Preterm Contractions Research Articles

Alpha-tocopherol succinate increases cyclooxygenase-2 activity: Tissue-specific action in pregnant rat uterus in vitro

AimsLipid soluble vitamin E plays a role in several physiological mechanisms, however, the mechanism of this action is controversial. We investigated how tocopherol (α-tocopherol acid succinate) influences the effects of cyclooxygenase inhibitors (COXi) in the smooth muscles. Main methodsThe contractility of the samples from 22-day-pregnant myometrium and non-pregnant myometrium and trachea was determined in an isolated organ bath in vitro. The activity of cyclooxygenase enzymes (COX) was also measured in the tissues. Key findingsDiclofenac (10−9–10−5M) and rofecoxib (10−10–10−5M) decreased the contractions in non-pregnant and 22-day-pregnant uteri. Tocopherol (10−7M) increased the relaxant effect only in pregnant uteri. Both diclofenac (10−9–10−5M) and rofecoxib (10−10–10−5M) reduced the tracheal tones, while they were slightly intensified by pretreatment with tocopherol (10−7M). Tocopherol enhanced the contractions of pregnant uteri. Tocopherol (10−7M) itself can induce the cyclooxygenase activity and shift the COX-1 and COX-2 ratio to COX-2. The lowest COX activity was found in non-pregnant uteri, while the highest one was in the trachea. SignificanceThe COX enzymes, especially COX-2, play an important role in the contraction of pregnant uteri in rat. Tocopherol has a tissue specific COX-2 activity increasing effect in pregnant rat uterus but has no such action in non-pregnant uteri or tracheal tissue. Hereby, tocopherol may intensify selectively the uterine relaxing effect of COX-2 inhibitors in preterm contractions. However, tocopherol can enhance the contractile response of pregnant uterus that may increase the risk of premature contractions.

Dedicated Entropy Measures for Early Assessment of Pregnancy Progression From Single-Channel Electrohysterography.

Preterm birth is a large-scale clinical problem involving over 10% of infants. Diagnostic means for timely risk assessment are lacking and the underlying physiological mechanisms unclear. To improve the evaluation of pregnancy before term, we introduce dedicated entropy measures derived from a single-channel electrohysterogram (EHG). The estimation of approximate entropy (ApEn) and sample entropy (SampEn) is adjusted to monitor variations in the regularity of single-channel EHG recordings, reflecting myoelectrical changes due to pregnancy progression. In particular, modifications in the tolerance metrics are introduced for improving robustness to EHG amplitude fluctuations. An extensive database of 58 EHG recordings with 4 monopolar channels in women presenting with preterm contractions was manually annotated and used for validation. The methods were tested for their ability to recognize the onset of labor and the risk of preterm birth. Comparison with the best single-channel methods according to the literature was performed. The reference methods were outperformed. SampEn and ApEn produced the best prediction of delivery, although only one channel showed a significant difference () between labor and nonlabor. The modified ApEn produced the best prediction of preterm delivery, showing statistical significance () in three channels. These results were also confirmed by the area under the receiver operating characteristic curve and fivefold cross validation. The use of dedicated entropy estimators improves the diagnostic value of EHG analysis earlier in pregnancy. Our results suggest that changes in the EHG might manifest early in pregnancy, providing relevant prognostic opportunities for pregnancy monitoring by a practical single-channel solution.

