In real-time and throughout the whole surface of the uterus during childbirth, Washington University School of Medicine researchers in St. Louis have created novel imaging equipment that can produce 3D maps displaying the size and distribution of uterine contractions. This technology, which builds on imaging techniques long used to picture the heart, can image uterine contractions noninvasively and in far more detail than current technologies, which can only detect the presence or absence of a contraction.
The clinical trial, which involved 10 individuals from the time of labor to delivery, was released on March 14 in the journal Nature Communications.
“There are all kinds of obstetrics and gynecological conditions that are associated with uterine contractions, but we don’t have very accurate ways of measuring them,” said senior author Yong Wang, Ph.D., an associate professor of obstetrics & gynecology, of electrical & systems engineering, of radiology, and of biomedical engineering. “With this new imaging technology, we are basically upgrading the standard way of measuring labor contractions—called tocodynamometry—from one-dimensional tracing to four-dimensional mapping. This kind of information could help improve care for patients with high-risk pregnancies and identify ways to prevent preterm birth, which occurs in about 10% of pregnancies globally.”
The uterus contracts during labor and delivery to exert the force necessary to eject the fetus, and a new technique for detecting these contractions is known as electro myometrial imaging (EMMI). For instance, such technology could assist in identifying the kinds of early contractions that result in premature birth and assist researchers in finding strategies to reduce or end these early contractions. A cesarean (C-section) delivery may be necessary if the contractions are abnormal and cause labor arrest. The risk of delivery injuries or newborn and parent death can rise with preterm birth and C-sections. Long-term neurodevelopmental disabilities for the child are among these injuries.
A new imaging technique has been created by scientists at Washington University School of Medicine in St. Louis to create accurate 3D maps of uterine contractions in real-time. The use of technology might make it easier to characterize the course of healthy labor and spot potential difficulties, like preterm labor or labor arrest. A video clip of the left and right views of the development of a single uterine contraction in real-time during typical labor is displayed. Thanks to WANG LAB
The researchers discovered that uterine contractions differ from heart contractions, which are normally recorded using similar technologies, in that they are less predictable and constant. The starting area and the direction of advancement of successive labor contractions can vary, even within the same patient.
The researchers also discovered that there are no regular places in the uterus where contractions start, indicating that the uterine contractions pacemaker is not physically fixed like the pacemaker in the heart. The team’s imaging method, which can track changes via progressive contractions, is enhanced by these factors.
Patients who had previously given birth as well as those who were giving birth for the first time were included in the study. Researchers discovered that patients who had never given birth before experienced longer, more variable contractions than those who had. This suggests that the uterus may have a memory impact.
According to Wang, EMMI could be used in the following therapeutic settings:
- In patients with preterm contractions, differentiating between productive and nonproductive contractions can help predict preterm birth.
- Real-time monitoring of labor contractions is done to improve medical care and avoid issues like labor arrest.
- Monitoring uterine contractions to prevent postpartum hemorrhage.
- Creating potential non-pharmaceutical treatments, like gentle electrical interventions to regulate contraction patterns.
- Examining uterine diseases other than pregnancy, like endometriosis and uncomfortable menstruation.
Wang’s research will next measure typical uterine contractions to determine whether or not they are productive and result in labor. The National Institutes of Health (NIH) awarded his team a grant last year to develop a kind of atlas that describes the appearance of contractions during typical labor. “The goal of this grant is to image healthy term labor in 300 patients so that we know what the normal range looks like—for first-time births and second- or third-time births,” Wang said. “This is a new measurement, so we don’t have a previous accumulation of knowledge. We have to produce a normal baseline atlas first.”
In resource-poor countries, this type of precise imaging could help make labor and deliveries safer. Wang hopes to replace pricey and impractical MRI scans with less-priced and more portable ultrasonic imaging in order to make the technology more broadly available. Additionally, Wang’s team is working closely with Chuan Wang, Ph.D., an assistant professor of electrical and systems engineering, and Shantanu Chakrabartty, Ph.D., the Clifford W. Murphy Professor of Electrical and Systems Engineering, with funding from the Bill & Melinda Gates Foundation, to produce disposable electrodes and wireless transmitters.
“We would like to develop a low-cost EMMI system that can be applicable in low- and moderate-resource settings,” Yong Wang said. “We are trying to make the electrodes much cheaper using printed, disposable electrodes and a wireless transmitter.”
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