Abstract
As one of the main aims of obstetrics is to be able to detect imminent delivery in patients with threatened preterm labor, the techniques currently used in clinical practice have serious limitations in this respect. The electrohysterogram (EHG) has now emerged as an alternative technique, providing relevant information about labor onset when recorded in controlled checkups without administration of tocolytic drugs. The studies published to date mainly focus on EHG-burst analysis and, to a lesser extent, on whole EHG window analysis. The study described here assessed the ability of EHG signals to discriminate imminent labor (< 7 days) in women with threatened preterm labor undergoing tocolytic therapy, using both EHG-burst and whole EHG window analyses, by calculating temporal, spectral, and non-linear parameters. Only two non-linear EHG-burst parameters and four whole EHG window analysis parameters were able to distinguish the women who delivered < 7 days from the others, showing that EHG can provide relevant information on the approach of labor, even in women with threatened preterm labor under the effects of tocolytic therapy. The whole EHG window outperformed the EHG-burst analysis and is seen as a step forward in the development of real-time EHG systems able to predict imminent labor in clinical praxis.
Similar content being viewed by others
References
Aboy M, Cuesta-Frau D, Austin D, Micó-Tormos P (2007) Characterization of sample entropy in the context of biomedical signal analysis. Conf Proc IEEE Eng Med Biol Soc:5942–5945. https://doi.org/10.1109/IEMBS.2007.4353701
Aboy M, Hornero R, Abásolo D, Álvarez D (2006) Interpretation of the Lempel-Ziv complexity measure in the context of biomedical signal analysis. IEEE Trans Biomed Eng 53:2282–2288. https://doi.org/10.1109/TBME.2006.883696
Chkeir A, Fleury MJ, Karlsson B, Hassan M, Marque C (2013) Patterns of electrical activity synchronization in the pregnant rat uterus. Biomed 3:140–144. https://doi.org/10.1016/j.biomed.2013.04.007
Crandon AJ (1979) Maternal anxiety and neonatal wellbeing. J Psychosom Res 23:113–115. https://doi.org/10.1016/0022-3999(79)90015-1
Devedeux D, Marque C, Mansour S, Germain G, Duchêne J (1993) Uterine electromyography: a critical review. Am J Obstet Gynecol 169:1636–1653. https://doi.org/10.1016/0002-9378(93)90456-S
Fele-Žorž G, Kavšek G, Novak-Antolič Ž, Jager F (2008) A comparison of various linear and non-linear signal processing techniques to separate uterine EMG records of term and pre-term delivery groups. Med Biol Eng Comput 46:911–922. https://doi.org/10.1007/s11517-008-0350-y
Fergus P, Cheung P, Hussain A, al-Jumeily D, Dobbins C, Iram S (2013) Prediction of preterm deliveries from EHG signals using machine learning. PLoS One 8:e77154. https://doi.org/10.1371/journal.pone.0077154
Garfield RE, Maner WL (2006) Biophysical methods of prediction and prevention of preterm labor: uterine electromyography and cervical light-induced fluorescence—new obstetrical diagnostic techniques. In: Preterm Birth pp 131–144
Garfield RE, Maner WL (2007) Physiology and electrical activity of uterine contractions. Semin Cell Dev Biol 18:289–295. https://doi.org/10.1016/j.semcdb.2007.05.004
Garfield RE, Maner WL, MacKay LB et al (2005) Comparing uterine electromyography activity of antepartum patients versus term labor patients. Am J Obstet Gynecol 193:23–29. https://doi.org/10.1016/j.ajog.2005.01.050
Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371:75–84. https://doi.org/10.1016/S0140-6736(08)60074-4
American College of Obstetricians and Gynecologists and Committee on Practice Bulletins— Obstetrics (2012) Practice bulletin no. 127. Obstet Gynecol 119(6):1308–1317.
