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

摘要/摘要 我们对子宫收缩如何发展并充分协调以排出子宫的了解有限。 足月的胎儿例如，我们缺乏关于分娩的基本问题的答案，例如宫缩在哪里， 开始，宫缩传播的速度，宫缩期间子宫的哪些区域活跃，以及如何 这些测量随着产程的进展而改变。为了解决这一知识缺口，一种新的成像技术， 子宫肌电成像（EMMI）是最近开发的，并在平移绵羊模型中进行了验证。Emmi 采用磁共振成像来获取受试者特定的身体-子宫几何形状，然后将 所得到的数据具有从腹部表面上多达256个电极收集的电生理数据。与 EMMI，它是可能的非侵入性成像的电激活和传导模式在收缩 整个子宫的三维图像初步数据表明，EMMI可用于系统地 描述人类正常足月分娩期间的收缩。此外，三个建议的特点，子宫 称为"收缩指数"的电活动似乎与分娩前的时间相关。这一目标 建议使用EMMI创建一个“正常术语图谱”，描述3D电激活模式， 人类子宫收缩在高空间和时间分辨率在整个劳动，并使用该图集开始， 识别与即将发生的分娩停滞相关的收缩特征。目的1是确定子宫电生理参数， 足月初产妇分娩过程中的成熟和收缩模式。在这一目标下，将进行EMMI 对430名未经产的妇女在整个劳动，数据将分析从365名妇女谁是预期的 正常足月分娩这一目的检验了一个假设，即至少有一个EMMI衍生的子宫收缩， 各项指标能准确反映初产妇正常足月产程的进展， 第一产程的不同阶段探索性目标2将评价子宫电收缩 来自Aim 1的预计75名经历劳动逮捕的妇女的分娩模式。这一探索性的目标 将为未来更大规模的EMMI研究提供基础，以充分表征子宫内膜异位症的时空特征。 出现宫缩的病人。在实现这两个目标的过程中，该项目将产生 初产妇足月子宫收缩指标的生理正常值 劳动这些正常标准将允许未来深入临床调查的因素导致 功能失调性分娩此外，从长远来看，它们可以作为监测怀孕的标准， 分娩进展和评估治疗策略的有效性，以管理分娩和预防分娩 并发症如早产、产程停止和产后出血。

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.