The objective of this study is to remove or, at least, reduce the noise in uterine EMG recordings, which at their present noise level render the data unusable. Predicting when true labor will start and recognizing when labor actually starts are important for both normal and complex pregnancies. For normal pregnancy, the prognosis of labor is important for reducing unnecessary hospital costs. About 10% of the four million babies born each year in the United States are born prematurely. At $1,500 a day for neonatal intensive care, this comprises national health care expenses of well over $5 billion. Spectral analysis, filter design, and 1/3 octave analysis were applied to analyze the uterine EMG recordings. Signal-to-noise ratio was increased with IIR Butterworth bandstop filter. The spectral band between 0.25 and 0.4 Hz shows matching of the Toco belt via spectral analysis. Nevertheless, 1/3 octave analysis gives the highest correct detection percentage compare with frequency analysis and filter design.

The objective of this study is to remove or, at least, reduce the noise in uterine EMG recordings, which at their present noise level render the data unusable. Predicting when true labor will start and recognizing when labor actually starts are important for both normal and complex pregnancies. For normal pregnancy, the prognosis of labor is important for reducing unnecessary hospital costs. About 10% of the four million babies born each year in the United States are born prematurely. At $1,500 a day for neonatal intensive care, this comprises national health care expenses of well over $5 billion. Spectral analysis, filter design, and 1/3 octave analysis were applied to analyze the uterine EMG recordings. Signal-to-noise ratio was increased with IIR Butterworth bandstop filter. The spectral band between 0.25 and 0.4 Hz shows matching of the Toco belt via spectral analysis. Nevertheless, 1/3 octave analysis gives the highest correct detection percentage compare with frequency analysis and filter design.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 4 uppsatser.

