Aina-Mumuney A, Hwang K, Sunwoo N, Burd I, Blakemore K
Division of Maternal Fetal Medicine, Department of Gynecology/Obstetrics, Johns Hopkins University School of Medicine Baltimore, MD, USA
Department of Biomedical Engineering, Johns Hopkins University Baltimore, MD, USA.
Reprod Sci. 2016 May;23(5):638-43. doi: 10.1177/1933719115611754. Epub 2015 Oct 22.
To examine the impact of maternal body mass index (BMI) and gestational age (GA) on uterine contraction detection by tocodynamometry.
Gravidas with preterm labor (PTL) complaints who were evaluated by tocodynamometry, discharged from Labor and Delivery triage, and subsequently readmitted for preterm delivery were studied. Forty-six patients in whom contractions were detected (group 1) were compared to 49 women in whom contractions were not detected (group 2) with respect to BMI and GA at both evaluation and delivery. Multivariable logistic regression was used to adjust for confounders.
Group 2 had a higher mean BMI (31.7 vs 26.1, P < .001), were more likely to be obese (57.1% vs 19.6%, P < .001), and were more likely to have been evaluated in the mid-trimester (36.7% vs 17.4%, P = .04) compared to group 1. Independent risk factors for the inability of the tocodynamometer to detect contractions were obesity (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.07-0.46) and evaluation in the mid-trimester (OR 0.33, 95% CI 0.13-0.84).
Our study provides evidence that the effectiveness of tocodynamometry diminishes with increasing maternal BMI. Efficacy of tocodynamometry is also decreased at earlier GA, most pronounced below 25 weeks. To evaluate women with PTL symptoms in the mid-trimester or symptomatic obese women at any GA, a modality other than tocodynamometry could be valuable to more accurately assess uterine activity.
探讨孕妇体重指数（BMI）和孕周（GA）对宫缩图检测子宫收缩的影响。
对因早产（PTL）主诉接受宫缩图评估、从分娩及接生分诊处出院、随后因早产再次入院的孕妇进行研究。将46例检测到宫缩的患者（第1组）与49例未检测到宫缩的女性（第2组）在评估和分娩时的BMI及GA进行比较。采用多变量逻辑回归分析调整混杂因素。
与第1组相比，第2组平均BMI更高（31.7 vs 26.1，P <.001），更易肥胖（57.1% vs 19.6%，P <.001），且更可能在孕中期接受评估（36.7% vs 17.4%，P =.04）。宫缩图无法检测到宫缩的独立危险因素为肥胖（比值比[OR] 0.18，95%置信区间[CI] 0.07 - 0.46）和孕中期评估（OR 0.33，95% CI 0.13 - 0.84）。
我们的研究表明，宫缩图的有效性随孕妇BMI增加而降低。宫缩图的效能在较早孕周时也会下降，在25周以下最为明显。对于在孕中期有PTL症状的女性或任何孕周有症状的肥胖女性，除宫缩图外的其他检查方法可能有助于更准确地评估子宫活动。
