Tracking labor with uterine electrophysiological recordings and multi-scale model

描述(由申请人提供)：早产可能会导致严重的健康问题，甚至对胎儿造成致命的影响，还会给医疗保健系统带来巨大的经济负担。早期和可靠的诊断对于制定成功的干预措施以预防早产和改善结局至关重要。在生理学方面，子宫是一个复杂的器官，目前我们对宫缩的发生和传播的生理机制的了解还不完全。子宫通常能够完成维护一个抑制子宫收缩活动并有利于胎儿发育的环境的显着任务。然而，在足月妊娠时，它会启动 并协调子宫肌层细胞的个体激发，产生有组织的收缩，导致胎儿被排出。由于鲜为人知的原因，这种协调活动的开始可能发生在足月妊娠之前，从而导致早产儿的出生。显然，子宫经历电生理变化导致有组织的子宫收缩，从而为开发准确预测活跃性分娩开始的方法学提供了基础。这项提案是由阿肯色大学医学科学分校(UAMS)、小石城阿肯色大学和圣路易斯华盛顿大学组成的多学科团队共同努力的结果。所有这些研究人员都拥有与协同环境发展相关的产科、应用科学和工程学等不同领域的专业知识。之所以需要这样的努力，是因为产科领域缺乏客观诊断分娩的工具。UAMS拥有世界上第一个专门为胎儿-母亲评估而建造的生物磁感应系统。SARA(用于生殖评估的鱿鱼阵列)系统由151个初级超导传感器组成，这些传感器探测由包括子宫肌肉在内的各种生物电源在体内产生的生物磁场。术语“SQUID”是“超导量子干涉装置”的首字母缩写。SARA系统是完全非侵入性的，允许调查从早期怀孕到分娩的胎儿和母体参数。我们已经证明，SARA能够记录子宫平滑肌的电活动，这可以提供分娩开始的电生理信号。为了将其转化为临床工具，我们需要研究治疗干预将如何改变产程。为了实现这一点，我们建议在考虑到电生理学和解剖学知识的情况下，建立妊娠期间收缩活动的多尺度正向电磁模型。通过将宏观记录与多尺度建模方法相结合，我们相信该模型不仅将提供与观察到的子宫电生理信号的联系，而且将为临床妊娠管理提供有用的治疗信息。

DESCRIPTION (provided by applicant): Preterm birth can cause severe health problems or even be fatal for the fetus, and, also imposes significant financial burdens on health care systems. Early and reliable diagnosis is essential to the development of successful interventions to prevent preterm delivery and improve outcome. In terms of physiology, the uterus is a complex organ, and at this time, our knowledge of the physiological mechanism of the onset and propagation of uterine contractions of labor remains incomplete. The uterus is normally able to accomplish the remarkable task of maintaining an environment which suppresses uterine contractile activity and is conducive to fetal development. At term gestation however, it initiates and coordinates the individual firing of myometrial cells to produce organized contractions resulting in expulsion of the fetus. For poorly understood reasons, the onset of this coordinated activity can occur prior to term gestation with consequential birth of a premature infant. It is evident that the uterus undergoes electrophysiological changes leading to organized uterine contractions, thus providing the basis for the development of a methodology to accurately predict the onset of active labor. This proposal is a development of the combined efforts of a multidisciplinary team of members of the University of Arkansas for Medical Sciences (UAMS), University of Arkansas at Little Rock and Washington University St. Louis. All of these researchers have specialized knowledge in diverse fields of obstetrics, applied sciences and engineering relevant to the development of a synergetic environment. The need for such an effort is based on lack of tools in field of obstetrics for objective diagnosis of labor. UAMS has the world's first biomagnetic sensing system built specifically for fetal-maternal assessment. The SARA (SQUID Array for Reproductive Assessment) system consists of 151 primary superconducting sensors which detect biomagnetic fields generated in the body by various bioelectric sources including uterine muscles. The term "SQUID" is an acronym for "Superconducting Quantum Interference Device." The SARA system is completely non-invasive and permits the investigation of fetal and maternal parameters from early gestation until delivery. We have shown that SARA is capable of recording electrical activity of the uterine smooth muscles that can provide an electrophysiological signature of onset of labor. To transform it into a clinical tool we need to investigate how therapeutic interventions will alter te labor process. In order to accomplish this we propose to develop a multiscale forward electromagnetic model of contractile activity during pregnancy taking into account electrophysiological and anatomical knowledge. By combining macroscopic recordings with multi-scale modeling approach, we believe the model will not only provide a link to observed uterine electrophysiological signals but also provide useful therapeutic information for the clinical management of pregnancy.