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Background: The literature suggests that the Jarisch–Herxheimer (J-H) reaction following antimicrobial treatment of syphilis is common and may precipitate uterine activity. Local practice is to transfer syphilitic parturients beyond gestational age of viability from rural locations to a tertiary care centre for treatment. Study objectives were to delineate local incidence and risk factors for the J-H reaction among pregnant women receiving treatment for syphilis. Methods: A retrospective chart review was conducted on pregnant women diagnosed with syphilis and treated during pregnancy at a tertiary care centre between 2012 and 2018. J-H reaction was defined as having ≥1 of the following symptoms within 24 hours of antibiotic treatment: fever (temperature ≥38°C), clinical description of a painful or itchy skin lesion, headache, hypotension (systolic blood pressure

Introduction: Preterm birth (PTB) is common, occurring in over 10% of all live births globally, and is increasing worldwide. The limitations of traditional biomarkers of PTB, such as fetal fibronectin (fFN) and phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as placental alpha macroglobulin-1 (PAMG-1); PartoSure, has the potential to improve disease monitoring and the best interventions. Areas covered: The present expert opinion evaluates the utility and limitations of PAMG-1; PartoSure as a biomarker for PTB in light of the current literature. Expert opinion: Although fFN, phIGFBP-1 and PAMG-1; PartoSure test had similar negative predictive value (NPV) and negative likelihood ratio (LR-), the PAMG-1; PartoSure test had the highest specificity, positive predictive value (PPV), and positive likelihood ratio (LR+) across all at-risk pregnant women. Although findings of this review may be encouraging, the PartoSure test should not be interpreted as absolute evidence for prediction of PTB. The PartoSure test result should always be used in conjunction with information available from the clinical evaluation of the pregnant woman and other diagnostic procedures such as cervical examination, assessment of uterine activity, and evaluation of other risk factors.

In this study it is presented the implementation of a low-cost automated prototype, in an open code platform, that simulates maternal fetal signals, allowing test executions and fetal detectors. The goal is guaranteeing the use of these equipments in a safe, effective way in the monitoring of maternal fetal signals in hospital environments, since the simulator is used to evaluate the correct use of the equipment. Another possible application of the simulator is as a teaching tool. The results are demonstrated in a man-machine interface, the views of the measurements of fetal movement, uterine activity and fetal heart rate, generated by the simulator. The values demonstrated in the man-machine interface can be compared with the ones presented by the fetal monitor. With this comparison it is possible to check the correct functioning of the equipment tested.

Introduction Labor dystocia is the most common cause of cesarean birth in the United States, yet how dystocia develops during labor remains elusive. Uterine activity monitoring has significant potential for advancing our understanding of labor dystocia. While evaluating contraction frequency and amplitude is a common component of labor dystocia management, the literature describing the relationship between measures of uterine activity and labor dystocia is heterogeneous and has not been synthesized to identify the best methods for use in clinical investigation. Methods We conducted a literature search for original research exploring the relationship between uterine activity and labor dystocia published between 2000 and 2019. Included articles were critically reviewed and synthesized. Results Across 11 identified studies, investigators employed 3 different techniques for monitoring uterine activity and 9 different measures were employed. Uterine activity measures, including Montevideo units, uterine electromyography power density spectrum and sample entropy, and the fall-to-rise ratio of contraction shape, detected patterns associated with labor dystocia or cesarean birth. Discussion The use of multiple regression with clinical covariates and a uterine activity measure increased the accuracy of predicting cesarean delivery. Uterine electromyography may be especially useful to evaluate labor dystocia phenotypes to differentiate uterine muscle fatigue from understimulation and lead to algorithms for increased precision in the diagnosis of labor dystocia and innovative approaches to treatment.

