Uterine Activity Monitoring Research Articles

Home Uterine Activity Monitoring for Preterm Labor

PRETERM birth is a leading cause of perinatal morbidity and mortality in the United States. Preterm neonates are thought to account for at least half of the mortality and morbidity among newborns without congenital anomalies.1These conditions represent a leading cause of years of potential life lost before the age of 65 years. Preterm births generate large societal costs by requiring neonatal intensive care and long-term treatment for complications. Both primary and secondary preventive measures have been proposed for the prevention of prematurity. Primary prevention includes efforts to reduce risk factors for prematurity, such as cessation of tobacco, alcohol, and other drug use, and programs to improve nutrition, socioeconomic conditions, and prenatal care. Secondary prevention involves the early detection and treatment of preterm labor. It has been suggested that the risk of preterm birth can be reduced significantly by the prompt initiation of treatment, which includes rest, hydration, and

Home Uterine Activity Monitoring for Preterm Labor

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Home uterine activity monitoring

Home uterine activity monitoring

Contribution of Home Uterine Activity Monitoring to the Reduction of Preterm Delivery Rate

A service for home-monitoring of uterine-activity was introduced to the Israeli obstetric community. Two hundred three patients at high risk for preterm delivery utilized this service. The patients contacted the center 8,109 times (82% “scheduled” and 18% “acute” contacts). The mean duration of the monitoring was 5 weeks and the average gestational age of delivery was 37 weeks.Of the study population, 96.4% delivered at term and 3.6% delivered prematurely with a corrected rate of 2.8%. Of the women that were sent to the hospital for evaluation 65% had only increased uterine activity on routine monitoring with no subjective symptoms and therefore would have been missed without this service.

274 Randomized Trial of Home Uterine Activity Monitoring (Huam) Versus Routine Care in Patients Discharged After Treatment for Preterm Labor

274 Randomized Trial of Home Uterine Activity Monitoring (Huam) Versus Routine Care in Patients Discharged After Treatment for Preterm Labor

273 Cost Effectiveness of Home Uterine Activity Monitoring

273 Cost Effectiveness of Home Uterine Activity Monitoring

Antenatal uterine activity monitoring of women at increased risk of preterm labour

The aim of the study was to investigate the usefulness of antenatal uterine activity monitoring in the management of women at increased risk of preterm labour on the basis of a past history of preterm birth or mid-trimester abortion. Uterine activity was recorded every 2 weeks between 20 and 28 weeks gestation. Activity was considered to be increased if pressure changes > 15 mmHg were detected. Fifty-eight women had uterine activity monitoring. Of them, 39 had normal uterine activity. Nineteen women had increased activity and they were randomized to either a study group (9) where the findings were revealed to the clinicians caring for them or a control group (10) where the findings were not revealed. There was no standard regimen of management for the study group except that additional uterine activity monitoring was performed to provide feed back to the clinicians about their interventions. The sensitivity, specificity, positive predictive value and negative predictive value of uterine activity monitoring for preterm births and for preterm births before 32 weeks were disappointing. Uterine activity monitoring was not useful for predicting births prior to 32 weeks; most of these were preceded by prelabour rupture of the membranes. The pregnancy outcome of women with increased uterine activity was not better if clinicians were aware of that increased activity than if they were not.

Unresolved controversies: home uterine activity monitoring.

Unresolved controversies: home uterine activity monitoring.

A Review of the Reviews on Home Uterine Activity Monitoring

A Review of the Reviews on Home Uterine Activity Monitoring

Home uterine activity monitoring in France: A randomized, controlled trial

We assessed the effectiveness of ambulatory tocodynamometry in reducing the preterm delivery rate in women at risk of preterm delivery such as women with risk factors and women previously hospitalized and discharged. In four public maternity units these women were randomly allocated to two groups: 84 had home uterine activity monitoring and daily midwife contact and 84 were given the standard care for high-risk women, which generally includes home visits by community midwives. The proportion of deliveries before 37 weeks' gestation was slightly higher in the monitored group than in the control group (32% vs 22%). The corresponding odds ratio was 1.7 (95% confidence interval: 0.9 to 3.5). Although the sample was small, these results suggest that home uterine activity monitoring was probably not beneficial to the population studied, or at least that any benefit would have been too small to justify extending this monitoring in this high-risk population.

Home Uterine Activity Monitoring

Despite tremendous improvements in maternal and neonatal care, preterm delivery remains the leading cause of infant mortality. Widespread use of tocolytics and aggressive preterm labor management have had little effect on reducing the overall neonatal mortality. To improve the success of tocolysis and preterm labor management, it is critical that preterm labor be diagnosed prior to significant cervical change. At present, a combination of several components is indicated for successful preterm birth prevention programs. These should include periodic risk assessment, patient education, cervical assessment, daily contact by highly skilled perinatal nurses, daily home uterine activity monitoring, and aggressive patient management. Studies support that this approach results in early detection of preterm labor, subsequently more effective tocolytic therapy and prevention of preterm birth.

