A Comparative Study of Vaginal Labor and Caesarean Section Postpartum Uterine Myoelectrical Activity

Abstract

Postpartum hemorrhage (PPH) is one of the major causes of maternal mortality and morbidity worldwide, with uterine atony being the most common origin. Currently there are no obstetrical techniques available for monitoring postpartum uterine dynamics, as tocodynamometry is not able to detect weak uterine contractions. In this study, we explored the feasibility of monitoring postpartum uterine activity by non-invasive electrohysterography (EHG), which has been proven to outperform tocodynamometry in detecting uterine contractions during pregnancy. A comparison was made of the temporal, spectral, and non-linear parameters of postpartum EHG characteristics of vaginal deliveries and elective cesareans. In the vaginal delivery group, EHG obtained a significantly higher amplitude and lower kurtosis of the Hilbert envelope, and spectral content was shifted toward higher frequencies than in the cesarean group. In the non-linear parameters, higher values were found for the fractal dimension and lower values for Lempel-Ziv, sample entropy and spectral entropy in vaginal deliveries suggesting that the postpartum EHG signal is extremely non-linear but more regular and predictable than in a cesarean. The results obtained indicate that postpartum EHG recording could be a helpful tool for earlier detection of uterine atony and contribute to better management of prophylactic uterotonic treatment for PPH prevention.

Comparison of Oxytocin vs. Carbetocin Uterotonic Activity after Caesarean Delivery Assessed by Electrohysterography: A Randomised Trial

“…There are much less data on use of EHG as a means for assessing postpartum uterine activity. The feasibility of such EHG use has already been demonstrated by Diaz Martinez et al [28]. They found uterine contractions after vaginal birth to be more frequent and more intense compared to caesarean section [21].…”

“…Traditionally, analysis of the EHG parameters was used for objectifying uterine dynamics [24,25], distinguishing true labour from false labour [17,26], or comparing preterm with term labour [27]. Only recently have studies regarding postpartum EHG been published [21,28]. However, no study to date used postpartum EHG to compare the efficacy of different uterotonic agents.…”

Optimized Feature Subset Selection Using Genetic Algorithm for Preterm Labor Prediction Based on Electrohysterography

“…Time reversibility (TimeRev) estimates the similarity in forward (natural) and reverse time and can be considered as a measurement of the degree of signal nonlinearity [ 8 ]. Uterine myoelectric activity has also been shown to possess fractal properties and is another way of measuring signal self-similarity [ 20 , 21 ]. We also computed Katz’s fractal dimension (KFD) [ 22 ] since it is less sensitive to noise than Higuchi’s method [ 23 ].…”

An open dataset with electrohysterogram records of pregnancies ending in induced and cesarean section delivery

“…Moreover, in the last 10 years the number of induced and cesarean deliveries has increased even if there is no apparent medical reason 54 , 55 . The latest related studies, using EHG records of induced or cesarean section delivery modes, focuses on characterization of antepartum, labor, and post-partum records 56 , characterization of bursts in late antepartum records of pregnant women with complete placenta previa 57 , differentiation between term spontaneous labor and induced late-term labor 58 , prediction of labor induction success in the first hours after induction of labor 59 , prediction of cesarean section and spontaneous vaginal delivery modes 60 , and predicting uterine atony after spontaneous or cesarean deliveries using post-partum EHG records 61 . However, these delivery-mode prediction methods relied on antepartum or labor EHG records recorded after the 37th week of gestation and did not take into account earlier recorded (before the 37th week) EHG records nor preterm birth prediction.…”