Multichannel EMG Diagnosing True Preterm Labor

Study Overview
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Brief Summary
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We have designed new electromyography sensors for measuring uterine activity. These sensors are directional - they preferentially report uterine muscle contractions at specific locations, called regions. By measuring the synchronization of the regions of the uterus during contractions we intend to non-invasively determine if any patient is in-labor or not-in-labor. Accurately diagnosing true preterm labor allows timely intervention to avoid preterm birth; Accurately diagnosing false preterm labor avoids needlessly treating patients who would not benefit.

Detailed Description
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The legacy device for assessing uterine contractions is the tocodynamometer (Toco). The Toco is plunger-driven device that measures the uterine shape change that occurs with a contraction. Toco only reports the timing of contractions, not the contraction strength, and cannot distinguish between false and true labor. Our overarching goal is to validate our method of determining if a patient experiencing contractions is in true labor or false labor. We will accomplish this by applying new knowledge to an old technology - uterine EMG. This trial is based on our advanced understanding of how the uterus generates coordinated contractions without a pacemaker or dedicated electrical conduction pathways - mechanotransduction and intrauterine pressure - but also uses bioelectrical signaling for local tissue recruitment. The uterus emits bioelectrical signals with each contraction that can be detected by electromyography (EMG). To observe uterine bioelectrical signals, we created a novel EMG sensor, we call the area sensor. This sensor is directional - capable of preferentially reporting muscle contractions from immediately below the sensor location. In this clinical trial we use multiple area sensors placed on the maternal abdomen to directly observe how well the regional contractions are synchronized. Our hypothesis to be tested is that highly synchronized contractions predicts true labor, unsynchronized predicts false labor. Patients with unclear labor status, or those in early labor will be studied. We will correlate the results of the synchronization analysis against the patient's progress over the ensuing 24 hours. These data will validate the ability to identify false and true labor using multichannel EMG and area sensors.

Official Title
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Optimizing and Validating an EMG-based Fetal Monitor to Identify True Preterm Labor

Conditions
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Pregnancy Preterm, Labor; Irregular, Preterm Labor

Intervention / Treatment
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* Device: Uncertain diagnosis of true labor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant One living fetus Experiencing frequent uterine contractions Exclusion Criteria: Cervical dilation > 4 cm Ruptured membranes Maternal or fetal indications for immediate delivery

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Uncertain diagnosis of true labor<br>Patients who cannot be accurately classified as experiencing true labor or false labor based on standard clinical assessments. | Device: Uncertain diagnosis of true labor<br>* Multichannel EMG of uterine bioelectrical signals will be recorded using area sensors. The output of the synchronization calculations will be correlated with the time to delivery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Validating prediction of true/false labor status with delivery within 24 hours | The test device predicts delivery. The prediction on each subject will be compared against the observed delivery time. | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Establishing the range and trend of synchronized sensor readings | The fraction of EMG channels active during each contraction, and the running average of the fraction, will be correlated with time to delivery | 48 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Preterm labor detection, Labor detection, False labor