Oral magnesium and the prevention of preterm labor in a high-risk group of patients

The null hypothesis of this study is that treatment with oral magnesium gluconate 1 gm four times daily will not decrease the rate of preterm labor and delivery in a high-risk group of pregnant women. Fifty-four women at risk for preterm delivery were selected randomly to receive magnesium gluconate 1 gm orally four times daily or placebo. These women were monitored prospectively for signs and symptoms of preterm labor. A subgroup of 31 women also received a home uterine activity monitor. The serum magnesium level was measured initially and again 2 weeks after study enrollment. The data were analyzed with Fisher's exact test and analysis of variance. Preterm labor developed in 15 women in the placebo group and in 16 women in the magnesium group. There were no differences in birth weight or gestational age at delivery. The mean increase in serum magnesium level while the patients were taking magnesium gluconate was 0.10 mg/dl (p = not significant). Five women did not have an increase in serum magnesium level and preterm labor developed in all of them. Magnesium gluconate in a dose of 1 gm four times daily is not effective for preventing preterm delivery in a high-risk group of patients.

Activation of cFos in Ovine Fetal Corticotropin- Releasing Hormone Neurons at the Time of Parturition*

The ovine fetal pituitary adrenal axis plays an important role in parturition. While lesions of the paraventricular nucleus (PVN) in the fetal sheep delay parturition, suggesting that the PVN is necessary for the processes that lead up to parturition, evidence for stimulation of PVN neurons at time of delivery/labor is lacking. The present study tested the hypothesis that activation (evidenced by expression of the oncogene product cFos) of a specific population of PVN neurons containing CRH accompanies labor in sheep. Monitoring of uterine electromyogram activity determined the onset of labor. The brains of nine fetuses (removed by ceasarian section under anesthesia at gestational ages of 125-145 days) and four newborn sheep were perfused and stained for cFos and CRH. Before labor, less than 5% of fetal paraventricular CRH neurons expressed cFos. Verification that the CRH neurons could express cFos when adequately stimulated was made by exposing an additional group of four preterm animals (125 days gestational age) to hypoxemia; the six untreated fetuses served as controls. Activation of the CRH neurons by hypoxemia produced a rapid induction of cFos in CRH neurons, with approximately 50% of the cells strongly expressing cFos protein 1 h after exposure to hypoxia. At the time uterine contractions were first detected, 70% of CRH neurons expressed cFos, and cFos immunoreactivity persisted until just after birth. cFos staining declined rapidly, reaching prelabor levels in some animals by 2-3 h after birth. These data are consistent with the hypothesis that in addition to their potential role in the processes that initiate parturition over several days before birth, fetal CRH neurons are stimulated during labor, and termination of stimulation probably occurs rapidly after delivery.

A Response from the FDA

SACHS et al., in discussing the Food and Drug Administration's approval of marketing of the Genesis Home Uterine Activity Monitor (HUAM), raise issues that require clarification. The authors contend that because the Genesis HUAM has not been shown to prevent premature births, it has no clinical value. We disagree. The FDA approved the device on the basis of its demonstrated ability to detect uterine contractions indicative of the onset of preterm labor, as evidenced by the degree of cervical dilation at the time of diagnosis. (It should be noted that in the supporting clinical study, none of the study subjects . . .

Does It Prevent Prematurity?

PREVENTION of premature births is the most important challenge in obstetrics. Recently a device for monitoring uterine activity at home (the Genesis Home Uterine Activity Monitor [HUAM] system, Tokos Medical Group), coupled with daily contact between patients and medical personnel, was reported to prevent premature births at an average cost per patient of over $5,000.1 The Food and Drug Administration recently approved this system for the early detection of preterm labor in women who had had a previous preterm delivery. The agency did not approve this system of care for the prevention of premature births, however, and has made it . . .

Relationship of Measured External Tocodynamometry with Measured Internal Uterine Activity

The use of home uterine activity monitoring for patients at high risk for preterm labor and delivery has become common in clinical perinatology. The ability of the monitoring devices to detect accurately uterine contractions in early pregnancy has not previously been reported. Ten women in labor between 20 and 35 weeks' gestation underwent simultaneous monitoring of uterine activity with a guard-ring tocodynamometer and an intrauterine pressure monitor. When compared with internal monitoring, the external monitor detected 90.8% of uterine contractions with a specificity for uterine quiescence of 98.1%. The predictive value of external monitoring was 97.3% for detecting uterine contractions and 93.6% for recording the absence of uterine contractions. The contractions detected externally were similar in duration: mean 63.7 +/- 23.0 seconds for internal monitoring and 62.2 +/- 22.6 seconds for external monitoring (p greater than 0.05). The intensity of contractions detected externally was less than internally measured contractions, mean difference, 19.7 +/- 15.9 mmHg (p less than 0.001). External tocodynamometry using this guarding tocodynamometer reliably distinguishes between uterine contractions and uterine quiescence in preterm pregnancies but does not adequately measure the intensity of contractions.

