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1.
Ned Tijdschr Geneeskd ; 1652021 08 05.
Artigo em Holandês | MEDLINE | ID: mdl-34351715

RESUMO

Electrohysterography monitors the electrical activity of the uterine muscle through electrodes on the maternal abdominal wall. It is a non-invasive method for uterine contraction monitoring and has a strong correlation with the invasive intra-uterine pressure catheter. A prospective validation study showed a significant higher sensitivity of electrohysterography compared to external tocodynamometry for uterine contraction detection (p-value < 0.001). Moreover, the sensitivity of electrohysterography appears to be less affected by maternal obesity compared to external tocodynamometry. A clinical pilotstudy comparing electrohysterography and external tocodynamometry during labor, showed no negative effect of electrohysterography on labor outcomes. Recently, technical improvements have been made and electrohysterography has become available in an adhesive electrode patch together with fetal and maternal electrocardiography. Therefore, we expect a successful implementation of electrohysterography in the near future.


Assuntos
Trabalho de Parto , Monitorização Uterina , Adolescente , Eletromiografia , Feminino , Humanos , Monitorização Fisiológica , Gravidez , Contração Uterina
2.
AJP Rep ; 8(3): e184-e191, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30250758

RESUMO

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.

3.
Obstet Gynecol Surv ; 73(5): 303-324, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29850920

RESUMO

IMPORTANCE: Real-time electrohysterography (EHG)-based technologies have recently become available for uterine monitoring during term labor. Therefore, obstetricians need to be familiar with the diagnostic value, advantages, and limitations of using EHG. OBJECTIVE: The aims of this study were to determine the diagnostic value of EHG in comparison to (1) the intrauterine pressure catheter (IUPC), (2) the external tocodynamometer (TOCO), and (3) in case of maternal obesity; (4) to evaluate EHG from users' and patients' perspectives; and (5) to assess whether EHG can predict labor outcome. EVIDENCE ACQUISITION: A systematic review was performed in the MEDLINE, EMBASE, and Cochrane library in October 2017 resulting in 209 eligible records, of which 20 were included. RESULTS: A high sensitivity for contraction detection was achieved by EHG (range, 86.0%-98.0%), which was significantly better than TOCO (range, 46.0%-73.6%). Electrohysterography also enhanced external monitoring in case of maternal obesity. The contraction frequency detected by EHG was on average 0.3 to 0.9 per 10 minutes higher compared with IUPC, which resulted in a positive predictive value of 78.7% to 92.0%. When comparing EHG tocograms with IUPC traces, an underestimation of the amplitude existed despite that patient-specific EHG amplitudes have been mitigated by amplitude normalization. Obstetricians evaluated EHG tocograms as better interpretable and more adequate than TOCO. Finally, potential EHG parameters that could predict a vaginal delivery were a predominant fundal direction and a lower peak frequency. CONCLUSIONS AND RELEVANCE: Electrohysterography enhances external uterine monitoring of both nonobese and obese women. Obstetricians consider EHG as better interpretable; however, they need to be aware of the higher contraction frequency detected by EHG and of the amplitude mismatch with intrauterine pressure measurements.


Assuntos
Eletromiografia/métodos , Monitorização Fetal/métodos , Monitorização Uterina/métodos , Feminino , Humanos , Trabalho de Parto/fisiologia , Monitorização Fisiológica/métodos , Gravidez , Sensibilidade e Especificidade , Nascimento a Termo/fisiologia
4.
J Perinatol ; 38(5): 580-586, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29467514

RESUMO

OBJECTIVE: To evaluate the influence of maternal obesity on the performance of external tocodynamometry and electrohysterography. STUDY DESIGN: In a 2-hour measurement during term labor, uterine contractions were simultaneously measured by electrohysterography, external tocodynamometry, and intra-uterine pressure catheter. The sensitivity was compared between groups based on obesity (non-obese/obese/morbidly obese) or uterine palpation (good/moderate/poor), and was correlated to maternal BMI and abdominal circumference. RESULT: We included 14 morbidly obese, 18 obese, and 20 non-obese women. In morbidly obese women, the median sensitivity was 87.2% (IQR 74-93) by electrohysterography and 45.0% (IQR 36-66) by external tocodynamometry (p < 0.001). The sensitivity of electrohysterography appeared to be non-influenced by obesity category (p = 0.279) and uterine palpation (p = 0.451), while the sensitivity of tocodynamometry decreased significantly (p = 0.005 and p < 0.001, respectively). Furthermore, the sensitivity of both external methods was negatively correlated with obesity parameters, being non-significant for electrohysterography (range p-values 0.057-0.088) and significant for external tocodynamometry (all p-values < 0.001). CONCLUSIONS: Electrohysterography performs significantly better than external tocodynamometry in case of maternal obesity.


