Automated electrohysterographic detection of uterine contractions for monitoring of pregnancy: feasibility and prospects

BACKGROUND: Preterm birth is a major public health problem in developed countries. In this context, we have conducted research into outpatient monitoring of uterine electrical activity in women at risk of preterm delivery. The objective of this preliminary study was to perform automated detection of uterine contractions (without human intervention or tocographic signal, TOCO) by processing the EHG recorded on the abdomen of pregnant women. The feasibility and accuracy of uterine contraction detection based on EHG processing were tested and compared to expert decision using external tocodynamometry (TOCO) . METHODS: The study protocol was approved by local Ethics Committees under numbers ID-RCB 2016-A00663-48 for France and VSN 02-0006-V2 for Iceland. Two populations of women were included (threatened preterm birth and labour) in order to test our system of recognition of the various types of uterine contractions. EHG signal acquisition was performed according to a standardized protocol to ensure optimal reproducibility of EHG recordings. A system of 18 Ag/AgCl surface electrodes was used by placing 16 recording electrodes between the woman’s pubis and umbilicus according to a 4 × 4 matrix. TOCO was recorded simultaneously with EHG recording. EHG signals were analysed in real-time by calculation of the nonlinear correlation coefficient H(2). A curve representing the number of correlated pairs of signals according to the value of H(2) calculated between bipolar signals was then plotted. High values of H(2) indicated the presence of an event that may correspond to a contraction. Two tests were performed after detection of an event (fusion and elimination of certain events) in order to increase the contraction detection rate. RESULTS: The EHG database contained 51 recordings from pregnant women, with a total of 501 contractions previously labelled by analysis of the corresponding tocographic recording. The percentage recognitions obtained by application of the method based on coefficient H(2) was 100% with 782% of false alarms. Addition of fusion and elimination tests to the previously obtained detections allowed the false alarm rate to be divided by 8.5, while maintaining an excellent detection rate (96%). CONCLUSION: These preliminary results appear to be encouraging for monitoring of uterine contractions by algorithm-based automated detection to process the electrohysterographic signal (EHG). This compact recording system, based on the use of surface electrodes attached to the skin, appears to be particularly suitable for outpatient monitoring of uterine contractions, possibly at home, allowing telemonitoring of pregnancies. One of the advantages of EHG processing is that useful information concerning contraction efficiency can be extracted from this signal, which is not possible with the TOCO signal.