Multicenter randomized clinical trial of horne uterine activity monitoring for detection of preterrn labor

Home uterine activity monitoring has been described as an effective means of detecting uterine contractions, but controversy exists whether it is home uterine activity monitoring or increased nursing support in conjunction with it that contributes to earlier detection of preterm labor. In this study 377 women at risk for preterm labor from three centers were prospectively, randomly assigned to high-risk prenatal care alone (not monitored) or to the same care with twice-daily home uterine activity monitoring without increased nursing support (monitored). The two groups were medically and demographically similar at entry into the study. Routine visits, nonroutine visits, and gestational age at diagnosis of preterm labor were similar in both groups. Preterm labor occurred in 41 of 198 monitored and 39 of 179 not monitored patients. Mean cervical dilatation was 1.4 em in 41 monitored compared with 2.5 em for 37 not monitored (p = 0.0006); 73.1% of monitored and 27.5% of not monitored had preterm labor detected before 2 em dilatation (p = 0.00009). Neonatal outcome of singleton pregnancies showed greater birth weight, fewer days in the neonatal intensive care unit, and fewer babies requiring oxygen therapy and mechanical ventilation in the monitored group. The better outcomes are probably due to the increased likelihood of diagnosis of preterm labor before advanced cervical dilatation with home uterine activity monitoring, thus providing the clinician with a better chance to initiate tocolytic therapy directed at improving pregnancy outcome.

Patterns of uterine activity after intravaginal prostaglandin E2 during preinduction cervical ripening

In a randomized study, uterine activity patterns were characterized with a portable pressure-sensitive device in 40 nonlaboring women at term with an unfavorable cervix who were undergoing preinduction cervical ripening with prostaglandin E2. The prostaglandin E2 was inserted into the posterior vaginal fornix as a single dose of either a 2.5 mg methylcellulose gel (20 cases) or 10 mg controlled-release pessary (20 cases). Uterine activity monitoring began 1 hour before dosing and continued for 12 hours. For those treated with the gel, low-amplitude, high-frequency contractions began within the first hour, reached a peak within 4 hours, and initiated sustained high-amplitude contractions in 10 (50%) cases. With the controlled-release pessary, low-amplitude, high-frequency contractions had a slightly later onset, reached a peak between the fifth and eighth hours, and initiated sustained high-amplitude contractions in 18 (80%) cases. Uterine hyperstimulation occurred in two (10%) pessary cases, with no adverse effect after removal. We conclude that low-amplitude, high-frequency uterine contractions began with either method of intravaginal prostaglandin E2 delivery but led to sustained, high-amplitude contractions primarily with the pessary.

Objective tocodynamometry identifies labor onset earlier than subjective maternal perception

The ability of women instructed in self-detection of uterine contractions to identify the abrupt rise in uterine activity known to precede the onset of labor has not been evaluated. This study was designed to assess the temporal relationship between objective uterine activity monitoring, subjective maternal perception of uterine activity above a commonly used threshold value (four or more contractions per hour), and progressive cervical change. Daily tocodynamometry (7-9 AM) was recorded in 79 women with preterm premature rupture of the membranes from admission until the onset of spontaneous labor (5.3 +/- 6.3 days). The subjects were at bed rest, received no tocolytic therapy, and were instructed in the signs of labor and uterine self-palpation. Patients simultaneously provided a subjective assessment of uterine activity (four or more contractions per hour). The majority of uterine activity recordings (78%) revealed fewer than four contractions per hour, and the patients' subjective reports agreed in almost all instances (97.6%). On 91 days, four or more contractions per hour were recorded objectively, but the patients' subjective reports agreed in only 25 instances (27%). On the day of labor onset, significantly more women had an objective assessment (32%) (P less than or equal to .01). Patients subjectively identified labor onset 10.6 +/- 6.7 hours after objective monitoring indicated increased uterine activity, and when subjectively identified, both cervical dilatation (4.9 +/- 2.5 cm) and effacement (85 +/- 30%) were significantly advanced (P less than or equal to .001) compared with the admission examination (1.1 +/- 1.2 cm; 20 +/- 30%).(ABSTRACT TRUNCATED AT 250 WORDS)

Uterine activity after preterm premature rupture of the membranes

Preterm premature rupture of the membranes complicates few pregnancies but is a major contributor to overall perinatal morbidity and mortality. Although a reduced incidence of preterm premature rupture of fetal membranes has been reported in women who had antepartum uterine activity monitoring, there are few data regarding uterine activity after preterm premature rupture of fetal membranes. Therefore daily uterine activity monitoring was performed in 101 consecutive women with preterm premature rupture of fetal membranes between 26 and 34 weeks' gestation. The mean gestational ages at rupture and delivery were 31.4 +/- 2.3 and 33.7 +/- 4.5 weeks, respectively. A significant increase in contraction frequency was identified within 24 hours of onset of preterm labor (p less than 0.005). A contraction frequency of four or more per hour predicted the onset of labor within 24 hours with a sensitivity of 72%, a specificity of 90%, a positive predictive value of 54%, and a negative predictive value of 95%. These results indicate that most women with preterm premature rupture of fetal membranes exhibit a baseline contraction frequency that is similar to that of women with intact membranes and premature labor. An abrupt increase in contraction frequency is a warning of impending labor.