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>
	<li>Hadar, E., Biron-Shental, T., Gavish, O., Raban, O., Yogev, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+between+electrical+uterine+monitor,+tocodynamometer+and+intra+uterine+pressure+catheter+for+uterine+activity+in+labor.">A comparison between electrical uterine monitor, tocodynamometer and intra uterine pressure catheter for uterine activity in labor.</a> The Journal of Maternal-Fetal &amp; Neonatal Medicine. 28 (12), 1367-1374 (2015).</li><li>Schlembach, D., Maner, W. L., Garfield, R. E., Maul, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+the+progress+of+pregnancy+and+labor+using+electromyography.">Monitoring the progress of pregnancy and labor using electromyography.</a> European Journal of Obstetrics, Gynecology, and Reproductive Biology. 144, S33-S39 (2009).</li><li>Jacod, B. C., Graatsma, E. M., Van Hagen, E., Visser, G. H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+validation+of+electrohysterography+for+uterine+activity+monitoring+during+labour.">A validation of electrohysterography for uterine activity monitoring during labour.</a> The Journal of Maternal-Fetal &amp; Neonatal Medicine. 23 (1), 17-22 (2009).</li><li>Garfield, R. 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. L., Garfield, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+human+term+and+preterm+labor+using+artificial+neural+networks+on+uterine+electromyography+data.">Identification of human term and preterm labor using artificial neural networks on uterine electromyography data.</a> Annals of Biomedical Engineering. 35 (3), 465-473 (2007).</li><li>Rabotti, C., 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=Propagation+of+electrical+activity+in+uterine+muscle+during+pregnancy:+a+review.">Propagation of electrical activity in uterine muscle during pregnancy: a review.</a> Acta Physiologica. 213 (2), 406-416 (2015).</li><li>Cohen, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+assessment+of+uterine+contractions.">Clinical assessment of uterine contractions.</a> International Journal of Gynaecology and Obstetrics. 139 (2), 137-142 (2017).</li><li>Maner, W. L., Garfield, R. 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. IEEE. , 3880-3883 (2011).</li><li>Wu, W., 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=Noninvasive+high-resolution+electromyometrial+imaging+of+uterine+contractions+in+a+translational+sheep+model.">Noninvasive high-resolution electromyometrial imaging of uterine contractions in a translational sheep model.</a> Science Translational Medicine. 11 (483), (2019).</li><li>Wang, H., 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=Accuracy+of+electromyometrial+imaging+of+uterine+contractions+in+clinical+environment.">Accuracy of electromyometrial imaging of uterine contractions in clinical environment.</a> Computers in Biology and Medicine. 116, 103543 (2020).</li><li>Cahill, A. G., 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=Analysis+of+electrophysiological+activation+of+the+uterus+during+human+labor+contractions.">Analysis of electrophysiological activation of the uterus during human labor contractions.</a> JAMA Network Open. 5 (6), 2214707 (2022).</li><li>Wang, H., 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=Noninvasive+electromyometrial+imaging+of+human+uterine+maturation+during+term+labor.">Noninvasive electromyometrial imaging of human uterine maturation during term labor.</a> Nature Communications. 14 (1), 1198 (2023).</li><li>Kok, R. D., de Vries, M. M., Heerschap, A., vanden Berg, P. 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. J., Bharatha, A., Montanera, W. J., Park, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+between+MRI+exposure+during+pregnancy+and+fetal+and+childhood+outcomes.">Association between MRI exposure during pregnancy and fetal and childhood outcomes.</a> JAMA. 316 (9), 952-961 (2016).</li><li>Benedetti, M. G., Agostini, V., Knaflitz, M., Bonato, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Applications+of+EMG+in+clinical+and+sports+medicine.">Applications of EMG in clinical and sports medicine.</a> Intech Open. , 117-130 (2012).</li><li>Lange, L., 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=Velocity+and+directionality+of+the+electrohysterographic+signal+propagation.">Velocity and directionality of the electrohysterographic signal propagation.</a> PloS One. 9 (1), e86775 (2014).</li><li>Planes, J. G., Morucci, J. P., Grandjean, H., Favretto, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=External+recording+and+processing+of+fast+electrical+activity+of+the+uterus+in+human+parturition.">External recording and processing of fast electrical activity of the uterus in human parturition.</a> Medical &amp; Biological Engineering &amp; Computing. 22 (6), 585-591 (1984).</li><li>Mikkelsen, E., Johansen, P., Fuglsang-Frederiksen, A., Uldbjerg, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electrohysterography+of+labor+contractions:+propagation+velocity+and+direction.">Electrohysterography of labor contractions: propagation velocity and direction.</a> Acta Obstetricia et Gynecologica Scandinavica. 92 (9), 1070-1078 (2013).</li><li>Young, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+uterine+pacemaker+of+labor.">The uterine pacemaker of labor.</a> Best Practice &amp; Research. Clinical Obstetrics &amp; Gynaecology. 52, 68-87 (2018).</li><li>Goldenberg, R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+management+of+preterm+labor.">The management of preterm labor.</a> Obstetrics and Gynecology. 100 (5), 1020-1037 (2002).</li><li>Rubens, C. 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=Prevention+of+preterm+birth:+harnessing+science+to+address+the+global+epidemic.">Prevention of preterm birth: harnessing science to address the global epidemic.</a> Science Translational Medicine. 6 (262), 5 (2014).</li><li>Shi, H., 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=Screen-printed+soft+capacitive+sensors+for+spatial+mapping+of+both+positive+and+negative+pressures.">Screen-printed soft capacitive sensors for spatial mapping of both positive and negative pressures.</a> Advanced Functional Materials. 29 (23), 1809116 (2019).</li><li>Lo, L. W., 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=An+inkjet-printed+PEDOT:PSS-based+stretchable+conductor+for+wearable+health+monitoring+device+applications.">An inkjet-printed PEDOT:PSS-based stretchable conductor for wearable health monitoring device applications.</a> ACS Applied Materials and Interfaces. 13 (18), 21693-21702 (2021).</li><li>Lo, L. W., 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=Stretchable+sponge+electrodes+for+long-term+and+motion-artifact-tolerant+recording+of+high-quality+electrophysiologic+signals.">Stretchable sponge electrodes for long-term and motion-artifact-tolerant recording of high-quality electrophysiologic signals.</a> ACS Nano. 16 (8), 11792-11801 (2022).</li></ol>

