Uterine Activity Monitoring during Labour – A Multi-Centre, Blinded Two-Way Trial of External Tocodynamometry against Electrohysterography

PURPOSE The aim of this study was to determine the quality of intrapartum uterine activity (UA) monitoring in daily practice during the first and second stages of labour. The total duration of inadequate UA monitoring is quantified in relation to the technique applied, namely, external tocodynamometry (TOCO) or electrohysterography (EHG). MATERIAL AND METHODS 144 UA recordings, collected from 1st September 2008 until 15th October 2009 from deliveries at the Marien-Hospital Witten, Germany, were analysed by obstetricians based at different centres. The included recordings were from singleton and simultaneously with external TOCO and EHG monitored pregnancies. External TOCO and EHG UA recordings were blinded. RESULTS The percentages of "adequate" UA recordings in the first and second stages of labour were much higher for the external EHG than the external TOCO mode (p<0.001). All doctors evaluated the UA assessment as "easier" (p <0.001) using the EHG compared with TOCO. CONCLUSION Intrapartum UA monitoring in -daily practice via the EHG mode provides a more recognisable UA trace than the TOCO.

[1]  C Marque,et al.  Uterine electromyography: a critical review. , 1993, American journal of obstetrics and gynecology.

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

[3]  Augmentation of Labor: Does Internal Tocography Result in Better Obstetric Outcome Than External Tocography? , 1990, Obstetrics and gynecology.

[4]  Dorothee E. Marossero,et al.  Monitoring Contractions in Obese Parturients: Electrohysterography Compared With Traditional Monitoring , 2007, Obstetrics and gynecology.

[5]  G. Saade,et al.  Predicting Term and Preterm Delivery With Transabdominal Uterine Electromyography , 2003, Obstetrics and gynecology.

[6]  H. V. van Geijn,et al.  The quality of intrapartum uterine activity monitoring. , 2008, Journal of perinatal medicine.

[7]  John G. Harris,et al.  Prediction of Intrauterine Pressure From Electrohysterography Using Optimal Linear Filtering , 2006, IEEE Transactions on Biomedical Engineering.

[8]  William L. Maner,et al.  Identification of Human Term and Preterm Labor using Artificial Neural Networks on Uterine Electromyography Data , 2007, Annals of Biomedical Engineering.

[9]  William L. Maner,et al.  Characterization of abdominally acquired uterine electrical signals in humans, using a non-linear analytic method , 2006, Medical and Biological Engineering and Computing.

[10]  Massimo Mischi,et al.  Estimation of internal uterine pressure by joint amplitude and frequency analysis of electrohysterographic signals , 2008, Physiological measurement.

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

[12]  Holger Maul,et al.  Use of uterine EMG and cervical LIF in monitoring pregnant patients , 2005, BJOG: an International Journal of Obstetrics and Gynaecology.

[13]  G J HERTSCH,et al.  Electrical activity of the human uterus in labor; the electrohysterograph. , 1950, American Journal of Obstetrics and Gynecology.

[14]  G. Visser,et al.  A validation of electrohysterography for uterine activity monitoring during labour , 2009, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[15]  Induction of Labour: Does Internal Tocography Result in Better Obstetric Outcome than External Tocography , 1993, The Australian & New Zealand journal of obstetrics & gynaecology.

[16]  G. Saade,et al.  Non-invasive transabdominal uterine electromyography correlates with the strength of intrauterine pressure and is predictive of labor and delivery , 2004, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[17]  G. Wolfs,et al.  Electromyographic Observations on the Human Uterus during Labour , 1979, Acta obstetricia et gynecologica Scandinavica. Supplement.

[18]  S. Thacker,et al.  Continuous electronic heart rate monitoring for fetal assessment during labor. , 2006, The Cochrane database of systematic reviews.

[19]  G. Saade,et al.  Comparing uterine electromyography activity of antepartum patients versus term labor patients. , 2005, American journal of obstetrics and gynecology.

[20]  S. Arulkumaran,et al.  Cardiotocography and medicolegal issues. , 2004, Best practice & research. Clinical obstetrics & gynaecology.

[21]  J. Jezewski,et al.  Quantitative analysis of contraction patterns in electrical activity signal of pregnant uterus as an alternative to mechanical approach , 2005, Physiological measurement.

[22]  W. Maner,et al.  Physiology and electrical activity of uterine contractions. , 2007, Seminars in cell & developmental biology.

[23]  T. Vanner,et al.  Intrapartum assessment of uterine activity. , 1996, Bailliere's clinical obstetrics and gynaecology.

[24]  Mark D. Skowronski,et al.  Prediction of intrauterine pressure waveform from transabdominal electrohysterography , 2006, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.