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Anthony R. Gregg - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Uterine Activity during Labor: Clinician Interpretation of Electrohysterography versus Intrauterine Pressure Catheter and Tocodynamometry.
American journal of perinatology, 2016Co-Authors: Tammy Y. Euliano, Minh Tam Nguyen, Shalom Darmanjian, John D. Busowski, Neil R. Euliano, Anthony R. GreggAbstract:Objective The aim of this article was to compare clinical interpretation of uterine activity tracings acquired by tocodynamometry and electrohysterography with the gold standard, Intrauterine Pressure. Study Design Using data from a previous study, subjects who had simultaneous monitoring with all three uterine activity devices were included in this study. These were parturients who required Intrauterine Pressure catheter (IUPC) placement for obstetric indication. A Web-based application displayed scrolling 30-minute segments of uterine activity. Two blinded obstetricians and two blinded obstetric nurses independently reviewed the segments, marking uninterpretable segments and the peak of each contraction. Interpretability was compared using positive percent agreement. False positives are contractions marked in the noninvasive strip that have no corresponding contraction in the IUPC strip. False negatives are the reverse. Results A total of 135 segments, acquired during either Stage 1 (active labor) or Stage 2 (pushing), from 105 women, were included in this analysis. For all four observers, both interpretability and sensitivity of electrohysterography exceeded that of tocodynamometry (p
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monitoring uterine activity during labor clinician interpretation of electrohysterography versus Intrauterine Pressure catheter and tocodynamometry
American Journal of Perinatology, 2016Co-Authors: Tammy Y. Euliano, Minh Tam Nguyen, Shalom Darmanjian, John D. Busowski, Neil R. Euliano, Anthony R. GreggAbstract:Objective The aim of this article was to compare clinical interpretation of uterine activity tracings acquired by tocodynamometry and electrohysterography with the gold standard, Intrauterine Pressure. Study Design Using data from a previous study, subjects who had simultaneous monitoring with all three uterine activity devices were included in this study. These were parturients who required Intrauterine Pressure catheter (IUPC) placement for obstetric indication. A Web-based application displayed scrolling 30-minute segments of uterine activity. Two blinded obstetricians and two blinded obstetric nurses independently reviewed the segments, marking uninterpretable segments and the peak of each contraction. Interpretability was compared using positive percent agreement. False positives are contractions marked in the noninvasive strip that have no corresponding contraction in the IUPC strip. False negatives are the reverse. Results A total of 135 segments, acquired during either Stage 1 (active labor) or Stage 2 (pushing), from 105 women, were included in this analysis. For all four observers, both interpretability and sensitivity of electrohysterography exceeded that of tocodynamometry (p < 0.0001). This remained true for the obese population (96 segments). Conclusion Compared with the IUPC, electrohysterography is more sensitive and provides tracings that are more often interpretable than tocodynamometry for intrapartum monitoring; electrohysterography is also less affected by increasing maternal body mass index.
Carl P. Weiner - One of the best experts on this subject based on the ideXlab platform.
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Intrauterine Pressure during the second stage of labor in obese women.
