1
|
Thijssen KMJ, Frenken MWE, Van der Hout-van der Jagt MB, Li W, Mo Z, Westerhuis MEMH, Swan GO. A randomized controlled trial reducing cesarean delivery rates in China by introducing trial of labor after cesarean and electrohysterography. J Matern Fetal Neonatal Med 2024; 37:2376661. [PMID: 39004516 DOI: 10.1080/14767058.2024.2376661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE A cesarean delivery (CD) can affect health of both mother and child and future pregnancies. Since the abandonment of the one-child policy in China, obstetricians tend to perform a repeat CD rather than a trial of labor after cesarean (TOLAC). This study aims to reduce CD rates by increasing vaginal births after cesarean (VBAC) rates and introducing electrohysterography (EHG) for accurate monitoring. METHODS In total, 82 women received counseling regarding TOLAC at the Shijiazhuang Sixth Hospital in China. Women opting for TOLAC were randomized for either external tocodynamometry (TOCO, i.e. standard care) or EHG. The primary outcome was the VBAC rate. Secondary outcomes were indications for CD, percentage of assisted vaginal deliveries, labor duration, maternal blood loss, complications and neonatal outcomes. RESULTS After accounting for preterm delivery and dropouts, all counseled women opted for a TOLAC (100%). After randomization, 42 women were included in the TOCO-group and 37 in the EHG-group. Women did not receive pain medication and labor was not augmented with oxytocin. The VBAC rate was 71.4% in the TOCO-group, versus 78.4% in the EHG-group (p = .48). Birth was assisted with forceps in 11.9% of TOCO-group versus 2.7% of EHG-group (p = .21). One secondary CD (i.e. a shift from intended vaginal delivery to surgical delivery within the same labor) was performed because of a suspicion of uterine rupture (TOCO-group). Other indications for CD were: fetal distress, labor dystocia, fetal position, cephalopelvic disproportion. There were no significant differences in secondary study outcomes. No complications were reported. CONCLUSION This study showed an average VBAC rate of 75%, without any complications, in a hospital with no previous experience with TOLAC. The VBAC rate with EHG-monitoring was higher than TOCO, although this difference was not significant. To demonstrate a significant difference, larger clinical studies are necessary. TRIAL REGISTRATION The Daily Board of the Medical Ethics Committee of The Maternal and Child Hospital of Shijiazhuang approved the study protocol (number 20171018, Dutch Trial Register NL8199).
Collapse
Affiliation(s)
- Kirsten Martine Johanna Thijssen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- University MC Utrecht, Utrecht, The Netherlands
| | - Maria Wilhelmina Elisabeth Frenken
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Marieke Beatrijs Van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Wang Li
- Department of Obstetrics and Gynaecology, The Maternal and Child Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, P.R. China
| | - Zhongfu Mo
- Department of Obstetrics and Gynaecology, The Maternal and Child Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, P.R. China
| | | | - Guid Oei Swan
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| |
Collapse
|
2
|
Thijssen KMJ, van den Broek MJM, Koenraads FA, Cantineau-Goedegebuure JI, Papatsonis DNM, van Willigen BG, Dieleman JP, van der Hout-van der Jagt MB, Westerhuis MEMH, Oei SG. Detection of postpartum uterine activity with electrohysterography. Eur J Obstet Gynecol Reprod Biol 2023; 291:23-28. [PMID: 37806028 DOI: 10.1016/j.ejogrb.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Uterine contractions are essential for childbirth, but also for expulsion of the placenta and for limiting postpartum blood loss. Postpartum hemorrhage is associated with almost 25% of the maternal deaths worldwide and the leading cause of maternal death in most low-income countries. Little is known about the physiology of the uterus postpartum, particularly due to the lack of an accurate measurement tool. The primary objective of this pilot study is to explore the potential of using electrohysterography to detect postpartum uterine contractions. If postpartum uterine activity can be objectified, this could contribute to understanding the physiology of the uterus and improve diagnosis and treatment of postpartum hemorrhage. STUDY DESIGN In this observational study we