Various linear and non-linear signal-processing techniques were applied to three-channel uterine EMG records to separate term and pre-term deliveries. The linear techniques were root mean square value, peak and median frequency of the signal power spectrum and autocorrelation zero crossing; while the selected non-linear techniques were estimation of the maximal Lyapunov exponent, correlation dimension and calculating sample entropy. In total, 300 records were grouped into four groups according to the time of recording (before or after the 26th week of gestation) and according to the total length of gestation (term delivery records--pregnancy duration >or=37 weeks and pre-term delivery records--pregnancy duration <37 weeks). The following preprocessing band-pass Butterworth filters were tested: 0.08-4, 0.3-4, and 0.3-3 Hz. With the 0.3-3 Hz filter, the median frequency indicated a statistical difference between those term and pre-term delivery records recorded before the 26th week (p = 0.03), and between all term and all pre-term delivery records (p = 0.012). With the same filter, the sample entropy indicated statistical differences between those term and pre-term delivery records recorded before the 26th week (p = 0.035), and between all term and all pre-term delivery records (p = 0.011). Both techniques also showed noticeable differences between term delivery records recorded before and after the 26th week (p

Objective-Power spectrum (PS) of uterine electromyography (EMG) can identify true labor. EMG propagation velocity (PV) to diagnose labor has not been reported. The objective was to compare uterine EMG against current methods to predict preterm delivery.Study design-EMG was recorded in 116 patients (preterm labor, n=20; preterm non-labor, n=68; term labor, n=22; term non-labor, n=6). Student's t-test was used to compare EMG values for labor vs. non-labor (P<0.05 significant). Predictive values of EMG, Bishop-score, contractions on tocogram, and transvaginal cervical length were calculated using receiver-operatorcharacteristics analysis.Results-PV was higher in preterm and term labor compared with non-labor (P<0.001). Combined PV and PS peak frequency predicted preterm delivery within 7 days with area-underthe-curve (AUC) = 0.96. Bishop score, contractions, and cervical length had AUC of 0.72, 0.67, and 0.54.Conclusions-Uterine EMG PV and PS peak frequency more accurately identify true preterm labor than clinical methods.

The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum.

Low PAPP-A level is associated with the delivery of an SGA baby and high PAPP-A with the delivery of an LGA baby. High inhibin-A is associated with preterm delivery before 34 weeks. Feto-placental products in the first trimester do not prove to be useful as a screening tool for predicting pregnancy complications.

ObjectiveTo assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity.DesignAnalysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries.SettingTwenty-five countries in the European Union and Norway.PopulationWomen giving birth in participating countries in 2003 and 2004.MethodsApplication of a common collection of data by selecting specific International Classification of Disease codes from the ‘Pregnancy, childbirth and the puerperium’ chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies.Main outcome measuresMaternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission.ResultsIn 22 countries that provided data, the maternal mortality ratio was 6.3 per 100 000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women).ConclusionsCurrently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended.