Vlemminx Marion W C, Thijssen Kirsten M J, Bajlekov Galin I, Dieleman Jeanne P, Van Der Hout-Van Der Jagt M Beatrijs, Oei S Guid
Department Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Department Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2017 Aug;215:197-205. doi: 10.1016/j.ejogrb.2017.05.027. Epub 2017 Jun 1.
Current uterine monitoring techniques have major drawbacks that could be avoided when using electrohysterography for uterine monitoring. Recently, a new electrohysterography method has been developed, providing a real-time tocogram on standard cardiotocography monitors. The diagnostic characteristics of this novel method need to be determined and compared to conventional methods We hypothesised that electrohysterography can perform better than external tocodynamometry due to the adhesive properties of the contact electrodes (less motion sensitive), and the improved signal acquisition through subcutaneous tissue (less obesity sensitive).
In this prospective diagnostic accuracy study, uterine contractions of labouring women were simultaneously monitored by three different monitoring techniques: electrohysterography, external tocodynamometry, and intra-uterine pressure catheter as method of reference. We performed a two-hour measurement during first and/or second stage of term labour. The contractions of each method were automatically detected by a computer-based algorithm. As the applied method had not been described in literature before, an interim analysis was performed to minimise exposure to the invasive pressure catheter. The main outcome parameter was the sensitivity of electrohysterography in comparison to external tocodynamometry for uterine contraction detection, tested by the Wilcoxon signed rank test.
Uterine contractions of 48 term labouring women were simultaneously monitored by electrohysterography, external tocodynamometry, and intra-uterine pressure catheter. The study was terminated after the interim analysis as the sensitivity of electrohysterography was significantly higher compared to external tocodynamometry: median 89.5% (interquartile range (IQR); 82-93) and 65.3% (IQR; 53-81) respectively, p<0.001. In a subgroup analysis of obese women (n=15), the sensitivity of electrohysterography was significantly higher than external tocodynamometry (median 88.4% (IQR; 79-95) and 45.8% (IQR; 38-61) respectively, p<0.001). Whereas in a subanalysis of second stage of labour (n=8), electrohysterography did not perform better than external tocodynamometry (median 72.8% (IQR; 61-87) and 66.4% (IQR; 46-75) respectively, p=0.225). Electrohysterography registered 0.4 more contractions per 10min than the intra-uterine pressure measurement (p<0.001) and 0.5 more contractions per 10min than external tocodynamometry (p<0.001).
Electrohysterography has a higher sensitivity for uterine contraction detection than external tocodynamometry during first stage of labour, in non-obese and obese women. Electrohysterography identifies more contractions than conventional techniques.
当前的子宫监测技术存在重大缺陷，而使用子宫电描记术进行子宫监测时这些缺陷可以避免。最近，一种新的子宫电描记术方法已被开发出来，可在标准的胎心监护仪上提供实时宫缩图。需要确定这种新方法的诊断特征并与传统方法进行比较。我们假设，由于接触电极的粘附特性（对运动不太敏感）以及通过皮下组织改善的信号采集（对肥胖不太敏感），子宫电描记术的表现优于外部宫缩图测量法。
在这项前瞻性诊断准确性研究中，通过三种不同的监测技术同时监测分娩妇女的子宫收缩：子宫电描记术、外部宫缩图测量法以及作为参考方法的宫内压力导管。我们在足月分娩的第一和/或第二阶段进行了两小时的测量。每种方法的宫缩由基于计算机的算法自动检测。由于之前文献中未描述所应用的方法，因此进行了中期分析以尽量减少侵入性压力导管的暴露。主要结局参数是子宫电描记术与外部宫缩图测量法相比在检测子宫收缩方面的敏感性，通过Wilcoxon符号秩检验进行测试。
通过子宫电描记术、外部宫缩图测量法和宫内压力导管同时监测了48名足月分娩妇女的子宫收缩。中期分析后研究终止，因为子宫电描记术的敏感性显著高于外部宫缩图测量法：中位数分别为89.5%（四分位间距（IQR）；82 - 93）和65.3%（IQR；53 - 81），p<0.001。在肥胖妇女亚组分析（n = 15）中，子宫电描记术的敏感性显著高于外部宫缩图测量法（中位数分别为88.4%（IQR；79 - 95）和45.8%（IQR；38 - 61），p<0.001）。而在分娩第二阶段亚分析（n = 8）中，子宫电描记术的表现并不优于外部宫缩图测量法（中位数分别为72.8%（IQR；61 - 87）和66.4%（IQR；46 - 75），p = 0.225）。子宫电描记术每10分钟记录的宫缩比宫内压力测量多0.4次（p<0.001），比外部宫缩图测量法多0.5次（p<0.001）。
在足月分娩第一阶段，对于非肥胖和肥胖妇女，子宫电描记术在检测子宫收缩方面比外部宫缩图测量法具有更高的敏感性。子宫电描记术比传统技术能识别更多的宫缩。