included women aiming for a vaginal birth in two large maternity clinics in the Netherlands, Amphia Hospital Breda (group A, N2018-0161) and Máxima Medical Center Veldhoven (group B, N17.149). An electrode patch was placed on the maternal abdomen to record real-time electrical uterine activity until one hour postpartum continuously. In group A, the placement of the patch was lower than in group B. For analysis, tracings were divided into five different phases (1: dilatation until start pushing, 2: from start pushing until childbirth, 3: from childbirth until placental expulsion, 4: first hour after placental expulsion and 5: after one hour postpartum). Readability, signal quality and contraction frequency per hour were assessed. Additionally, patient satisfaction was evaluated through a survey. RESULTS In total 91 pregnant women were included of whom 45 in group A and 46 women in group B. Complete registrations were obtained throughout the five labor phases with very little artefacts or signal loss. The readability of the tracings decreased after childbirth. A significantly better readability was found in tracings where the patch placement was lower on the abdomen for phases 4 and 5. Contraction frequency was highest during phase 2 and decreased towards phase 5. Women rated the satisfaction with electrohysterography as high and mostly did not notice the patch. CONCLUSION It is possible to detect uterine activity postpartum with electrohysterography. Further investigation is recommended to improve diagnosis and treatment of postpartum hemorrhage.
Collapse
Affiliation(s)
- Kirsten M J Thijssen
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands; University MC Utrecht, P.O Box 85500, 3508 GA, Utrecht, the Netherlands.
| | - Michelle J M van den Broek
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands
| | - Feikje A Koenraads
- Amphia Hospital, Department of Obstetrics and Gynecology, P.O. Box 90158, 4800 RK Breda, the Netherlands
| | | | - Dimitri N M Papatsonis
- Amphia Hospital, Department of Obstetrics and Gynecology, P.O. Box 90158, 4800 RK Breda, the Netherlands
| | - Bettine G van Willigen
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands
| | - Jeanne P Dieleman
- MMC Academy, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands; Faculty of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, the Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands
| |
Collapse
|
3
|
Monitoring uterine contractions during labor: current challenges and future directions. Am J Obstet Gynecol 2023; 228:S1192-S1208. [PMID: 37164493 DOI: 10.1016/j.ajog.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 03/21/2023]
Abstract
Organ-level models are used to describe how cellular and tissue-level contractions coalesce into clinically observable uterine contractions. More importantly, these models provide a framework for evaluating the many different contraction patterns observed in laboring patients, ideally offering insight into the pitfalls of currently available recording modalities and suggesting new directions for improving recording and interpretation of uterine contractions. Early models proposed wave-like propagation of bioelectrical activity as the sole mechanism for recruiting the myometrium to participate in the contraction and increase contraction strength. However, as these models were tested, the results consistently revealed that sequentially propagating waves do not travel long distances and do not encompass the gravid uterus. To resolve this discrepancy, a model using 2 mechanisms, or a "dual model," for organ-level signaling has been proposed. In the dual model, the myometrium is recruited by action potentials that propagate wave-like as far as 10 cm. At longer distances, the myometrium is recruited by a mechanotransduction mechanism that is triggered by rising intrauterine pressure. In this review, we present the influential models of uterine function, highlighting their main features and inconsistencies, and detail the role of intrauterine pressure in signaling and cervical dilation. Clinical correlations demonstrate the application of organ-level models. The potential to improve the recording and clinical interpretation of uterine contractions when evaluating labor is discussed, with emphasis on uterine electromyography. Finally, 7 questions are posed to help guide future investigations on organ-level signaling mechanisms.
