Frenken Maria W E, Thijssen Kirsten M J, Vlemminx Maria W C, van den Heuvel Edwin R, Westerhuis Michelle E M H, Oei S Guid
Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, the Netherlands.
Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5600 MB, Eindhoven, the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2021 Apr;259:178-184. doi: 10.1016/j.ejogrb.2021.02.029. Epub 2021 Mar 2.
Electrohysterography is a non-invasive technique to monitor uterine activity and has a significantly higher sensitivity compared to conventional external tocodynamometry. Whether this technique could lead to improved obstetrical outcomes is still unknown. In this propensity score matched study, clinical results of the first pilot implementing electrohysterography during labor were evaluated. The hypothesis tested is that electrohysterography will help to optimize uterine activity and thereby lead to fewer obstetric interventions. Secondary outcomes were Apgar score, arterial umbilical pH values, first stage labor duration, episiotomy rate and postpartum vaginal blood loss.
From November 2017 until October 2018, electrohysterography was introduced as a standard alternative for monitoring uterine activity in high-risk deliveries. It could be applied in case of induced labor, previous cesarean delivery, body mass index ≥30 kg/m or an inadequate external tocodynamometry monitoring. Outcomes were compared to a matched group of women in which external tocodynamometry was applied for uterine activity monitoring during labor. These women were identified using propensity scores.
A total of 348 women received electrohysterography as standard method of uterine monitoring during labor. A match (1:1 ratio) was found for 317 women, resulting in a total population of 634 women. No significant differences were seen in obstetric interventions (i.e. cesarean deliveries and assisted vaginal deliveries) between the electrohysterography and tocodynamometry group (P = 0.80). No statistically significant differences were seen regarding the secondary outcomes.
This first pilot study implementing electrohysterography as monitoring method during labor in a high-risk population did not result in statistically significant differences regarding obstetric interventions, low Apgar scores or low umbilical artery pH values. Therefore, we suggest that electrohysterography causes no harm and we recommend further implementation and evaluation in clinical practice.
子宫电描记术是一种监测子宫活动的非侵入性技术，与传统的外部宫缩图法相比，其灵敏度显著更高。该技术是否能改善产科结局仍不清楚。在这项倾向评分匹配研究中，对首次在分娩期间应用子宫电描记术的初步试验的临床结果进行了评估。所检验的假设是，子宫电描记术将有助于优化子宫活动，从而减少产科干预。次要结局包括阿氏评分、脐动脉pH值、第一产程时长、会阴切开率和产后阴道失血量。
2017年11月至2018年10月，子宫电描记术被引入作为高危分娩中监测子宫活动的标准替代方法。在引产、既往剖宫产、体重指数≥30kg/m²或外部宫缩图监测不充分的情况下均可应用。将结局与一组在分娩期间应用外部宫缩图法监测子宫活动的匹配女性进行比较。这些女性通过倾向评分进行识别。
共有348名女性在分娩期间接受子宫电描记术作为子宫监测的标准方法。为317名女性找到了匹配对象（1:1比例），从而形成了一个634名女性的总体。子宫电描记术组和宫缩图法组之间在产科干预（即剖宫产和阴道助产）方面未见显著差异（P = 0.80）。在次要结局方面也未见统计学上的显著差异。
这项首次在高危人群中进行的将子宫电描记术作为分娩期间监测方法的初步试验，在产科干预、低阿氏评分或低脐动脉pH值方面未产生统计学上的显著差异。因此，我们认为子宫电描记术无害，并建议在临床实践中进一步实施和评估。
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