Abstract
Postpartum hemorrhage (PPH) is one of the major causes of maternal mortality and morbidity worldwide, with uterine atony being the most common origin. Currently there are no obstetrical techniques available for monitoring postpartum uterine dynamics, as tocodynamometry is not able to detect weak uterine contractions. In this study, we explored the feasibility of monitoring postpartum uterine activity by non-invasive electrohysterography (EHG), which has been proven to outperform tocodynamometry in detecting uterine contractions during pregnancy. A comparison was made of the temporal, spectral, and non-linear parameters of postpartum EHG characteristics of vaginal deliveries and elective cesareans. In the vaginal delivery group, EHG obtained a significantly higher amplitude and lower kurtosis of the Hilbert envelope, and spectral content was shifted toward higher frequencies than in the cesarean group. In the non-linear parameters, higher values were found for the fractal dimension and lower values for Lempel-Ziv, sample entropy and spectral entropy in vaginal deliveries suggesting that the postpartum EHG signal is extremely non-linear but more regular and predictable than in a cesarean. The results obtained indicate that postpartum EHG recording could be a helpful tool for earlier detection of uterine atony and contribute to better management of prophylactic uterotonic treatment for PPH prevention.
Highlights
Postpartum hemorrhage (PPH) is defined as more than 500 mL and 1000 mL of bleeding following vaginal or cesarean delivery, respectively, and is one of the major causes of maternal mortality and morbidity worldwide [1]
Since the most common cause of PPH is associated with uterine atony, in this work we proposed to use the EHG technique for monitoring postpartum uterine activity for early detection of uterine atony for PPH prevention
We found the Hilbert transform envelope kurtosis of the vaginal deliveries (VGN) signal was significantly lower than in cesarean sections (CSR), suggesting that postpartum uterine myoelectrical activity after caesarean deliveries presents a greater degree of impulsiveness, which may be related to the interruption or abrupt changes in the direction of action potential propagation due to incised tissue
Summary
Postpartum hemorrhage (PPH) is defined as more than 500 mL and 1000 mL of bleeding following vaginal or cesarean delivery, respectively, and is one of the major causes of maternal mortality and morbidity worldwide [1]. Without effective recognition and management, women rapidly experience shock, organ dysfunction, and even death [4]. It is estimated that around 75,000 women die of PPH each year, one every 7 min [4], or almost a quarter of maternal deaths worldwide [4]. More than half of these deaths occur within 24 h of delivery, mostly from excessive bleeding [5]. The developing countries continue to experience higher numbers of maternal deaths: in 2015, the maternal mortality ratio in these was Sensors 2020, 20, 3023; doi:10.3390/s20113023 www.mdpi.com/journal/sensors
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