Assuntos
Eletromiografia/métodos , Trabalho de Parto/fisiologia , Monitorização Fisiológica/métodos , Obesidade Mórbida/complicações , Útero/fisiologia , Adulto , Feminino , Humanos , Modelos Lineares , Obesidade/complicações , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Contração Uterina/fisiologia , Monitorização Uterina
5.
Eur J Obstet Gynecol Reprod Biol ; 215: 197-205, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28649034

RESUMO

OBJECTIVE: Current uterine monitoring techniques have major drawbacks that could be avoided when using electrohysterography for uterine monitoring. Recently, a new electrohysterography method has been developed, providing a real-time tocogram on standard cardiotocography monitors. The diagnostic characteristics of this novel method need to be determined and compared to conventional methods We hypothesised that electrohysterography can perform better than external tocodynamometry due to the adhesive properties of the contact electrodes (less motion sensitive), and the improved signal acquisition through subcutaneous tissue (less obesity sensitive). STUDY DESIGN: In this prospective diagnostic accuracy study, uterine contractions of labouring women were simultaneously monitored by three different monitoring techniques: electrohysterography, external tocodynamometry, and intra-uterine pressure catheter as method of reference. We performed a two-hour measurement during first and/or second stage of term labour. The contractions of each method were automatically detected by a computer-based algorithm. As the applied method had not been described in literature before, an interim analysis was performed to minimise exposure to the invasive pressure catheter. The main outcome parameter was the sensitivity of electrohysterography in comparison to external tocodynamometry for uterine contraction detection, tested by the Wilcoxon signed rank test. RESULTS: Uterine contractions of 48 term labouring women were simultaneously monitored by electrohysterography, external tocodynamometry, and intra-uterine pressure catheter. The study was terminated after the interim analysis as the sensitivity of electrohysterography was significantly higher compared to external tocodynamometry: median 89.5% (interquartile range (IQR); 82-93) and 65.3% (IQR; 53-81) respectively, p<0.001. In a subgroup analysis of obese women (n=15), the sensitivity of electrohysterography was significantly higher than external tocodynamometry (median 88.4% (IQR; 79-95) and 45.8% (IQR; 38-61) respectively, p<0.001). Whereas in a subanalysis of second stage of labour (n=8), electrohysterography did not perform better than external tocodynamometry (median 72.8% (IQR; 61-87) and 66.4% (IQR; 46-75) respectively, p=0.225). Electrohysterography registered 0.4 more contractions per 10min than the intra-uterine pressure measurement (p<0.001) and 0.5 more contractions per 10min than external tocodynamometry (p<0.001). CONCLUSION: Electrohysterography has a higher sensitivity for uterine contraction detection than external tocodynamometry during first stage of labour, in non-obese and obese women. Electrohysterography identifies more contractions than conventional techniques.


Assuntos
Eletromiografia/métodos , Trabalho de Parto/fisiologia , Monitorização Fisiológica/métodos , Contração Uterina/fisiologia , Útero/fisiologia , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Monitorização Uterina
6.
Arch Gynecol Obstet ; 295(1): 17-26, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27722806

RESUMO

PURPOSE: Timely diagnosing a uterine rupture is challenging. Based on the pathophysiology of complete uterine wall separation, changes in uterine activity are expected. The primary objective is to identify tocogram characteristics associated with uterine rupture during trial of labor after cesarean section. The secondary objective is to compare the external tocodynamometer with intrauterine pressure catheters. METHODS: MEDLINE, EMBASE, and the Cochrane library were systematically searched for eligible records. Moreover, clinical guidelines were screened. Studies analyzing tocogram characteristics of uterine rupture during trial of labor after cesarean section were appraised and included by two independent reviewers. Due to heterogeneity, a meta-analysis was only feasible for uterine hyperstimulation. RESULTS: Thirteen studies were included. Three tocogram characteristics were associated with uterine rupture. (1) Hyperstimulation was more frequently observed compared with controls during the delivery (38 versus 21 % and 58 versus 53 %), and in the last 2 h prior to birth (19 versus 4 %). Results of meta-analysis: OR 1.68 (95 % CI 0.97-2.89), p = 0.06. (2) Decrease of uterine activity was observed in 14-40 % and (3) an increasing baseline in 10-20 %. Five studies documented no changes in uterine activity or Montevideo units. A direct comparison between external tocodynamometer and intrauterine pressure catheters was not feasible. CONCLUSIONS: Uterine rupture can be preceded or accompanied by several types of changes in uterine contractility, including hyperstimulation, reduced number of contractions, and increased or reduced baseline of the uterine tonus. While no typical pattern has been repeatedly reported, close follow-up of uterine contractility is advised and hyperstimulation should be prevented.


