UTERINE CONTRACTILITY AND CERVICAL RIPENING IN PREGNANCY

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The problems associated with labor during pregnancy are among the most important health issues facing physicians. Understanding the role of the uterus and cervix in labor and developing methods to control their function is essential to solving problems relating to labor. At the moment, only crude, inaccurate and subjective methods are used to assess changes in the uterus and cervix that occur in preparation for or during labor. In the past several years, the applicant and his colleagues have developed noninvasive methods to quantitatively evaluate the uterus and cervix based respectively on recording of uterine electrical signals from the abdominal surface (uterine EMG) and measurement of light- induced cervical collagen fluorescence (LIF) with an optical device (Collascope). The methods are rapid and allow assessment of uterine contractility and cervical ripening. Preliminary studies in rats and humans indicate that uterine and cervical function can be successfully monitored during pregnancy using these approaches and that these techniques might be used in a variety of conditions associated with labor to better define management. This application is for funds to extend the initial studies. Four studies are proposed using abdominal EMB recordings and cervical LIF. A competent team of investigators and staff has been assembled to fulfill the needs and goals of this proposal. The specific hypotheses are that LIF and abdominal EMG recordings can be used to: 1) differentiate between true and false labor; 2) predict the onset of labor; 3) monitor patients during tocolysis or induction of labor. The specific aims are to use EMG activity and LIF to determine if they are helpful to: 1) assess patients in true versus false labor; 2) monitor antepartum patients longitudinally; 3) examine the effectiveness of tocolytics or induction. The potential benefits of the proposed instrumentation and methods include reducing the rate of preterm delivery, improving maternal and perinatal outcome, monitoring treatment, decreasing cesarean section rate and improving research methods to understand uterine and cervical function.