Case Report of Recurrent Sigmoid Volvulus in Pregnancy and Management Plan of the OB/GYN Hospitalist [35D

INTRODUCTION: Sigmoid volvulus is a rare and dangerous surgical complication of pregnancy that has a maternal and fetal mortality rate of 6-12% and 20-26%, respectively. We present a case report of a 31 year old gravida 3 para 2002 female at 31 5/7 weeks who was diagnosed with a recurrent sigmoid volvulus and the management plan by the OB/GYN Hospitalist in coordination with General Surgery and Neonatology. METHODS: At 12 weeks gestation, the patient had an endoscopic decompression of a sigmoid volvulus. The patient then presented at 31 5/7 weeks with the triad of severe abdominal pain, distention, and obstipation consistent with recurrent sigmoid volvulus, as well as preterm contractions. Determining the timing of surgical intervention and delivery were essential for optimal maternal and neonatal outcome. RESULTS: Patient underwent supportive and betamethasone treatment for 48 hours. At this time, recurrence of severe abdominal pain and contractions resulted in urgent surgery. Cesarean section with B-lynch suture was performed to decrease uterine size in order to facilitate sigmoid volvulus evaluation and treatment by General Surgery. CONCLUSION: Mother and neonate were discharged home without significant sequelae. Worldwide literature review of volvulus in pregnancy including pathophysiology, clinical diagnosis, imaging guidelines, and surgical treatment will optimize the Laborist management of this rare third trimester complication.

Impact of prior breast cancer on mode of delivery and pregnancy-associated disorders: a retrospective analysis of subsequent pregnancy outcomes.

The aim of this paper is to analyze the impact of prior breast cancer (BC) on mode of delivery and pregnancy-associated disorders. A database from 262 German gynecological practices including 289,712 women between the ages of 18 and 45 with documented pregnancies between 2000 and 2014 was used to search for patients with a history of BC up to 10years prior to pregnancy. A total of 165 patients with a history of BC were found and matched with 165 patients without a history of any cancer (1:1) by age, physician, obesity, and documented referral to a fertility center up to 12months before the index pregnancy. The impact of prior BC on the mode of delivery and pregnancy-associated disorders was analyzed using Cox regression models. The mean maternal age at first visit was 34.6years in both groups. The early and late pregnancy loss was significantly reduced (17.7 versus 29.9%, OR 0.50) and delivery of a live-born child more frequent (82.3 versus 70.1%, OR 2.00) in women who had had BC than in controls. Furthermore, preterm contractions without preterm birth were less frequent in women with BC compared to controls (9.2 versus 18.9%, OR 0.43). No significant differences were found for other pregnancy complications, such as suspected fetal growth restriction, genito-urinary infections, fetal malpresentation, gestational diabetes, pre-eclampsia, or breastfeeding issues. Based on the decreased rate of early and late pregnancy loss and the absence of significant differences in most documented pregnancy-associated disorders, women with the previous BC can be assured of the possibility of a good outcome on a subsequent pregnancy.

Live birth following abdominal cervical cerclage in a woman with recurrent pregnancy losses

We present a case of abdominal cervical cerclage with live birth. She was a 40-year-old woman with a history of recurrent second-trimester pregnancy losses and preterm deliveries. A cervicoisthmic cerclage was applied through the abdominal route at 16 weeks of gestation and the pregnancy progressed to 35 weeks and 4 days when she developed preterm contractions necessitating an emergency cesarean delivery of a set of healthy twins. Only few centers in Nigeria offer abdominal cerclage because of paucity in skills. This case is presented as a reminder that such cases still exist, and the skill must be maintained and taught resident doctors as it may become useful when such cases present.

Contraction-based uterine artery Doppler velocimetry: novel approach for prediction of preterm birth in women with threatened preterm labor.

