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Thijssen KMJ, Kierkels JJM, van Meurs A, Verhoeven CJ, van der Hout-van der Jagt MB, Oei SG. Visualization of contractions: Evaluation of a new experience design concept to enhance the childbirth experience. Birth 2023; 50:1025-1033. [PMID: 37550881 DOI: 10.1111/birt.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The purpose of this study was to develop and evaluate an innovative design proposition intended to help enhance the childbirth experience. The innovation consists of a smartphone application for birth preparation during pregnancy with information and coaching, in addition to a wall projection at the labor ward that visualizes the progress of labor based on uterine monitoring data. METHODS We conducted a randomized controlled clinical pilot study. Singleton pregnant people pursuing a vaginal birth were recruited between 28 and 32 weeks of gestation and allocated to the intervention group (mobile application during the third trimester and wall projection at the labor ward) or to care as usual. Childbirth expectations and experiences were measured with validated questionnaires, which were completed at 32 and 36 weeks of gestation, immediately after birth, and at 4 weeks postpartum. Quantitative outcomes were analyzed and feedback about the proposition was evaluated using qualitative methods. RESULTS The qualitative feedback from patients was largely positive; however, we could not detect any significant differences between the intervention and control groups about fear of childbirth and other outcome measures. CONCLUSION In this pilot study, we evaluated a new experience design proposition for pregnancy and childbirth. This study generated data that will help to further improve and evaluate similar innovations in the future. This application may facilitate participatory care, promoting active involvement of parents in the healthcare processes of pregnancy and childbirth.
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Affiliation(s)
- Kirsten M J Thijssen
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Corine J Verhoeven
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Midwifery Science, AVAG, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Midwifery, University of Nottingham, Nottingham, UK
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Faculty 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
| | - S Guid Oei
- Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
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Fischer A, Rietveld A, Teunissen P, Bakker P, Hoogendoorn M. End-to-end learning with interpretation on electrohysterography data to predict preterm birth. Comput Biol Med 2023; 158:106846. [PMID: 37019011 DOI: 10.1016/j.compbiomed.2023.106846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
Prediction of preterm birth is a difficult task for clinicians. By examining an electrohysterogram, electrical activity of the uterus that can lead to preterm birth can be detected. Since signals associated with uterine activity are difficult to interpret for clinicians without a background in signal processing, machine learning may be a viable solution. We are the first to employ Deep Learning models, a long-short term memory and temporal convolutional network model, on electrohysterography data using the Term-Preterm Electrohysterogram database. We show that end-to-end learning achieves an AUC score of 0.58, which is comparable to machine learning models that use handcrafted features. Moreover, we evaluate the effect of adding clinical data to the model and conclude that adding the available clinical data to electrohysterography data does not result in a gain in performance. Also, we propose an interpretability framework for time series classification that is well-suited to use in case of limited data, as opposed to existing methods that require large amounts of data. Clinicians with extensive work experience as gynaecologist used our framework to provide insights on how to link our results to clinical practice and stress that in order to decrease the number of false positives, a dataset with patients at high risk of preterm birth should be collected. All code is made publicly available.
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Reynolds AJ, Murray ML, Geary MP, Ater SB, Hayes BC. Uterine activity in labour and the risk of neonatal encephalopathy: a case control study. Eur J Obstet Gynecol Reprod Biol 2022; 274:73-79. [PMID: 35605517 DOI: 10.1016/j.ejogrb.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the relationship between intrapartum contraction frequency, rest interval duration, and cervical dilation speed and the risk of neonatal hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN This was a retrospective case-control study conducted in a maternity hospital in Dublin, Ireland. Babies born without major congenital anomalies between September 2006 and November 2017 at ≥ 35 + 0 weeks' gestational age were eligible. Cases were diagnosed with moderate-severe HIE. The controls were the first eligible baby born before and after each case with normal Apgar scores and not admitted to the neonatal unit. Intrapartum uterine activity was assessed by automated analysis of external tocography recordings. Cervical dilation was assessed by linear interpolation between vaginal examination measurements. The speed of cervical dilation was expressed as the times from 4 to 6 cm, >6 cm to the start of pushing, and from pushing to delivery. RESULTS Intrapartum tocographs results were available in 49 of 88 cases and 121 of 176 controls. The median contraction rate in cases was 7.7 (Interquartile range [IQR]: 6.6-9.0) compared to 7.0 in controls (IQR: 6.2-7.9) (p = 0.021). The median rest interval duration was 56 s (IQR: 38-76) in cases and 62 s (IQR: 50-79) in controls (p = 0.058). Cases took longer to progress from > 6 cm to the start of pushing (cases: 02:58 [01:14-04:49], controls: 01:48 [00:51-03:34], p = 0.020) and from pushing to delivery (cases: 00:34 [00:24-01:10], controls: 00:27 [00:13-00:56], p = 0.036). CONCLUSIONS Higher contraction frequencies and slower progress towards the end of labour are both independently associated with the risk of moderate-severe HIE. Inter-contraction rest interval duration as measured by external tocography does not provide additional accuracy.
