Uterine Synchronization Analysis During Pregnancy and Labor Using Graph Theory,Classification Based on Neural Network and Deep Learning

1) ObjectivesPreterm birth caused by preterm labor is one of the major health problems in the world. In this article, we present a new framework for dealing with this problem through the processing of electrohysterographic signals (EHG) that are recorded during labor and pregnancy. The objective in this research is to improve the classification between labor and pregnancy contractions by using a new approach that focuses on the connectivity analysis based on graph parameters, representative of uterine synchronization, and comparing neural network and machine learning methods in order to classify between labor and pregnancy.2) Material and methodsafter denoising of the 16 EHG signals recorded from pregnant women abdomen, we applied different connectivity methods to obtain connectivity matrices; then by using the graph theory, we extracted some graph parameters from the connectivity matrices; finally, we tested different neural network and machine learning methods on the features obtained from both graph and connectivity methods in order to classify between labor and pregnancy.3) ResultsThe best results were obtained by using the logistic regression method. We also evidence the power of graph parameters extracted from the connectivity matrices to improve the classification results.4) ConclusionThe use of graph analysis associated with machine learning methods can be a powerful tool to improve labor and pregnancy classification based on the analysis of EHG signals.     

Velocity and Directionality of the Electrohysterographic Signal Propagation

Objective

The initiation of treatment for women with threatening preterm labor requires effective distinction between true and false labor. The electrohysterogram (EHG) has shown great promise in estimating and classifying uterine activity. However, key issues remain unresolved and no clinically usable method has yet been presented using EHG. Recent studies have focused on the propagation velocity of the EHG signals as a potential discriminator between true and false labor. These studies have estimated the propagation velocity of individual spikes of the EHG signals. We therefore focus on estimating the propagation velocity of the entire EHG burst recorded during a contraction in two dimensions.

Study Design

EHG measurements were performed on six women in active labor at term, and a total of 35 contractions were used for the estimation of propagation velocity. The measurements were performed using a 16-channel two-dimensional electrode grid. The estimates were calculated with a maximum-likelihood approach.

Results

The estimated average propagation velocity was 2.18 (±0.68) cm/s. No single preferred direction of propagation was found.

Conclusion

The propagation velocities estimated in this study are similar to those reported in other studies but with a smaller intra- and inter-patient variation. Thus a potential tool has been established for further studies on true and false labor contractions.     

Characteristics of power spectrum density function of EMG during muscle contraction below 30%MVC

The aim of the study was to quantify changes in PSDF frequency bands of the EMG signal and EMG parameters such as MF, MPF and zero crossing, with an increase in the level of muscle contractions in the range from 0.5% to 30% RMS_max and to determine the frequency bands with the lowest dependency on RMS level so that this could be used in investigating muscle fatigue.Sixteen men, aged from 23 to 33 years old (mean 26.1), who participated in the study performed two force exertion tests. Fragments of EMG which corresponded to the levels of muscle contraction of 0.5%, 1%, 2.5%, 5%, 10%, 15%, 20%, 25%, 30% RMS_max registered from left and right trapezius pars descendents (TP) and left and right extensor digitorum superficialis (ED) muscles were selected for analysis. The analysis included changes in standard parameters of the EMG signal and changes in PSDF frequency bands, which occurred across muscle contraction levels. To analyze changes in PSDF across the level of muscle contraction, the spectrum was divided into six frequency bandwidths. The analysis of parameters focused on the differences in those parameters between the analyzed muscles, at different levels of muscle contraction.The study revealed that, at muscle contraction levels below 5% RMSmax, contraction level influences standard parameters of the EMG signal and that at such levels of muscle contraction every change in muscle contraction level (recruitment of additional MUs) is reflected in PSDF. The frequency band with the lowest dependency on contraction level was 76–140 Hz for which in both muscles no contraction level effect was detected for contraction levels above 5% RMS_max. The reproducibility of the results was very high, since the observations in of the left and right muscles were almost equal. The other factor, which strongly influences PSDF of the EMG signal, is probably the examined muscle structure (muscle morphology, size, function, subcutaneous layer, cross talk). It seems that low frequency bands up to 25 Hz are especially feasible for type of muscle.     