To evaluate whether uterine artery (UtA) Doppler velocimetry during peak uterine contraction is a useful marker for the prediction of preterm delivery. In this prospective cohort study, 172 patients admitted with preterm (24-35 weeks' gestation) uterine contractions were evaluated by UtA Doppler velocimetry during peak uterine contraction and by common obstetric measurements including cervical length. For UtA Doppler velocimetry, flow-velocity waveforms during peak uterine contraction (determined visually on tocodynamometry) were recorded during three consecutive heart cycles, and the mean UtA pulsatility index (UtA-PI) was calculated. UtA-PI during the peak of contractions was significantly higher in patients who delivered within 7 days than in those who did not (P < 0.001). On receiver-operating characteristics curve analysis of UtA-PI on contraction, the areas under the curve for prediction of delivery within 48 h, 7 days or 14 days, ≤ 35 weeks and ≤ 37 weeks were 0.92, 0.88, 0.81, 0.83 and 0.74, respectively. Multiple regression analysis identified UtA-PI on contraction (P < 0.001) and cervical length (P < 0.001) as predictors of admission-to-delivery interval. The corresponding adjusted odds ratios for delivery within 7 days were 16.5 (95% CI, 5.7-47.2) for UtA-PI on contraction ≥ 1.32, and 14.7 (95% CI, 5.2-41.8) for cervical length ≤ 28 mm. Use of UtA Doppler velocimetry during peak uterine contraction for patients exhibiting symptoms of preterm labor might be effective for the identification of pregnant women at risk of preterm delivery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Success rate in preterm uterine contraction inhibition with tocolytic agents in a tertiary care center.

ObjectiveThis study aims to assess the success rate of inhibiting preterm uterine contraction with tocolytic agents to delay delivery for at least 48 hours and risk factors of failure inhibition.Materials and methodsBetween January 2013 and July 2014, medical records of all singleton pregnant women between 24 0/7 and 33 6/7 weeks of gestation with the diagnosis of preterm labor (with cervical dilatation) or threatened preterm labor (without cervical dilatation) who received tocolytic agents were reviewed. The success rate of preterm uterine contraction inhibition was accounted in patients with 48 hours delayed delivery. The risk factors of the inhibition failure and neonatal outcomes were also investigated in this study.ResultsAmong 424 pregnant women diagnosed of preterm labor or threatened preterm labor, 103 singleton pregnant women met the study criteria. Overall success rate of preterm uterine contraction inhibition to prolong pregnancy for at least 48 hours was 86.4% (95% confidence interval [CI]: 78.3, 92.3). However, the success rate among the threatened preterm labor group was 93.8% (95% CI: 88.3, 99.1) while the preterm labor group was 60.9% (95% CI: 39.3, 82.4). The significant factor associated with inhibition failure was preterm labor (adjusted odds ratio 7.22; 95% CI: 1.99, 26.20).ConclusionThe success rate of preterm uterine contraction inhibition with tocolytic agents to delay delivery for at least 48 hours was high in threatened preterm labor and low in preterm labor. A significant risk factor for inhibition failure was the preterm uterine contraction with cervical change.

Successful treatment with granulocyte-colony stimulating factor for ritodrine-induced neutropenia in a twin pregnancy

ObjectiveNeutropenia developed after continuous intravenous infusion of ritodrine hydrochloride (Yutopar) for preterm uterine contractions in a twin pregnancy. We successfully returned the low neutrophil count to the normal range after discontinuation of infusion of ritodrine and treatment with granulocyte colony stimulating factor (G-CSF). Case ReportA 34-year-old woman with twin pregnancy was treated with ritodrine for preterm uterine contractions at 27 weeks and 6 days gestation. Neutropenia developed after continuous intravenous infusion of ritodrine for about 4 weeks. We ceased the ritodrine infusion immediately and treated the neutropenia with G-CSF. A cesarean delivery was performed the day after cessation of the ritodrine infusion because of uncontrolled preterm labor. There were no adverse side effects or infectious complications in the mother or the newborns. The maternal neutrophil count recovered to the normal range 4 days after administration of G-CSF. ConclusionBased on prior case reports and the clinical presentation of our case, G-CSF may be a useful treatment for pregnant women with ritodrine-induced neutropenia. However, more clinical studies are required to confirm the safety and efficacy of this treatment.