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Affiliation(s)
| | | | - Michael P Geary
- Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland
| | | | - Breda C Hayes
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
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4
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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]
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5
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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]
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6
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Ince O, Karaca SY, Karaca I. M-mode Ultrasound Scan as a Potential Alternative Technique for Monitoring Uterine Contractions in Obese Patients. Reprod Sci 2021; 28:1989-1995. [PMID: 33442847 DOI: 10.1007/s43032-020-00435-9] [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: 07/27/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
We investigate motion mode (M-mode) ultrasound scan as a potential non-invasive uterine monitoring technique and compare its contraction characteristics with external tocodynamometry (TOCO). This prospective diagnostic accuracy study included 39 term pregnant woman in active spontaneous labor. M-mode and TOCO were simultaneously performed and uterine contraction characteristics and consistency were compared quantitatively and visually. The results identified a 71.5% ± 35.3% uterine wall thickening during uterine contractions on M-mode. Uterine monitoring with M-mode had a consistency rate of 88.7% ± 6.9% with conventional TOCO method. During 20-min monitoring, the number of detected contractions was significantly higher (p < 0.001) in M-mode (8.2 ± 1.2) than TOCO (7.4 ± 1.5). As for the mean value of the duration of a contraction (seconds), it was significantly shorter (p < 0.001) in M-mode (38.5 ± 3.5) than TOCO (49.2 ± 4.1). For M-mode, the number of detected contractions had a negative but insignificant correlation with the body mass index (BMI) (r = - 0.25 [- 0.52, 0.07], p = 0.127) and the subcutaneous tissue thickness (STT) (r = - 0.21 [- 0.49, 0.11], p = 0.200). As for TOCO, the contractions had a negative and significant correlation with BMI (r = - 0.41 [- 0.64, - 0.11], p = 0.009) and negative and insignificant correlation with STT (r = - 0.26 [- 0.54, 0.06], p = 0.104). The evidence suggests that contraction detection with M-mode is a promising non-invasive technique for uterine monitoring. The preliminary analysis finds that contraction detection is not affected by BMI or STT. With future sensitivity studies, and improvements in image-processing and software technologies, the proposed technique promises to be a viable alternative to existing techniques, especially for obese patients.
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Affiliation(s)
- Onur Ince
- Department of Obstetrics and Gynaecology, Kutahya Health Sciences University, 43000, Kutahya, Turkey.,Department of Statistics, Faculty of Arts and Science, Middle East Technical University, 06800, Ankara, Turkey
| | - Suna Yildirim Karaca
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, 35020, Izmir, Turkey
| | - Ibrahim Karaca
- Department of Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, 34147, Istanbul, Turkey.
