Download PDF
Am J Perinatol 2019; 36(09): 924-929
DOI: 10.1055/s-0038-1675621
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluating Fundal Dominant Contractions on Spatiotemporal Electrohysterography as a Marker for Effective Labor Contractions

Rodney K. Edwards
1   Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
,
Neil R. Euliano
2   Convergent Engineering, Newberry, Florida
,
Savyasachi Singh
2   Convergent Engineering, Newberry, Florida
,
Rachel C. LeDuke
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
William W. Andrews
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Victoria Jauk
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
4   Departments of Biostatistics and Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations Funding This work was supported by grant 1 R21 HD076352-01A1 from the Eunice Kennedy Shriver National Institute for Child Health and Human Development. Contents are the authors' sole responsibility and do not necessarily represent official NIH views.
Further Information

Publication History

11 July 2018

21 September 2018

Publication Date:
10 November 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Objective To evaluate if fundal (F) dominance of the electrohysterogram is associated with vaginal delivery and lack of F dominance is associated with cesarean for labor dystocia.

Study Design We conducted a prospective cohort study of nulliparous women in spontaneous labor at ≥36 weeks. Clinicians were blinded to electrohysterography data which were in addition to standard cardiotocography. All contractions in the hour preceding diagnosis of complete cervical dilation (for women delivering vaginally) or the hour preceding the decision for cesarean were analyzed.

Results Of 224 patients, 167 had evaluable data. The proportion of F dominant contractions was not different for women undergoing cesarean for labor dystocia (n = 11) compared with all others (n = 156)—88.7 ± 10.2 versus 86.0 ± 11.4%; p = 0.44. Results were similar when comparing the cesarean for labor dystocia group to those undergoing cesarean for other indications (n = 10) and vaginal deliveries (n = 146)—88.7 ± 10.2 versus 86.5 ± 10.0 versus 85.9 ± 11.5%; p = 0.74.

Conclusion We were unable to confirm our earlier finding that F dominance of the electrohysterogram is associated with vaginal delivery and lack of F dominance is associated with cesarean for dystocia.

Keywords

labor - labor dystocia - electrohysterography - cesarean delivery - uterine contraction - monitoring
 

  • References

  • 1 Martin JA, Hamilton BE, Ventura SJ. , et al. Births: final data for 2009. Natl Vital Stat Rep 2011; 60 (01) 1-70
    PubMedGoogle Scholar
  • 2 MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol 2008; 35 (02) 293-307
    CrossrefPubMedGoogle Scholar
  • 3 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep 2018; 67 (01) 1-55
    PubMedGoogle Scholar
  • 4 Hall MH, Bewley S. Maternal mortality and mode of delivery. Lancet 1999; 354 (9180): 776
    PubMedGoogle Scholar
  • 5 Villar J, Carroli G, Zavaleta N. , et al; World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007; 335 (7628): 1025
    CrossrefPubMedGoogle Scholar
  • 6 Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol 2004; 103 (5 Pt 1): 907-912
    CrossrefPubMedGoogle Scholar
  • 7 Declercq E, Barger M, Cabral HJ. , et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol 2007; 109 (03) 669-677
    CrossrefPubMedGoogle Scholar
  • 8 Henderson J, McCandlish R, Kumiega L, Petrou S. Systematic review of economic aspects of alternative modes of delivery. BJOG 2001; 108 (02) 149-157
    PubMedGoogle Scholar
  • 9 Joseph KS, Young DC, Dodds L. , et al. Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol 2003; 102 (04) 791-800
    PubMedGoogle Scholar
  • 10 Murthy K, Grobman WA, Lee TA, Holl JL. Association between rising professional liability insurance premiums and primary cesarean delivery rates. Obstet Gynecol 2007; 110 (06) 1264-1269
    CrossrefPubMedGoogle Scholar
  • 11 American College of Obstetrics and Gynecology Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin Number 49, December 2003: Dystocia and augmentation of labor. Obstet Gynecol 2003; 102 (06) 1445-1454
    PubMedGoogle Scholar
  • 12 Gifford DS, Morton SC, Fiske M, Keesey J, Keeler E, Kahn KL. Lack of progress in labor as a reason for cesarean. Obstet Gynecol 2000; 95 (04) 589-595
    PubMedGoogle Scholar
  • 13 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
    CrossrefPubMedGoogle Scholar
  • 14 Rouse DJ, Owen J, Savage KG, Hauth JC. Active phase labor arrest: revisiting the 2-hour minimum. Obstet Gynecol 2001; 98 (04) 550-554
    PubMedGoogle Scholar
  • 15 Hellman LM, Harris J, Reynolds SRM. Characteristics of the gradients of uterine contractility during the first stage of true labor. Bull Johns Hopkins Hosp 1950; 86 (04) 234-248
    PubMedGoogle Scholar
  • 16 Euliano TY, Marossero D, Nguyen MT, Euliano NR, Principe J, Edwards RK. Spatiotemporal electrohysterography patterns in normal and arrested labor. Am J Obstet Gynecol 2009; 200 (01) 54.e1-54.e7
    CrossrefPubMedGoogle Scholar
  • 17 Euliano TY, Nguyen MT, Marossero D, Edwards RK. Monitoring contractions in obese parturients: electrohysterography compared with traditional monitoring. Obstet Gynecol 2007; 109 (05) 1136-1140
    CrossrefPubMedGoogle Scholar
  • 18 Euliano T, Skowronski M, Marossero D, Shuster J, Edwards R. Prediction of intrauterine pressure waveform from transabdominal electrohysterography. J Matern Fetal Neonatal Med 2006; 19 (12) 811-816
    PubMedGoogle Scholar