Assuntos
Prova de Trabalho de Parto , Monitorização Uterina , Ruptura Uterina/diagnóstico , Nascimento Vaginal Após Cesárea/efeitos adversos , Feminino , Humanos , Gravidez , Pressão , Contração Uterina/fisiologia , Ruptura Uterina/etiologia , Ruptura Uterina/fisiopatologia , Ruptura Uterina/prevenção & controle
7.
J Matern Fetal Neonatal Med ; 30(5): 574-579, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27160153

RESUMO

OBJECTIVE: Observational cohort study which aimed to explore the potential of electrohysterogram (EHG) analysis for detecting a uterine rupture during trial of labor after cesarean. The EHG propagation characteristics surrounding the uterine scar of six patients with a previous cesarean section were compared to a control group of five patients without a scarred uterus. METHODS: The EHG was recorded during the first stage of labor using a high-resolution 64-channel electrode grid positioned on the maternal abdomen across the cesarean scar. Based on simulations, the inter-channel correlation and propagation direction were adopted as EHG parameters for evaluating possible disruption of electrical propagation by the uterine scar. RESULTS: No significant differences in inter-channel correlation or propagation direction were observed between the group of patients with an intact uterine scar and the control group. A strong predominance of vertical propagation was observed in one case, in which scar rupture occurred. CONCLUSIONS: The results support unaffected propagation of electrical activity through the intact uterine scar tissue suggesting that changes in the EHG might only occur in case of rupture.


Assuntos
Cesárea/efeitos adversos , Monitorização Fetal/métodos , Primeira Fase do Trabalho de Parto , Prova de Trabalho de Parto , Ruptura Uterina/diagnóstico , Nascimento Vaginal Após Cesárea/efeitos adversos , Análise de Variância , Cicatriz/fisiopatologia , Estudos de Coortes , Fenômenos Eletrofisiológicos , Feminino , Humanos , Gravidez
8.
Ned Tijdschr Geneeskd ; 159: A8532, 2015.
Artigo em Holandês | MEDLINE | ID: mdl-25740190

RESUMO

A 55-year-old postmenopausal woman presented with acute abdominal pain. Ultrasound and MRI revealed a large, unilocular, cystic abdominal mass, with remarkable floating spheres. Histopathology showed a dermoid cyst. This is a benign ovarian neoplasm, which can contain elements of all three germ layers: primarily hair, teeth, skin or sebaceous tissue.


Assuntos
Cisto Dermoide/diagnóstico , Neoplasias Ovarianas/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Cisto Dermoide/complicações , Cisto Dermoide/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/cirurgia
9.
Ned Tijdschr Geneeskd ; 159: A8535, 2015.
Artigo em Holandês | MEDLINE | ID: mdl-25650036

RESUMO

Monitoring contractions during labour using the external tocodynamometer can be difficult or even impossible, and using the invasive intrauterine pressure catheter is associated with rare but serious complications. A new non-invasive technique is currently available: electrohysterography (EHG). This technique converts the electrical activity of the uterine muscle into a legible tocogram. The EHG signal has a high correlation with the intra-uterine pressure and provides a more accurate assessment of uterine activity compared to external tocodynamometry. EHG is suitable for women in labour with failure of the external tocodynamometer. In clinical practice EHG also appeared to report a more detailed tocographic waveform, like hypertonia or unorganized electrical uterine activity. However, its signal quality depends on adequate skin preparation and correct positioning of the electrodes on the maternal abdomen. Hence, with electrohysterography as non-invasive alternative for uterine monitoring, choosing between safety and accuracy is no longer necessary.


Assuntos
Eletromiografia/métodos , Contração Uterina/fisiologia , Monitorização Uterina/métodos , Feminino , Humanos , Trabalho de Parto , Gravidez , Monitorização Uterina/instrumentação
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