316: Comparing vaginal probe uterine electromyography to transabdominal & tocodynamometer in morbidly obese pregnant women (original) (raw)
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Taiwanese Journal of Obstetrics and Gynecology, 2016
Objective: It has been shown that noninvasive uterine electromyography (EMG) can identify true preterm labor more accurately than methods available to clinicians today. The objective of this study was to evaluate the effect of body mass index (BMI) on the accuracy of uterine EMG in predicting preterm delivery. Materials and Methods: Predictive values of uterine EMG for preterm delivery were compared in obese versus overweight/normal BMI patients. HanleyeMcNeil test was used to compare receiver operator characteristics curves in these groups. Previously reported EMG cutoffs were used to determine groups with false positive/false negative and true positive/true negative EMG results. BMI in these groups was compared with Student t test (p < 0.05 significant). Results: A total of 88 patients were included: 20 obese, 64 overweight, and four with normal BMI. EMG predicted preterm delivery within 7 days with area under the curve ¼ 0.95 in the normal/overweight group, and with area under the curve ¼ 1.00 in the obese group (p ¼ 0.08). Six patients in true preterm labor (delivering within 7 days from EMG measurement) had low EMG values (false negative group). There were no false positive results. No significant differences in patient's BMI were noted between false negative group patients and preterm labor patients with high EMG values (true positive group) and nonlabor patients with low EMG values (true negative group; p ¼ 0.32). Conclusion: Accuracy of noninvasive uterine EMG monitoring and its predictive value for preterm delivery are not affected by obesity.
Gulhane Medical Journal, 2020
Over the last few decades, obesity [body mass ındex (BMI) ≥30 kg/m 2 ] has become one of the major health problems worldwide. Globally, the prevalence of overweight and obese adult women has increased from 29.8% in 1980 to 38.0% in 2013 (1). Obesity, which has also become common in women of reproductive age, increases the occurrence of obstetric complications, such as gestational diabetes mellitus, hypertension, fetal macrosomia, prolonged delivery time, and dystocia at birth (2-6). Obese women are also at increased risk for labor induction and their cesarean section rates are increased (7-9).
Journal of Maternal-Fetal and Neonatal Medicine, 2004
The study was conducted to investigate whether the strength of uterine contractions monitored invasively by intrauterine pressure catheter could be determined from transabdominal electromyography (EMG) and to estimate whether EMG is a better predictor of true labor compared to tocodynamometry (TOCO). Study design: Uterine EMG was recorded from the abdominal surface in laboring patients simultaneously monitored with an intrauterine pressure catheter (n =13) or TOCO (n 24). Three to five contractions per patient and corresponding electrical bursts were randomly selected and analyzed (integral of intrauterine pressure; integral, frequency, amplitude of contraction curve on TOCO; burst energy for EMG). The Mann-Whitney test, Spearman correlation and receiver operator characteristics (ROC) analysis were used as appropriate (significance was assumed at a value of p C 0.05). Results: EMG correlated strongly with intrauterine pressure (r -0.764; p = 0.002), EMG burst energy levels were significantly higher in patients who delivered within 48 h compared to those who delivered later (median [25%/75%]: 96640 [26520--322240] vs. 2960 [1560-10240]; p <0.001), whereas none of the TOCO parameters were different. In addition, burst energy levels were highly predictive of delivery within 48 h (AUC = 0.9531; p C 0.0001). Conclusion: EMG measurements correlated strongly with the strength of contractions and therefore may be a valuable alternative to invasive measurement of intrauterine pressure. Unlike TOGO, transabdominal uterine EMG can be used reliably to predict labor and delivery.