Research objective: to study the use of uterine activity and variables of acceleration capacity (AC) and deceleration capacity (DC) in uterine contractile activity and fetal well-being monitoring in women at risk of preterm birth.Materials and methods. 292 pregnant women were included in the prospective study. All involved women underwent ultrasound cervicometry at 16 weeks. 124 pregnant women with a “short cervix” of the III (main) group were observed in the dynamics, as well as uterine activity and fetal AC/DC at 26, 32 and 38 weeks of gestation, and during labor were studied. In 112 women of group II the variables of fetal AC/DC were detected at these terms of pregnancy. They were monitored via conventional cardiotocography during labor. 56 pregnant women in group I with normal cervicometry were monitored.Results. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the main group was 97.30% and 94.74% respectively. Diagnostic accuracy in the case of uterine activity according to fetal non-invasive electrocardiography was 96.18%. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the comparison group were significantly lower: 89.29% and 87.80% respectively. The diagnostic accuracy was 88.41%.Patients in all clinical groups at 26 weeks had low AC/DC values. However, later in women of group I was found highest AC/DC level. AC/DC values in patients with risk of preterm birth were reduced compared with controls (p < 0.05). Sensitivity and specificity of the diagnosis of fetal distress if AC/DC was used were 91.67% and 99.12% respectively. Diagnostic accuracy of the test was 98.41%. In the comparison group the sensitivity was 77.78%, and the specificity was 89.22%. Diagnostic accuracy of intranatal cardiotocography was 86.82%.Conclusions. Uterine activity extracted from the maternal abdominal signal can significantly improve the diagnosis of the threatenedpreterm delivery. Patients at risk of preterm birth have a delayed fetal neurological, which leads to fetal distress. AC/DC variables obtained via fetal non-invasive electrocardiography allow increasing the accuracy of fetal distress diagnosis., Цель исследования: изучение возможностей использования маточной активности и показателей акцелераций (AC) и децелераций (DC) для мониторинга сократительной деятельности матки и состояния плода у женщин с угрозой преждевременных родов (ПР).Материалы и методы. В проспективном исследовании приняли участие 292 беременные. Всем участницам исследования в сроке 16 недель проводили ультразвуковую цервикометрию. Женщины были разделены на три группы: III (основная) группа – 124 беременные с «короткой шейкой», которых наблюдали в динамике и изучали маточную активность и показатели АС/DC у плода на 26, 32 и 38 неделях беременности, а также при родах; II группа – 112 женщин, у которых в указанные сроки беременности изучали только показатели АС/DC плода, а в родах проводили традиционную кардиотокографию; I группа – 56 беременных с нормальными показателями цервикометрии.Результаты. Чувствительность и специфичность диагноза угрозы ПР составляла в основной группе соответственно 97,30% и 94,74%. Диагностическая точность при использовании маточной активности по данным неинвазивной ЭКГ плода – 96,18%. В группе сравнения чувствительность и специфичность диагноза угрозы ПР были значительно ниже и составляли соответственно 89,29% и 87,80%. Диагностическая точность составила 88,41%.В 26 недель у пациенток всех клинических групп значения AC/DC были низкими. Однако в дальнейшем наивысший уровень AC/DC был установлен у женщин I группы. У пациенток с угрозой ПР показатели AC/DC были снижены по сравнению с контролем (р < 0,05). Чувствительность и специфичность диагноза дистресса плода в случае использования показателей АС/DC составляли соответственно 91,67% и 99,12%. Диагностическая точность теста – 98,41%. В группе сравнения чувствительность составила 77,78%, а специфичность – 89,22%. Диагностическая точность интранатальной кардиотокографии составила 86,82%.Выводы. Использование маточной активности, выделенной из абдоминального сигнала матери, позволяет значительно улучшить диагностику угрозы ПР. У пациенток с угрозой ПР наблюдается замедленное развитие автономной нервной регуляции, что приводит к возникновению дистресса плода. Применение показателей AC/DC по данным неинвазивной ЭКГ позволяет повысить точность диагностики дистресса плода., Мета дослідження: вивчення можливостей застосування маткової активності та показників акцелерацій (AC) і децелерацій (DC) для моніторингу скоротливої діяльності матки та стану плода у жінок із загрозою передчасних пологів (ПП). Матеріали та методи. У проспективному дослідженні взяли участь 292 вагітні. Усім учасницям дослідження у терміні 16 тижнів проводили ультразвукову цервікометрію. Жінок було розподілено на три групи: ІІІ (основна) група – 124 вагітні з «короткою шийкою», за якими спостерігали в динаміці та вивчали маткову активність і показники АС/DC у плода на 26, 32 і 38 тижнях вагітності, а також під час пологів; ІІ група – 112 жінок, в яких у вказані терміни вагітності вивчали лише показники АС/DC плода, а в пологах проводили традиційну кардіотокографію; I група – 56 вагітних із нормальними показниками цервікометрії. Результати. Чутливість і специфічність діагнозу загрози ПП становила в основній групі відповідно 97,30% і 94,74%. Діагностична точність при використанні маткової активності за даними неінвазивної ЕКГ плода – 96,18%. У групі порівняння чутливість і специфічність діагнозу загрози ПП були значно нижчими і становили відповідно 89,29% і 87,80%. Діагностична точність склала 88,41%. У 26 тижнів у пацієнток всіх клінічних груп значення AC/DC були низькими. Проте в подальшому найбільший рівень AC/DC був визначений у жінок І групи. У пацієнток із загрозою ПП показники AC/DC були знижені в порівнянні з контролем (р < 0,05). Чутливість і специфічність діагнозу дистресу плода в разі використання показників АС/DC склали відповідно 91,67% і 99,12%. Діагностична точність тесту складала 98,41%. У групі порівняння чутливість становила 77,78%, а специфічність – 89,22%. Діагностична точність інтранатальної кадіотокографії склала 86,82%. Висновки. Використання маткової активності, виділеної з абдомінального сигналу матері, дозволяє значно покращити діагностику загрози ПП. У пацієнток із загрозою ПП спостерігається сповільнений розвиток автономної нервової регуляції, що призводить до виникнення дистресу плода. Застосування показників AC/DC за даними неінвазивної ЕКГ дає змогу підвищити точність діагностики дистресу плода.

In-vitro fertilization (IVF) is the most advanced treatment for infertility problems; however, its failure rate is still above 70% and the exact causes are often unknown. There is increasing evidence of the involvement of uterine contractions in IVF failure, especially during and after embryo transfer (ET). In this paper, we propose a new method to predict the success of IVF based on quantitative features extracted from electrohysterography (EHG) and B-mode transvaginal ultrasound (TVUS) recordings. To this end, probabilistic classification of the uterine activity, as either favorable or adverse to embryo implantation, is investigated using machine learning. Prior to machine learning, an additional method for EHG and TVUS feature extraction is here proposed that is based on singular value decomposition of the acquired EHG and TVUS recordings. Sixteen women were measured during three phases of the IVF treatment: follicular stimulation (FS), one hour before embryo transfer (ET1), and five to seven days after ET (ET5-7). After feature space reduction by correlation filtering, three machine-learning models, namely, support vector machine (SVM), K-nearest neighbors (KNN), and Gaussian mixture model (GMM), were optimized and tested by nested leave-one-out cross validation for their ability to predict successful embryo implantation. The highest accuracy (93.8%) was achieved by KNN in all phases and by SVM and in the FS and ET1 phases. Contraction frequency, unnormalized first moment and standard deviation, obtained from EHG and TVUS analysis, were the best features selected by the three classifiers. Our results show a multi-modal, multi-parametric strategy based on quantitative features to represent a novel, promising option for prediction of successful embryo implantation, overcoming the limitations of alternative approaches based on qualitative assessment of clinical variables. Yet, a larger dataset is required for improved training of the classifiers, as well as to assess their clinical value in the context of IVF procedures.

