Abstract
Objective
To evaluate the influence of maternal obesity on the performance of external tocodynamometry and electrohysterography.
Study design
In a 2-hour measurement during term labor, uterine contractions were simultaneously measured by electrohysterography, external tocodynamometry, and intra-uterine pressure catheter. The sensitivity was compared between groups based on obesity (non-obese/obese/morbidly obese) or uterine palpation (good/moderate/poor), and was correlated to maternal BMI and abdominal circumference.
Result
We included 14 morbidly obese, 18 obese, and 20 non-obese women. In morbidly obese women, the median sensitivity was 87.2% (IQR 74–93) by electrohysterography and 45.0% (IQR 36–66) by external tocodynamometry (p < 0.001). The sensitivity of electrohysterography appeared to be non-influenced by obesity category (p = 0.279) and uterine palpation (p = 0.451), while the sensitivity of tocodynamometry decreased significantly (p = 0.005 and p < 0.001, respectively). Furthermore, the sensitivity of both external methods was negatively correlated with obesity parameters, being non-significant for electrohysterography (range p-values 0.057–0.088) and significant for external tocodynamometry (all p-values < 0.001).
Conclusions
Electrohysterography performs significantly better than external tocodynamometry in case of maternal obesity.
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References
Obesity. World Health Organization. 2017. Available from http://www.who.int/topics/obesity/en/. Cited 15 Dec 2017.
Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25:1175–82.
Royal College of Obstetricians and Gynaecologists and Centre for Maternal and Child Enquiries. Management of women with obesity in pregnancy. 2010. Available from https://www.rcog.org.uk/en/guidelines-research-services/guidelines/management-of-women-with-obesity-in-pregnancy/. Cited 15 Dec 2017.
Hendler I, Blackwell SC, Bujold E, Treadwell MC, Wolfe HM, Sokol RJ, et al. The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures. Int J Obes Relat Metab Disord. 2004;28:1607–11.
Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women--systematic review and meta-analysis of cohort studies. Obes Rev. 2009;10:28–35.
Barau G, Robillard PY, Hulsey TC, Dedecker F, Laffite A, Gerardin P, et al. Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries. BJOG. 2006;113:1173–7.
Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol. 2004;103:452–6.
Bakker PC, Van Rijswijk S, van Geijn HP. Uterine activity monitoring during labor. J Perinat Med. 2007;35:468–77.
Bakker PC, Zikkenheimer M, van Geijn HP. The quality of intrapartum uterine activity monitoring. J Perinat Med. 2008;36:197–201.
Ray A, Hildreth A, Esen UI. Morbid obesity and intra-partum care. J Obstet Gynaecol. 2008;28:301–4.
Bakker PC, van Geijn HP. Uterine activity: implications for the condition of the fetus. J Perinat Med. 2008;36:30–7.
Euliano TY, Nguyen MT, Darmanjian S, McGorray SP, Euliano N, Onkala A, et al. Monitoring uterine activity during labor: a comparison of 3 methods. Am J Obstet Gynecol. 2013;208:66. e1-6
Hayes-Gill BR, Hassan M, Mirza FG, Ommani S, Himsworth JM, Solomon M, et al. Accuracy and reliability of uterine contraction identification using abdominal suface electrodes. Clin Med Insights Women’s Health. 2012;5:65–75.
ACOG. ACOG Practice Bulletin Number 49, December 2003: dystocia and augmentation of labor. Obstet Gynecol. 2003;102:1445–54..
Wilmink FA, Wilms FF, Heydanus R, Mol BW, Papatsonis DN. Fetal complications after placement of an intrauterine pressure catheter: a report of two cases and review of the literature. J Matern Fetal Neonatal Med. 2008;21:880–3.
Handwerker SM, Selick AM. Placental abruption after insertion of catheter tip intrauterine pressure transducers: a report of four cases. J Reprod Med. 1995;40:845–9.
Schlembach D, Maner WL, Garfield RE, Maul H. Monitoring the progress of pregnancy and labor using electromyography. Eur J Obstet Gynecol Reprod Biol. 2009;144(Suppl 1):S33–9.
Maul H, Maner WL, Saade GR, Garfield RE. The physiology of uterine contractions. Clin Perinatol. 2003;30:665–76.
Devedeux D, Marque C, Mansour S, Germain G, Duchene J. Uterine electromyography: a critical review. Am J Obstet Gynecol. 1993;169:1636–53.
Vlemminx MWC, Thijssen KMJ, Bajlekov GI, Dieleman JP, Van Der Hout-Van Der Jagt MB, Oei SG. Electrohysterography for uterine monitoring during term labour compared to external tocodynamometry and intra-uterine pressure catheter. Eur J Obstet Gynecol Reprod Biol. 2017;215:197–205.
Reuwer PJ, Bruinse HW, Franx A. Proactive support of labor. The challenge of normal childbirth. 2nd ed. New York: Cambridge University Press; 2015.
Rabotti C, Mischi M, van Laar JO, Oei GS, Bergmans JW. Estimation of internal uterine pressure by joint amplitude and frequency analysis of electrohysterographic signals. Physiol Meas. 2008;29:829–41.
Jezewski J, Horoba K, Matonia A, Wrobel J. Quantitative analysis of contraction patterns in electrical activity signal of pregnant uterus as an alternative to mechanical approach. Physiol Meas. 2005;26:753–67.
O’Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003;14:368–74.
Cohen WR, Hayes-Gill B. Influence of maternal body mass index on accuracy and reliability of external fetal monitoring techniques. Acta Obstet Gynecol Scand. 2014;93:590–5.
Basroan S, Jain S, Fox K, Mateus J, Wen T, Maner W, et al. Abstract 316: comparing vaginal probe uterine electromyography to transabdominal & tocodynamometer in morbidly obese pregnant women. Am J Obstet Gynecol. 2009;201:S126.
Bakker JJ, Verhoeven CJ, Janssen PF, van Lith JM, van Oudgaarden ED, Bloemenkamp KW, et al. Outcomes after internal versus external tocodynamometry for monitoring labor. N Engl J Med. 2010;362:306–13.
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Author Professor Oei is a gynecologist and the Head of the Obstetric Department of Máxima Medical Center and leader of the fundamental perinatology research group from Eindhoven University of Technology. From this scientific research, the described EHG device and the company Nemo Healthcare has originated. Máxima Medical Centre has a research collaboration with Nemo Healthcare. Professor Oei has no affiliations with or involvement in Nemo Healthcare with any financial interest. During the study, authors MV, KT, and BvdH were financially supported by a general gift of the independent Dutch ‘Stichting De Weijerhorst’ for electro-fetal-maternal monitoring. From 2016, author KT is being paid by a grant from the European Framework Research and Innovation Program ‘Horizon 2020’ (Grant number 719500). Authors GB and JD have no conflicts of interest.
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Clinical trial registry:W3-study, Dutch Trial Registry, NTR5894 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5894
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Vlemminx, M.W.C., Thijssen, K.M.J., Bajlekov, G.I. et al. Could electrohysterography be the solution for external uterine monitoring in obese women?. J Perinatol 38, 580–586 (2018). https://doi.org/10.1038/s41372-018-0065-3
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DOI: https://doi.org/10.1038/s41372-018-0065-3
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