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Objective To identify the effect of cervical muscle activity as an additional factor influencing the duration of the latent and active phase of labour. Design Prospective observational study. Setting The Ljubljana Maternity Hospital. Participants Fifty healthy nulliparous women requiring induction of labour having relatively unripe cervices. Methods At the onset of labour an open-ended catheter was inserted to measure intrauterine pressure during the latent and active phase of labour. Electromyographic activity of the cervix was registered by two bipolar spiral needle electrodes placed in the transverse direction on the proximal part of the cervix in the vagina. The mean intensity of distinctive peaks in an electromyographic spectrogram were calculated in the time/frequency domain. Multiple linear regression was used to find factors affecting the duration of the latent and active phase of labour. Main outcome measures Duration of the latent and active phase of labour. Results Eleven independent variables explained 64% of the variance of the latent phase duration, the most important being the effacement and consistency of the cervix, and intensity of electromyographic signals. For the duration of the active phase the same variables explained 36% of the variance; the most important variables were mean duration of uterine contractions, mean maximum intensity of uterine contractions and the newborn's head circumference. Conclusions The cervical smooth muscle activity, expressed as an electromyographic signal, contributes to the duration of the latent phase but not to the duration of the active phase. However, frequent cervical contractions are not associated with a longer latent phase.

Objective: To estimate the risk of preterm birth in women admitted to the tertiary maternity hospital for preterm contractions by measuring electrical uterine activity. Study design: The study included 47 patients with contractions between the 25th and 35th week of gestation and additional risk factors for preterm delivery. Uterine electrical activity was recorded using bipolar electrodes placed on the abdominal surface. A logistic model with the electromyographic and obstetric data was built, preterm delivery before 37th week of gestation being the outcome measure. Results: Seventeen patients (36%) delivered before term. Logistic regression model suggested only the intensity of electrical uterine activity and woman’s body weight to be significant predictors of preterm delivery, with high values related to preterm birth. They predict preterm delivery with the sensitivity of 47% and specificity of 90%. Conclusion: We propose uterine EMG as a simple, non-invasive means to estimate the risk of preterm birth in a high-risk population with multiple risk factors present.

Objective: To find the similarities and dissimilarities between the activity of the human smooth muscles in the cervix and in the uterine corpus at the onset of induced labour. Study design: Electromyographic activity was measured in 14 primiparous women after amniotomy. The data were sampled and stored digitally in real time. For statistical analysis, the first 20 min of recordings following amniotomy were analyzed. The ratio between the mean activity at a given time and the mean activity over the whole 20 min was used for the comparison between the cervical and uterine activity. Results: The analysis of correlation showed that the electromyographic activity in the cervix differed from that in the uterine corpus in the majority of the enrolled cases. Conclusions: The muscular activity in the cervix is independent of that in the uterine corpus at the onset of induced labour.

The greatest risk of preterm prelabour rupture of membranes (PPROM) is preterm delivery. According to the Perinatal Information System of Slovenia there were 5.92% preterm deliveries in 1994. We studied 809 deliveries of less than 34 weeks of gestation in the Ljubljana Maternity, from 1992 to 1994; 33.7% of these started with PPROM. Risk factors for PPROM were conization, cerclage and use of antibiotics for any reason in current pregnancy. Amnionitis and febrile illness during labour increased with longer duration of PPROM but maternal postpartum infections did not. In neonates, more cases of lower Apgar scores after 1 and 5 min and more cases of suspected sepsis were found with the increased duration of PPROM. In Slovenia, with good facilities for transport in utero and good neonatal care. after PPROM it is best to transport the pregnant women to the third level center and then wait until labour starts or to recur to prompt delivery when maternal or fetal signs so require. From 1987 to 1993 there were 159 264 deliveries in gestations equal to or over 34 weeks; 20.8% started with PROM. In our observational study we found the best results when labour was induced. There are, however, many disagreements about the management of (P)PROM.

Our purpose was to build and test a lightweight solution for generating clinical research information systems (CRIS) that would allow non-IT professionals with basic knowledge of computer usage to quickly define and build a ready-to-use, safe and secure web-based clinical research system for data management. We use the acronym MAGIC (Medical Application Generator InteraCtive) for the system. The generated CRIS should be very easy to build and use, so a common LAMP (Linux Apache MySQL Perl) platform was used, which also enables short development cycles. The application was built and tested using eXtreme Programming (XP) principles by a small development team consisting of one informatics specialist, one physician and one graphical designer/programmer. The parameter and graphical user interface (GUI) definitions for the CRIS can be made by non-IT professionals using an intuitive English-language-like formalism called application definition language (ADL). From these definitions, the MAGIC builds an end-user CRIS that can be used on a wide variety of platforms (from standard workstations to hand-held devices). A working example of a national health-care-quality assessment program is presented to illustrate this process. The lightweight application for generating CRIS (MAGIC) has proven to be useful for both clinical and analytical users in real working environment. To achieve better performance and interoperability, we are planning to recompile the application using XML schemas (XSD) in HL7 CDA or openEHR archetypes formats used for parameters definition and for data interchange between different information systems.