基于小波变换的土壤有机质含量高光谱估测

利用统计分析方法选取了土壤N、P、K元素含量近似而有机质含量差异较大的样本60个,通过高光谱探测分析获得样本反射率对数的一阶导数光谱,采用Bior 1.3函数进行多层离散小波分解,剔除低频近似信号和高频噪声信号,得到反映土壤理化参数的特征光谱曲线;采用相关分析筛选土壤有机质含量的显著相关波段,基于显著相关波段和特征光谱曲线分别构建土壤有机质含量高光谱多元回归估测模型;通过比较分析,确定了提取土壤有机质特征光谱的最佳小波分解尺度并构建了最佳预测模型.结果表明： 提取土壤有机质特征光谱的最佳小波分解层数是9层,其次是8层和10层;基于小波9层分解特征光谱曲线的有机质含量估测模型最佳,其决定系数（R²）为0.89,比基于显著相关波段构建模型的R²增加了0.31,比基于原始光谱所构建模型的R²增加了0.10.     

Electrodes in external electrohysterography: a systematic literature review

BackgroundIn low-income countries, pregnant women do not have easy access to health care, especially in rural and peri-urban areas. In this context, they can be surprised by the uterine contractions that precede childbirth and sometimes find themselves giving birth at home or on the way to the nearest health facility (located miles away from their home). In view of the development of an external uterine electrohysterogram acquisition system for labour prediction, a review of the literature on electrodes and their characteristics is necessary.MethodsA comprehensive literature review was conducted to collate information on the use of electrodes in external EHG recording and their characteristics.ResultsWet electrodes based on Ag/AgCl redox chemistry are the most common type of electrodes for EHG, employed in different configurations on the pregnant woman’s abdomen. All positioning configurations are around the vertical median axis if they are not placed directly on it. Positioning below the navel seems to be the most efficient. The number of source, reference, and ground electrodes used varies from one author to another, as does the distance between the electrodes.ConclusionTwo well-positioned source electrodes on the vertical median axis, with ground electrode on the right side of the hip and reference one on the left side, are able to generate a good external EHG recording signal. The minimum allowed inter-electrode distance is approximately 17.5 to 25mm.     

Detection of Movement Artefacts and Contraction Bursts Using Accelerometer and Electrohysterograms for Home Monitoring of Pregnancy

Background

In developed countries, 10% of labors occur prematurely and are mainly due to contractions appearing too soon during the pregnancy. To detect such contractions, we developed a wearable device able to record both the electrical activity of the uterus, electrohysterograms (EHG), thanks to 18 electrodes, but also the mother movements, thanks to an embedded accelerometer.

肌肉动态收缩期间表面肌电信号的时频分析

介绍了用于肌肉动态收缩期间非平稳表面肌电信号的时频分析方法。用短时傅里叶变换、Wigner-Ville分布及Choi-Williams分布计算了表面肌电信号的时频分布,用于信号频率内容随时间演化的可视化观察。通过计算瞬时频谱参数,对肌肉疲劳的电表现进行量化描述。分析了反复性的膝关节弯曲和伸展运动期间从股外侧肌所记录的表面肌电信号。发现和在静态收缩过程中观察到的平均频率线性下降不同,在动态收缩期间瞬时平均频率的变化过程是非线性的并且更为复杂,且与运动的生物力学条件有关。研究表明将时频分析技术应用于动态收缩期间的表面肌电信号可以增加用传统的频谱分析技术不能得到的信息。     

The effect of ampholytes on ferritin isoelectric focussing patterns

Ferritin was subjected to isoelectric focussing (IEF) on agarose gels containing different commercial carrier ampholytes. In two gels protein staining revealed banded patterns which differed from one another, while a third gel yielded zones rather than discrete bands, indicating that the bands may be artefacts.The differences between banded patterns were studied by isolating bands from an IEF gel and refocussing these on gels containing either the original ampholyte or a different ampholyte preparation. Striking differences were noted.Chromatofocussing of ferritin resulted in the elution of broad peaks between the same pH limits as indicated by IEF patterns.     

Different patterns of myometrial activity and 24-h rhythms in myometrial contractility in the gravid baboon during the second half of pregnancy.

