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Noninvasive monitoring of uterine electrical activity among patients with obesity: a new external monitoring device

  • Saila S. Moni
    Correspondence
    Corresponding author: Saila S. Moni, MD.
    Affiliations
    Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Drs Moni, Kirshenbaum, Comfort, Kuba, Wolfe, and Bernstein)

    Department of Maternal-Fetal Medicine, OSF HealthCare, Peoria, IL (Dr Moni)
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  • Rachel Kirshenbaum
    Affiliations
    Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Drs Moni, Kirshenbaum, Comfort, Kuba, Wolfe, and Bernstein)

    Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY (Dr Kirshenbaum)
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  • Lizelle Comfort
    Affiliations
    Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Drs Moni, Kirshenbaum, Comfort, Kuba, Wolfe, and Bernstein)
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  • Kfier Kuba
    Affiliations
    Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Drs Moni, Kirshenbaum, Comfort, Kuba, Wolfe, and Bernstein)
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  • Diana Wolfe
    Affiliations
    Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Drs Moni, Kirshenbaum, Comfort, Kuba, Wolfe, and Bernstein)
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  • Xianhong Xie
    Affiliations
    Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Drs Xie and Negassa)
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  • Abdissa Negassa
    Affiliations
    Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Drs Xie and Negassa)
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  • Peter S. Bernstein
    Affiliations
    Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (Drs Moni, Kirshenbaum, Comfort, Kuba, Wolfe, and Bernstein)
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      BACKGROUND

      Tocodynamometry is a common, noninvasive tool used to measure contraction frequency; however, its utility is often limited in patients with obesity. An intrauterine pressure catheter provides a more accurate measurement of uterine contractions but requires ruptured membranes, limiting its utility during early latent labor. Electrical uterine myography has shown promise as a noninvasive contraction monitor with efficacy similar to that of the intrauterine pressure catheter; however, its efficacy has not been widely studied in the obese population.

      OBJECTIVE

      This study aimed to validate the accuracy of electrical uterine myography by comparing it with tocodynamometry and intrauterine pressure catheters among laboring patients with obesity.

      STUDY DESIGN

      This was a prospective observational study from February 2017 to April 2018 of patients with obesity, aged 18 years or older, who were admitted to the labor unit with viable singleton pregnancies and no contraindications for electromyography. Patients were monitored simultaneously with electrical myography and tocodynamometry or intrauterine catheter for more than 30 minutes. Two blinded obstetricians reviewed the tracings. The outcomes of interest were continuous and interpretable tracing, number of contractions, and timing and duration of contractions, interpreted as point estimates and associated 95% confidence intervals.

      RESULTS

      A total of 110 patients were enrolled (65 tocodynamometry, 55 intrauterine catheter). Electrical myography was significantly more interpretable during a 30-minute tracing (P=.001) and detected 39% more contractions than tocodynamometry (P<.0001; 95% confidence interval, 23%–57%), whereas there was no difference in the interpretability of tracings or number of contractions between electrical myography and an intrauterine catheter (P=.16; 95% confidence interval, –0.19 to 1.19). Patients who underwent simultaneous monitoring preferred the electrical myography device over tocodynamometry.

      CONCLUSION

      Electrical uterine myography is superior to tocodynamometry in the detection of intrapartum uterine contraction monitoring and comparable with internal contraction monitoring.

      Key words

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