Appendectomy for asymptomatic appendicitis during caesarean section - an interesting case report

Background: The authors present an interesting case report of an appendectomy during caesarean section in an asymptomatic pregnant woman, which highlights the need of peritoneal cavity check during every caesarean section. Materials and Methods: A 32-yearold para 0 woman at 34 weeks of gestation attended to the present clinic because of a feeling of reduced fetal movements in the last 24 hours. She underwent a non-stress test (NST), that was non-reassuring and no contractions were recorded. The woman underwent a caesarean section, which revealed a large phlegmonic appendix. Appendectomy was decided after the closure of the uterine cavity. Results: The woman was treated with appendectomy. Histology came back as an appendicitis three days later. Conclusions: Acute appendicitis during pregnancy may be associated with serious maternal and fetal complications. It is also associated with a high risk of premature delivery. In the absence of lower abdominal pain and inflammatory changes, the incidence of acute appendicitis is low, but exists. In every caesarean section at any week of gestation, we should check the peritoneal cavity and especially the appendix, as appendicitis is the most frequent non-obstetric surgical situation in pregnancy. Asymptomatic appendicitis should be considered as a cause in every pregnant woman who mentions preterm contractions or/and reduced fetal movements.

Repeat Measurement of Cervical Length in Women with Threatened Preterm Labor.

To examine the value of a repeat measurement some days after the first cervical length measurement done at the time of preterm contractions. Retrospective study involving women with singleton pregnancies who presented with preterm contractions at 24 to 33 + 6 weeks of gestation. The cervical length was measured at the time of presentation and some days afterwards. The study population consisted of 17 cases with a preterm delivery within 14 days and 288 uneventful pregnancies. Univariate logistic regression analysis indicated a significant correlation between delivery within 14 days and both, the first and second cervical length measurements as well as the difference between the two measurements. Up to a false positive rate of 20 %, ROC curve analysis showed an improved detection rate for preterm delivery by inluding both measurements. At a false positive rate of 10 % - which corresponds to a first and second cervical length of 10 and 9 mm - the detection rate was 17.6 % with the first cervical length measurement, 47.0 % with the second and 52.9 % if the difference between both measurements was added. Our results indicate that in women with symptoms of preterm labor it is worth to repeat the measurement some days later and to take into account the difference between both measurements.

Is there an association between subclinical hypothyroidism and preterm uterine contractions? A prospective observational study*

Objective: To investigate the association between subclinical hypothyroidism and preterm contractions. Methods: Prospective observational study among women at 23 + 0/7 and 34 + 6/7 weeks of gestation, with no known thyroid function abnormality, and preterm uterine contractions (PTC). All patients underwent laboratory evaluation of Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4). Patients with and without PTC were compared. Results: No association was found between PTC and subclinical hypothyroidism. Rate of spontaneous preterm delivery (PTD) was comparable between women with abnormal and normal thyroid function tests. Excluding indicated PTD, patients in the study group had a higher rate of spontaneous PTD (24.7% versus 9.6%, p = 0.03). Patients with past PTD and preterm contractions had higher rates of hypothyroxinemia compared with patients without past PTD (54.6% versus 19.0% and 31.2%, p = 0.001), and patients with past PTD (regardless of the presence or absence of PTC) had higher rate of subclinical hypothyroidism compared with patients with PTC and without PTD (59.1% and 66.7% versus 31.6%, p = 0.017). Conclusions: No association was found between PTC and subclinical hypothyroidism in the entire cohort, except for patients with preterm contractions and a history of past PTD. This specific group of patients might benefit from thyroid function evaluation.

Effect of sleep disorders on threatened premature delivery.