Two clearly distinct epochs of myometrial contractility were observed in 13 pregnant baboons when recorded either as intraamniotic pressure (IAP) or myometrial electromyogram (EMG). Contractures, epochs lasting longer than 3 min, were the characteristic form of myometrial activity throughout pregnancy. Contractures generated only small increases in IAP. Short-lived contractions, generating larger increases in IAP, were characteristic of labor and delivery. Power spectral analysis of IAP and myometrial EMG activity proved to be an effective means whereby periods when the myometrium was in the contractures or contractions mode could be easily distinguished. Concomitantly recorded maternal intraabdominal temperature showed significant 24-h variations. When myometrial activity switched from low-amplitude, long-lasting regular contractures of pregnancy to contractions, the switch always occurred around the onset of darkness. Five baboons went into spontaneous labor, 3 prematurely and 2 at term. In these animals the switch from contractures to contractions occurred for several nights before delivery. The recurrence and timing of the switch from contractures to contractions for several nights before delivery were similar to the pattern we and others have observed in the pregnant rhesus monkey. The presence of 24-h periodicity in the patterns of specific types of myometrial activity in another nonhuman primate lends support to the view that similar 24-h patterns of myometrial activity may occur in pregnant women.     

Assessment of Coupling between Trans-Abdominally Acquired Fetal ECG and Uterine Activity by Bivariate Phase-Rectified Signal Averaging Analysis

Couplings between uterine contractions (UC) and fetal heart rate (fHR) provide important information on fetal condition during labor. At present, couplings between UC and fHR are assessed by visual analysis and interpretation of cardiotocography. The application of computerized approaches is restricted due to the non-stationarity of the signal, missing data and noise, typical for fHR. Herein, we propose a novel approach to assess couplings between UC and fHR, based on a signal-processing algorithm termed bivariate phase-rectified signal averaging (BPRSA).

Methods

Electrohysterogram (EHG) and fetal electrocardiogram (fECG) were recorded non-invasively by a trans-abdominal device in 73 women at term with uneventful singleton pregnancy during the first stage of labor. Coupling between UC and fHR was analyzed by BPRSA and by conventional cross power spectral density analysis (CPSD). For both methods, degree of coupling was assessed by the maximum coefficient of coherence (C_PRSA and C_RAW, respectively) in the UC frequency domain. Coherence values greater than 0.50 were consider significant. C_PRSA and C_RAW were compared by Wilcoxon test.

Results

At visual inspection BPRSA analysis identified coupled periodicities in 86.3% (63/73) of the cases. 11/73 (15%) cases were excluded from further analysis because no 30 minutes of fECG recording without signal loss was available for spectral analysis. Significant coupling was found in 90.3% (56/62) of the cases analyzed by BPRSA, and in 24.2% (15/62) of the cases analyzed by CPSD, respectively. The difference between median value of C_PRSA and C_RAW was highly significant (0.79 [IQR 0.69–0.90] and 0.29 [IQR 0.17–0.47], respectively; p<0.0001).

Conclusion

BPRSA is a novel computer-based approach that can be reliably applied to trans-abdominally acquired EHG-fECG. It allows the assessment of correlations between UC and fHR patterns in the majority of labors, overcoming the limitations of non-stationarity and artifacts. Compared to standard techniques of cross-correlations, such as CPSD, BPRSA is significantly superior.     

Maturation of spontaneous and agonist-induced uterine contractions in the peripartum mouse uterus.

This study tested the hypothesis that the uterus achieves maximum contractile capabilities before the onset of labor. Basal and agonist-stimulated contractions were assessed in uterine strips on Day 15 or 18 of pregnancy, the day of parturition, or 1 day postpartum (n = 4-13 per group). Spontaneous contractions were evident in all groups (n = 4-13 per gestational group); contraction frequency was greater in peripartum groups than in virgin controls ( approximately 4.6 versus 2.8/200 sec). Peak amplitude was nearly 9-fold higher on Days 15 and 18 and over 30-fold higher in the postpartum and 1 day postpartum groups than in nonpregnant mice. Maximum frequency and peak amplitude were achieved in response to 10(-6) to 10(-8) M oxytocin or arginine vasopressin (OT(max) or AVP(max)). Frequency of contractions in response to OT(max) peaked on Day 18 and then declined. Contraction amplitude increased 5-fold on Day 15, declined on the day of birth (equivalent to nonpregnant level), then rebounded to peak on postpartum Day 1. AVP(max) similarly increased frequency and amplitude of contractions, except that maximum contraction amplitude occurred postpartum. Thus, an endogenous oscillator, residing in the uterus, sustains high basal and agonist-induced contraction frequency during pregnancy. Although acceleration of this pacemaker occurred before term, the data suggest that peripartum increases in contraction amplitude characterize the transition to the powerful synchronous contractions of parturition.     

Fetal ECG extraction during labor using an adaptive maternal beat subtraction technique.