Collapse
|
4
|
Rosen H, Yogev Y. Assessment of uterine contractions in labor and delivery. Am J Obstet Gynecol 2023; 228:S1209-S1221. [PMID: 37164494 DOI: 10.1016/j.ajog.2022.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 03/21/2023]
Abstract
Normal labor and delivery are dependent on the presence of regular and effective contractions of the uterine myometrium. The mechanisms responsible for the initiation and maintenance of adequate and synchronized uterine activity that are necessary for labor and delivery result from a complex interplay of hormonal, mechanical, and electrical factors that have not yet been fully elucidated. Monitoring uterine activity during term labor and in suspected preterm labor is an important component of obstetrical care because cases of inadequate and excessive uterine activity can be associated with substantial maternal and neonatal morbidity and mortality. Inadequate labor progress is a common challenge encountered in intrapartum care, with labor dystocia being the most common indication for cesarean deliveries performed during labor. Hereafter, an accurate assessment of uterine activity during labor can assist in the management of protracted labor by diagnosing inadequate uterine activity and facilitating the titration of uterotonic medications before a trial of labor is prematurely terminated. Conversely, the ability to diagnose unwanted or excessive uterine activity is also critical in cases of threatened preterm labor, tachysystole, or patients undergoing a trial of labor after cesarean delivery. Knowledge of uterine activity in these cases may guide the use of tocolytic medications or raise suspicion of uterine rupture. Current diagnostic capabilities are less than optimal, hindering the medical management of term and preterm labor. Currently, different methods exist for evaluating uterine activity during labor, including manual palpation, external tocodynamometry, intrauterine pressure monitoring, and electrical uterine myometrial activity tracing. Legacy uterine monitoring techniques have advantages and limitations. External tocodynamometry is the most widespread tool in clinical use owing to its noninvasive nature and its ability to time contractions against the fetal heart rate monitor. However, it does not provide information regarding the strength of uterine contractions and is limited by signal loss with maternal movements. Conversely, the intrauterine pressure catheter quantifies the strength of uterine contractions; however, its use is limited by its invasiveness, risk for complications, and limited additive value in all but few clinical scenarios. New monitoring methods are being used, such as electrical uterine monitoring, which is noninvasive and does not require ruptured membranes. Electrical uterine monitoring has yet to be incorporated into common clinical practice because of lack of access to this technology, its high cost, and the need for appropriate training of clinical staff. Further work needs to be done to increase the accessibility and implementation of this technique by experts, and further research is needed to implement new practical and useful methods. This review describes current clinical tools for uterine activity assessment during labor and discusses their advantages and shortcomings. The review also summarizes current knowledge regarding novel technologies for monitoring uterine contractions that are not yet in widespread use, but are promising and could help improve our understanding of the physiology of labor, delivery, and preterm labor, and ultimately enhance patient care.
Collapse
Affiliation(s)
- Hadar Rosen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yariv Yogev
- Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
5
|
Mhajna M, Sadeh B, Yagel S, Sohn C, Schwartz N, Warsof S, Zahar Y, Reches A. A Novel, Cardiac-Derived Algorithm for Uterine Activity Monitoring in a Wearable Remote Device. Front Bioeng Biotechnol 2022; 10:933612. [PMID: 35928952 PMCID: PMC9343786 DOI: 10.3389/fbioe.2022.933612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Uterine activity (UA) monitoring is an essential element of pregnancy management. The gold-standard intrauterine pressure catheter (IUPC) is invasive and requires ruptured membranes, while the standard-of-care, external tocodynamometry (TOCO)’s accuracy is hampered by obesity, maternal movements, and belt positioning. There is an urgent need to develop telehealth tools enabling patients to remotely access care. Here, we describe and demonstrate a novel algorithm enabling remote, non-invasive detection and monitoring of UA by analyzing the modulation of the maternal electrocardiographic and phonocardiographic signals. The algorithm was designed and implemented as part of a wireless, FDA-cleared device designed for remote pregnancy monitoring. Two separate prospective, comparative, open-label, multi-center studies were conducted to test this algorithm.Methods: In the intrapartum study, 41 laboring women were simultaneously monitored with IUPC and the remote pregnancy monitoring device. Ten patients were also monitored with TOCO. In the antepartum study, 147 pregnant women were simultaneously monitored with TOCO and the remote pregnancy monitoring device.Results: In the intrapartum study, the remote pregnancy monitoring device and TOCO had sensitivities of 89.8 and 38.5%, respectively, and false discovery rates (FDRs) of 8.6 and 1.9%, respectively. In the antepartum study, a direct comparison of the remote pregnancy monitoring device to TOCO yielded a sensitivity of 94% and FDR of 31.1%. This high FDR is likely related to the low sensitivity of TOCO.Conclusion: UA monitoring via the new algorithm embedded in the remote pregnancy monitoring device is accurate and reliable and more precise than TOCO standard of care. Together with the previously reported remote fetal heart rate monitoring capabilities, this novel method for UA detection expands the remote pregnancy monitoring device’s capabilities to include surveillance, such as non-stress tests, greatly benefiting women and providers seeking telehealth solutions for pregnancy care.