Obstetrics and gynecology, 2004Co-Authors: Catalin S. Buhimschi, Irina A. Buhimschi, Andrew M. Malinow, Carl P. WeinerAbstract:Objective The perception that obese women have longer labors and a higher frequency of operative delivery because they are "poor pushers" persists despite the absence of objective study. We tested the hypothesis that obese women generate inadequate Intrauterine Pressure during the second stage of labor. Methods Intrauterine Pressure was prospectively measured in 71 women during the second stage of labor. Obesity was defined as a body mass index (BMI) greater than 29 (n = 17). A BMI below 25 was normal (n = 40). Women with a BMI between 26 and 29 (n = 14) were considered overweight. All women labored with epidural analgesia and were alert and responsive throughout the study. After recording the baseline contractility, a standardized Valsalva maneuver was performed during contractions. The area under the Intrauterine Pressure curve (integral) was used as an estimate of uterine contractility. Results All women delivered vaginally. There were no significant differences in baseline uterine contractility among obese, overweight, and normal women either before (obese 1,787 mm Hg/s; 95% confidence interval [CI] 1,164, 2,742 versus normal 1,569 mm Hg/s; 95% CI 718, 2,371 versus overweight 1,770 mm Hg/s; 95% CI 1,305, 2,835; P =.223) or during Valsalva maneuver (obese 2,831 mm Hg/s; 95% CI 1,771, 4,599 versus normal 2,637 mm Hg/s; 95% CI 1,240, 4,390 versus overweight 2,813 mm Hg/s; 95% CI 1,209, 4,982; P =.742). A BMI greater than 25 was associated with a higher frequency of oxytocin augmentation (P =.037). Univariate analysis revealed a relationship between labor duration and BMI (r = 0.299, P =.018). Obese women labored longer during the active phase (one-way analysis of variance, P =.02), but second-stage duration was similar among groups (one-way analysis of variance P =.44). Obesity did not increase the incidence of perineal lacerations (P =.82) or frequency of operative delivery (relative risk obese versus nonobese = 0.212; 95% CI 0.04, 1.05). Conclusion Obese women produce second-stage Intrauterine Pressures equivalent to women with a normal BMI, although they may require oxytocin augmentation more often. Level of evidence II-2
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The effect of fundal Pressure manoeuvre on Intrauterine Pressure in the second stage of labour
BJOG : an international journal of obstetrics and gynaecology, 2002Co-Authors: Catalin S. Buhimschi, Jerome Kopelman, Irina A. Buhimschi, Andrew M. Malinow, Carl P. WeinerAbstract:Abstract Objective To investigate the relationship between Intrauterine Pressure and the application of a standardised fundal Pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship. Design Prospective measurement of Intrauterine Pressure during the second stage of labour. Setting North American university hospital. Population Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia. Methods A fundal Pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine Pressure was measured using a sensor–tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal Pressure and valsalva during a contraction; 3. fundal Pressure during a contraction without valsalva; 4. fundal Pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions. Results Women in the second stage of labour transiently increased their expulsive force (as reflected by Intrauterine Pressure) by 86% of their baseline contraction using valsalva and fundal Pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased Intrauterine Pressure was directly related to gestational age and inversely related to myometrial thickness. Conclusion Fundal Pressure applied under controlled conditions significantly increases Intrauterine Pressure in some, but not all women. Simultaneous measurement of Intrauterine Pressure, to maintain feedback during application will create a ‘controlled environment’ for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal Pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions.
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The effect of fundal Pressure maneuver on Intrauterine Pressure during the second stage of labor
Obstetrics & Gynecology, 2001Co-Authors: Catalin S. Buhimschi, Jerome Kopelman, Irina A. Buhimschi, Andrew M. Malinow, Lindsay Alger, Carl P. WeinerAbstract:Abstract Objective: Fundal Pressure (FP) and Valsalva (V) are used alone and together to enhance uterine forces during the second stage of labor despite reported complications. We hypothesize that FP aids or complicates delivery by increasing Intrauterine Pressure (IP). Methods: We investigated the relationship between FP and IP during the second stage in 41 women with epidural analgesia. Intrauterine Pressure was measured electronically. Fundal Pressure was applied under standardized conditions across a Pressure cuff connected to a manometer after the vertex reached +2. Interventions included V or FP during contraction (CTXV, CTXFP); FP during V during contraction (CTXVFP); and FP and V alone between contractions. Integral, amplitude, duration, and basal tone were calculated. Multiple regression was used to identify interactions between maternal, fetal, and labor characteristics, and the effect of FP on IP. Results: IP transiently increased by 92% after V and FP together. Fifty-six percent of the maximal force resulted from contraction, 27% from V, and 17% from FP. Applied over V, FP significantly enhanced IP (P Download : Download full-size image Conclusion: FP increases IP but to a lesser extent than V. Large increases in IP after standardized application of FP could help to predict relative cephalopelvic disproportion and thus prevent further delay of a needed operative delivery.