Fetal ECG (FECG) monitoring using abdominal maternal signals is a non-invasive technique that allows early detection of changes in fetal wellbeing. Several other signal components have stronger energy than the FECG, the most important being maternal ECG (MECG) and, especially during labor, uterine EMG. This study proposes a new method to subtract MECG after detecting and removing abdominal signal segments with high-amplitude variations due to uterine contractions. The method removes MECG from abdominal signals using an approximation of the current MECG segment based on a linear combination of previous MECG segments aligned on the R-peak. The coefficients of the linear model are computed so that the squared error of the approximation over the whole current segment is minimized. Abdominal signal segments strongly affected by uterine contractions are detected by applying median filtering. The methods proposed are tested on real abdominal data recorded during labor, with FECG recorded using scalp electrodes synchronously recorded for comparison.     

Effect of decimation on the classification rate of non-linear analysis methods applied to uterine EMG signals

Recently, much attention has been paid to the use of non-linear analysis techniques for the characterization of biological signals. Several measures have been proposed to detect non-linear characteristics in time series. The effect of sampling frequency on the performance of these non-linear methods has rarely been evaluated. In this paper, we present a preliminary study of this effect for four methods that are widely used in non-linearity detection: Time reversibility, Sample Entropy, Lyapunov Exponents and Delay Vector Variance. These methods have been applied to real uterine EMG signals with the aim of distinguishing between pregnancy and labor contractions. The signals were used to classify contractions before and after decimating them by a factor 10. The results show that decimation improves the performance for sample entropy. It reduces it considerably for Delay Vector Variance and only slightly for Time reversibility and Lyapunov exponents. Time reversibility still gives the highest classification rate. The methods were much less computationally expensive after down sampling.     

Alvarez waves in pregnancy: a comprehensive review

Alvarez waves are local rhythmic contractions of the myometrium with high frequency and low intensity. They can be detected using internal or external tocography and electrohysterography. Some researchers correlate these small contractions with the initiation of labor, since they have been described as a pattern representing the uterine response to prostaglandin production. Other authors either do not validate a causality relation between Alvarez waves and labor or suggest that they have low predictive value for preterm labor. Alvarez waves’ research has become a multidisciplinary subject with inputs ranging from medical science, biomedical engineering, and related areas. A comprehensive review is herein conducted to summarize the state of the art regarding Alvarez waves and their role in the initiation of labor, namely in preterm birth. The results show that a large number of studies have analyzed and characterized Alvarez waves without necessarily digging into their relationship with labor. Publications were categorized in three groups: (A) reports about morphology and characterization of Alvarez waves; (B) publications reporting a positive causality relation between Alvarez waves and labor; and (C) publications reporting an absence of causality regarding the previous hypothesis. Studies in group B outnumbered those in group C. A critical analysis is presented.     

Myoelectric signal measurement during prolonged computer terminal work.

Myoelectric signal (MES) behaviour was studied during prolonged, sustained, low level contractions using a portable system with limited data storage capacity. A pre-processing technique is described which overcomes memory and data storage limitations in a portable multichannel MES data logger. This technique for data reduction was used to study MES behaviour in four muscle groups during prolonged computer terminal work. Myoelectric signal parameters were recorded from eighteen individuals while they performed computer work both without breaks, and with "microbreaks" (short rest breaks of 30 seconds duration) at twenty minute intervals. Myoelectric signal (MES) data were collected from the cervical paraspinal extensors, the lumbar erector spinae, the upper trapezius, and the forearm extensors while participants performed their usual computer work activities. No significant slope for either amplitude or mean frequency was determined in either the break or no break trials over an eighty minute recording period. Instead, most data sets revealed a cyclic trend in terms of frequency and amplitude parameters of the MES. Characteristic values were compared between trials when subjects did and did not take microbreaks. It was found that the overall median value of mean frequency was higher for the "break" than the "no break" protocol only in the cervical extensors, although the clinical significance of this finding is not well understood. By far, the most interesting finding of this work was the discovery of a cyclic trend in the mean frequency of the myoelectric signals studied. This trend was present even when participants did not take breaks. The trend is a potential indicator of the cyclic recruitment of motor units during sustained postural contractions, and is the primary area to be investigated in future studies by the authors.     

Premature labor and indomethacin.