Collapse
Affiliation(s)
- Muhammad Mhajna
- Nuvo-Group, Ltd, Tel-Aviv, Israel
- *Correspondence: Muhammad Mhajna,
| | | | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University Hospital, Heidelberg, Germany
| | - Nadav Schwartz
- Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Steven Warsof
- Ob-Gyn/MFM at Eastern Virginia Medical School, Norfolk, VA, United States
| | | | | |
Collapse
|
6
|
Almeida M, Mouriño H, Batista AG, Russo S, Esgalhado F, dos Reis CRP, Serrano F, Ortigueira M. Electrohysterography extracted features dependency on anthropometric and pregnancy factors. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
7
|
Schwartz N, Mhajna M, Moody HL, Zahar Y, Shkolnik K, Reches A, Lowery CL. Novel uterine contraction monitoring to enable remote, self-administered nonstress testing. Am J Obstet Gynecol 2022; 226:554.e1-554.e12. [PMID: 34762863 DOI: 10.1016/j.ajog.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The serial fetal monitoring recommended for women with high-risk pregnancies places a substantial burden on the patient, often disproportionately affecting underprivileged and rural populations. A telehealth solution that can empower pregnant women to obtain recommended fetal surveillance from the comfort of their own home has the potential to promote health equity and improve outcomes. We have previously validated a novel, wireless pregnancy monitor that can remotely capture fetal and maternal heart rates. However, such a device must also detect uterine contractions if it is to be used to robustly conduct remote nonstress tests. OBJECTIVE This study aimed to describe and validate a novel algorithm that uses biopotential and acoustic signals to noninvasively detect uterine contractions via a wireless pregnancy monitor. STUDY DESIGN A prospective, open-label, 2-center study evaluated simultaneous detection of uterine contractions by the wireless pregnancy monitor and an intrauterine pressure catheter in women carrying singleton pregnancies at ≥32 0/7 weeks' gestation who were in the first stage of labor (ClinicalTrials.gov Identifier: NCT03889405). The study consisted of a training phase and a validation phase. Simultaneous recordings from each device were passively acquired for 30 to 60 minutes. In a subset of the monitoring sessions in the validation phase, tocodynamometry was also deployed. Three maternal-fetal medicine specialists, blinded to the data source, identified and marked contractions in all modalities. The positive agreement and false-positive rates of both the wireless monitor and tocodynamometry were calculated and compared with that of the intrauterine pressure catheter. RESULTS A total of 118 participants were included, 40 in the training phase and 78 in the validation phase (of which 39 of 78 participants were monitored simultaneously by all 3 devices) at a mean gestational age of 38.6 weeks. In the training phase, the positive agreement for the wireless monitor was 88.4% (1440 of 1692 contractions), with a false-positive rate of 15.3% (260/1700). In the validation phase, using the refined and finalized algorithm, the positive agreement for the wireless pregnancy monitor was 84.8% (2722/3210), with a false-positive rate of 24.8% (897/3619). For the subgroup who were monitored only with the wireless monitor and intrauterine pressure catheter, the positive agreement was 89.0% (1191/1338), with a similar false-positive rate of 25.4% (406/1597). For the subgroup monitored by all 3 devices, the positive agreement for the wireless monitor was significantly better than for tocodynamometry (P<.0001), whereas the false-positive rate was significantly higher (P<.0001). Unlike tocodynamometry, whose positive agreement was significantly reduced in the group with obesity compared with the group with normal weight (P=.024), the positive agreement of the wireless monitor did not vary across the body mass index groups. CONCLUSION This novel method to noninvasively monitor uterine activity, via a wireless pregnancy monitoring device designed for self-administration at home, was more accurate than the commonly used tocodynamometry and unaffected by body mass index. Together with the previously reported remote fetal heart rate monitoring capabilities, this added ability to detect uterine contractions has created a complete telehealth solution for remote administration of nonstress tests.
