The three-dimensional spatiotemporal dynamics of human uterine contractions using electromyometrical imaging (EMMI)

使用肌电成像 (EMMI) 测量人体子宫收缩的三维时空动态

• 批准号: 10366693
• 负责人: ALISON G CAHILL
• 金额: $ 61.42万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10366693
• 关键词: 3-Dimensional; Abdomen; Address; Anatomy; Atlases; Body of uterus; Cervical; Cervix Uteri; Cesarean section; Clinical; Clinical Trials; Data; Electrodes; Electrophysiology (science); Enrollment; Face; Fetal Development; Fetus; First Labor Stage; Future; Geometry; Gold; Human; Image; Imaging technology; Intervention; Knowledge; Labor Complications; Magnetic Resonance Imaging; Maps; Measures; Monitor; Nulliparity; Patients; Pattern; Phase; Physiological; Positioning Attribute; Postpartum Hemorrhage; Pregnancy; Pregnant Women; Premature Birth; Procedures; Publishing; Resolution; Shapes; Signal Transduction; Surface; Technology; Testing; Time; Uterine Contraction; Uterus; Vaginal delivery procedure; Woman; clinical investigation; effectiveness evaluation; effectiveness testing; experience; imaging study; indexing; individual patient; neuroimaging; new technology; non-invasive imaging; prepregnancy; prevent; sheep model; spatiotemporal; temporal measurement; tool; translational study; treatment strategy

Summary/Abstract We have limited understanding of how uterine contractions develop and become sufficiently coordinated to expel the fetus at term. For example, we lack answers to basic questions about labor such as where contractions initiate, how fast contractions propagate, which regions of the uterus are active during contractions, and how these measures change as labor progresses. To address this knowledge gap, a new imaging technology, Electromyometrial Imaging (EMMI) was recently developed and validated in a translational sheep model. EMMI employs magnetic resonance imaging to acquire a subject-specific body-uterus geometry, then combines the resulting data with electrophysiological data collected from up to 256 electrodes on the abdominal surface. With EMMI, it is possible to noninvasively image the electrical activation and conduction patterns during contractions across the entire uterus in three dimensions. Preliminary data indicate that EMMI can be used to systematically characterize contractions during normal term labor in humans. Additionally, three proposed features of uterine electrical activity, termed "contraction indices", appear to correlate with time until delivery. The objectives of this proposal are to use EMMI to create a "normal term atlas" describing the 3D electrical activation patterns of human uterine contractions at high spatial and temporal resolution across labor, and to use this atlas to begin to identify contraction features associated with impending labor arrest. Aim 1 is to define the uterine electrical maturation and contraction patterns during labor in term nulliparous women. In this Aim, EMMI will be conducted on 430 nulliparous women throughout labor, and data will be analyzed from the 365 women who are anticipated to have normal term labor. This aim tests the hypothesis that at least one of the EMMI-derived uterine contraction indices can precisely reflect progression of normal term labor in nulliparous women, and can reliably differentiate the different phases of the first stage of labor. Exploratory Aim 2 will evaluate uterine electrical contraction patterns during labor in the anticipated 75 women from Aim1 who experience labor arrest. This exploratory aim will provide the basis for a future larger EMMI study to fully characterize the spatial-temporal signatures of uterine contractions in patients who develop arrested labor. In completing these two aims, this project will generate physiologically normal standards of uterine contraction indices of nulliparous women during the progress of term labor. These normal standards will permit future in-depth clinical investigations of the factors leading to dysfunctional labor. Moreover, they may, in the longer term, serve as standards for monitoring pregnancy and labor progression and assessing the effectiveness of treatment strategies to manage labor and prevent labor complications such as preterm birth, labor arrest, and postpartum hemorrhage.

摘要/摘要 我们对子宫收缩如何发展并如何充分协调以排出体外的了解有限。 足月胎儿。例如，我们缺乏有关分娩的基本问题的答案，例如宫缩在哪里 宫缩开始、宫缩传播的速度、子宫的哪些区域在宫缩期间活跃以及如何进行 这些措施随着劳动力的进步而变化。为了解决这一知识差距，一种新的成像技术， 最近在转化羊模型中开发并验证了肌电成像 (EMMI)。 EMMI 采用磁共振成像来获取受试者特定的身体子宫几何形状，然后结合 通过从腹部表面多达 256 个电极收集的电生理数据得出数据。和 EMMI，可以对收缩期间的电激活和传导模式进行无创成像 整个子宫的三个维度。初步数据表明，EMMI 可用于系统地 表征人类正常足月分娩期间的宫缩。此外，提出了子宫的三个特征 电活动，称为“收缩指数”，似乎与分娩前的时间相关。本次活动的目标 建议使用 EMMI 创建一个“正常术语图集”来描述 3D 电激活模式 人类子宫收缩在整个分娩过程中以高空间和时间分辨率进行，并使用该图集开始 识别与即将临产逮捕相关的宫缩特征。目标 1 是定义子宫电 足月未产妇分娩过程中的成熟和收缩模式。为此，将进行 EMMI 对 430 名未产妇整个分娩过程中的数据进行分析，并对 365 名预计产妇的数据进行分析 进行正常的足月分娩。这一目标检验了以下假设：至少一种 EMMI 衍生的子宫收缩 各项指标能够准确反映未产妇正常足月产程的进展情况，并能可靠地区分 第一产程的不同阶段。探索性目标 2 将评估子宫电收缩 预计 Aim1 中 75 名经历过分娩逮捕的妇女在分娩过程中的模式。这一探索性目标 将为未来更大规模的 EMMI 研究提供基础，以充分表征子宫的时空特征 发生停产的患者出现宫缩。在完成这两个目标的过程中，该项目将产生 未产妇足月期间子宫收缩指数生理正常标准 劳动。这些正常标准将允许未来对导致这些因素的深入临床研究 功能失调的劳动。此外，从长远来看，它们可以作为监测怀孕和妊娠的标准。 临产进展并评估管理临产和预防临产的治疗策略的有效性 早产、临产、产后出血等并发症。