Nipple stimulation has been documented as a method of birth induction and cervical ripening in many cultures...

La monitoria fetal intraparto hace parte de las pruebas para la valoracion del bienestar fetal. Es metodo de facil realizacion e interpretacion, no invasivo, de bajo costo, reproducible, sin efectos secundarios ni contraindicaciones. El objetivo fundamental del estudio es la evaluacion del estado fetal durante el parto, identificando los fetos que posiblemente puedan estar comprometidos. Ello se determina por alteraciones en las siguientes variables. [A] Frecuencia, variabilidad y desaceleraciones del ritmo cardiaco fetal. [B] Movimientos fetales. [C] Cambios en la actividad cardiaca en relacion con la actividad uterina. Los hallazgos permiten clasificar el estado fetal en tres categorias. Asi se pueden establecer medidas oportunas antes que se produzcan danos irreversibles en el feto o en el peor de los casos la muerte fetal. Rev.cienc.biomed. 2015;6(1):170- 178 PALABRAS CLAVE Cardiotocografia; monitoreo fetal; Frecuencia cardiaca fetal; Trabajo de parto. SUMMARY The intrapartum fetal monitoring is part of the tests to assess the fetal well-being. It is an easy, cheap, reproducible and non-invasive method without adverse effects or contraindications. The main objective of this method is to assess the fetal status during the obstetric labor, identifying the fetus that probably could have alterations. It is deter­mined for alterations in the next variables: [A] Frequency, variability and decelerations of the fetal cardiac rhythm [B] Fetal movements. [C] Changes in the cardiac activity ac­cording to the uterine activity. The findings allow classifying the fetal status in three cat­egories. And in this way, the adequate measures could be established before irreversible lesions and death could occur in the fetus. Rev.cienc.biomed. 2015;6(1):170-178 KEYWORDS Cardiotocography; Fetal Monitoring; Heart fetal rate; Obstetric labor.

The proposed dataset provides annotations for the 552 cardiotocographic (CTG) recordings included in the publicly available "CTU-CHB intra-partum CTG database" from Physionet (https://physionet.org/content/ctu-uhb-ctgdb/1.0.0/). Each CTG recording is composed by two simultaneously acquired signals: i) the fetal heart rate (FHR) and ii) the maternal tocogram (representing uterine activity). Annotations consist in the detection of starting and ending points of specific CTG events on both FHR signal and maternal tocogram. Annotated events for the FHR signal are the bradycardia, tachycardia, acceleration and deceleration episodes. Annotated events for the maternal tocogram are the uterine contractions. The dataset also reports classification of each deceleration as early, late, variable or prolonged, in relation to the presence of a uterine contraction. Annotations were obtained by an expert gynecologist with the support of CTG Analyzer, a dedicated software application for automatic analysis of digital CTG recordings. These annotations can be useful in the development, testing and comparison of algorithms for the automatic analysis of digital CTG recordings, which can make CTG interpretation more objective and independent from clinician's experience.

The Cardiotocography is the most broadly utilized technique in obstetrics practice to monitor fetal health condition. The foremost motive of monitoring is to detect the fetal hypoxia at early stage. This modality is also widely used to record fetal heart rate and uterine activity. The exact analysis of cardiotocograms is critical for further treatment. In this manner, fetal state evaluation utilizing machine learning technique using cardiotocogram data has achieved significant attention. In this paper, we implement a model based CTG data classification system utilizing a supervised Random Forest (RF) which can classify the CTG data based on its training data. As per the showed up results, the overall performance of the supervised machine learning based classification approach provided significant performance. In this study, Precision, Recall and F-Score has been employed as the metric to evaluate the performance. It was found that, the RF based classifier could identify normal, suspicious and pathologic condition, from the nature of CTG data with 94.8% accuracy. We also highlight the major features based on Mean Decrease Accuracy and Mean Decrease Gini.

[EN] Electrohysterography (EHG) has been shown to provide relevant information on uterine activity and could be used for predicting preterm labor and identifying other maternal fetal risks. The extraction of high-quality robust features is a key factor in achieving satisfactory prediction systems from EHG. Temporal, spectral, and non-linear EHG parameters have been computed to characterize EHG signals, sometimes obtaining controversial results, especially for non-linear parameters. The goal of this work was to assess the performance of EHG parameters in identifying those robust enough for uterine electrophysiological characterization. EHG signals were picked up in different obstetric scenarios: antepartum, including women who delivered on term, labor, and post-partum. The results revealed that the 10th and 90th percentiles, for parameters with falling and rising trends as labor approaches, respectively, differentiate between these obstetric scenarios better than median analysis window values. Root-mean-square amplitude, spectral decile 3, and spectral moment ratio showed consistent tendencies for the different obstetric scenarios as well as non-linear parameters: Lempel-Ziv, sample entropy, spectral entropy, and SD1/SD2 when computed in the fast wave high bandwidth. These findings would make it possible to extract high quality and robust EHG features to improve computer-aided assessment tools for pregnancy, labor, and postpartum progress and identify maternal fetal risks., This work was supported by the Spanish Ministry of Economy and Competitiveness, the European Regional Development Fund (MCIU/AEI/FEDER, UE RTI2018-094449-A-I00-AR) and the Generalitat Valenciana (AICO/2019/220 & GV/2018/104)