Collapse
|
8
|
The association between uterine contraction frequency and fetal scalp pH in women with suspicious or pathological fetal heart rate tracings: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2022; 271:1-6. [DOI: 10.1016/j.ejogrb.2022.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 11/18/2022]
|
9
|
Şan M, Batista A, Russo S, Esgalhado F, dos Reis CRP, Serrano F, Ortigueira M. A Preliminary Exploration of the Placental Position Influence on Uterine Electromyography Using Fractional Modelling. SENSORS 2022; 22:s22051704. [PMID: 35270857 PMCID: PMC8914849 DOI: 10.3390/s22051704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/25/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
The uterine electromyogram, also called electrohysterogram (EHG), is the electrical signal generated by uterine contractile activity. The EHG has been considered an expanding technique for pregnancy monitoring and preterm risk evaluation. Data were collected on the abdominal surface. It has been speculated the effect of the placenta location on the characteristics of the EHG. In this work, a preliminary exploration method is proposed using the average spectra of Alvarez waves contractions of subjects with anterior and non-anterior placental position as a basis for the triple-dispersion Cole model that provides a best fit for these two cases. This leads to the uterine impedance estimation for these two study cases. Non-linear least square fitting (NLSF) was applied for this modelling process, which produces electric circuit fractional models’ representations. A triple-dispersion Cole-impedance model was used to obtain the uterine impedance curve in a frequency band between 0.1 and 1 Hz. A proposal for the interpretation relating the model parameters and the placental influence on the myometrial contractile action is provided. This is the first report regarding in silico estimation of the uterine impedance for cases involving anterior or non-anterior placental positions.
Collapse
Affiliation(s)
- Müfit Şan
- Department of Mathematics, Çankırı Karatekin University, Çankırı 18100, Turkey;
| | - Arnaldo Batista
- NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal; (S.R.); (F.E.); (M.O.)
- UNINOVA-CTS, NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Lisbon, Portugal
- Correspondence:
| | - Sara Russo
- NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal; (S.R.); (F.E.); (M.O.)
| | - Filipa Esgalhado
- NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal; (S.R.); (F.E.); (M.O.)
- NMT S.A., Parque Tecnológico de Cantanhede, Núcleo 04, Lote 3, 3060-197 Lisbon, Portugal
| | - Catarina R. Palma dos Reis
- Maternidade Alfredo da Costa, Rua Viriato 1, 1050-170 Lisbon, Portugal; (C.R.P.d.R.); (F.S.)
- Faculty of Medical Sciences, Nova Medical School, NOVA University Lisbon, 1169-056 Lisbon, Portugal
| | - Fátima Serrano
- Maternidade Alfredo da Costa, Rua Viriato 1, 1050-170 Lisbon, Portugal; (C.R.P.d.R.); (F.S.)
- Faculty of Medical Sciences, Nova Medical School, NOVA University Lisbon, 1169-056 Lisbon, Portugal
| | - Manuel Ortigueira
- NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal; (S.R.); (F.E.); (M.O.)
