A model for educational simulation of the evolution of uterine contractions during labor

Electronic fetal monitoring remains an important tool in labor ward settings, providing continuous information on fetal heart rate and maternal uterine contractions. A prompt detection of abnormalities in these signals is essential for the timely resolution of situations that may put both mother and fetus at risk. Uterine contraction signals provide information that is important to evaluate the onset and progress of labor, as well as the significance of certain fetal heart rate abnormalities. We present a model for educational simulation of the spontaneous evolution of uterine contractions during labor, which combines a previously published signal generator with literature-based pre-programmed scripts for educationally relevant scenarios. This model is an essential component of a high-fidelity simulator of intrapartum emergencies, aimed to improve the competency of healthcare providers. Real and simulated tracings were presented to three independent clinical experts who judged simulated signals to be indistinguishable or negligibly different from real tracings.

[1]  Andrew Whitelaw,et al.  Does training in obstetric emergencies improve neonatal outcome? , 2006, BJOG : an international journal of obstetrics and gynaecology.

[2]  E. Sadovsky,et al.  The relationship between fetal heart rate accelerations, fetal movements, and uterine contractions. , 1984, American journal of obstetrics and gynecology.

[3]  A. Miles,et al.  Correlation of external and internal monitoring of uterine activity in a cohort of term patients. , 2001, American journal of perinatology.

[4]  H. V. van Geijn,et al.  Uterine activity monitoring during labor , 2007, Journal of perinatal medicine.

[5]  Richard Cookson,et al.  Royal College of Obstetricians and Gynaecologists. The Use of Electronic Fetal Monitoring full guidance published by the RCOG. RCOG Clinical Effectiveness Support Unit, London , 2001 .

[6]  H. V. van Geijn,et al.  Uterine activity: implications for the condition of the fetus , 2008, Journal of perinatal medicine.

[7]  S. Arulkumaran,et al.  Symptoms and Signs with Scar Rupture ‐ Value of Uterine Activity Measurements , 1992, The Australian & New Zealand journal of obstetrics & gynaecology.

[8]  S. Wray,et al.  The Physiological Basis of Uterine Contractility: A Short Review , 2001, Experimental physiology.

[9]  K. Matsuo,et al.  Staircase sign: A newly described uterine contraction pattern seen in rupture of unscarred gravid uterus , 2008, The journal of obstetrics and gynaecology research.

[10]  Doina Precup,et al.  Identification of the Dynamic Relationship Between Intrapartum Uterine Pressure and Fetal Heart Rate for Normal and Hypoxic Fetuses , 2009, IEEE Transactions on Biomedical Engineering.

[11]  H. Gee,et al.  Scar rupture in labour after previous lower uterine segment caesarean section: the role of uterine activity measurement , 1991, British journal of obstetrics and gynaecology.

[12]  J. Parer.  Handbook of Fetal Heart Rate Monitoring , 1983 .

[13]  Odendaal Hj,et al.  Uterine contraction patterns in abruptio placentae. , 1985 .

[14]  E. Cobo,et al.  Uterine behavior in abruptio placentae. I. Contraction patterns and their reactivity to oxytocin. , 1965, American journal of obstetrics and gynecology.

[15]  H. Odendaal,et al.  Raised uterine resting tone in patients with abruptio placentae , 1985, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[16]  P. Gill,et al.  Spontaneous prolonged hypertonic uterine contractions (essential uterine hypertonus) and a possible infective etiology , 2002, Archives of Gynecology and Obstetrics.

[17]  K. Leveno,et al.  Williams Manual of Obstetrics , 2002 .

[18]  S. Wray.  Uterine contraction and physiological mechanisms of modulation. , 1993, The American journal of physiology.

[19]  K. Jackson,et al.  Increasing baseline intrauterine pressure associated with impending spontaneous uterine rupture , 1997, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[20]  M L Barclay,et al.  A Computer Model of Uterine Contractions Based on Discrete Contractile Elements , 1995, Obstetrics and gynecology.

[21]  J. Hasbún,et al.  [Intrapartum fetal distress]. , 1994, Revista chilena de obstetricia y ginecologia.

[22]  K. M. Sweeten,et al.  Spontaneous rupture of the unscarred uterus. , 1995, American journal of obstetrics and gynecology.

[23]  J. Phelan,et al.  Uterine rupture: are intrauterine pressure catheters useful in the diagnosis? , 1989, American journal of obstetrics and gynecology.

[24]  G. Harbert.  Assessment of uterine contractility and activity. , 1992, Clinical obstetrics and gynecology.

[25]  M. Lancet,et al.  Sinusoidal Pattern of Uterine Contractions in Abruptio Placentae , 1980, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[26]  L. Korst,et al.  Uterine Activity Patterns in Uterine Rupture: A Case‐Control Study , 1998, Obstetrics and gynecology.

[27]  R. Young,et al.  A Computer Model of Uterine Contractions Based on Action Potential Propagation and Intercellular Calcium Waves , 1997, Obstetrics and gynecology.

[28]  A Mathematical Model of Uterine Dynamics and its Application to Human Parturition , 2000, Acta biotheoretica.

[29]  J. Guise.  Anticipating and responding to obstetric emergencies. , 2007, Best practice & research. Clinical obstetrics & gynaecology.

[30]  M. Druzin,et al.  Use of Simulation Based Team Training for Obstetric Crises in Resident Education , 2008, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[31]  T. Eskes,et al.  Abruptio placentae : A "classic" dedicated to Elizabeth Ramsey , 1997 .

[32]  Diogo Ayres-de-Campos,et al.  An intrauterine pressure generator for educational simulation of labour and delivery. , 2010, Medical engineering & physics.

[33]  R. Simon,et al.  Obstetric Simulation as a Risk Control Strategy: Course Design and Evaluation , 2008, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[34]  H. Odendaal.  The frequency of uterine contractions in abruptio placentae. , 1976, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.