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Thijssen KMJ, van den Broek MJM, Koenraads FA, Cantineau-Goedegebuure JI, Papatsonis DNM, van Willigen BG, Dieleman JP, van der Hout-van der Jagt MB, Westerhuis MEMH, Oei SG. Detection of postpartum uterine activity with electrohysterography. Eur J Obstet Gynecol Reprod Biol 2023; 291:23-28. [PMID: 37806028 DOI: 10.1016/j.ejogrb.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Uterine contractions are essential for childbirth, but also for expulsion of the placenta and for limiting postpartum blood loss. Postpartum hemorrhage is associated with almost 25% of the maternal deaths worldwide and the leading cause of maternal death in most low-income countries. Little is known about the physiology of the uterus postpartum, particularly due to the lack of an accurate measurement tool. The primary objective of this pilot study is to explore the potential of using electrohysterography to detect postpartum uterine contractions. If postpartum uterine activity can be objectified, this could contribute to understanding the physiology of the uterus and improve diagnosis and treatment of postpartum hemorrhage. STUDY DESIGN In this observational study we included women aiming for a vaginal birth in two large maternity clinics in the Netherlands, Amphia Hospital Breda (group A, N2018-0161) and Máxima Medical Center Veldhoven (group B, N17.149). An electrode patch was placed on the maternal abdomen to record real-time electrical uterine activity until one hour postpartum continuously. In group A, the placement of the patch was lower than in group B. For analysis, tracings were divided into five different phases (1: dilatation until start pushing, 2: from start pushing until childbirth, 3: from childbirth until placental expulsion, 4: first hour after placental expulsion and 5: after one hour postpartum). Readability, signal quality and contraction frequency per hour were assessed. Additionally, patient satisfaction was evaluated through a survey. RESULTS In total 91 pregnant women were included of whom 45 in group A and 46 women in group B. Complete registrations were obtained throughout the five labor phases with very little artefacts or signal loss. The readability of the tracings decreased after childbirth. A significantly better readability was found in tracings where the patch placement was lower on the abdomen for phases 4 and 5. Contraction frequency was highest during phase 2 and decreased towards phase 5. Women rated the satisfaction with electrohysterography as high and mostly did not notice the patch. CONCLUSION It is possible to detect uterine activity postpartum with electrohysterography. Further investigation is recommended to improve diagnosis and treatment of postpartum hemorrhage.
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Affiliation(s)
- Kirsten M J Thijssen
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands; University MC Utrecht, P.O Box 85500, 3508 GA, Utrecht, the Netherlands.
| | - Michelle J M van den Broek
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands
| | - Feikje A Koenraads
- Amphia Hospital, Department of Obstetrics and Gynecology, P.O. Box 90158, 4800 RK Breda, the Netherlands
| | | | - Dimitri N M Papatsonis
- Amphia Hospital, Department of Obstetrics and Gynecology, P.O. Box 90158, 4800 RK Breda, the Netherlands
| | - Bettine G van Willigen
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands
| | - Jeanne P Dieleman
- MMC Academy, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands; Faculty of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, the Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands
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