Home uterine activity monitoring: a critical review

System-level biomechanical approach for the evaluation of term and preterm pregnancy maintenance

Preterm birth is the primary contributor to perinatal morbidity and mortality, with those born prior to 32 weeks disproportionately contributing compared to those born at 32-37 weeks. Outcomes for babies born prematurely can be devastating. Parturition is recognized as a mechanical process that involves the two processes that are required to initiate labor: rhythmic myometrial contractions and cervical remodeling with subsequent dilation. Studies of parturition tend to separate these two processes rather than evaluate them as a unified system. The mechanical property characterization of the cervix has been primarily performed on isolated cervical tissue, with an implied understanding of the contribution from the uterine corpus. Few studies have evaluated the function of the uterine corpus in the absence of myometrial contractions or in relationship to retaining the fetus. Therefore, the cervical-uterine interaction has largely been neglected in the literature. We suggest that a system-level biomechanical approach is needed to understand pregnancy maintenance. To that end, this paper has two main goals. One goal is to highlight the gaps in current knowledge that need to be addressed in order to develop any comprehensive and clinically relevant models of the system. The second goal is to illustrate the utility of finite element models in understanding pregnancy maintenance of the cervical-uterine system. The paper targets an audience that includes the reproductive biologist/clinician and the engineer/physical scientist interested in biomechanics and the system level behavior of tissues.

Deciding When It's Labor: The Experience of Women Who Have Received Antepartum Care at Home for Preterm Labor

OBJECTIVE

To describe how women who had received antepartum care at home for preterm labor managed subsequent episodes of preterm labor symptoms.

DESIGN

Grounded theory method.

SETTING

2 Canadian antepartum home care programs.

PARTICIPANTS

12 women who received antepartum care at home for preterm labor that had been diagnosed in hospital prior to 34 weeks gestation.

RESULTS

The core psychosocial process was reconciling body knowledge and professional knowledge. Study participants reported knowing something's not right and followed decision guides to seek help. If, when they returned to the hospital to see what's going on, they felt dissonance between what their bodies were telling them (body knowledge) and what their health care providers were telling them (professional knowledge) an overriding tension developed between not wanting to take a risk for the baby versus not wanting to overreact. These women reestablished their baselines of nonthreatening symptoms at a higher level by setting a new normal to avoid the humiliation associated with appearing to overreact. Attempting to ignore recurring symptoms of preterm labor delayed help seeking and caused anxiety.

CONCLUSIONS

To avoid delayed help seeking, nursing interventions should be geared to reducing anxiety and validating the experiences of women with recurring preterm labor symptoms.