The present observational study aimed to clarify the effects of sleep disorders on threatened premature delivery, especially preterm uterine contraction. The participants included 122 healthy singleton pregnant women. The Pittsburgh sleep quality index was used to evaluate the quality of sleep during the previous month at the initial examination and at 16, 24, and 32 weeks of gestation; scores >5 indicate poor sleep. Threatened premature delivery was defined as preterm uterine contraction >6 times/h and requiring tocolytic therapy before 37 weeks of gestation. We analyzed the relationship between poor sleep and threatened premature delivery. Poor sleep affected 27% (n=33) at the initial examination, 34% (n=41) at 16 weeks, 37% (n=45) at 24 weeks, and 41% (n=50) at 32 weeks of gestation. There were 23 patients (19%) with threatened premature delivery. Poor sleep affected 35% and 25% of patients with threatened and non-threatened premature delivery at the initial examination, respectively, 52% and 29% at 16 weeks, 48% and 34% at 24 weeks, and 43% and 40% at 32 weeks of gestation. Sleep disorders at 16 weeks of gestation were the most significantly associated with threatened premature delivery.

Vaginal fluid pH and buffer capacity for predicting false preterm labor in Japanese women.

To determine the relationship between preterm labor and delivery, and the pH and buffer capacity of vaginal secretions. Between January 1, 2009 and March 31, 2012, two cohorts of patients at 22-36weeks of pregnancy were enrolled in a prospective cohort study at Nara Medical University Hospital, Japan. Patients experiencing preterm contractions and a control group of patients experiencing normal pregnancies were included. The pH and buffer capacity of vaginal secretions were measured and compared. Of the 237 patients enrolled, 48 (20.3%) were experiencing symptoms of preterm labor and 189 (79.7%) were included in the control group. The pH was higher (P<0.001) and the buffer capacity was lower (P=0.0135) in the vaginal secretions of the patients experiencing preterm contractions compared with the control group. There was no difference in the pH and buffer capacity of the vaginal secretions of symptomatic patients who would experience preterm delivery and those who would not. Receiver operating characteristic curve analyses demonstrated that vaginal-secretion pH and buffer capacity could differentiate between patients experiencing preterm contractions and those not, but could not differentiate between patients who would experience preterm delivery and those who would not. Vaginal-secretion pH and buffer capacity could be useful in diagnosing preterm labor; further studies are needed to determine potential practical diagnostic criteria.

Preterm uterine contractions ultimately delivered at term: safe but not out of danger

ObjectivesPatients with pregnancies complicated with premature uterine contractions (PMC), but delivered at term are considered as false preterm labor (PTL), and represent a common obstetric complication. We aimed to assess obstetric and neonatal outcomes of pregnancies complicated with PMC, but delivered at term, as compared to term normal pregnancies. Study designObstetric, maternal and neonatal outcomes of singleton pregnancies complicated with PMC between 24–336/7 weeks (PMC group), necessitating hospitalization and treatment with tocolytics and/or steroids, during 2009–2014, were reviewed. The study group included only cases who eventually delivered ≥37 weeks, which were compared to a control group of subsequent term singleton deliveries who had not experienced PMC during pregnancy. Neonatal adverse composite outcome included: phototherapy, RDS, sepsis, blood transfusion, cerebral injury, NICU admission. ResultsThe PMC group (n=497) was characterized by higher rates of nulliparity (p=0.002), infertility treatments (p=0.02), and polyhydramnios (p<0.001), as compared to controls (n=497). Labor was characterized by higher rates of instrumental deliveries (p=0.03), non-reassuring fetal heart rate tracings (p<0.001) prolonged third stage of labor (p=0.04), and increased rate of post-partum maternal anemia (Hb<8g/dL) p=0.004, in the PMC group as compared to controls. Neonates in the PMC groups had lower birth weights compared to controls, 3149g±429 vs. 3318g±1.1, p<0.001, respectively. By logistic regression analysis, PMC during pregnancy was independently associated with neonatal birth-weight <3rd percentile (adjusted OR 4.6, 95% CI 1.5–13.7). ConclusionsPregnancies complicated with PMC, even-though delivered at term, entail adverse obstetric and neonatal outcomes, and may warrant continued high risk follow up.