Hadar E, Biron-Shental T, Gavish O, Raban O, Yogev Y (2015) A comparison between electrical uterine monitor, tocodynamometer and intra uterine pressure catheter for uterine activity in labor. J Matern Neonatal Med 28:1367–1374. https://doi.org/10.3109/14767058.2014.954539
Hans P, Dewandre P, Brichant JF, Bonhomme V (2005) Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia. Br J Anaesth 94:336–340. https://doi.org/10.1093/bja/aei047
Hassan M, Terrien J, Marque C, Karlsson B (2011) Comparison between approximate entropy, correntropy and time reversibility: application to uterine electromyogram signals. Med Eng Phys 33:980–986. https://doi.org/10.1016/j.medengphy.2011.03.010
Hassan M, Terrien J, Muszynski C et al (2013) Better pregnancy monitoring using nonlinear correlation analysis of external uterine electromyography. IEEE Trans Biomed Eng 60:1160–1166. https://doi.org/10.1109/TBME.2012.2229279
Horoba K, Jezewski J, Matonia A, Wrobel J, Czabanski R, Jezewski M (2016) Early predicting a risk of preterm labour by analysis of antepartum electrohysterograhic signals. Biocybern Biomed Eng 36:574–583. https://doi.org/10.1016/j.bbe.2016.06.004
Lawn JE, Wilczynska-Ketende K, Cousens SN (2006) Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol 35:706–718. https://doi.org/10.1093/ije/dyl043
Lemancewicz A, Borowska M, Kuć P, Jasińska E, Laudański P, Laudański T, Oczeretko E (2016) Early diagnosis of threatened premature labor by electrohysterographic recordings—the use of digital signal processing. Biocybern Biomed Eng 36:302–307. https://doi.org/10.1016/j.bbe.2015.11.005
M L WLM, LR C (2012) Noninvasive uterine electromyography for prediction of preterm delivery. Am J Obstet Gynecol 204:1–20. https://doi.org/10.1016/j.ajog.2010.09.024.Noninvasive
Maner WL, Garfield RE (2007) Identification of human term and preterm labor using artificial neural networks on uterine electromyography data. Ann Biomed Eng 35:465–473. https://doi.org/10.1007/s10439-006-9248-8
Maner WL, Garfield RE, Maul H, Olson G, Saade G (2003) Predicting term and preterm delivery with transabdominal uterine electromyography. Obstet Gynecol 101:1254–1260. https://doi.org/10.1016/S0029-7844(03)00341-7
Marque C, Gondry J (1999) Use of the electrohysterogram signal for characterization of contractions during pregnancy. IEEE Trans Biomed Eng 46:1222–1229
Maul H, Maner WL, Olson G, Saade GR, Garfield RE (2004) Non-invasive transabdominal uterine electromyography correlates with the strength of intrauterine pressure and is predictive of labor and delivery. J Matern Fetal Neonatal Med 15:297–301
Mischi M, Chen C, Ignatenko T, de Lau H, Ding B, Oei SGG, Rabotti C (2018) Dedicated entropy measures for early assessment of pregnancy progression from single-channel electrohysterography. IEEE Trans Biomed Eng 65:875–884. https://doi.org/10.1109/TBME.2017.2723933
Most O, Langer O, Kerner R, Ben David G, Calderon I (2008) Can myometrial electrical activity identify patients in preterm labor? Am J Obstet Gynecol 199:378. https://doi.org/10.1016/j.ajog.2008.08.003
Petrou S (2005) The economic consequences of preterm birth during the first 10 years of life. BJOG 112:10–15. https://doi.org/10.1111/j.1471-0528.2005.00577.x
Rabotti C, Sammali F, Kuijsters N, et al (2015) Analysis of uterine activity in nonpregnant women by electrohysterography: a feasibility study. In: Proc Annu Int Conf IEEE Eng Med Biol Soc EMBS pp 5916–5919
Schlembach D, Maner WL, Garfield RE, Maul H (2009) Monitoring the progress of pregnancy and labor using electromyography. Eur J Obstet Gynecol Reprod Biol 144:2–8. https://doi.org/10.1016/j.ejogrb.2009.02.016
Sikora J, Matonia A, Czabański R et al (2011) Recognition of premature threatening labour symptoms from bioelectrical uterine activity signals. Arch Perinat Med 17:97–103
Vinken MPGC, Rabotti C, Mischi M, van Laar JOEH, Oei SG (2010) Nifedipine-induced changes in the electrohysterogram of preterm contractions: feasibility in clinical practice. Obstet Gynecol Int 2010:325635. https://doi.org/10.1155/2010/325635
Vrhovec J, Lebar AM (2012) An uterine electromyographic activity as a measure of labor progression. Appl EMG Clin Sport Med 243–268. doi: https://doi.org/10.5772/25526
Vrhovec J, Macek-Lebar A, Rudel D (2007) Evaluating uterine electrohysterogram with entropy. 11th Mediterr Conf Med Biomed Eng Comput 144–147. https://doi.org/10.1007/978-3-540-73044-6_36
Ye-Lin Y, Bueno-Barrachina JM, Prats-boluda G, Rodriguez de Sanabria R, Garcia-Casado J (2017) Wireless sensor node for non-invasive high precision electrocardiographic signal acquisition based on a multi-ring electrode. Measurement 97:195–202. https://doi.org/10.1016/J.MEASUREMENT.2016.11.009
Ye-Lin Y, Garcia-Casado J, Prats-Boluda G, Alberola-Rubio J, Perales A (2014) Automatic identification of motion artifacts in EHG recording for robust analysis of uterine contractions. Comput Math Methods Med 2014:1–11. https://doi.org/10.1155/2014/470786
Zhang XS, Roy RJ, Jensen EW (2001) EEG complexity as a measure of depth of anesthesia for patients. IEEE Trans Biomed Eng 48:1424–1433. https://doi.org/10.1109/10.966601
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”
Rights and permissions
About this article
Cite this article
Mas-Cabo, J., Prats-Boluda, G., Perales, A. et al. Uterine electromyography for discrimination of labor imminence in women with threatened preterm labor under tocolytic treatment. Med Biol Eng Comput 57, 401–411 (2019). https://doi.org/10.1007/s11517-018-1888-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11517-018-1888-y