- UNINOVA-CTS, NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Lisbon, Portugal
| |
Collapse
|
10
|
Batista AG, Cebola R, Esgalhado F, Russo S, dos Reis CRP, Serrano F, Vassilenko V, Ortigueira M. The contractiongram: A method for the visualization of uterine contraction evolution using the electrohysterogram. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
11
|
Thijssen KMJ, Tissink JGLJ, Dieleman JP, Van der Hout-van der Jagt MB, Westerhuis MEMH, Oei SG. Qualitative assessment of interpretability and observer agreement of three uterine monitoring techniques. Eur J Obstet Gynecol Reprod Biol 2020; 255:142-146. [PMID: 33129016 DOI: 10.1016/j.ejogrb.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/27/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this research was to assess the quality and inter- and intra-observer agreement of tracings obtained by three different techniques for uterine contraction monitoring: the external tocodynamometer (TOCO), the intrauterine pressure catheter (IUPC) and a recently introduced method based on electrohysterography (EHG). STUDY DESIGN We included 150 uterine activity registrations from a previous prospective observational study (W3 study), conducted at Máxima Medical Centre in Veldhoven, the Netherlands. Term singleton pregnant women were simultaneously monitored with TOCO, IUPC and EHG during labor. Six clinicians, blinded to the source (TOCO, IUPC, or EHG) and subject, evaluated all tracings that were subsequently presented in random order. They annotated contractions and assigned each tracing a score for interpretability of 2 (good), 1 (moderate) or 0 (poor). To evaluate inter-observer agreement, we calculated kappa values for the qualitative assessment, and intraclass correlation coefficients (ICC) for the number of contractions annotated by clinicians. Four clinicians repeated this procedure to evaluate intra-observer agreement. RESULTS IUPC tracings received the highest quality rating, with a mean score of 1.95, followed by a mean score of 1.60 for EHG and 0.80 for TOCO (p < 0.05). Mean weighted kappa values were 0.63 for TOCO and 0.45 for EHG. The average number of contractions that was picked up by clinicians was 59.8 for the intrauterine pressure catheter, 49.8 for EHG and 26.4 for TOCO. The ICC of the intrauterine pressure catheter was significantly higher than the external methods, regarding both inter- and intra-observer agreement (0.98 and 0.99 respectively). CONCLUSION IUPC recordings scored best regarding quality, inter- and intra-observer agreement. However, due to safety issues, in many countries this technique is not used anymore. The quality of TOCO was rated as poor and many contractions were missed as compared to the gold standard. From a clinical interpretational point of view, EHG is favorable to TOCO. EHG recordings were assigned higher quality scores, but with less agreement between clinicians. An explanation could be that EHG is a relatively new technique, while IUPC and the TOCO are being used for decades. Building experience with EHG (training) is therefore recommended.
Collapse
Affiliation(s)
- Kirsten M J Thijssen
- Department of Obstetrics and Gynecology, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands.
| | - Juul G L J Tissink
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Jeanne P Dieleman
- MMC Academy, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands
| | - M Beatrijs Van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynecology, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, the Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynecology, Máxima MC, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands
| |
Collapse
|
12
|
Kuijsters NPM, Sammali F, Ye X, Blank C, Xu L, Mischi M, Schoot BC, Rabotti C. Propagation of spontaneous electrical activity in the ex vivo human uterus. Pflugers Arch 2020; 472:1065-1078. [PMID: 32691139 PMCID: PMC7376519 DOI: 10.1007/s00424-020-02426-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022]
Abstract
Contractions of the non-pregnant uterus play a key role in fertility. Yet, the electrophysiology underlying these contractions is poorly understood. In this paper, we investigate the presence of uterine electrical activity and characterize its propagation in unstimulated ex vivo human uteri. Multichannel electrohysterographic measurements were performed in five freshly resected human uteri starting immediately after hysterectomy. Using an electrode grid externally and an electrode array internally, measurements were performed up to 24 h after hysterectomy and compared with control. Up to 2 h after hysterectomy, we measured biopotentials in all included uteri. The median root mean squared (RMS) values of the external measurements ranged between 3.95 μV (interquartile range (IQR) 2.41–14.18 μV) and 39.4 μV (interquartile range (IQR) 10.84–105.64 μV) and were all significantly higher than control (median RMS of 1.69 μV, IQR 1.13–3.11 μV), consisting of chicken breast meat. The RMS values decreased significantly over time. After 24 h, the median RMS (1.27 μV, IQR 0.86–3.04 μV) was comparable with the control (1.69 μV, IQR 1.13–3.11 μV, p = 0.125). The internal measurements showed a comparable pattern over time, but overall lower amplitude. The measured biopotentials propagated over the uterine surface, following both a plane-wave as well as an erratic pattern. No clear pacemaker location nor a preferred propagation direction could be identified. These results show that ex vivo uteri can spontaneously generate propagating biopotentials and provide novel insight contributing to improving our understanding of the electrophysiology of the human non-pregnant uterus.