La seguridad de la acupuntura obstétrica: los puntos prohibidos revaluados

Background/aimAlthough the safety of acupuncture per se in pregnancy is reasonably well accepted, there remains debate regarding needling at points historically considered to be ‘forbidden’ during pregnancy. This article reviews the scientific literature on this topic. Main findingsThere is no objective evidence of harm following needling at forbidden points, summarised by the following four lines of evidence. (1) In 15 clinical trials (n=823 women receiving n=4549-7234 acupuncture treatments at one or more forbidden points) rates of preterm birth (PTB) and stillbirth following are equivalent to those in untreated control groups and consistent with background rates of these complications in the general population. (2) Observational studies, including a large cohort of 5885 pregnant women needled at forbidden points at all stage of pregnancy, demonstrate that rates of miscarriage, PTB, preterm prelabour rupture of membranes (PPROM), and preterm contractions (preterm labour (PTL) or threatened PTL) are comparable with untreated controls and/or consistent with their anticipated incidence. (3) There is no reliable evidence that acupuncture/electroacupuncture (EA) can induce miscarriage/labour, even under otherwise favourable circumstances such as post-dates pregnancy or intrauterine fetal death. (4) Laboratory experiments using pregnant rats have demonstrated that repeated EA at forbidden points throughout gestation does not influence rates of post-implantation embryonic demise or cause miscarriage, fetal loss or resorption. ConclusionsThese findings are reassuring and will help individualised risk:benefit assessment before treating pregnant women. Given the numerous evidence-based indications for obstetric acupuncture and lack of evidence of harm, risk:benefit assessments will often fall in favour of treatment.

Efficacy of terbutaline in preterm labour - our experience

Background: Preterm birth is one of the important causes of perinatal mortality and morbidity in developed countries after congenital malformations. Postponement of delivery plays essential role in preventing such incidences by allowing fetal lung maturity. Methods: This is a prospective study conducted over a period of 20 months among the patients admitted for preterm labour with gestational period between 27 to 36 weeks. After the patients obeyed all the inclusion criteria, they were administered terbutaline 250 µg subcutaneously every 8th hourly followed by 5 mg tablet orally twice daily till contractions ceased. The patients were analysed for gestational period at which they presented with preterm labour contractions, associated risk factors, response to terbutaline, and gestational period at delivery, perinatal complications, neonatal and maternal outcomes. The data obtained were analysed by descriptive analysis. Results: There were 1,678 deliveries during study period, out of which 207 (12%) presented with preterm labour and 20 (~10%) patients received terbutaline. Idiopathic (50%) and vaginal infections (25%) were common causes of preterm labour among the patients who received terbutaline. The labour was prolonged by 3 - 5 days among 8 patients, 7 - 15 days in 9 patients and 15 - 30 days in 3 patients. Common maternal side effects were nausea and tremors. Neonatal outcome was good in most of the cases except in 5 (25%) neonates who required NICU admission but they all recovered well without any morbidity. Conclusions: Administration of terbutaline prolonged labour without any serious maternal complications and better neonatal outcome as 90% of the neonates were born without any complications. Hence, terbutaline can be used as a safe and effective tocolytic agent among patients presenting with preterm labour.

Spasmodic versus spasmolytic activities of Euphorbia spinidens extract on rat isolated uterus.

Preterm contraction of uterus is a main cause of miscarriages and preterm labour. Euphorbia known as Ferphion in Iranian traditional medicine texts like Al-Hawi, is reported for prevention of preterm labour. Therefore, the objective of this research was to investigate the effect of Euphorbia spinidens Bornm. Ex Prokh. on motility of rat uterus. Uterine horns were isolated form non-pregnant female rats pretreated with estrogen. E. spinidens hydroalcoholic extract was examined on KCl (80 mM) induced and spontaneous periodic contraction in isolate uterine strips suspended in an organ bath and compared with nifedipine and ritodrine. In isolated rat uterine strips, E. spinidens extract (1-500 µg/mL) showed mixed effects. At lower concentrations, firstly potentiated the spontaneous periodic contraction, while in concentrations above 256 µg/mL the spontaneous periodic contractions were completely attenuated. These findings demonstrated that although lower concentrations of hydroalcoholic extract potentiated the spontaneous periodic contraction of rat uterine smooth muscle, but at higher concentrations it had inhibitory effect on rat uterus contraction.