Archives of Gynecology and Obstetrics, 2013
Objective To determine the patterns of uterine action potentials in laboring and non-laboring women at term using the non-invasive abdominal electromyography technique. Methods One hundred pregnant women at term who fulfilled the inclusion criteria were enrolled in the study and equally divided into two groups. Group I consisted of 50 women in active labor, while group II included 50 women not in labor. After enrollment, the cardiotocograph was applied to all women. Abdominal electromyographic recording was started and for every burst of action potential, we measured the amplitude, frequency and duration of action potential. The results were tabulated and statistically analyzed. Results Both groups were comparable in demographic characteristics. Four patterns of EMG were detected. The amplitude of action potentials was significantly higher in laboring compared to non-laboring women (77.44 ± 11.25 vs 13.71 ± 8.57, P \ 0.001). Similar significantly longer durations of electrical bursts were also noted in laboring women (45.94 ± 8.77 vs 7.11 ± 4.68 s, P \ 0.001). Specific electromyographic changes were noted in women passing from the non-laboring to laboring state and in women who required oxytocin augmentation during labor. Conclusion Abdominal electromyography may help to distinguish between women in true active labor from those who are not. It also may help to identify women who will enter into labor within 24-72 h and those who require augmentation of labor.
Comparing uterine electromyography activity of antepartum patients versus term labor patients
American Journal of Obstetrics and Gynecology, 2005
Objective: The purpose of this study was to compare uterine electromyography of patients delivering O24 hours from measurement with laboring patients %24 hours from measurement. Study design: Fifty patients (group 1: labor, n = 24; group 2: antepartum, n = 26) were monitored using transabdominal electrodes. Group 2 was recorded at several gestations. Uterine electrical ''bursts'' were analyzed by power-spectrum from 0.34 to 1.00 Hz. Average power density spectrum (PDS) peak frequency for each patient was plotted against gestational age, and compared between group 1 and group 2. Frequency was partitioned into 6 bins, and associated burst histograms compared. Results: Group 1 was significantly higher than group 2 for gestational age (39.87 G 1.08 vs 32.96
Monitoring uterine activity during labor: a comparison of 3 methods
American Journal of Obstetrics and Gynecology, 2013
Objective-Tocodynamometry (Toco-strain gauge technology) provides contraction frequency and approximate duration of labor contractions, but suffers frequent signal dropout necessitating re-positioning 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 three 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 three 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 one or more of the devices (12) or inadequate data collection duration(2). Results-In comparison with the gold-standard IUPC, EHG performed significantly better than Toco with regard to Contractions Consistency Index (CCI). The mean CCI for EHG was 0.88 ± 0.17 compared to 0.69 ± 0.27 for Toco (p<.0001). In contrast to Toco, EHG was not significantly affected by obesity.
Monitoring Contractions in Obese Parturients
Obstetrics & Gynecology, 2007
To compare electrohysterogram-derived contractions with both tocodynamometry and intrauterine pressure monitoring in obese laboring women. METHODS: From a large database of laboring patients with electrohysterogram monitoring, obese subjects were selected in whom data were recorded for at least 30 minutes before and after intrauterine pressure catheter placement for obstetric indication. Using a contraction detection algorithm, the relationship between the methods was determined with regard to both frequency and contraction duration. RESULTS: Of the 25 subjects (median body mass index 39.6 [25th percentile 36.5, 75th percentile 46.3]), seven underwent amniotomy at the time of intrauterine pressure catheter placement. Tocodynamometry identified 248 contractions compared with 336 by electrohysterography, whereas intrauterine pressure catheter monitoring identified 319 contractions compared with 342 by electrohysterography. Using the Contractions Consistency Index, electrohysterogram contraction detection correlated better with the intrauterine pressure catheter (0.94؎0.06) than with tocodynamometry (0.77؎0.25), P.400.؍ Electrohysterogram-derived contraction lengths closely approximated those calculated from the intrauterine pressure catheter signal.
American Journal of Obstetrics and Gynecology, 2012
Intrauterine pressure catheter (IUPC) is the primary device used to evaluate uterine activity. In contrast to the IUPC, electrical uterine myography (EUM) enables noninvasive measurement of frequency, intensity, and tone of contractions. The aim of this study was to determine the accuracy of EUM compared to IUPC. STUDY DESIGN: EUM measured myometrial electrical activity using a multichannel amplifier and a noninvasive position sensor. In all, 47 women in labor were monitored simultaneously with an IUPC and EUM. We compared the frequency, intensity, and tone of uterine contractions between the methods. RESULTS: The correlation of the frequency, intensity, and tone of contractions between uterine electromyography and IUPC was strong with significant r values of 0.808-1 (P Ͻ .0001). CONCLUSION: Electrical uterine electromyography yields information about uterine contractility comparable to that obtained with IUPC.