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 我们对子宫收缩的发展方式有限 胎儿在​​学期。例如，我们缺乏对劳动的基本问题的答案，例如收缩地点 发起，宫缩的速度传播的速度，子宫的哪些地区在收缩期间活跃，以及如何 随着劳动的进展，这些措施发生了变化。为了解决这个知识差距，这是一种新的成像技术， 最近在翻译绵羊模型中开发并验证了肌马肌成像（EMMI）。艾米 采用磁共振成像来获取特定于主题的身体 - 截然者几何形状，然后结合 产生的数据具有从腹表面收集到256个电极的电生理数据。和 emmi，可以在收缩过程中非侵入性地对电动激活和传导模式进行非侵入性图像 在整个子宫中都有三个维度。初步数据表明EMMI可以系统地使用 表征人类正常劳动期间收缩。此外，子宫的三个提议特征 电活动称为“收缩指数”，似乎与时间相关，直到交付。目标的目标 建议是使用EMMI创建一个描述3D电激活模式的“正常术语地图图集” 人子宫收缩在整个劳动的高空间和时间分辨率下，并使用此图集开始 确定与即将逮捕劳动力有关的收缩特征。目标1是定义子宫电气 劳动期间的成熟和收缩模式在术语无效的妇女中。在此目标中，将进行Emmi 在整个劳动期间，有430名无效妇女，将对365名妇女进行分析 具有正常的劳动。这个目的检验了以下假设：至少一种Emmi衍生的子宫收缩 指数可以准确反映无效妇女正常术语劳动的进展，并且可以可靠地区分 第一阶段的不同阶段。探索性目标2将评估子宫电收缩 劳动期间的模式在AIM1的预期75名妇女中遭受劳动逮捕。这个探索目标 将为将来的更大的EMMI研究提供基础，以充分表征子宫的时空特征 发展被捕劳动的患者的收缩。在完成这两个目标时，该项目将产生 久期无效妇女子宫收缩指标的生理正常标准 劳动。这些正常标准将允许对未来的深入临床研究，从而 功能失调的劳动。此外，从长远来看，它们可能是监测怀孕和 劳动进步并评估治疗策略管理劳动和预防劳动的有效性 早产，劳动逮捕和产后出血等并发症。