Name: Author Spotlight: Advancing Labor Management Through Electromyometrial Imaging for Understanding Uterine Contractions
Uploaded: 2023-05-26T13:40:00
Description: Watch this Scientific Journal Video about Advancing Labor Management Through Electromyometrial Imaging for Understanding Uterine Contractions at JoVE.com

We thank Deborah Frank for editing this manuscript and Jessica Chubiz for organizing the project. Funding: This work was supported by the March of Dimes Center Grant (22-FY14-486), by grants from NIH/National Institute of Child Health and Human Development (R01HD094381 to PIs Wang/Cahill; R01HD104822 to PIs Wang/Schwartz/Cahill), by grants from Burroughs Wellcome Fund Preterm Birth Initiative (NGP10119 to PI Wang), and by grants from the Bill and Melinda Gates Foundation (INV-005417, INV-035476, and INV-037302 to PI Wang).

All methods described here have been approved by the Washington University Institutional Review Board.
1. MRI-safe marker patches, electrode patches, and rulers (Figure 1)
<ol>
	<li>Print the MRI and electrode patch templates (Figure 1A) on paper.</li>
	<li>Cut clear vinyl and silicone rubber sheets (Table of Materials) into 22 (vinyl) and 44 (rubber) rectangular (120 mm x 60 mm), a...

Visualizing Uterine Contractions by EMMI for Improved Labor Management

<ol>
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E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Uterine+Electromyography+and+light-induced+fluorescence+in+the+management+of+term+and+preterm+labor.">Uterine Electromyography and light-induced fluorescence in the management of term and preterm labor.</a> Journal of the Society for Gynecologic Investigation. 9 (5), 265-275 (2016).</li><li>Devedeux, D., Marque, C., Mansour, S., Germain, G., Duch&#234;ne, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Uterine+electromyography:+A+critical+review.">Uterine electromyography: A critical review.</a> American Journal of Obstetrics and Gynecology. 169 (6), 1636-1653 (1993).</li><li>Jain, S., Saad, A. F., Basraon, S. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparing+uterine+electromyography+&amp;+tocodynamometer+to+intrauterine+pressure+catheter+for+monitoring+labor.">Comparing uterine electromyography &amp; tocodynamometer to intrauterine pressure catheter for monitoring labor.</a> Journal of Woman's Reproductive Health. 1 (3), 22-30 (2016).</li><li>Lucovnik, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+uterine+electromyography+to+diagnose+term+and+preterm+labor.">Use of uterine electromyography to diagnose term and preterm labor.</a> Acta Obstetricia et Gynecologica Scandinavica. 90 (2), 150-157 (2011).</li><li>Garcia-Casado, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrohysterography+in+the+diagnosis+of+preterm+birth:+a+review.">Electrohysterography in the diagnosis of preterm birth: a review.</a> Physiological Measurement. 39 (2), 02 (2018).</li><li>Maner, W. 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E., Maul, H., Olson, G., Saade, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predicting+term+and+preterm+delivery+with+transabdominal+uterine+electromyography.">Predicting term and preterm delivery with transabdominal uterine electromyography.</a> Obstetrics &amp; Gynecology. 101 (6), 1254-1260 (2003).</li><li>Leman, H., Marque, C., Gondry, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+the+electrohysterogram+signal+for+characterization+of+contractions+during+pregnancy.">Use of the electrohysterogram signal for characterization of contractions during pregnancy.</a> IEEE Transactions on Biomedical Engineering. 46 (10), 1222-1229 (1999).</li><li>Vasak, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Uterine+electromyography+for+identification+of+first-stage+labor+arrest+in+term+nulliparous+women+with+spontaneous+onset+of+labor.">Uterine electromyography for identification of first-stage labor arrest in term nulliparous women with spontaneous onset of labor.</a> American Journal of Obstetrics and Gynecology. 209 (3), e1-e8 (2013).</li><li>Euliano, T. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+uterine+activity+during+labor:+a+comparison+of+3+methods.">Monitoring uterine activity during labor: a comparison of 3 methods.</a> American Journal of Obstetrics and Gynecology. 208 (1), e1-e6 (2013).</li><li>Garfield, R. E., Maner, W. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Physiology+and+electrical+activity+of+uterine+contractions.">Physiology and electrical activity of uterine contractions.</a> Seminars in Cell &amp; Developmental Biology. 18 (3), 289-295 (2007).</li><li>Rabotti, C., Bijloo, R., Oei, G., Mischi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vectorial+analysis+of+the+electrohysterogram+for+prediction+of+preterm+delivery:+a+preliminary+study.">Vectorial analysis of the electrohysterogram for prediction of preterm delivery: a preliminary study.</a> 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 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P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Absence+of+harmful+effects+of+magnetic+resonance+exposure+at+1.5+T+in+utero+during+the+third+trimester+of+pregnancy:+A+follow-up+study.">Absence of harmful effects of magnetic resonance exposure at 1.5 T in utero during the third trimester of pregnancy: A follow-up study.</a> Magnetic Resonance Imaging. 22 (6), 851-854 (2004).</li><li>Choi, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+case+series+of+15+women+inadvertently+exposed+to+magnetic+resonance+imaging+in+the+first+trimester+of+pregnancy.">A case series of 15 women inadvertently exposed to magnetic resonance imaging in the first trimester of pregnancy.</a> Journal of Obstetrics and Gynaecology. 35 (8), 871-872 (2015).</li><li>Ray, J. G., Vermeulen, M. 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Electromyography has indicated that the frequency and amplitude of uterine electrical signals alter during the gestational period2,16,25. Several studies have explored the uterine propagation patterns of uterine contractions in patients in active labor10,17,26,27,28. ...