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.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>16 G Vinyl 54&#34; Clear</td>
			<td>Jo-Ann Stores</td>
			<td>1532449</td>
			<td></td>
		</tr>
		<tr>
			<td>3 T Siemens Prisma</td>
			<td>Siemens</td>
			<td>N/A</td>
			<td>MRI scanner</td>
		</tr>
		<tr>
			<td>3M double coated medical tape &#8211; transparent</td>
			<td>MBK tape solutions</td>
			<td>1522</td>
			<td>Width - 0.5&#34;</td>
		</tr>
		<tr>
			<td>Active electrode holders with X -ring</td>
			<td>Biosemi</td>
			<td>N/A</td>
			<td>17 mm</td>
		</tr>
		<tr>
			<td>Amira</td>
			<td>Thermo Fisher Scientific</td>
			<td>N/A</td>
			<td>&#160;Data analysis software</td>
		</tr>
		<tr>
			<td>Bella storage solution 28 Quart clear underbed storage tote</td>
			<td>Mernards</td>
			<td>&#160;6455002</td>
			<td></td>
		</tr>
		<tr>
			<td>Extreme-temperature silicone rubber translucent</td>
			<td>McMaster-Carr</td>
			<td>86465K71</td>
			<td>Thickness 1.32&#8221;</td>
		</tr>
		<tr>
			<td>Gorilla super glue gel</td>
			<td>Amazon</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>LifeTime carbide punch and die set, 9 Pc.</td>
			<td>Harbor Freight</td>
			<td>95547</td>
			<td></td>
		</tr>
		<tr>
			<td>Optical 3D scan</td>
			<td>Artec 3D</td>
			<td></td>
			<td>Artec Eva Lite</td>
		</tr>
		<tr>
			<td>PDI super sani cloth germicidal wipes</td>
			<td>McKesson medical supply company</td>
			<td>Q55172</td>
			<td>Santi-cloth</td>
		</tr>
		<tr>
			<td>Pin-type active electrodes</td>
			<td>Biosemi</td>
			<td>Pin-type</td>
			<td></td>
		</tr>
		<tr>
			<td>REDUX electrolyte gel</td>
			<td>Amazon</td>
			<td>67-05</td>
			<td></td>
		</tr>
		<tr>
			<td>Soft cloth measuring tape</td>
			<td>Amazon</td>
			<td>N/A</td>
			<td>any brand can be used</td>
		</tr>
		<tr>
			<td>Sterilite layer handle box</td>
			<td>Walmart</td>
			<td>14228604</td>
			<td>Closed box</td>
		</tr>
		<tr>
			<td>TD-22 Electrode collar 8 mm</td>
			<td>Discount disposables</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Vida scanner</td>
			<td>Siemens</td>
			<td>N/A</td>
			<td>MRI scanner</td>
		</tr>
		<tr>
			<td>Vitamin E dl-Alpha 400 IU - 100 liquid softgels</td>
			<td>Nature made</td>
			<td>SU59FC52EE73DC3</td>
			<td></td>
		</tr>
	</tbody>
</table>

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

Our research aims to develop a non-invasive imaging technology termed electromyometrial imaging to generate real-time, 3D images of uterine contractions in humans. Our work will create a deeper understanding of the mechanism of uterine contractions during human labor. We aim to answer major questions in human labor management and the prediction of preterm birth and the labor arrest.The correlation pattern of the EMMI-derived uterine activation index, maximal activation ratio, and cervical dilation differed between nulliparous and multiparous groups, suggesting myometrial memory may contribute to faster labor progression in multiparous patients than in nulliparous patients. EMMI-derived activation curves have a sigmoid evolution nature, potentially reflecting the bioelectrical stimulation response dynamics during contractions. With the non-invasive electromyometrial imaging system, we are ready to visualize human labor, uterine contractions, to answer some fundamental questions about human labor, such as where the contraction start, how they propagate, and where they stop.Electromyometrial imaging can also provide multiple novel measures to reflect human labor progression. We plan to make EMMI portable and low-cost for extensive research by substituting MRI with ultrasound and a costly wired electrode system with disposable wireless electrode patches. This will expedite our work on creating a normal term atlas of EMMI.This atlas will serve as a reference point for studying different disease conditions by defining normal labor contractions.

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 ...