Redefining Dystocia Diagnosis in Labor using Electrohysterography (RIDDLE)

使用宫腔电图重新定义难产诊断 (RIDDLE)

• 批准号: 8848870
• 负责人: WILLIAM Walton ANDREWS
• 金额: $ 14.33万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8848870
• 关键词: Abdomen; Accounting; Address; Applications Grants; Area Under Curve; Birth; Blinded; Catheters; Cervical; Cessation of life; Characteristics; Cohort Studies; Data; Development; Diagnosis; Dystocia; Enrollment; Evolution; Failure; Fetal Monitoring; Fetus; Fundus; Goals; Health; Health Care Costs; Healthy People 2000; Healthy People 2010; Hemorrhage; Hysterectomy; Infection; Labor Complications; Maps; Maternal Mortality; Measures; Medical; Monitor; Morbidity - disease rate; Nested Case-Control Study; Outcome; Oxytocin; Patients; Pattern; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Pregnant Women; Probability; Provider; Randomized Clinical Trials; Rattus; Signal Transduction; Silver; Staging; Technology; Thromboembolism; Time; United States; Uterine Contraction; Uterine Rupture; Vagina; Vaginal Birth after Cesarean; Vaginal delivery procedure; Woman; base; cost; fetal; high risk; innovation; maternal morbidity; mortality; myometrium; neonatal morbidity; performance tests; pressure; prevent; prospective; silver chloride electrode; spatiotemporal; tool

DESCRIPTION (provided by applicant): Compared to vaginal delivery, cesarean birth results in higher maternal morbidity/mortality and medical costs. In 2009, the cesarean rate in the United States was 33%, and it is still increasing. 'Failure to progress in labor' (a.k.a. dystocia)is the leading cause of non-elective (during labor) primary cesareans and directly or indirectly accounts for about 60% of all cesarean deliveries. Management of patients with poor labor progress focuses on the administration of oxytocin, presuming that the power of uterine contractions is inadequate. However, contraction "power" does not predict labor dystocia. We have developed a noninvasive maternal-fetal monitor that collects both fetal electrocardiographic signals and uterine electrical activity (electrohysterogram, EHG). Using the EHG signal to generate a real-time topographic map of uterine contractile activity, in a preliminary nested case-control study, we demonstrated that the spatiotemporal patterns of the EHG differed significantly between women with normal labor progress culminating in vaginal delivery and those who underwent cesarean for labor dystocia (p=0.003) and predicted mode of delivery (ROC area under the curve=0.91). In this grant application, we propose a larger, prospective cohort study to better define specific spatiotemporal patterns of the EHG that are associated with cesarean delivery for labor dystocia. We will define the test performance characteristics of those patterns that differentiate women who progress to vaginal delivery from those who do not. We propose to also evaluate whether specific (abnormal) EHG patterns predictive of dystocia precede cessation of cervical dilation or only occur once there is an arrest of dilation. Finally, we will explore the use of EHG patterns as a real-time monitor for predicting labor dystocia. Accomplishment of these aims will set the stage for a randomized clinical trial to evaluate the utility of this technology as a tool for not only decreasing the cesarean delivery rat but also reducing maternal and neonatal morbidities associated with protracted labor.

描述（由申请人提供）：与阴道分娩相比，剖腹产会导致产妇发病率/死亡率和医疗费用更高。 2009年，美国的剖宫产率为33%，并且仍在增加。 “产程进展缓慢”（又称难产）是非选择性（产程中）初次剖宫产的主要原因，直接或间接约占所有剖宫产的 60%。分娩进展不佳的患者的处理重点是使用催产素，假设子宫收缩的力量不足。然而，宫缩“力量”并不能预示难产。我们开发了一种无创母胎监护仪，可以收集胎儿心电图信号和子宫电活动（子宫电图，EHG）。在一项初步的巢式病例对照研究中，我们利用 EHG 信号生成子宫收缩活动的实时地形图，证明了正常产程并最终阴道分娩的女性与阴道分娩的女性之间 EHG 的时空模式存在显着差异。因难产而接受剖宫产 (p = 0.003) 和预测的分娩方式 (ROC 曲线下面积 = 0.91)。在本次拨款申请中，我们提出了一项更大规模的前瞻性队列研究，以更好地定义与难产剖宫产相关的 EHG 的特定时空模式。我们将定义这些模式的测试表现特征，以区分进行阴道分娩的女性和未进行阴道分娩的女性。我们还建议评估预测难产的特定（异常）EHG 模式是否先于宫颈扩张停止，还是仅在宫缩发生后出现 的扩张。最后，我们将探索使用 EHG 模式作为实时监测器来预测 难产。这些目标的实现将为一项随机临床试验奠定基础，以评估该技术作为工具的效用，不仅可以减少剖宫产大鼠，还可以减少与旷产相关的孕产妇和新生儿发病率。

项目成果

Evaluating Fundal Dominant Contractions on Spatiotemporal Electrohysterography as a Marker for Effective Labor Contractions.

评估时空宫腔电图上的宫底主导收缩作为有效宫缩的标志。

• 发表时间: 2019
• 影响因子: 2
• 作者: Edwards, Rodney K;Euliano, Neil R;Singh, Savyasachi;LeDuke, Rachel C;Andrews, William W;Jauk, Victoria;Subramaniam, Akila;Szychowski, Jeff M
• 通讯作者: Szychowski, Jeff M