Background:The purpose of this study was the possibility to follow the progress of labour using electromyographic (EMG) signals obtained from the uterine corpus and the cervix. Methods: 28 healty primiparous women with induced labour at an age from 19 to 29 years were enrolled in the study. For interpretation of EMG signals Sample entropy (SampEn), the measure of time series regularity was used. SampEn values were related to the progress of labour recorded in the partogram. h e main outcome is association between labour progress and values of SampEn. Results: Approaching the childbirth during normally progressing labour, regular activity of uterine corpus muscles and cervical muscles is indicated as a decreasing trend in values of SampEn. A delay in the active phase of labour due to active contractions of cervical circular muscles is indicated in greater values of SampEn calculated from cervical EMG activity. Conclusions: By measuring and processing of EMG signals from the uterine corpus and the cervix an obstetrician can obtain an additional useful information on the progress of labour.

To study the activity of the human uterine cervix at the onset of labour and further characterise cervical asynchronous electromyographic (EMG) activity in the latent phase.Prospective observational study.Clinical hospital in Ljubljana.Forty-seven healthy nulliparous women with relatively unripe cervices requiring induction of labour.Simultaneous registration of a cervical EMG and of the intrauterine pressure at the very early stage of labour; subsequent EMG signal processing to determine its time, amplitude and frequency parameters.Simultaneous comparison of the cervical EMG and the mechanical activity of the uterine corpus to deduce electrical properties of the cervical smooth muscle tissue and its activity.EMG bursts, asynchronous with the contractions of the uterine corpus, were registered in 20 out of 47 women. In 14 women bursts appeared independent of uterine corpus contractions and in six they followed the peak of contractions. The bursts had low average median frequency (0.3 Hz). In seven women bursts were superimposed onto a background EMG (median frequency = 1.2 Hz).Bursts in the cervical EMG may appear asynchronously with the uterine contractions. Bursts not related to contractions suggest active and independent cervical muscle activity. The bursts which follow contractions may be an active response of the cervical musculature to passive stretching during a contraction. The EMG frequency content suggests two different contraction mechanisms or a different origin of the EMG in the cervix.

Objective: To evaluate the effects of abdominal versus vaginal delivery in the groups of newborns with different birth weights. Methods: 5012 single breech deliveries with birth weight over 1000 g, lethal malformations and stillbirths excluded, were enrolled in the study. The comparison of early neonatal mortality and the incidence of 12 different symptoms and signs of fetal morbidity for abdominally/vaginally delivered newborns was made within four birth-weight groups. Results: In abdominal delivery we found statistically significantly lower neonatal mortality and incidence of low 5-min Apgar score in the 1000–1499-g birth-weight group; incidence of brachial plexus damage and hyperbilirubinemia due to blood resorption in the 2500–3799-g birth-weight group. In vaginal delivery we found statistically significantly lower incidence of low 1- and 5-min Apgar score, light and moderate hypoxia and RDS in the 1500–2499-g birth-weight group; low 1-min Apgar score and light hypoxia in the 2500–3799-g birth-weight group. Conclusion: The effects of abdominal delivery on newborn in breech are in many aspects poorer than in vaginal delivery. In our opinion the actual incidence (36%) of cesarean section could be decreased, especially in cases with expected birth weight over 1500 g.

The electrical activity of the cervix can be measured during labour. The influence of oxytocin on electromyographic (EMG) activity of the cervical musculature was studied in 80 primiparous women after induction of labor. The highest electrical activity registered at the time of uterine contraction and between two contractions was used for analysis. The basic pattern of oxytocin-produced changes in muscular contractions in the cervix observed via EMG activity is that of the activity increasing with contractions of the uterine corpus and diminishing between contractions. The effect of oxytocin on cervical musculature is different in ripe and unripe cervices.

In order to accelerate rehabilitation of patients with peripheral nerve lesions, hypnosis was employed to encourage them voluntarily to move those muscles with weak re-innervation and to achieve the best possible activity of the affected muscle' groups. By measuring muscle force and endurance and by observing the electrical activity of the affected muscles, it was found that the activity of the affected muscles was much better while patients were in hypnosis than when they were in the waking state. The patients were able to contract even paretic muscles having only weak re-innervation with such strength, that clinically perceptible contraction of the muscles and movement of paretic extremities occurred. Such early and improved activation is very important for prevention of much permanent damage.

The study of both voluntary and electrically stimulated activity of the neuromuscular system of striated muscles in various conditions of a hypnotic state and under various verbal suggestions in those states of hypnosis, has shown interesting neuromuscular responses in normal test subjects, in patients with various lesions of the peripheral nerves as well as in patients with hemiparesis. An increased EMG response in an electrically stimulated muscle, an increased EMG response and an increased force of the paretic muscle, altered neuromuscular excitability in subjects with lesions of the peripheral nerves (reaction to another type of electrical stimulation), changed fatiguability, altered spasticity, and a corresponding complex mobility at a lower muscle activity have all been observed. It has been noticed that these changes of the neuromuscular system activity often result from a specific state of hypnosis and mostly from specific suggestions and their intensity. Recently we have been studying the effect of hypnosis upon the activity of the smooth muscles, i.e. the bladder and the pregnant uterus before and during labor.