Tammy Y. Euliano - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Uterine Activity during Labor: Clinician Interpretation of Electrohysterography versus Intrauterine Pressure Catheter and Tocodynamometry.
American journal of perinatology, 2016Co-Authors: Tammy Y. Euliano, Minh Tam Nguyen, Shalom Darmanjian, John D. Busowski, Neil R. Euliano, Anthony R. GreggAbstract:Objective The aim of this article was to compare clinical interpretation of uterine activity tracings acquired by tocodynamometry and electrohysterography with the gold standard, Intrauterine Pressure. Study Design Using data from a previous study, subjects who had simultaneous monitoring with all three uterine activity devices were included in this study. These were parturients who required Intrauterine Pressure catheter (IUPC) placement for obstetric indication. A Web-based application displayed scrolling 30-minute segments of uterine activity. Two blinded obstetricians and two blinded obstetric nurses independently reviewed the segments, marking uninterpretable segments and the peak of each contraction. Interpretability was compared using positive percent agreement. False positives are contractions marked in the noninvasive strip that have no corresponding contraction in the IUPC strip. False negatives are the reverse. Results A total of 135 segments, acquired during either Stage 1 (active labor) or Stage 2 (pushing), from 105 women, were included in this analysis. For all four observers, both interpretability and sensitivity of electrohysterography exceeded that of tocodynamometry (p
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monitoring uterine activity during labor clinician interpretation of electrohysterography versus Intrauterine Pressure catheter and tocodynamometry
American Journal of Perinatology, 2016Co-Authors: Tammy Y. Euliano, Minh Tam Nguyen, Shalom Darmanjian, John D. Busowski, Neil R. Euliano, Anthony R. GreggAbstract:Objective The aim of this article was to compare clinical interpretation of uterine activity tracings acquired by tocodynamometry and electrohysterography with the gold standard, Intrauterine Pressure. Study Design Using data from a previous study, subjects who had simultaneous monitoring with all three uterine activity devices were included in this study. These were parturients who required Intrauterine Pressure catheter (IUPC) placement for obstetric indication. A Web-based application displayed scrolling 30-minute segments of uterine activity. Two blinded obstetricians and two blinded obstetric nurses independently reviewed the segments, marking uninterpretable segments and the peak of each contraction. Interpretability was compared using positive percent agreement. False positives are contractions marked in the noninvasive strip that have no corresponding contraction in the IUPC strip. False negatives are the reverse. Results A total of 135 segments, acquired during either Stage 1 (active labor) or Stage 2 (pushing), from 105 women, were included in this analysis. For all four observers, both interpretability and sensitivity of electrohysterography exceeded that of tocodynamometry (p < 0.0001). This remained true for the obese population (96 segments). Conclusion Compared with the IUPC, electrohysterography is more sensitive and provides tracings that are more often interpretable than tocodynamometry for intrapartum monitoring; electrohysterography is also less affected by increasing maternal body mass index.
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Prediction of Intrauterine Pressure waveform from transabdominal electrohysterography.
The Journal of Maternal-Fetal & Neonatal Medicine, 2006Co-Authors: Tammy Y. Euliano, Mark D. Skowronski, Dorothee Marossero, Jonathan J. Shuster, Rodney K. EdwardsAbstract:Objective. We investigated the ability to non-invasively obtain uterine electromyograms (EMG; electrohysterogram (EHG)) to predict the Intrauterine Pressure (IUP) waveform.Study design. Patients enrolled in a term labor study of trans-abdominal electrical activity, who underwent IUP monitoring for obstetric indication, were included in this study (n = 14). EHG signals were processed and prediction filters trained against the IUP from the same patient. Sixty-eight 10-minute traces each of EHG and IUP waveforms were reviewed (Montevideo unit (MVU) calculation) by two experienced labor nurses and one obstetrician, blinded to patient and EHG vs. IUP output. In addition, area under the contraction curve (AUC), contraction detection and duration were compared.Results. EHG-derived MVUs statistically correlated with IUP (r = 0.795; p < 0.0001), but mathematically differed by 17±20% with 83% of EHG MVUs underestimating the IUP. The coefficients of variation between the two methods were relatively high (∼20%), and ...