Women in the 29th - 32nd week of gestation were admitted to hospital following the onset of premature labor contractions. After treatment with bed rest and beta-stimulating drugs, those patients with persistent uterine contractions were treated with oral indomethacin (25 mg every 6 hours for 5 days). The effect of indomethacin therapy was monitored by serial external tocometry recordings. This treatment schedule with indomethacin was repeated on several occasions at intervals of 5 to 10 days. Using a standardized technique, uterine contractility was monitored every second or third day throughout the entire treatment period. In this way, the frequency of contractions was evaluated in the presence or absence of indomethacin therapy. Following indomethacin treatment, there was a significant decrease in the frequency of contractions in all cases and a complete arrest of contractions occurred in some women. An increased frequency of contractions was observed during those times that the patient did not receive indomethacin. The plasms concentration of 15-keto-13, 14-dihydro-PGF2alpha, the major serum metabolite of PGF2alpha, was determined by the gas chromatography - mass spectrometry method before and after indomethacin in a limited number of cases. At the doses given for the duration of therapy used, no untoward effects could be detected in either the mother or the infant. These results indicate that indomethacin is a potent and useful drug in the treatment of premature labor.     

Optimal rejection of movement artefacts from myoelectric signals by means of a wavelet filtering procedure.

In this work the problem of rejection of motion artefacts from surface myoelectric signals, recorded during dynamic contractions, is studied. In fact, the extraction of frequency parameters and the detection of muscular activation patterns can be detrimentally affected by artefacts due to the movement of the surface electrodes, particularly stressed by the dynamic conditions of the exercise performed during measurement. In order to overcome this difficulty, four different filtering procedures have been tested and compared: a high-pass filtering procedure, a moving average procedure, a moving median procedure and a new adaptive wavelet based procedure, expressly designed for this work. Orthogonal Meyer wavelets are used with the aim of obtaining both a good reconstruction and a decomposition of the signal into non-overlapping bands. The four procedures have been tested with a set of different proofs utilising both synthetic and experimentally recorded myoelectric signals. The results show that the wavelet procedure performs better than the other methods both in information preservation and in time-detection. Moreover, the features of user-independence and adaptivity to the noise level suggest a wider range of applications of the proposed algorithm.     

Pregnancy termination

During pregnancy, the antiprogestin mifepristone will induce uterine contractions, increase the sensitivity of the myometrium to prostaglandin, and ripen the cervix. These effects indicate that mifepristone can be used for termination of pregnancy. The clinical experience has shown that mifepristone is sufficiently effective for this purpose only if combined with a suitable prostaglandin, e.g. gemeprost or misoprostol. The combined treatment has been used for termination of early pregnancy (up to 63 days of amenorrhea) and for termination of second trimester pregnancy. During early pregnancy, the recommended dose of mifepristone is 600 mg (although 200 mg seems sufficient), followed 36-48 h later by 0.4-0.8 mg misoprostol administered either orally or vaginally, or vaginal administration of 1.0 mg gemeprost. For termination of second trimester pregnancy, the treatment with mifepristone is most commonly combined with 1.0 mg gemeprost repeated at 3-6-h intervals. The combined treatment is as effective and safe during early pregnancy as is the alternative vacuum aspiration and is also equally acceptable if the woman is allowed to choose the method she prefers. During the second trimester, the pretreatment will significantly reduce the duration of labor, dose of prostaglandin, and the frequency of side effects.     

Factors Influencing the Estimates of Correlation between Motor Unit Activities in Humans

Background

Alpha motoneurons receive common synaptic inputs from spinal and supraspinal pathways. As a result, a certain degree of correlation can be observed between motoneuron spike trains during voluntary contractions. This has been studied by using correlation measures in the time and frequency domains. These measures are interpreted as reflecting different types of connectivity in the spinal networks, although the relation between the degree of correlation of the output motoneuron spike trains and of their synaptic inputs is unclear.

Methodology/Principal Findings

In this study, we analyze theoretically this relation and we complete this analysis by simulations and experimental data on the abductor digiti minimi muscle. The results demonstrate that correlation measures between motoneuron output spike trains are inherently influenced by the discharge rate and that this influence cannot be compensated by normalization. Because of the influence of discharge rate, frequency domain measures of correlation (coherence) do not identify the full frequency content of the common input signal when computed from pairs of motoneurons. Rather, an increase in sampling rate is needed by using cumulative spike trains of several motoneurons. Moreover, the application of averaging filters to the spike trains influences the magnitude of the estimated correlation levels calculated in the time, but not in the frequency domain (coherence).

Conclusions

It is concluded that the analysis of coherence in different frequency bands between cumulative spike trains of a sufficient number of motoneurons provides information on the spectrum of the common synaptic input. Nonetheless, the absolute values of coherent peaks cannot be compared across conditions with different cumulative discharge rates.