Abstract
ObjectiveThe initiation of treatment for women with threatening preterm labor requires effective distinction between true and false labor. The electrohysterogram (EHG) has shown great promise in estimating and classifying uterine activity. However, key issues remain unresolved and no clinically usable method has yet been presented using EHG. Recent studies have focused on the propagation velocity of the EHG signals as a potential discriminator between true and false labor. These studies have estimated the propagation velocity of individual spikes of the EHG signals. We therefore focus on estimating the propagation velocity of the entire EHG burst recorded during a contraction in two dimensions.Study DesignEHG measurements were performed on six women in active labor at term, and a total of 35 contractions were used for the estimation of propagation velocity. The measurements were performed using a 16-channel two-dimensional electrode grid. The estimates were calculated with a maximum-likelihood approach.ResultsThe estimated average propagation velocity was 2.18 (±0.68) cm/s. No single preferred direction of propagation was found.ConclusionThe propagation velocities estimated in this study are similar to those reported in other studies but with a smaller intra- and inter-patient variation. Thus a potential tool has been established for further studies on true and false labor contractions.
Highlights
Premature birth, defined as birth before 37 completed weeks of gestation, is a serious obstetric challenge which is associated with a high occurrence of neonatal morbidity and mortality
A potential tool has been established for further studies on true and false labor contractions
[3] On the contrary, the preterm birth rate in the United States has increased from 9.4% in 1981 to 12.8% in 2006, the latest reports show a slight decrease to 12.2% in 2009
Summary
Premature birth, defined as birth before 37 completed weeks of gestation, is a serious obstetric challenge which is associated with a high occurrence of neonatal morbidity and mortality. Preterm delivery is responsible for 70% of mortality and 75% of morbidity in the neonatal period. The current therapeutic treatment for threatening preterm labor has two goals: To delay the actual delivery and to optimize fetal status before preterm delivery. In the effort to delay delivery, several methods are used These include administration of anticontraction medications (tocolytic agents), antibiotics when infection is suspected, and strengthening of the uterine cervix (cervical cerclage) in women with a weakened cervix. Today it is difficult to identify which women will benefit from the above mentioned treatments. This is mainly due to the fact that it is difficult to make a distinction between true labor contractions and Braxton Hicks contractions, which are sporadic uterine contractions that occur in false labor. The inability to make a distinction between the two types of contractions, often leads to pregnant women with Braxton Hicks contractions being overtreated, and women in preterm labor being undertreated
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