Tal Biron-shental - One of the best experts on this subject based on the ideXlab platform.
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A comparison of surface acquired uterine electromyography and Intrauterine Pressure catheter to assess uterine activity
American journal of obstetrics and gynecology, 2011Co-Authors: Gabi Haran, Michal Elbaz, Moshe D. Fejgin, Tal Biron-shentalAbstract:Objective Intrauterine Pressure catheter (IUPC) is the primary device used to evaluate uterine activity. In contrast to the IUPC, electrical uterine myography (EUM) enables noninvasive measurement of frequency, intensity, and tone of contractions. The aim of this study was to determine the accuracy of EUM compared to IUPC. Study Design EUM measured myometrial electrical activity using a multichannel amplifier and a noninvasive position sensor. In all, 47 women in labor were monitored simultaneously with an IUPC and EUM. We compared the frequency, intensity, and tone of uterine contractions between the methods. Results The correlation of the frequency, intensity, and tone of contractions between uterine electromyography and IUPC was strong with significant r values of 0.808-1 ( P Conclusion Electrical uterine electromyography yields information about uterine contractility comparable to that obtained with IUPC.
Catalin S. Buhimschi - One of the best experts on this subject based on the ideXlab platform.
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Intrauterine Pressure Catheter Use Is Associated with an Increased Risk of Postcesarean Surgical Site Infections.
American Journal of Perinatology, 2019Co-Authors: Stephen E. Gee, Catalin S. Buhimschi, Marwan Ma'ayeh, Calvin L. Ward, Mark Klebanoff, Kara M. RoodAbstract:Objective This study aimed to determine if intrapartum placement of an Intrauterine Pressure catheter (IUPC) is associated with an increased rate of surgical site infections in women undergoing a cesarean delivery. Study Design This was a secondary analysis of the prospective observational Maternal–Fetal Medicine Units Network Vaginal Birth after Cesarean Registry. We compared patients with and without IUPC use. A multivariable logistic regression was performed to evaluate for an association between IUPC use and postcesarean surgical site infections. Results The study included 16,887 women: 7,441 with IUPC use and 9,446 without IUPC use. After adjustment for potential cofounders, IUPC use was associated with an increased risk of postcesarean infections compared with those without IUPC use (adjusted odds ratio: 1.28; 95% confidence interval: 1.10–1.50; p = 0.002). Conclusion IUPC use is associated with an increased risk of postcesarean surgical site infections. This supports the judicious use of IUPC for limited clinical indications and provides a potential area of focus for reduction in postcesarean infections.
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Intrauterine Pressure during the second stage of labor in obese women.
