The three-dimensional spatiotemporal dynamics of human uterine contractions using electromyometrical imaging (EMMI)

摘要/摘要 我们对子宫收缩是如何发展并变得足够协调以排出 足月的胎儿。例如，我们对分娩的基本问题缺乏答案，比如哪里宫缩 开始，宫缩传播的速度，子宫的哪些区域在宫缩期间是活跃的，以及如何 这些措施随着劳动力的进步而变化。为了解决这一知识鸿沟，一种新的成像技术， 子宫肌电成像(EMMI)是最近发展起来的，并在绵羊模型中得到了验证。艾美奖 使用磁共振成像来获取特定于对象的身体-子宫几何图形，然后将 结果数据是从腹部表面多达256个电极收集的电生理数据。使用 Emmi，有可能无创地成像收缩过程中的电激活和传导模式 横跨整个子宫的三维图像。初步数据表明，EMMI可以系统地应用于 描述人类正常足月分娩时宫缩的特征。此外，子宫的三个拟议特征 电活动被称为“收缩指数”，似乎与分娩前的时间相关。这样做的目的是 提案是使用EMMI创建一个描述3D电激活模式的“正常术语图谱” 人类在分娩过程中高时空分辨率的子宫收缩，并利用这一图谱开始 识别与即将到来的劳工停职相关的收缩特征。目标1是定义子宫电信号 足月未分娩妇女产程中的成熟和收缩模式。在这一目标下，将进行EMMI 在整个分娩过程中，将对430名未分娩的妇女进行调查，并对365名预期妇女的数据进行分析 才能有正常的产程。这一目标验证了这样的假设，即至少有一种由Emmi引起的子宫收缩 这些指标能准确地反映未产妇正常足月分娩的进展，并能可靠地区分 第一产程的不同阶段。探索性目标2将评估子宫电收缩 来自Aim1的预计75名经历过劳工逮捕的女性在分娩期间的模式。这个探索性的目标 将为未来更大规模的EMMI研究提供基础，以充分表征子宫的时空特征 发展为停滞分娩的患者的宫缩。在实现这两个目标的过程中，本项目将产生 未分娩妇女足月子宫收缩指数生理正常标准 劳力。这些正常标准将允许未来深入的临床调查导致的因素 不正常的分娩。此外，从长远来看，它们可以作为监测怀孕和 产程进展与管理分娩和预防分娩治疗策略的有效性评估 并发症，如早产、分娩骤停和产后出血。

Summary/Abstract We have limited understanding of how uterine contractions develop and become sufficiently coordinated to expel the fetus at term. For example, we lack answers to basic questions about labor such as where contractions initiate, how fast contractions propagate, which regions of the uterus are active during contractions, and how these measures change as labor progresses. To address this knowledge gap, a new imaging technology, Electromyometrial Imaging (EMMI) was recently developed and validated in a translational sheep model. EMMI employs magnetic resonance imaging to acquire a subject-specific body-uterus geometry, then combines the resulting data with electrophysiological data collected from up to 256 electrodes on the abdominal surface. With EMMI, it is possible to noninvasively image the electrical activation and conduction patterns during contractions across the entire uterus in three dimensions. Preliminary data indicate that EMMI can be used to systematically characterize contractions during normal term labor in humans. Additionally, three proposed features of uterine electrical activity, termed "contraction indices", appear to correlate with time until delivery. The objectives of this proposal are to use EMMI to create a "normal term atlas" describing the 3D electrical activation patterns of human uterine contractions at high spatial and temporal resolution across labor, and to use this atlas to begin to identify contraction features associated with impending labor arrest. Aim 1 is to define the uterine electrical maturation and contraction patterns during labor in term nulliparous women. In this Aim, EMMI will be conducted on 430 nulliparous women throughout labor, and data will be analyzed from the 365 women who are anticipated to have normal term labor. This aim tests the hypothesis that at least one of the EMMI-derived uterine contraction indices can precisely reflect progression of normal term labor in nulliparous women, and can reliably differentiate the different phases of the first stage of labor. Exploratory Aim 2 will evaluate uterine electrical contraction patterns during labor in the anticipated 75 women from Aim1 who experience labor arrest. This exploratory aim will provide the basis for a future larger EMMI study to fully characterize the spatial-temporal signatures of uterine contractions in patients who develop arrested labor. In completing these two aims, this project will generate physiologically normal standards of uterine contraction indices of nulliparous women during the progress of term labor. These normal standards will permit future in-depth clinical investigations of the factors leading to dysfunctional labor. Moreover, they may, in the longer term, serve as standards for monitoring pregnancy and labor progression and assessing the effectiveness of treatment strategies to manage labor and prevent labor complications such as preterm birth, labor arrest, and postpartum hemorrhage.