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Reynolds AJ, Waldron OM, Halpern EM, McGarvey CM, Murray ML, Ater SB, Geary MP, Hayes BC. A wavelet-based algorithm for automated analysis of external tocography: How does it compare to human interpretation? Comput Biol Med 2020; 122:103814. [PMID: 32658728 DOI: 10.1016/j.compbiomed.2020.103814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/25/2020] [Accepted: 05/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Studies which use external tocography to explore the relationship between increased intrapartum uterine activity and foetal outcomes are feasible because the technology is safe and ubiquitous. However, periods of poor signal quality are common. We developed an algorithm which aims to calculate tocograph summary variables based on well-recorded contractions only, ignoring artefact and excluding sections deemed uninterpretable. The aim of this study was to test that algorithm's reliability. METHODS Whole recordings from labours at ≥35 weeks of gestation were randomly selected without regard to quality. Contractions and rest intervals were measured by two humans independently, and by the algorithm using two sets of models; one based on a series of pre-defined thresholds, and another trained to imitate one of the human interpreters. The absolute agreement intraclass correlation coefficient (ICC) was calculated using a two-way random effects model. RESULTS The training dataset included data from 106 tocographs. Of the tested algorithms, AdaBoost showed the highest initial cross-validated accuracy and proceeded to optimization. Forty tocographs were included in the validation set. The ICCs for the per tocograph mean contraction rates were; human B to human A: 0.940 (0.890-0.968), human A to initial models: 0.944 (0.898-0.970), human A to trained models 0.962 (0.927-0.980), human B to initial models: 0.930 (0.872-0.962), human B to trained models: 0.948 (0.903-0.972). CONCLUSIONS The algorithm described approximates interpretation of external tocography performed by trained humans. The performance of the AdaBoost trained models was marginally superior compared to the initial models.
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Affiliation(s)
- Adam J Reynolds
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.
| | - Orna M Waldron
- The Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Cliona M McGarvey
- National Paediatric Mortality Register, The Children's University Hospital, Ireland
| | | | | | - Michael P Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
| | - Breda C Hayes
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
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8
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Georgieva A, Abry P, Chudáček V, Djurić PM, Frasch MG, Kok R, Lear CA, Lemmens SN, Nunes I, Papageorghiou AT, Quirk GJ, Redman CWG, Schifrin B, Spilka J, Ugwumadu A, Vullings R. Computer-based intrapartum fetal monitoring and beyond: A review of the 2nd Workshop on Signal Processing and Monitoring in Labor (October 2017, Oxford, UK). Acta Obstet Gynecol Scand 2019; 98:1207-1217. [PMID: 31081113 DOI: 10.1111/aogs.13639] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/08/2019] [Indexed: 12/30/2022]
Abstract
The second Signal Processing and Monitoring in Labor workshop gathered researchers who utilize promising new research strategies and initiatives to tackle the challenges of intrapartum fetal monitoring. The workshop included a series of lectures and discussions focusing on: new algorithms and techniques for cardiotocogoraphy (CTG) and electrocardiogram acquisition and analyses; the results of a CTG evaluation challenge comparing state-of-the-art computerized methods and visual interpretation for the detection of arterial cord pH <7.05 at birth; the lack of consensus about the role of intrapartum acidemia in the etiology of fetal brain injury; the differences between methods for CTG analysis "mimicking" expert clinicians and those derived from "data-driven" analyses; a critical review of the results from two randomized controlled trials testing the former in clinical practice; and relevant insights from modern physiology-based studies. We concluded that the automated algorithms performed comparably to each other and to clinical assessment of the CTG. However, the sensitivity and specificity urgently need to be improved (both computerized and visual assessment). Data-driven CTG evaluation requires further work with large multicenter datasets based on well-defined labor outcomes. And before first tests in the clinic, there are important lessons to be learnt from clinical trials that tested automated algorithms mimicking expert CTG interpretation. In addition, transabdominal fetal electrocardiogram monitoring provides reliable CTG traces and variability estimates; and fetal electrocardiogram waveform analysis is subject to promising new research. There is a clear need for close collaboration between computing and clinical experts. We believe that progress will be possible with multidisciplinary collaborative research.