Background Increased uterine activity (UA) may not allow adequate recovery time for foetal oxygenation. Methods The aim of the study was to determine if increased UA during labour is associated with an increased risk of either short- or long-term neurological injury in term neonates, or with neonatal proxy measures of intrapartum hypoxia-ischemia. MEDLINE, CINAHL, and ClinicalTrials.gov were searched using the following terms: uterine activity, excessive uterine activity, XSUA, uterine hyperstimulation, and tachysystole. Any study that analysed the relationship between UA during term labour and neurological outcomes/selected proxy neurological outcomes was eligible for inclusion. Outcomes from individual studies were reported in tables and presented descriptively with odds ratios (OR) and 95% confidence intervals (CI) for dichotomous outcomes and means with standard deviations for continuous outcomes. Where group numbers were provided, ORs and their CIs were calculated according to Altman. Main results Twelve studies met the inclusion criteria. Seven studies featured umbilical artery pH as an individual outcome. Umbilical artery base excess and Apgar scores were both reported as individual outcomes in four studies. No study examined long term neurodevelopmental outcomes and only one study reported on encephalopathy as an outcome. The evidence for a relationship between UA and adverse infant outcomes was inconsistent. The reported estimated effect size varied from non-existent to clinically significant. Conclusions There is some evidence that increased UA may be a non-specific predictor of depressed neurological function in the newborn, but it is inconsistent and insufficient to support the conclusion that an association generally exists.

A novel technique for detection and recognition of normal and premature births is proposed and experimentally examined. It is based on the extraction of novel class of informative features contained in higher-order spectrum, namely, bispectrum of the abdominal electromyography signals registered on the abdominal surface of pregnant woman. It is demonstrated that the amplitude bispectrum, phase bispectrum and bicoherence signatures computed for electromyography signals can serve as the perspective facilities for detection and recognition of the normal and premature births. The proposed bispectrum-based information features were studied by real-life experimental data processing. Uterine activity corresponding to two weeks and one week before birth for several patients has been investigated. Experimental results obtained for a number of the patients demonstrate the possibility to extract novel classification features contained in the computed biamplitude, biphase and bicoherence signatures. acceptedVersion

Monitoring the progression of uterine activity provides important prognostic information during pregnancy and delivery. Currently, uterine activity monitoring relies on direct or indirect mechanical measurements of intrauterine pressure (IUP), which are unsuitable for continuous long-term observation. The electrohysterogram (EHG) provides a non-invasive alternative to the existing methods and is suitable for long-term ambulatory use. Several published state-of-the-art methods for EHG-based IUP estimation are here discussed, analyzed, optimized, and compared. By means of parameter space exploration, key parameters of the methods are evaluated for their relevance and optimal values. We have optimized all methods towards higher IUP estimation accuracy and lower computational complexity. Their accuracy was compared with the gold standard accuracy of internally measured IUP. Their computational complexity was compared based on the required number of multiplications per second (MPS). Significant reductions in computational complexity have been obtained for all published algorithms, while improving IUP estimation accuracy. A correlation coefficient of 0.72 can be obtained using fewer than 120 MPS. We conclude that long-term ambulatory monitoring of uterine activity is possible using EHG-based methods. Furthermore, the choice of a base method for IUP estimation is less important than the correct selection of electrode positions, filter parameters, and postprocessing methods. The presented review of state-of-the-art methods and applied optimizations show that long-term ambulatory IUP monitoring is feasible using EHG measurements.

Uterine activity plays a crucial role in labor, especially when utero-tonic materials are administered. We aimed to determine the electrical responsiveness of the uterine musculature to labor augmentation with oxytocin using electrical uterine myography (EUM) technology, and to assess whether the kinetics of the EUM device may serve as a predictor for successful vaginal delivery. EUM prospectively measured electrical uterine activity in women with singleton gestations at term (≥ 37 + 0 weeks) undergoing labor augmentation by oxytocin administration. The results were reported as the EUM index, which represented the mean electrical activity in 10-min intervals and measured in units of microwatt per second (mW/s). Measurements were performed at least 30 min before oxytocin initiation and until at least four contractions per 10 min were recorded by standard tocodynamometry. The delta EUM index was defined as the difference between the mean EUM index before and after the initiation of oxytocin. The mean EUM index increased significantly during oxytocin augmentation in all the parturients (P

In this issue, Hautakangas et al report that "we found significantly lower intrauterine pressure (IUP) in failed Trial Of Labour After Caesarean (TOLAC), compared with Vaginal Birth After Caesarean", although "the dosages of oxytocin tended to be higher among failed TOLACs". They commented that "it seems that raising the oxytocin dosage does not necessarily improve uterine contractile activity in this group". Why is this?

What you need to know Preterm birth and its complications account for nearly one million neonatal deaths each year globally.1 Women who present with a dilated cervix in the second trimester are at increased risk of pregnancy loss and preterm birth (fig 1). They generally have no or minimal preceding symptoms such as change in discharge or mild abdominal pain and are detected to have a dilated cervix on examination. Cervical dilatation may also be detected in the anomaly scan. Fig 1 Premature cervical dilatation and exposed unruptured fetal membranes International guidelines from the US, UK, and Canada suggest considering emergency cervical cerclage, or rescue cerclage, to prevent preterm birth in women presenting with cervical dilatation and exposed fetal membranes between 16 and 28 weeks of gestation if there are no signs of bleeding, infection, or uterine activity (see box 1).2 Box 1 ### NICE guidelines for management of preterm labour and birth (NG25)2 #### Women with a closed cervixRETURN TO TEXT

Antenatal corticosteroids before preterm births are considered to be most effective 48 h after and up to 1 week after the first dose. We aim to evaluate: (1) our practice of administration of antenatal corticosteroids in Singapore; (2) admission characteristics of women for discriminatory factors of spontaneous preterm delivery within 1 week. This is a retrospective study in a tertiary obstetrics unit in Singapore. 3044 women who delivered live births (at term or preterm) from 1st November 2014 to 31st January 2015, who were at risk of spontaneous or induced preterm delivery, were included. Data related to the time of and indications for antenatal corticosteroids administration, characteristics assessed at the time of presentation, and time of delivery were collected and analysed. 85.9% of women who delivered at gestational age ≤ 34+6 received at least one dose. 22.1% had delivered within the window of efficacy. Gestational age > 32 weeks at presentation, uterine activity on tocography and cervical dilation with effacement were associated with preterm delivery within 1 week of presentation. Overall, our antenatal corticosteroids administration rate is comparable to that attained by centres in other developed countries. It is difficult but important to discriminate women who will benefit from this timely intervention.