The safety of obstetric acupuncture: forbidden points revisited.

Background/aimAlthough the safety of acupuncture per se in pregnancy is reasonably well accepted, there remains debate regarding needling at points historically considered to be ‘forbidden’ during pregnancy. This article reviews the scientific literature on this topic.Main findingsThere is no objective evidence of harm following needling at forbidden points, summarised by the following four lines of evidence. (1) In 15 clinical trials (n=823 women receiving n=4549–7234 acupuncture treatments at one or more forbidden points) rates of preterm birth (PTB) and stillbirth following are equivalent to those in untreated control groups and consistent with background rates of these complications in the general population. (2) Observational studies, including a large cohort of 5885 pregnant women needled at forbidden points at all stage of pregnancy, demonstrate that rates of miscarriage, PTB, preterm prelabour rupture of membranes (PPROM), and preterm contractions (preterm labour (PTL) or threatened PTL) are comparable with untreated controls and/or consistent with their anticipated incidence. (3) There is no reliable evidence that acupuncture/electroacupuncture (EA) can induce miscarriage/labour, even under otherwise favourable circumstances such as post-dates pregnancy or intrauterine fetal death. (4) Laboratory experiments using pregnant rats have demonstrated that repeated EA at forbidden points throughout gestation does not influence rates of post-implantation embryonic demise or cause miscarriage, fetal loss or resorption.ConclusionsThese findings are reassuring and will help individualised risk:benefit assessment before treating pregnant women. Given the numerous evidence-based indications for obstetric acupuncture and lack of evidence of harm, risk:benefit assessments will often fall in favour of treatment.

The development of an obstetric tele-monitoring system.

Fetal growth restriction and preterm uterine contractions can turn a normal pregnancy into a problematic one. In previous work, we have developed a system for electrophysiological measurement of fetal heart rate (fHR), fetal electrocardiogram (fECG) and (premature) uterine contractions to enable early detection of foetal problems. In this work we have expanded this system into a tele-monitoring system for measurement at home. In order to permit home monitoring, the communication chain of the data has to be designed such that home-measured signals (fHR, fECG, uterine activities) are available in the hospital in real-time. Furthermore, the data must be transferred wirelessly to any location (worldwide) for interpretation by gynaecologists. A web application helps the gynaecologist or midwife to access the signals everywhere, provided that internet access is available. We developed a webserver as the heart of the entire system; it manages the patient database, transforms the signals in a graphical representation similar to that of the cardiotocography and manages the data communication with the proper data security policy. This tele-monitoring system can be used also during home deliveries enabling prompt transfer and proper intervention in the hospital when complications occur.

Electrohysterographic detection of uterine contractions in term pregnancy.

Uterine-contraction detection is a fundamental component of pregnancy monitoring. Electrohysterography (EHG) provides a non-invasive and accurate alternative to intrauterine pressure (IUP) measurements, and several techniques provide an estimated IUP (eIUP) based on the EHG alone. Commonly, EHG contraction detection is based on amplitude thresholding of the eIUP. We aim at improving the reliability of contraction detection, such that automatic contraction detection can be realized. An algorithm for template-matching of the eIUP signal is proposed. This method is based on Bayesian evidence using a Gaussian likelihood function to classify uterine activity. Gaussian templates are matched to the input signal, with weights obtained empirically from manually-annotated contraction events in a training data-set. The results show an improvement in contraction detection accuracy compared to threshold-based methods. The template-matching method is adaptable to relevant features in the input training data, and is thus less sensitive to differences in eIUP derivation or measurement variability. The method allows for improved automatic uterine contraction detection in labor EHG data, while being extensible to e.g. preterm contraction detection.