EASI: Shear Wave Elastography Assessment For Predicting Success Of Labor Induction

EASI：用于预测引产成功的剪切波弹性成像评估

• 批准号: 9981768
• 负责人: Helen Feltovich
• 金额: $ 56.14万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-07 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9981768
• 关键词: Acoustics; Algorithms; Biomechanics; Cervical; Cervical Dilatations; Cervix Uteri; Cesarean section; Characteristics; Clinical; Clinical assessments; Collagen; Complex; Cross-Sectional Studies; Data; Development; Dilatation - action; Discipline of obstetrics; Epithelial Cell Aggregation and Separation; Evaluation; Feedback; Frequencies; Future; Gestational Age; Individual; Induced Labor; Intervention; Lead; Length; Measurable; Measurement; Measures; Medical; Methods; Morbidity - disease rate; Mothers; Nulliparity; Observational Study; Outcome; Predictive Value; Pregnancy; Pregnant Women; Process; Property; Prospective Studies; Public Health; Readiness; Recording of previous events; Reproducibility; Research Design; Resources; Source; Speed; Structure; Techniques; Time; Tissues; Vagina; Vaginal delivery procedure; Woman; base; clinical translation; data acquisition; digital; elastography; expectation; improved; neonate; personalized approach; quantitative ultrasound; success

Project Summary The most recent data indicate that 1 in 4 pregnant women in the U.S. undergoes induction of labor (IOL), making this one of today's most common obstetrical interventions. Yet it is one of the least predictable with respect to outcome (vaginal vs. cesarean delivery) and one of the least well studied with respect to best practice. The frequency of IOL has increased in recent years, paralleled by an increase in the number of cesarean deliveries. The relationship between IOL and cesarean delivery is not straightforward, but it is clear that both interventions have become significant public health issues because of their associated increased resource utilization and morbidity. Specifically, higher utilization is seen in women who undergo labor induction and cesarean delivery is associated with higher morbidity (immediate and future) for both mother and neonate. Cervical readiness is crucial to IOL success. This is logical since the cervix must open for the baby to deliver. Given this, it is almost unbelievable that today's practitioner relies on a subjective clinical assessment of cervical "favorability" for important decisions about who should undergo IOL or, if delivery is medically indicated, whose cervix needs ripening (softening) before IOL and what type of ripening would be best. To assess cervical favorability, the practitioner assigns points to cervical characteristics such as dilatation, softness, and length as assessed per vaginal exam. The points are combined into a summative Bishop score (BS), which is supposed to predict success of IOL. Practitioners often complain about the subjectivity and lack of reproducibility of the BS, but many do not even know about another significant issue: the BS was developed more than 50 years ago for a purpose that today is no longer relevant. Specifically, it was developed to predict time to delivery in a woman with a history of vaginal delivery at full term gestation in the current pregnancy. This information was eventually leveraged to imply success from IOL in these women. Today we know that the chance of success in such a woman is so high that her cervical exam is almost irrelevant. But the BS is still used on a daily basis in obstetrical practice to predict the chance of vaginal delivery in a woman at any gestational age who has never before had a baby. Unsurprisingly, this re-purposed BS is a poor predictor of IOL success. That said, it certainly makes sense that characteristics such as cervical dilatation and softness would predict how well the cervix will open because these are physical manifestations of underlying biomechanical characteristics that dictate tissue function. Quantitative ultrasound (QUS) techniques can provide objective, measurable information about tissue properties such as softness, which means that they could contribute to a personalized metric to predict approach to, and expectations for, IOL. Toward that end, this proposal describes a prospective, observational, cross-sectional study designed to evaluate whether QUS techniques can improve prediction of IOL success.

项目摘要 最新数据表明，美国每4名孕妇中就有1名接受引产（IOL）， 使其成为当今最常见的产科干预措施之一。然而，这是最不可预测的尊重之一 结果（阴道分娩与剖腹产）和最佳实践方面研究最少的一个。的 近年来，随着剖腹产数量的增加，IOL的使用频率增加。的 人工晶状体和剖腹产之间的关系并不直接，但很明显，这两种干预措施都具有 由于其相关的资源利用率和发病率增加，因此成为重大的公共卫生问题。 特别是，在接受引产和剖宫产的妇女中， 母亲和新生儿的发病率（近期和未来）较高。 宫颈准备对IOL成功至关重要。这是合乎逻辑的，因为子宫颈必须打开才能分娩。 鉴于此，几乎令人难以置信的是，今天的从业者依赖于颈椎病的主观临床评估。 “可选择性”，指关于谁应该接受IOL的重要决定，或者如果有医学指征， 子宫颈在IOL前需要成熟（软化），什么类型的成熟最好。为了评估宫颈可切除性， 医生根据评估的宫颈特征，如扩张、柔软度和长度， 这些分数被合并成一个总结性的Bishop评分（BS），它被认为是预测成功的 的IOL。从业者经常抱怨BS的主观性和缺乏可重复性，但许多人并不这样认为。 我甚至知道另一个重要的问题：BS是在50多年前开发的， 今天已经不重要了具体地说，它被开发来预测有以下病史的妇女的分娩时间： 本次妊娠足月阴道分娩。这些信息最终被用来暗示 在这些女性中获得IOL的成功。今天我们知道，这样的女性成功的机会如此之高，以至于她 子宫颈检查几乎无关紧要但是，在产科实践中，BS仍然每天用于预测 在任何孕龄从未有过孩子的妇女阴道分娩的机会。不出意外的是， 这种重新利用的BS是IOL成功的不良预测器。 也就是说，它肯定是有道理的，如宫颈扩张和柔软的特点将预测如何 子宫颈会打开，因为这是潜在的生物力学特征的物理表现， 决定组织功能。定量超声（QUS）技术可以提供客观、可测量的信息 关于组织特性，如柔软度，这意味着它们可以有助于预测个性化的指标 IOL的方法和期望。为此，本提案描述了一个前瞻性的、观察性的、 横断面研究，旨在评价QUS技术是否可以改善IOL成功的预测。