Monitoring uterine contractions is essential during pregnancy and labor to obtain information on time-to-delivery and maternal and fetal wellbeing Intrauterine pressure (IUP) is considered the "gold standard" to monitor uterine activity, though it requires membrane rupture and is highly invasive. Considering that uterine mechanical activity is a direct consequence of uterine myoelectrical activity, IUP signal can be non-invasively estimated from abdominal electrohysterogram (EHG) recordings. Previous works have reported EHG-based IUP estimates with linear parameters as root-mean-square or Teager energy. Due to non-linear nature of biological processes, the aim of this study was to test the performance of different non-linear EHG parameters to estimate IUP signal. Simultaneous EHG and IUP recordings were conducted in 17 women during labour. Teager energy (TE), Sample entropy (SampEn), Spectral entropy (SpEn), Lempel-Ziv (LZ), and Poincare parameters: SD1, SD2, SDRR and SD1/SD2 were computed from the EHG. Different window lengths for computation and for a smoothing moving average filter were tested. Mono-variable linear regression models were used to obtain IUP estimates. The best results were obtained with TE and SD1, both computed and filtered with windows of 5 s and 20 s, respectively. In the latter case, the RMSerror was 12.25 +/- 4.03 mmHg, which points that non-linear EHG parameters can provide relevant information for non-invasive uterine activity monitoring.

Stillbirths are a worldwide challenge, with an estimated 2.6 million stillbirths in 2015, of these 1.3 million are estimated to have died during labour and birth, i.e. fresh stillbirth. In addition to the 2.6 million, one million newborns die within their first and only day of life. Complications due to birth asphyxia are the primary cause of these deaths. The vast majority, 98%, of stillbirths and early neonatal deaths are found in low resource settings. This thesis investigates two main challenges related to neonatal deaths, 1) fetal heart rate (FHR) and labour analysis, and 2) improving newborn resuscitation. The FHR is known to be important for effectively assessing the well-being of the fetus during labour. In high resource countries, the FHR is measured using cardiotocography for all high-risk labours. While in low income countries, assessment of the FHR is often done manually using a Pinard. With the use of continuous FHR monitoring in low income countries, abnormalities in FHR could potentially be identified at an earlier stage. In this thesis, we facilitate for further analysis of FHR signals by proposing a method to remove less trustworthy time periods of the measured signal, such as noise. And how missing data can be estimated using dictionary learning to allow for continuous analysis. The FHR signals should be interpreted in combination with the uterine activity. We therefore propose a method for detecting uterine contractions using an accelerometer mounted together with the Doppler ultrasound FHR sensor. Finally, we explore how FHR develops during labour and how this trend differs for labours with a normal and adverse outcomes. For newborns who are unable to start breathing themselves after birth, immediate help from the healthcare workers are crucial. We therefore explore which parameters during newborn resuscitation are important for the resuscitation outcome. One of the identified parameters is the amount of stimulation, i.e. rubbing the back of the newborn. To get a greater understanding of how stimulation affects newborn resuscitation, and how it should be applied, a large number of annotated resuscitation episodes are required. Manual annotation is both a time consuming and challenging process for the reviewer. We have proposed a complete system for automatically annotating stimulation by using ECG and accelerometer signals measured on the abdomen of the newborn.

The rate of labor induction is steadily increasing and, in industrialized countries, approximately one out of four pregnant women has their labor induced. Induction of labor should be considered when the benefits of prompt vaginal delivery outweigh the maternal and/or fetal risks of waiting for the spontaneous onset of labor. However, this procedure is not free of risks, which include an increase in operative vaginal or caesarean delivery and excessive uterine activity with risk of fetal heart rate abnormalities. A search for “Induction of Labor” retrieves more than 18,000 citations from 1844 to the present day. The aim of this review is to summarize the controversies concerning the indications, the methods, and the tools for evaluating the success of the procedure, with an emphasis on the scientific evidence behind each.

Fetal well-being is commonly assessed by monitoring the fetal heart rate (fHR). In clinical practice, the de facto standard technology for fHR monitoring is based on the Doppler ultrasound (US). Continuous monitoring of the fHR before and during labor is performed using a US transducer fixed on the maternal abdomen. The continuous fHR monitoring, together with simultaneous monitoring of the uterine activity, is referred to as cardiotocography (CTG). In contrast, for intermittent measurements of the fHR, a handheld Doppler US transducer is typically used. In this article, the technology of Doppler US for continuous fHR monitoring and intermittent fHR measurements is described, with emphasis on fHR monitoring for CTG. Special attention is dedicated to the measurement environment, which includes the clinical setting in which fHR monitoring is commonly performed. In addition, to understand the signal content of acquired Doppler US signals, the anatomy and physiology of the fetal heart and the surrounding maternal abdomen are described. The challenges encountered in these measurements have led to different technological strategies, which are presented and critically discussed, with a focus on the US transducer geometry, Doppler signal processing, and fHR extraction methods.

