![]() Thus EMMI’s future clinical use will better characterize labor progression and facilitate labor management.ĭevelopment and implementation of the human EMMI system EMMI 3D maps and indices provide new insights into human myometrial electrical maturation, which is the development of the capacity of the uterus to appropriately initiate and conduct electrical signals across the myometrium. This human EMMI system was employed to robustly image the 3D electrical activation patterns of uterine contractions from nulliparous and multiparous subjects in the active first stage of labor and demonstrates that EMMI can noninvasively characterize the initiation and dynamics of uterine electrical activation during uterine labor contractions. Herein, we describe the development of the human EMMI system, for use in women in labor. Moreover, using the sheep model, experimental simulation studies mimicking noise contaminations anticipated in a clinical environment demonstrated that the electrical noise error within physiological ranges has a minor effect on EMMI accuracy 14, 15. We demonstrated and validated that EMMI could accurately map electrical activity onto the entire three-dimensional (3D) uterine surface by comparing uterine electrical signals derived by EMMI from the body surface measurements (up to 192 electrodes) to those measured directly from the uterine surface in sheep 13. ![]() To enable safe, noninvasive monitoring of uterine contractions, we recently developed a new imaging modality, electromyometrial imaging (EMMI), which noninvasively images the electrical properties of uterine contractions at high spatial and temporal resolution up to 2 kHz in sheep 13– 15. ![]() Therefore, a better method capable of noninvasively imaging and quantifying uterine contractions is needed to address these clinical challenges. In addition, between 30 and 50% of subjects diagnosed with preterm contractions go on to deliver at term 12. Particularly, previous studies found that TOCO cannot identify patients who are in labor, at term or preterm 10, 11. Previous studies have shown that these methods have limited ability to distinguish between women who will respond to induction/oxytocin augmentation and deliver vaginally and those that require cesarean 9. In current clinical practice, overall signals generated by uterine contractions are measured qualitatively via tocodynamometry (TOCO) or quantitatively via an invasive intrauterine pressure catheter (IUPC) 8. Accurately assessing and interpreting uterine contractions is essential for diagnosing both labor dysfunction and preterm labor. Preterm birth occurs in 10.6% of women globally 4, with increased infant risks of mortality before 5 years of age 5, adverse long-term neurodevelopmental outcomes 6, and an increased economic burden on the family and society 7. Cesarean deliveries increase the risks of maternal morbidity and neonatal respiratory morbidity compared to vaginal delivery 3. Approximately 29% of women deliver via cesarean 1, the majority of which are performed for labor arrest 2. Two essential challenges in obstetrics worldwide are arrest of labor and preterm birth. We thus show that the human EMMI system can provide detailed 3D images and quantification of uterine contractions as well as novel insights into the role of human uterine maturation during labor progression. Quantitative indices, including the uterine activation curve, are developed and defined to characterize uterine surface contraction patterns. ![]() We demonstrate the successful integration of the human EMMI system during subjects’ clinical visits to generate noninvasively the uterine surface electrical potential maps, electrograms, and activation sequence through an inverse solution using up to 192 electrodes distributed around the abdomen surface. Herein we describe the development and application of a human EMMI system to image and evaluate 3D uterine electrical activation patterns at high spatial and temporal resolution during human term labor. Electromyometrial imaging (EMMI) was recently developed to image the three-dimensional (3D) uterine electrical activation during contractions noninvasively and accurately in sheep.
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