Collapse
Affiliation(s)
- Nienke P M Kuijsters
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands. .,Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.
| | - Federica Sammali
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
| | - Xin Ye
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
| | - Celine Blank
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands.,Department of Obstetrics and Gynaecology, University Hospital (UZ) Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lin Xu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Massimo Mischi
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
| | - Benedictus C Schoot
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands.,Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.,Department of Obstetrics and Gynaecology, University Hospital (UZ) Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Chiara Rabotti
- Department of Electrical Engineering (Signal Processing Systems: Biomedical Diagnostics), Eindhoven Technical University, Post box 513, 5600 MB, Eindhoven, the Netherlands
| |
Collapse
|
13
|
Lempersz C, Noben L, van Osta G, Wassen MLH, Meershoek BPJ, Bakker P, Jacquemyn Y, Cuerva MJ, Vullings R, Westerhuis MEMH, Oei GS. Intrapartum non-invasive electrophysiological monitoring: A prospective observational study. Acta Obstet Gynecol Scand 2020; 99:1387-1395. [PMID: 32306380 DOI: 10.1111/aogs.13873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Doppler ultrasound cardiotocography is a non-invasive alternative that, despite its poor specificity, is often first choice for intrapartum monitoring. Doppler ultrasound suffers from signal loss due to fetal movements and is negatively correlated with maternal body mass index (BMI). Reported accuracy of fetal heart rate monitoring by Doppler ultrasound varies between 10.6 and 14.3 bpm and reliability between 62.4% and 73%. The fetal scalp electrode (FSE) is considered the reference standard for fetal monitoring but can only be applied after membranes have ruptured with sufficient cervical dilatation and is sometimes contra-indicated. A non-invasive alternative that overcomes the shortcomings of Doppler ultrasound, providing reliable information on fetal heart rate, could be the answer. Non-invasive fetal electrocardiography (NI-fECG) uses a wireless electrode patch on the maternal abdomen to obtain both fetal and maternal heart rate signals as well as an electrohysterogram. We aimed to validate a wireless NI-fECG device for intrapartum monitoring in term singleton pregnancies, by comparison with the FSE. MATERIAL AND METHODS We performed a multicenter cross-sectional observational study at labor wards of 6 hospitals located in the Netherlands, Belgium, and Spain. Laboring women with a healthy singleton fetus in cephalic presentation and gestational age between 36 and 42 weeks were included. Participants received an abdominal electrode patch and FSE after written informed consent. Accuracy, reliability, and success rate of fetal heart rate readings were determined, using FSE as reference standard. Analysis was performed for the total population and measurement period as well as separated by labor stage and BMI class (≤30 and >30 kg/m2 ). RESULTS We included a total of 125 women. Simultaneous registrations with NI-fECG and FSE were available in 103 women. Overall accuracy is -1.46 bpm and overall reliability 86.84%. Overall success rate of the NI-fECG is around 90% for the total population as well as for both BMI subgroups. Success rate dropped to 63% during second stage of labor, similar results are found when looking at the separate BMI groups. CONCLUSIONS Performance measures of the NI-fECG device are good in the overall group and the separate BMI groups. Compared with Doppler ultrasound performance measures from the literature, NI-fECG is a more accurate alternative. Especially, when women have a higher BMI, NI-fECG performs well, resembling FSE performance measures.