Clinically, uterine contractions are measured either by using an intrauterine pressure catheter or by performing tocodynamometry1. In the research setting, uterine contractions can be measured by electromyography (EMG), in which electrodes are placed on the abdominal surface to measure the bioelectrical signals generated by the myometrium2,3,4,5,6,7. One can use the magnitude, frequency, and propagation features of electrical bursts8,9,10,11,12&#160;derived from EMG to predict the onset of labor in the preterm. However, in conventional EMG, the electrical activity of uterine contractions is measured from only a tiny region of the abdominal surface with a limited number of electrodes (two13 and four7,14,15,16 at the center of the abdominal surface, and 6417 at the lower abdominal surface). Furthermore, conventional EMG is limited in its ability to study the mechanisms of labor, as it reflects only the averaged electrical activities from the entire uterus and cannot detect the specific electrical initiation and activation patterns on the uterine surface during contractions.
A recent development called electromyometrial imaging (EMMI) has been introduced to overcome the shortcomings of conventional EMG. EMMI enables noninvasive imaging of the entire myometrium&#39;s electrical activation sequence during uterine contractions18,19,20,21. To acquire the body-uterus geometry, EMMI uses T1-weighted magnetic resonance imaging (MRI)22,23,24, which has been widely used for pregnant women during their second and third trimesters. Next, up to 192 pin-type electrodes placed on the body surface are used to collect electrical recordings from the myometrium. Finally, the EMMI data processing pipeline is performed to combine the body-uterus geometry with the electrical data to reconstruct and image electrical activities on the uterine surface21. EMMI can accurately locate the initiation of uterine contractions and image propagation patterns during uterine contractions in three dimensions. This article aims to present the EMMI procedures and demonstrate the representative results obtained from pregnant women.

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electromyometrial imaging of uterine contractions in pregnant women

During normal pregnancy, the uterine smooth muscle, the myometrium, begins to have weak, uncoordinated contractions at late gestation to help the cervix remodel. In labor, the myometrium has strong, coordinated contractions to deliver the fetus. Various methods have been developed to monitor uterine contraction patterns to predict labor onset. However, the current techniques have limited spatial coverage and specificity. We developed electromyometrial imaging (EMMI) to noninvasively map uterine electrical activity onto the three-dimensional uterine surface during contractions. The first step in EMMI is to use T1-weighted magnetic resonance imaging to acquire the subject-specific body-uterus geometry. Next, up to 192 pin-type electrodes placed on the body surface are used to collect electrical recordings from the myometrium. Finally, the EMMI data processing pipeline is performed to combine the body-uterus geometry with body surface electrical data to reconstruct and image uterine electrical activities on the uterine surface. EMMI can safely and noninvasively image, identify, and measure early activation regions and propagation patterns across the entire uterus in three dimensions.

Author Spotlight: Advancing Labor Management Through Electromyometrial Imaging for Understanding Uterine Contractions 

Electromyometrial Imaging of Uterine Contractions in Pregnant Women

Representative MRI-safe patches and electrode patches are shown in Figure 1B,C, created from the template shown in Figure 1A. The bioelectricity mapping hardware is shown in Figure 1C, with the connections of each component marked in detail. Figure 2 shows the entire EMMI procedure, including an MRI scan of the subject wearing MRI patches (Figure 2A), 3D op...

Watch this Scientific Journal Video about Advancing Labor Management Through Electromyometrial Imaging for Understanding Uterine Contractions at JoVE.com

We present a protocol for conducting electromyometrial imaging (EMMI), including the following procedures: multiple electromyography electrode sensor recordings from the body surface, magnetic resonance imaging, and uterine electrical signal reconstruction.

During normal pregnancy, the uterine smooth muscle, the myometrium, begins to have weak, uncoordinated contractions at late gestation to help the cervix ...