[EN] Background: Uterine activity monitoring is an essential part of managing the progress of pregnancy and labor. Although intrauterine pressure (IUP) is the only reliable method of estimating uterine mechanical activity, it is highly invasive. Since there is a direct relationship between the electrical and mechanical activity of uterine cells, surface electrohysterography (EHG) has become a noninvasive monitoring alternative. The Teager energy (TE) operator of the EHG signal has been used for IUP continuous pressure estimation, although its accuracy could be improved. We aimed to develop new optimized IUP estimation models for clinical application. Approach: We first considered enhancing the optimal estimation of IUP clinical features (maximum pressure and tonus) rather than optimizing the signal only (continuous pressure). An adaptive algorithm was also developed to deal with inter-patient variability. For each optimizing signal feature (continuous pressure, maximum pressure and tonus), individual (single patient), global (full database) and adaptive models were built to estimate the recorded IUP signal. The results were evaluated by computing the root mean square errors (RMSe): continuous pressure error (CPe), maximum pressure error (MPe) and tonus error (TOe). Main results: The continuous pressure global model yielded IUP estimates with Cpe = 14.61mm Hg, MPe = 29.17mm Hg and Toe = 7.8mm Hg. The adaptive models significantly reduced errors to CPe = 11.88, MPe = 16.02 and Toe = 5.61mm Hg. The EHG-based IUP estimates outperformed those from traditional tocographic recordings, which had significantly higher errors (CPe = 21.93, MPe = 26.97, and TOe = 13.96). Significance: Our results show that adaptive models yield better IUP estimates than the traditional approaches and provide the best balance of the different errors computed for a better assessment of the labor progress and maternal and fetal wellbeing., This research project was supported by the Spanish Ministry of Economy and Competitiveness, the European Regional Development Fund (DPI2015-68397-R), and by the projects UPV_ FE-2018-C03 and GV/2018/104.

Objetivo: describir las características del proceso de inducción del trabajo de parto relacionadas con el exceso de cesáreas en las mujeres a quienes se les realiza este procedimiento. Materiales y Métodos: cohorte histórica descriptiva en la que se incluyeron las gestantes sin antecedente de cesárea, con embarazo único, a término y presentación cefálica, sometidas a inducción del trabajo de parto en un hospital de tercer nivel de complejidad, en Medellín, Colombia, en el periodo de mayo de 2015 a octubre de 2016. Se excluyeron mujeres con feto muerto antes de la inducción. Muestreo consecutivo. Se midieron: edad materna, paridad, edad gestacional, indicación de la inducción del trabajo de parto, favorabilidad del cérvix, tiempo de la inducción, calidad de la actividad uterina lograda, tipo de parto, momento de la inducción en que se decide la cesárea. Para definir el cumplimiento de las recomendaciones de inducción se tuvieron como referencia las guías de práctica clínica de organizaciones internacionales de la especialidad y las nuevas directrices generadas en la propuesta de reducción de la primera cesárea del año 2012. Se utilizó estadística descriptiva. Resultados: de 2402 nacimientos se seleccionaron 289 que cumplieron con los criterios de inclusión. Se realizó cesárea al 48 % de las gestantes, a 60,8 % de las nulíparas y a 32,1 % de las multíparas someti- das a inducción. El 72,2 % de las que tenían cérvix desfavorable recibieron oxitocina como método de maduración cervical. A 108 (37%) de las mujeres llevadas a inducción de parto se les realizó cesárea por diagnóstico de inducción fallida que se conside- ró inadecuado en todas ellas, ya que el diagnóstico se realizó antes de alcanzar 6 cm de dilatación en 88 (81,5 %), con membranas íntegras en 67 (62 %), sin actividad uterina en 42 (38,9 %), con actividad uterina de mala calidad en 23 (21,3 %) y 55 (61 %), no tuvieron al menos 24 horas de fase latente antes de realizar la cesárea. Conclusión: se encontró falta de cumplimiento de las recomendaciones para una adecuada inducción que lleva a un diagnóstico errado de inducción fallida.

Recent warnings postulate a possible damaging effect of volatile anesthetics on the fetus. In our archive of fetal surgeries, we found wide variation in dosing of volatile anesthetics during spina bifida surgeries. We hypothesized that there was an association between volatile anesthetic exposure and uterine activity.Sixty anesthesia records from spina bifida operations were assessed. We analyzed the course of the administered volatile anesthetic during surgery and calculated from each patient's anesthesia record the volatile anesthetic exposure expressed in vol%h. We divided the records into two post hoc groups of the 20 lowest exposure (Group L) versus the 20 highest exposure (Group H), and compared them for uterine activity and fetal heart rate.The number of contractions per hour was significantly greater in Group H (mean 1.3, SD ± 1.2) compared with Group L (mean 0.5, SD ± 0.6, P=0.049). There was no difference between the groups for the administration of the tocolytic drug atosiban (P=0.29). The course of the mean arterial pressure did not significantly differ but group H needed significantly more vasoactive medication (P0.05).We found that a lower intra-operative volatile anesthetic exposure than recommended in the MOMS-trial (i.e.2.0 minimum alveolar concentration [MAC]) was not associated with an increase in intra-operative uterine activity. This is an indication that during spina bifida surgery, 2.0 MAC may not be necessary to avoid potentially harmful uterine activity.