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Affiliation(s)
- Antoniya Georgieva
- Nuffield Department of Women's and Reproductive Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Patrice Abry
- University of Lyon, Ens de Lyon, University Claude Bernard, CNRS, Laboratoire de Physique, Lyon, France
| | - Václav Chudáček
- CIIRC, Czech Technical University in Prague, Prague, Czech Republic
| | - Petar M Djurić
- Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - René Kok
- Nemo Healthcare, Veldhoven, the Netherlands
| | | | | | - Inês Nunes
- Department of Obstetrics and Gynecology, Centro Materno-Infantil do Norte-Centro Hospitalar do Porto, Instituto de Ciências Biomédicas Abel Salazar, Centro de Investigação em Tecnologias e Serviços de Saúde, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Gerald J Quirk
- Department of Obstetrics and Gynecology at Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Christopher W G Redman
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - Jiri Spilka
- CIIRC, Czech Technical University in Prague, Prague, Czech Republic
| | - Austin Ugwumadu
- Department of Obstetrics & Gynecology, St. George's University of London, London, UK
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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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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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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12
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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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13
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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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14
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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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15
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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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16
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Bakker JJH, Janssen PF, van Halem K, van der Goes BY, Papatsonis DNM, van der Post JAM, Mol BWJ. Internal versus external tocodynamometry during induced or augmented labour. Cochrane Database Syst Rev 2013:CD006947. [PMID: 23913521 DOI: 10.1002/14651858.cd006947.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Uterine contractions can be registered by external tocodynamometry (ET) or, after rupture of the membranes, by internal tocodynamometry (IT). Monitoring of the frequency of contractions is important especially when intravenous oxytocin is used as excessive uterine activity (hyperstimulation or tachysystole) can cause fetal distress. During induction of labour as well as during augmentation with intravenous oxytocin, some clinicians choose to monitor frequency and strength of contractions with IT rather than with ET as an intrauterine pressure catheter measures intrauterine activity more accurately than an extra-abdominal tocodynamometry device. However, insertion of an intrauterine catheter has higher costs and also potential risks for mother and child. OBJECTIVES To assess the effectiveness of IT compared with using ET when intravenous oxytocin is used for induction or augmentation of labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013) and PubMed (1966 to 6 April 2013). SELECTION CRITERIA We included all published randomised controlled trials with data from women in whom IT was compared with ET in induced or augmented labour with oxytocin. We excluded trials that employed quasi-randomised methods of treatment allocation. We found no unpublished or ongoing studies on this subject. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information. MAIN RESULTS Three studies involving a total of 1945 women were included. Overall, risk of bias across the three trials was mixed. No serious complications were reported in the trials and no neonatal or maternal deaths occurred. The neonatal outcome was not statistically different between groups: Apgar score less than seven at five minutes (RR 1.78, 95% CI 0.83 to 3.83; three studies, n = 1945); umbilical artery pH less than 7.15 (RR 1.31, 95% CI 0.95 to 1.79; one study, n = 1456); umbilical artery pH less than 7.16 (RR 1.23, 95% CI 0.39 to 3.92; one study, n = 239); admission to the neonatal intensive care unit (RR 0.34, 95% CI 0.07 to 1.67; two studies, n = 489); and more than 48 hours hospitalisation (RR 0.92, 95% CI 0.71 to 1.20; one study, n = 1456). The pooled risk for instrumental delivery (including caesarean section, ventouse and forceps extraction) was not statistically significantly different (RR 1.05, 95% CI 0.91 to 1.21; three studies, n = 1945). Hyperstimulation was reported in two studies (n = 489), but there was no statistically significant difference between groups (RR 1.21, 95% CI 0.78 to 1.88). AUTHORS' CONCLUSIONS This review found no differences between the two types of monitoring (internal or external tocodynamometry) for any of the maternal or neonatal outcomes. Given that this review is based on three studies (N = 1945 women) of moderate quality, there is insufficient evidence to recommend the use of one form of tocodynamometry over another for women where intravenous oxytocin was administered for induction or augmentation of labour.