Collapse
Affiliation(s)
- Carlijn Lempersz
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Lore Noben
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Gonnie van Osta
- Author! Et al. BV Data analysis and reporting, Hilversum, The Netherlands
| | - Martine L H Wassen
- Department of Obstetrics and Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Bert P J Meershoek
- Department of Obstetrics and Gynecology, Van Weel-Bethesda Hospital, Dirksland, The Netherlands
| | - Petra Bakker
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Yves Jacquemyn
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium
| | - Marcos Javier Cuerva
- Department of Obstetrics and Gynecology, University Hospital La Paz, Madrid, Spain
| | - Rik Vullings
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Guid S Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| |
Collapse
|
14
|
Noben L, Westerhuis MEMH, van Laar JOEH, Kok RD, Oei SG, Peters CHL, Vullings R. Feasibility of non-invasive Foetal electrocardiography in a twin pregnancy. BMC Pregnancy Childbirth 2020; 20:215. [PMID: 32293330 PMCID: PMC7161133 DOI: 10.1186/s12884-020-02918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Twin pregnancy is associated with increased perinatal mortality. Close foetal monitoring is therefore warranted. Doppler Ultrasound cardiotocography is currently the only available method to monitor both individual foetuses. Unfortunately, the performance measures of this method are poor and erroneous monitoring of the same twin with both transducers may occur, leaving the second twin unmonitored. In this study we aimed to determine the feasibility of monitoring both foetuses simultaneously in twin gestation by means of non-invasive foetal electrocardiography (NI-fECG), using an electrode patch on the maternal abdomen. METHODS A NI-fECG recording was performed at 25 + 3 weeks of gestation on a multiparous woman pregnant with dichorionic diamniotic twins. An electrode patch consisting of eight adhesive electrodes was applied on the maternal abdomen, yielding six channels of bipolar electrophysiological measurements. The output was digitized and stored for offline processing. The recorded signals were preprocessed by suppression of high-frequency noise, baseline wander, and powerline interference. Secondly, the maternal ECG was subtracted and segmentation into individual ECG complexes was performed. Finally, ensemble averaging of these individual ECG complexes was performed to suppress interferences. RESULTS Six different recordings were obtained from each of the six recording channels. Depending on the orientation and distance of the fetal heart with respect to each electrode, a distinction could be made between each fetus based on the morphology of the signals. Yielding of the fetal ECGs was performed manually based on the QRS complexes of each fetus. CONCLUSION NI-fECG with multiple electrodes allows for monitoring of the fetal heart rate and ECG of both individual fetuses in twin pregnancies.
Collapse
Affiliation(s)
- Lore Noben
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands.
- Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600, MB, Eindhoven, The Netherlands.
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Judith O E H van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600, MB, Eindhoven, The Netherlands
| | - René D Kok
- Nemo Healthcare BV, 'MMC Incubator', De Run 4630, 5504, DB, Veldhoven, The Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Chris H L Peters
- Department of Clinical Physics, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's Hertogenbosch, The Netherlands
| | - Rik Vullings
- Eindhoven MedTech Innovation Centre (e/MTIC), P.O. Box 513, 5600, MB, Eindhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600, MB, Eindhoven, The Netherlands
| |
Collapse
|
15
|
Abstract
Contractions are produced through a complex interplay of hormonal, mechanical, and electrical factors. In labor, contractions are measured using the Montevideo unit. Clinical considerations in labor wherein contraction assessment becomes paramount include the care of women whose labor is complicated by abnormal progress or tachysystole. In an era of obstetrics in which the high cesarean rate is a major issue of concern, there remain many questions as to how to best incorporate contraction monitoring into practice in order to optimize care. Technological advancement has led to the development on new modalities that can be used to study contraction physiology, and there may be an opportunity in the future to apply these methods for use in the clinical setting. This article also makes a case for the need to reevaluate the current measures of uterine contractile activity and the definition of contraction adequacy using updated definitions of normal labor progress.
Collapse
Affiliation(s)
- Stephen E Gee
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W. 12th Ave, 5th floor, 43210 Columbus, OH, United States.
| | - Heather A Frey
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W. 12th Ave, 5th floor, 43210 Columbus, OH, United States
| |
Collapse
|
16
|
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]
|
17
|
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.
Collapse
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
| |
Collapse
|