that can be used for non-invasive pregnancy risk stratification and for preventing complications due to pre-term birth. Current EMMI systems are bulky and require a tethered connection to desktop instrumentation, as a result, the system cannot be used in non-clinical and ambulatory settings. In this article, we propose an approach for designing a scalable, portable wireless EMMI recording system that can be used for in-home and remote monitoring. The wearable system uses a non-equilibrium differential electrode multiplexing approach to enhance signal acquisition bandwidth and to reduce the artifacts due to electrode drifts, amplifier 1/f noise, and bio-potential amplifier saturation. A combination of active shielding, a passive filter network, and a high-end instrumentation amplifier ensures sufficient input dynamic range ([Formula: see text]) such that the system can simultaneously acquire different bio-potential signals like maternal electrocardiogram (ECG) in addition to the EMMI electromyogram (EMG) signals. We show that the switching artifacts and the channel cross-talk introduced due to non-equilibrium sampling can be reduced using a compensation technique. This enables the system to be potentially scaled to a large number of channels without significantly increasing the system power dissipation. We demonstrate the feasibility of the proposed approach in a clinical setting using an 8-channel battery-powered prototype which dissipates less than 8 μW per channel for a signal bandwidth of 1 KHz.
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Stout MJ, Chubiz J, Raghuraman N, Zhao P, Tuuli MG, Wang LV, Cahill AG, Cuculich PS, Wang Y, Jungheim ES, Herzog ED, Fay J, Schwartz AL, Macones GA, England SK. A multidisciplinary Prematurity Research Cohort Study. PLoS One 2022; 17:e0272155. [PMID: 36006907 PMCID: PMC9409532 DOI: 10.1371/journal.pone.0272155] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 07/13/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Worldwide, 10% of babies are born preterm, defined as a live birth before 37 weeks of gestation. Preterm birth is the leading cause of neonatal death, and survivors face lifelong risks of adverse outcomes. New approaches with large sample sizes are needed to identify strategies to predict and prevent preterm birth. The primary aims of the Washington University Prematurity Research Cohort Study were to conduct three prospective projects addressing possible causes of preterm birth and provide data and samples for future research. STUDY DESIGN Pregnant patients were recruited into the cohort between January 2017 and January 2020. Consenting patients were enrolled into the study before 20 weeks' gestation and followed through delivery. Participants completed demographic and lifestyle surveys; provided maternal blood, placenta samples, and cord blood; and participated in up to three projects focused on underlying physiology of preterm birth: cervical imaging (Project 1), circadian rhythms (Project 2), and uterine magnetic resonance imaging and electromyometrial imaging (Project 3). RESULTS A total of 1260 participants were enrolled and delivered during the study period. Of the participants, 706 (56%) were Black/African American, 494 (39%) were nulliparous, and 185 (15%) had a previous preterm birth. Of the 1260 participants, 1220 (97%) delivered a live infant. Of the 1220 with a live birth, 163 (14.1%) had preterm birth, of which 74 (6.1%) were spontaneous preterm birth. Of the 1220 participants with a live birth, 841 participated in cervical imaging, 1047 contributed data and/or samples on circadian rhythms, and 39 underwent uterine magnetic resonance imaging. Of the 39, 25 underwent electromyometrial imaging. CONCLUSION We demonstrate feasibility of recruiting and retaining a diverse cohort in a complex prospective, longitudinal study throughout pregnancy. The extensive clinical, imaging, survey, and biologic data obtained will be used to explore cervical, uterine, and endocrine physiology of preterm birth and can be used to develop novel approaches to predict and prevent preterm birth.
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Affiliation(s)
- Molly J. Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jessica Chubiz
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Peinan Zhao
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, United States of America
| | - Lihong V. Wang
- Department of Medical Engineering, California Institute of Technology, Pasadena, California, United States of America
| | - Alison G. Cahill
- Department of Women’s Health, University of Texas at Austin, Austin, Texas, United States of America
| | - Phillip S. Cuculich
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Yong Wang
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Emily S. Jungheim
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
| | - Erik D. Herzog
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Justin Fay
- Department of Biology, University of Rochester, Rochester, New York, United States of America
| | - Alan L. Schwartz
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - George A. Macones
- Department of Women’s Health, University of Texas at Austin, Austin, Texas, United States of America
| | - Sarah K. England
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, United States of America
- * E-mail:
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