sample (SureCALL records 100 per second) and n is the number of samples specified in the RMS buffer. The RMS labeled x is the RMS size recorded for each EMG sample window. This technique was applied to all data in the EMG datasets to identify and represent contraction events and generate visual traceability that can be compared to that of toco and IUPC. When comparing the contraction representation properties of these clinical products, it is useful to know how good the devices are in terms of the frequency of “pairing” contractions as they are commonly used to evaluate labor. The lower PPA and NPA values in printed paper tracking clearly showed that digitally stored data with timestamps was far superior. When it comes to tocodynamics, there can`t really be any “normal.” I tell all the work points and most of my sorting pts that the height of the “hills” means absolutely nothing to me when I look at a tape. There are so many irrelevant variables that it`s not even funny. Like what. Toco position, baby position, mother position, baby size, mother size, uterine wall thickness, fat layer thickness, strap tightness, toco age, toco sensitivity, monitor age and monitor sensitivity. In addition to the overall CCI score, a window CCI (15 minutes) was also calculated for each patient and device combination to determine the percentage of time the CCI was less than 0.75 at the time of data collection.
Records below this threshold were considered noisy with an increased time of low coherence of contraction between methods. Figure 1. Patient with uterine electromyography electrodes, tocodynamometer transducer and fetal heart rate Doppler applied to the abdomen. Recordings of the subjects were made for 20 to 40 minutes. Contraction diagram records printed on paper by traditional TOCO and IUPC were compared to time-stamped digital tracks passed by the SureCall EMG system. Braxton Hicks contractions are not considered real labor because they do not cause cervical change. Remember that if your contractions don`t increase in intensity or frequency, you`re probably experiencing Braxton Hicks contractions. Unlike real contractions, Braxton Hicks contractions are: women in labor are traditionally monitored with the tocodynamometer (TOCO), which is based on the compressive force generated by the deformation of the abdomen during uterine contractions. Contractions are measured with a pressure transmitter placed on the patient`s abdomen. Unless an internal uterine pressure (UIC) catheter is used, this measurement provides only a graphical representation of each contraction. I like the fact that you were able to use your nursing judgment to titrate the pitocin. You have also involved the Director General in your decisions.
When it comes to Pitocin, always be very vigilant when stressing the baby. Even with good variability and acceleration, you expected the baby to be compromised if the contractions continued. You have used your breastfeeding judgment wisely to reduce pitocin levels due to the decrease in the baby`s heart rate. Uterine monitoring is based on the idea that the frequency of contractions per hour increases as a woman approaches childbirth. As labor progresses, contractions become longer, harder, and stronger. If the machine measures four or fewer contractions per hour, you probably won`t have a job. Figure 3. Simultaneous recording and comparison of signals (from top to bottom): raw EMG signal, IUPC recording.
External TOCO recording and RMS signal of a single subject. Note the exceptional correspondence between the contractions traced RMS and the contractions traced by IUPC. Oops, I forgot to add that any contraction of two minutes or more is also considered tachysystole. Using intrauterine pressure as a gold standard, electrohysterography surpassed tocynamnamometry to monitor uterine activity during active labor in 59 women with varying body habits. There was a good visual match between the 3 contraction tracers shown in Figure 3. Fetal heart rate measurement could potentially be evaluated in the same way as TOCO and IUPC. In 3 patients, additional activity of the smooth muscles of the uterus was observed on the RMS, which was not observed with iUPC or TOCO. It has been suggested that this is the triggering of signals from a smooth muscle group that are not large enough to cause significant contraction (CTX). These were not associated with a change in the fetal heart rate pattern.
