RESUMO
AIM: To obtain and study new data on the dynamics of the labor process and to develop a contraction-based index of labor progress. METHODS: This study was carried out at the Delivery Room, Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel, using a new device (Birth Track). We continuously monitored cervical dilatation (CD) and head descent (HD) in 30 nulliparaous women during active labor with (augmented group) and without (study group) oxytocin augmentation. This led to the development and validation of progress indices based on features extracted from continuous monitoring. RESULTS: There were no significant differences between the average of each parameter in the study and augmented groups, except for HD velocity. Average HD velocity was faster in the study group. Linear regression analyses demonstrated that head station (HS) amplitude and Toco amplitude were the best parameters for predicting HD velocity in both groups. In the study group, average HD velocity was also significantly related to Toco rate and contraction efficiency. In the augmented group, only a weak correlation with Toco rate was seen, and no correlation with contraction efficiency. CONCLUSION: With the assistance of the Birth Track device, we can obtain continuous data on the labor process and indices to estimate the labor progress process without the use of vaginal (manual) examination.
Assuntos
Monitorização Fetal/métodos , Primeira Fase do Trabalho de Parto , Segunda Fase do Trabalho de Parto , Contração Uterina , Monitorização Uterina/métodos , Adulto , Analgesia Epidural , Analgesia Obstétrica , Feminino , Monitorização Fetal/instrumentação , Humanos , Israel , Primeira Fase do Trabalho de Parto/efeitos dos fármacos , Segunda Fase do Trabalho de Parto/efeitos dos fármacos , Unidade Hospitalar de Ginecologia e Obstetrícia , Ocitócicos , Ocitocina , Guias de Prática Clínica como Assunto , Gravidez , Contração Uterina/efeitos dos fármacos , Monitorização Uterina/instrumentação , Adulto JovemRESUMO
An ultrasound-based computerized system was developed for monitoring cervix dilatation and fetal head station during labor. The system was designed to provide continuous and accurate assessment of the progression of labor. The computerized labor-monitor (CLM) was tested in the laboratory and was studied in over 95 women during labor. The laboratory test showed that the mean error of measurement is 0.1 mm with standard deviation of 1.14 mm. In the clinical experiments, safety of the various system components was demonstrated and partograms were compared to manual measurements. The systematic error of the fetal head station measurement is estimated as 10-20%, depending on patient's anatomy. In addition, the clinical tests indicated that measurements of the changes of both cervix dilatation and fetal head station are feasible. The CLM is expected to change patient management in the labor room. It will enable timely recognition of abnormal labor patterns such as dysfunctional and precipitous labor. Continuous accurate data will allow earlier diagnosis and intervention that is very likely to improve both mother's and baby's clinical outcome.