[EN] Postpartum hemorrhage (PPH) is one of the major causes of maternal mortality and morbidity worldwide, with uterine atony being the most common origin. Currently there are no obstetrical techniques available for monitoring postpartum uterine dynamics, as tocodynamometry is not able to detect weak uterine contractions. In this study, we explored the feasibility of monitoring postpartum uterine activity by non-invasive electrohysterography (EHG), which has been proven to outperform tocodynamometry in detecting uterine contractions during pregnancy. A comparison was made of the temporal, spectral, and non-linear parameters of postpartum EHG characteristics of vaginal deliveries and elective cesareans. In the vaginal delivery group, EHG obtained a significantly higher amplitude and lower kurtosis of the Hilbert envelope, and spectral content was shifted toward higher frequencies than in the cesarean group. In the non-linear parameters, higher values were found for the fractal dimension and lower values for Lempel-Ziv, sample entropy and spectral entropy in vaginal deliveries suggesting that the postpartum EHG signal is extremely non-linear but more regular and predictable than in a cesarean. The results obtained indicate that postpartum EHG recording could be a helpful tool for earlier detection of uterine atony and contribute to better management of prophylactic uterotonic treatment for PPH prevention., This work was supported by the Spanish Ministry of Economy and Competitiveness, the European Regional Development Fund (MCIU/AEI/FEDER, UE RTI2018-094449-A-I00-AR) and the Generalitat Valenciana (GV/2018/104 and AICO/2019/220).

Preterm birth (PTB) is one of the most important complications in pregnancy. Reliable diagnosis means are lacking and the underlying physiological mechanisms are unclear. Determining the location of various correlated and simultaneously active uterus sources from abdominal ElectroHysterogram (EHG) recordings and extracting the corresponding uterus signals is a challenging problem. The use of the EHG for imaging the sources of the uterine electrical activity could be a new and powerful diagnosis technique. In this paper we compare the ability of six distributed source localization methods to recover extended sources of uterus activity from abdominal EHG. As no gold standard to evaluate source localization methods, exists, we perform our evaluation by using a well-controlled realistic simulations of EHG signals, involving several locations. Simulated data were corrupted by physiological EHG noise. The performance of several state-of-the-art techniques for extended source localization is evaluated using a detection accuracy index using the Dipole Localization Error, the Area Under the Receiver Operating Characteristic (ROC) Curve AUC, and the Correlation Coefficient. Keywords: EHG, Uterine activity, Source imaging

[EN] Objective: The objective of this study is to compare the uterine activity response between women administered dinoprostone (prostaglandin E2) and misoprostol (prostaglandin E1) for induction of labour (IOL) by analysing not only the traditional obstetric data but also the parameters extracted from uterine electrohysterogram (EHG). Methods: Two cohorts were defined: misoprostol (25-mg vaginal tablets; 251 women) and dinoprostone cohort (10 mg vaginal inserts; 249 women). All the mothers were induced by a medical indication of a Bishop Score < ¿ 6. Results: The misoprostol cohort was associated with a shorter time to achieve active labour (p ¿ .017) and vaginal delivery (p ¿ .009) and with a higher percentage of vaginal delivery in less than 24 h in mothers with a very unfavourable cervix score (risk ratio (RR): 1.41, IC95% 1.17¿1.69, p ¿ .002). Successful inductions with misoprostol showed EHG parameter values significantly higher than basal state for amplitude and pseudo Montevideo units (PMU) 60¿ after drug administration, while spectral parameters significantly increased after 150¿. This response was not observed in failed inductions. In the successful dinoprostone group, the duration and number of contractions increased significantly after 120¿, PMU did so after 180¿, and no significant differences were found for spectral parameters, possibly due to the slower pharmacokinetics of this drug. Conclusion: Successful inductions of labour by misoprostol are associated with earlier effective contractions than in labours induced by dinoprostone., This work was partially supported by the Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund under grant [DPI2015-68397-R] and by the company Bial SA.

This study examined the extent to which prolonged farrowing and parity are associated with plasma oxytocin concentrations and follicular development of oestrous sows during subsequent insemination. A total of 30 sows were allocated to two groups based on farrowing duration: (i) SHORT (n = 14): 159 ± 29 min, (ii) LONG (n = 16): 533 ± 190 min. The sows were also divided into two parity classes: (i) YOUNG (n = 14): parity 2.5 ± 0.8, (ii) OLD (n = 16): parity 6.4 ± 2.3. After weaning, the ovaries were examined daily with transrectal ultrasound. On the second day of oestrus, blood samples were collected for oxytocin (OT) assay at -15, -10, -5, 0, +1, +2, +3, +4, +6, +8, +10, +15, +20, +25, +30, +40, +50 and +60 min with a boar contact between 0 and +10 min. Boar presence stimulated an increase in OT concentrations (p < .05). During boar presence, OT in the LONG group was higher than in the SHORT group (p < .01). The sows in the OLD group had a longer farrowing duration than in the YOUNG group (p < .05). OT levels and diameters of follicles were more relevant for parity than was the duration of farrowing. We therefore conclude that the OT levels and follicular development of oestrous sows are associated due to parity but difficult to be predicted from the duration of previous farrowing.

Purpose: Uterine activity plays a key role in reproduction, and altered patterns of uterine contractility have been associated with important physiopathological conditions, such as subfertility, dysmenorrhea, and endometriosis. However, there is currently no method to objectively quantify uterine contractility outside pregnancy without interfering with the spontaneous contraction pattern. Transabdominal electrohysterography has great potential as a clinical tool to characterize noninvasively uterine activity, but results of this technique in nonpregnant women are poorly documented. The purpose of this study is to investigate the feasibility of transabdominal electrohysterography in nonpregnant women. Methods: Longitudinal measurements were performed on 22 healthy women in 4 representative phases of the menstrual cycle. Twelve electrohysterogram-based indicators previously validated in pregnancy have been estimated and compared in the 4 phases of the cycle. Using the Tukey honest significance test, significant differences were defined for P values below.05. Results: Half of the selected electrohysterogram-based indicators showed significant differences between menses and at least 1 of the other 3 phases, that is the luteal phase. Conclusion: Our results suggest transabdominal electrohysterography to be feasible for analysis of uterine activity in nonpregnant women. Due to the lack of a golden standard, this feasibility study is indirectly validated based on physiological observations. However, these promising results motivate further research aiming at evaluating electrohysterography as a method to improve understanding and management of dysfunctions (possibly) related to altered uterine contractility, such as infertility, endometriosis, and dysmenorrhea.