There was no statistical difference between the three different modalities in terms of ctX number and frequencies (Figure 4). The frequency difference of CTX between RMS and IUPC was 0.42±0.07 compared to TOCO and IUPC, which was 0.44±0.14. As expected, data stored digitally with timestamp showed a higher percentage of match (98.5% – 100%) than printed paper traces (91.5% to 94%). Jezewski et al. compared EMG with TOCO in relation to pregnant women who did not have work and found a high match and consistency in the number of CTX between the two 13. Our study supports this by comparing this with the IUPC, the gold standard. In fact, if we look at the images of each subject, the RMS records were well correlated with the IUPC, even in subjects where the TOCO did not do as well. In some cases, RMS showed signs of some smooth muscle electrical activity that was not strong enough to cause the IUPC or TOCO signal to contract, but unlike TOCO, RMS never missed a contraction signal picked up by the IUPC.
This shows the high sensitivity of rms to the electrical activity of the smooth muscles of the uterus. In addition, there was no significant difference in the recording of the 3 devices with or without Pitocin augmentation. The cost-benefit ratio is important in all discussions about new technologies. Benefits such as reduced care interventions for Toco failures, improved patient comfort, and reduced infectious complications induced by IUPC are difficult to quantify. Toco`s recurring physical costs lie in the occasional replacement of inexpensive disposable sensors and belts. A UIC has certainly increased the cost of acquisition per patient. EHG sensors are mainly made up of electrodes and can therefore be between the cost of the Toco and the IUPC. A design goal would be to interact directly with existing electronic fetal monitoring systems to reduce the cost of adoption. The training of nurses should be minimal and consist only of proper preparation of the skin and the application of electrodes. This study suggests that EHG is superior to Toco in non-invasive monitoring of uterine activity. An ongoing study will evaluate whether this leads to superior clinical use: Clinicians and nurses will assess the fetal heart rate/uterine activity strips of the three technologies and compare interpretability.
Comparison of the performance of uterine EMG and toCO with IUPC in the detection of uterine contractions in patients on duty. I`m new to L&D – right outside of orientation. I wanted to hear what others had to say about this situation. I had a pt on the pit 50 hours ago that was induced for PROM. She was at the beginning of my 15-milliunit shift and her ctxs were sometimes q 1.5 minutes. So I reduced the pit to 6. The baby looked good. Around this time, it was verified and turned out to be 8-9/100/0. Their ctx became irregular, but very long – some lasted up to 4 minutes. I had stopped the pit to see what was going on because it seemed that she had entered into her own work, and if she had made so much progress (from 5 to 8-9 in 2 hours), I thought it was good. After a discussion with the md, I restarted the pit at 1 when the ctx were separated.
The TA did not claim to be in transition; no constant pressure, no intrusive. The monstrous ctxs worried me even though the baby looked good. However, at the beginning of the shift (4 hours before), the baseline was at 130 and now at 110 (I don`t know how important it was), with variability still maintained with accelerations. I carefully crawled up to 3 milliunits and left it there for a while. On the next examination, the resident found that the PT was 6 years old (her previous check was wrong – she had felt vaginal wrinkles?). That`s why we placed an IUPC and I was able to title the pit more precisely. However, the PT bought epidural anesthesia and had wished for a natural delivery. The ctxes were not as long as they had appeared with the Toco, and established a more regular pattern at higher doses of pits. She slept a few hours and was complete with 13 mill units. The only thing I`m interested in in external monitoring is when contractions occur and what the fetal heart rate does when it occurs.
I can get this information better with my hand than with a Toco. The intensity of contractions can be estimated by touching the uterus. The relaxed or slightly contracted uterus usually feels as firm as a cheek, a moderately contracted uterus feels as firm as the tip of the nose, and a heavily contracted uterus is as firm as the forehead. Each patient`s data included one uterine activity channel from two mother-fetus monitors (corometry, GE Medical Systems; Waukesha, Wisconsin, USA) at 8 Hz with 8-bit resolution. These cardiotocographs (CTGs) reported contraction curves derived from Toco and IUPC. The data also included the output of 4 abdominal EHG channels sampled at 500 Hz with a resolution of 24 bits. If you do not have internal monitoring of uterine pressure, the intensity of the contraction is quite meaningless. The external toco is influenced by the firmness with which it is applied. Apply it firmly and the amount of contraction “appears” higher (stronger).
Apply it loosely, and the height will be lower (“appear” softer). . . .