Obstetrics and gynecology, 2004Co-Authors: Catalin S. Buhimschi, Irina A. Buhimschi, Andrew M. Malinow, Carl P. WeinerAbstract:Objective The perception that obese women have longer labors and a higher frequency of operative delivery because they are "poor pushers" persists despite the absence of objective study. We tested the hypothesis that obese women generate inadequate Intrauterine Pressure during the second stage of labor. Methods Intrauterine Pressure was prospectively measured in 71 women during the second stage of labor. Obesity was defined as a body mass index (BMI) greater than 29 (n = 17). A BMI below 25 was normal (n = 40). Women with a BMI between 26 and 29 (n = 14) were considered overweight. All women labored with epidural analgesia and were alert and responsive throughout the study. After recording the baseline contractility, a standardized Valsalva maneuver was performed during contractions. The area under the Intrauterine Pressure curve (integral) was used as an estimate of uterine contractility. Results All women delivered vaginally. There were no significant differences in baseline uterine contractility among obese, overweight, and normal women either before (obese 1,787 mm Hg/s; 95% confidence interval [CI] 1,164, 2,742 versus normal 1,569 mm Hg/s; 95% CI 718, 2,371 versus overweight 1,770 mm Hg/s; 95% CI 1,305, 2,835; P =.223) or during Valsalva maneuver (obese 2,831 mm Hg/s; 95% CI 1,771, 4,599 versus normal 2,637 mm Hg/s; 95% CI 1,240, 4,390 versus overweight 2,813 mm Hg/s; 95% CI 1,209, 4,982; P =.742). A BMI greater than 25 was associated with a higher frequency of oxytocin augmentation (P =.037). Univariate analysis revealed a relationship between labor duration and BMI (r = 0.299, P =.018). Obese women labored longer during the active phase (one-way analysis of variance, P =.02), but second-stage duration was similar among groups (one-way analysis of variance P =.44). Obesity did not increase the incidence of perineal lacerations (P =.82) or frequency of operative delivery (relative risk obese versus nonobese = 0.212; 95% CI 0.04, 1.05). Conclusion Obese women produce second-stage Intrauterine Pressures equivalent to women with a normal BMI, although they may require oxytocin augmentation more often. Level of evidence II-2
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The effect of fundal Pressure manoeuvre on Intrauterine Pressure in the second stage of labour
BJOG : an international journal of obstetrics and gynaecology, 2002Co-Authors: Catalin S. Buhimschi, Jerome Kopelman, Irina A. Buhimschi, Andrew M. Malinow, Carl P. WeinerAbstract:Abstract Objective To investigate the relationship between Intrauterine Pressure and the application of a standardised fundal Pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship. Design Prospective measurement of Intrauterine Pressure during the second stage of labour. Setting North American university hospital. Population Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia. Methods A fundal Pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine Pressure was measured using a sensor–tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal Pressure and valsalva during a contraction; 3. fundal Pressure during a contraction without valsalva; 4. fundal Pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions. Results Women in the second stage of labour transiently increased their expulsive force (as reflected by Intrauterine Pressure) by 86% of their baseline contraction using valsalva and fundal Pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased Intrauterine Pressure was directly related to gestational age and inversely related to myometrial thickness. Conclusion Fundal Pressure applied under controlled conditions significantly increases Intrauterine Pressure in some, but not all women. Simultaneous measurement of Intrauterine Pressure, to maintain feedback during application will create a ‘controlled environment’ for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal Pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions.
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The effect of fundal Pressure maneuver on Intrauterine Pressure during the second stage of labor
Obstetrics & Gynecology, 2001Co-Authors: Catalin S. Buhimschi, Jerome Kopelman, Irina A. Buhimschi, Andrew M. Malinow, Lindsay Alger, Carl P. WeinerAbstract:Abstract Objective: Fundal Pressure (FP) and Valsalva (V) are used alone and together to enhance uterine forces during the second stage of labor despite reported complications. We hypothesize that FP aids or complicates delivery by increasing Intrauterine Pressure (IP). Methods: We investigated the relationship between FP and IP during the second stage in 41 women with epidural analgesia. Intrauterine Pressure was measured electronically. Fundal Pressure was applied under standardized conditions across a Pressure cuff connected to a manometer after the vertex reached +2. Interventions included V or FP during contraction (CTXV, CTXFP); FP during V during contraction (CTXVFP); and FP and V alone between contractions. Integral, amplitude, duration, and basal tone were calculated. Multiple regression was used to identify interactions between maternal, fetal, and labor characteristics, and the effect of FP on IP. Results: IP transiently increased by 92% after V and FP together. Fifty-six percent of the maximal force resulted from contraction, 27% from V, and 17% from FP. Applied over V, FP significantly enhanced IP (P Download : Download full-size image Conclusion: FP increases IP but to a lesser extent than V. Large increases in IP after standardized application of FP could help to predict relative cephalopelvic disproportion and thus prevent further delay of a needed operative delivery.