Background: Good obstetrician must always be alert to detect any sign and symptoms of abnormal labor. Prolongation of labor presents a picture of mental anguish, physical morbidity and may lead to surgical intervention. The goal of this study is to use partograph to monitor labor, initiate uterine activity that is sufficient to produce cervical change and fetal descent while avoiding uterine hyperstimulation, hypostimulation and fetal distress and provide timely surgical intervention where required. Methods: Total of 100 primigravidae, who were booked with us till term were selected for the study and partograph recordings were commenced at 4 cm dilatation. Close foetal and maternal monitoring was done throughout the labour and Partogram was plotted to detect any deviation from normal course. Results: Based on the Partogram findings the patients were grouped into “before alert line” and “between alert and action line” the mode of delivery in these patients was studied. Of the 42% of women who came into this group, 52.3% underwent cesarean delivery, 42.5% had instrumental deliveries and the remaining had vaginal deliveries. Conclusions: This study shows that using the Partogram improves the quality of delivery care, since it permits to identify dystocia and make logical and effective interventions. It reduces unnecessary strain on mothers by reducing total duration of labour, without any increased foetal morbidity and mortality. If accepted as routine procedure, it will be suitable in all situations where the labour room remains busy and congested day and night for better and more efficient management of labour.

We perform the literature review of safety and risks when using uterotonic agents during labor. We consider the conditions for fetus existence during perinatal period, the pathogenesis of fetal hypoxia, including cases of uterotonic agents using. We pay particular attention to approaches for uterine activity monitoring during intrapartum period. We also consider various methods of fetus diagnosis during labor and methods of the newborns state diagnosing in the article.

In this experiment on 38 isolated strips of myometrium (under the experimental conditions in vitro) we have demonstrated the possibility to assess the nature of myometrium contractions as a model of labor. We have recorded contractions caused by pre-stretching bands as well as contractions induced by oxytocin. We have identified the changes in the rhythm and amplitude of contractions in the background of opiates and calcium channel blockers, and demonstrated synergistic effect of opiates acts of on the contractile activity of the myometrium strips through calcium channels.

Tocodynamometry is the most common method of labor evaluation but most clinicians would agree it has limited utility before 26 weeks of gestation. The obesity epidemic has further reduced our ability to accurately detect uterine contractions using the tocodynamometer at any gestational age. We sought to design and test a novel contraction monitor that bypasses the maternal abdomen.An optimized version of an intravaginal electrohysterographic ring device was tested in an ovine model. The device and its methodology as well as the tocodynamometer were validated against the current gold standard uterine activity monitor, the intrauterine pressure catheter in six sheep at varying gestational ages.Both the intravaginal ring device and the tocodynamometer correlated well with IUPC, r = 0.69 and 0.73, respectively (p 0.001). The number of contractions detected by each monitor remained similar even after accounting for confounders.These results suggest that uterine activity can be monitored from the vaginal interface in an ovine model and offers an alternative clinical tool for the detection of contractions in situations, in which tocodynamometry would be ineffective or intrauterine monitoring inappropriate.

El sufrimiento fetal agudo es un grave problema que se presenta en aproximadamente el 15% de las gestantes en trabajo de parto, produciendo una mortalidad perinatal elevada o lesiones neurológicas irreversibles si no se actúa a tiempo. Es por ello que las gestantes en peligro de desarrollar insuficiencia úteroplacentaria o portadoras de enfermedades crónicodegenerativas que alteren su homeostasis, deben ser vigiladas cercanamente para buscar signos de posible deterioro del producto. Uno de los cambios más impresionantes en obstetricia ha sido el empleo de parámetros biofísicos y bioquímicos en la valoración del bienestar fetal, lo que ha permitido identificar a los productos de riesgo y orientar el tratamiento, lográndose así disminuir los problemas perinatales. El empleo del monitoreo electrónico fetal permite evaluar el estado del producto de riesgo en el periodo prenatal a través de una prueba de contracción, así como en el intraparto, ya que en la mayor parte de los casos, la actividad uterina es el factor desencadenante del sufrimiento fetal, al sumarse a las otras causas o factores predisponentes.

El trabajo de parto es una actividad uterina rítmica y coordinada mediante la cual se logra la dilatación cervical progresiva que acaba por dilatar completamente el cuello uterino.

Se ha estudiado el efecto ocitócico, madurador del cuello uterino y acción potenciadora a la ocitocina del 17 -Beto Estradiol aplicada en cavidad amniótica en 10 gestantes de 38 o 40 semanas de gestación. Obteniéndose un aumento de la actividad uterina debido a un aumento en la intensidad y frecuencia de las contracciones, la maduración del cuello uterino en el 50 % de los casos y el gran aumento de la actividad uterina cuando se administra pequeñas dosis de ocitocina, demostrándose así el efecto potenciador que tiene esta hormona a la ocitocina.

This article presents the results of experimental investigation of opioid (opiate analgesics) influence on the nociceptive response of rat’s circulatory dynamics, breath and skeletal muscles tonus. The article demonstrates influence of opiate analgesics on intact and pregnant rat’s amplitude and frequency of uterine activity. The results of investigation of drug-induced effect of opiate analgesics in case of pregnant and in case of act of delivery model pain reaction were also described in this article.