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Affiliation(s)
- Jannet J H Bakker
- Department of Obstetrics and Gynaecology, Academic Medical Center, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ
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17
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Euliano TY, Nguyen MT, Darmanjian S, McGorray SP, Euliano N, Onkala A, Gregg AR. Monitoring uterine activity during labor: a comparison of 3 methods. Am J Obstet Gynecol 2013; 208:66.e1-6. [PMID: 23122926 DOI: 10.1016/j.ajog.2012.10.873] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tocodynamometry (Toco; strain gauge technology) provides contraction frequency and approximate duration of labor contractions but suffers frequent signal dropout, necessitating repositioning by a nurse, and may fail in obese patients. The alternative invasive intrauterine pressure catheter (IUPC) is more reliable and adds contraction pressure information but requires ruptured membranes and introduces small risks of infection and abruption. Electrohysterography (EHG) reports the electrical activity of the uterus through electrodes placed on the maternal abdomen. This study compared all 3 methods of contraction detection simultaneously in laboring women. STUDY DESIGN Upon consent, laboring women were monitored simultaneously with Toco, EHG, and IUPC. Contraction curves were generated in real-time for the EHG, and all 3 curves were stored electronically. A contraction detection algorithm was used to compare frequency and timing between methods. Seventy-three subjects were enrolled in the study; 14 were excluded due to hardware failure of 1 or more of the devices (n = 12) or inadequate data collection duration (n = 2). RESULTS In comparison with the gold-standard IUPC, EHG performed significantly better than Toco with regard to the Contractions Consistency Index (CCI). The mean CCI for EHG was 0.88 ± 0.17 compared with 0.69 ± 0.27 for Toco (P < .0001). In contrast to Toco, EHG was not significantly affected by obesity. CONCLUSION Toco does not correlate well with the gold-standard IUPC and fails more frequently in obese patients. EHG provides a reliable noninvasive alternative, regardless of body habitus.
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Affiliation(s)
- Tammy Y Euliano
- Department of Anesthesiology and Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA.
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18
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Bakker JJH, Janssen PF, van Halem K, van der Goes BY, Papatsonis DNM, van der Post JAM, Mol BWJ. Internal versus external tocodynamometry during induced or augmented labour. Cochrane Database Syst Rev 2012; 12:CD006947. [PMID: 23235636 DOI: 10.1002/14651858.cd006947.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Uterine contractions can be registered by external tocodynamometry (ET) or, after rupture of the membranes, by internal tocodynamometry (IT). Monitoring of the frequency of contractions is important especially when intravenous oxytocin is used as excessive uterine activity (hyperstimulation or tachysystole) can cause fetal distress. During induction of labour as well as during augmentation with intravenous oxytocin, some clinicians choose to monitor frequency and strength of contractions with IT rather than with ET as an intrauterine pressure catheter measures intrauterine activity more accurately than an extra-abdominal tocodynamometry device. However, insertion of an intrauterine catheter has higher costs and also potential risks for mother and child. OBJECTIVES To assess the effectiveness of IT compared with using ET when intravenous oxytocin is used for induction or augmentation of labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 April 2012) and PubMed (1966 to 7 March 2012). SELECTION CRITERIA We included all published randomised controlled trials with data from women in whom IT was compared with ET in induced or augmented labour with oxytocin. We excluded trials that employed quasi-randomised methods of treatment allocation. We found no unpublished or ongoing studies on this subject. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information. MAIN RESULTS Three studies involving a total of 1945 women were included. Overall, risk of bias across the three trials was mixed. No serious complications were reported in the trials and no neonatal or maternal deaths occurred. The neonatal outcome was not statistically different between groups: Apgar score less than seven at five minutes (RR 1.78, 95% CI 0.83 to 3.83; three studies, n = 1945); umbilical artery pH less than 7.15 (RR 1.31, 95% CI 0.95 to 1.79; one study, n = 1456); umbilical artery pH less than 7.16 (RR 1.23, 95% CI 0.39 to 3.92; one study, n = 239); admission to the neonatal intensive care unit (RR 0.34, 95% CI 0.07 to 1.67; two studies, n = 489); and more than 48 hours hospitalisation (RR 0.92, 95% CI 0.71 to 1.20; one study, n = 1456). The pooled risk for instrumental delivery (including caesarean section, ventouse and forceps extraction) was not statistically significantly different (RR 1.05, 95% CI 0.91 to 1.21; three studies, n = 1945). Hyperstimulation was reported in two studies (n = 489), but there was no statistically significant difference between groups (RR 1.21, 95% CI 0.78 to 1.88). AUTHORS' CONCLUSIONS This review found no differences between the two types of monitoring (internal or external tocodynamometry) for any of the maternal or neonatal outcomes. Given that this review is based on three studies (N = 1945 women) of moderate quality, there is insufficient evidence to recommend the use of one form of tocodynamometry over another for women where intravenous oxytocin was administered for induction or augmentation of labour.
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Affiliation(s)
- Jannet J H Bakker
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, Netherlands.
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