Résumé : Les anomalies de la contractilité utérine induisent des complications majeures. Il a été décrit que les facteurs inflammatoires et hormonaux déterminent la qualité des contractions utérines. FACTEURS INFLAMMATOIRES : Lors de prématurité spontanée, un statut inflammatoire est présent dans 60 % des cas où des médiateurs lipidiques inflammatoires (leucotriènes, prostaglandines) jouent un rôle majeur. Cette étude évalue l’effet du Montélukast, un antagoniste des récepteurs aux cys-leucotriènes, sur l’activité myométriale humaine in vitro. L’effet du Montélukast anténatal a été quantifié en condition inflammatoire sur l’activité contractile in vitro et sur la prolongation de la grossesse. Deux modèles sont utilisés. Le premier modèle est basé sur le prélèvement de biopsies utérines humaines, lors de césariennes. Le deuxième modèle est basé sur l’induction d’inflammation chez des rates gestantes suivie par des prélèvements utérins. En condition basale, les résultats montrent que le Montélukast a un effet tocolytique significatif sur l’activité contractile in vitro humaine et que son effet est additif à celui de la Nifédipine, le tocolytique de référence. Par ailleurs, l’effet du Montélukast est maximal en condition de prématurité spontanée. Lors de l'ajout d'agent pharmacologique bien caractérisé in vitro dans le modèle inflammatoire, la réactivité contractile à l'ocytocine des biopsies utérines des rates traitées au Montélukast est abolie alors que la sensibilité à la niféfipine était augmentée. Finalement, 3 des 9 rates traitées au Montélukast présentaient une prolongation anormale de la gestation. FACTEURS HORMONAUX : Lors d’une observation fortuite, une modification du patron de contractions utérines a été observée in vitro chez des femmes enceintes présentant une hypothyroïdie et traitées à la T[indice inférieur 4]. Des anomalies de contractilité peuvent conduire à des césariennes avec les risques chirurgicaux associés. Cette partie évalue si cette modification de la contractilité utérine est causée par l’hypothyroïdie sous-jacente ou l’administration de T[indice inférieur 4]. Par des biopsies utérines de rates, nous avons démontré que l’hypothyroïdie réduit la durée et augmente significativement la fréquence des contractions tandis qu’à forte dose de T[indice inférieur 4], une augmentation de la durée et une fréquence diminuée sont quantifiées. Ces résultats miment le patron anormal de contractions observé chez les femmes enceintes traitées à la T[indice inférieur 4]. Nos données suggèrent donc que la modification de la réactivité myométriale est due au traitement à la T[indice inférieur 4]. Cette approche originale montre que ces deux facteurs influencent la contractilité utérine et que des prises en charge plus personnalisées et mieux adaptées permettront de revenir à une contractilité utérine physiologique. / Abstract : Abnormalities of uterine contractility result in major complications. It has been described that inflammatory and hormonal factors determine the quality of uterine contractions. INFLAMMATION FACTORS: In spontaneous prematurity, inflammatory status is present in 60 % of preterm birth cases, where inflammatory lipid mediators (leukotrienes, prostaglandins) play a key role. This section aims to evaluate the effect of montelukast, a cysteinyl-leucotrienes receptor antagonist, on in vitro human myometrial activity. Then, the effect of antenatal montelukast on contractile activity will be quantified under an inflammatory condition in vitro and on the prolongation of the pregnancy. Two models have been used. The first model is based on human uterine biopsies recovered from c-sections. The second model is based on the induction of inflammation in pregnant rats, in which hysterectomies were performed. In the basal condition, montelukast has a tocolytic effect in vitro on human uterine contractile activity and its effect is additive to the effect of nifedipine, the reference tocolytic. Moreover, the effect of montelukast is maximal under spontaneous preterm birth. When adding in vitro pharmacological agent s well characterized to pregnant rats from the inflammatory model, uterine reactivity to oxytocin is abolished after antenatal montelukast treatment while the uterine sensitivity to nifedipine was increased. Finally, three of the nine rats treated with montelukast had an abnormal delay of gestation. HORMONAL FACTORS: After a fortuitous observation, an abnormal pattern of uterine contraction was observed in pregnant women with hypothyroidism and treated with T[subscript 4]. Contractile abnormalities can lead to c-sections with associated surgical risks. This section assesses whether this change in uterine contractility is caused by an underlying hypothyroid condition or the administration of T[subscript 4]. In uterine biopsies from a female rat hypothyroid model, we have demonstrated that hypothyroidism significantly shortens and increases the contractions, while with high doses of T[subscript 4] an increased duration and a decreased frequency were quantified. These results mimic the abnormal pattern of contractions observed in pregnant women treated with T[subscript 4]. Thus, our data suggest that this change in myomterial reactivity is due to T[subscript 4] treatment. This original approach shows that these two factors influence uterine contractility and that appropriate management will allow their uterine contractile activity to return to physiological values.

This thesis investigates the origin of spontaneous activity in the uterus. This organ does not show any activity until shortly before delivery, where fast and efficient contractions are generated. The aim of this work is to provide insight into the origin of spontaneous oscillations and into the transition from asynchronous to synchronized activity in the pregnant uterus. One intriguing aspect in the uterus is the absence of any pacemaker cell. The organ is composed of muscular cells, which are excitable, and connective cells, whose behavior is purely passive; None of these cells, taken in isolation, spontaneously oscillates. We develop an hypothesis based on the observed strong increase in the electrical coupling between cells in the last days of pregnancy. The study is based on a mathematical model of excitable cells, coupled to each other on a regular lattice, and to a fluctuating number of passive cells, consistent with the known structure of the uterus. The two parameters of the model, the coupling between excitable cells, and between excitable and passive cells, grow during pregnancy.Using both a model based on measured electrophysiological properties, and a generic model of excitable cell, we demonstrate that spontaneous oscillations can appear when increasing the coupling coefficients, ultimately leading to coherent oscillations over the entire tissue. We study the transition towards a coherent regime, both numerically and semi-analytically, using the simple model of excitable cells. Last, we demonstrate that, the realistic model reproduces irregular action potential propagation patterns as well as the bursting behavior, observed in the in-vitro experiments.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Objetivos: O presente estudo teve como objetivo comparar a frequência das contrações uterinas em gestações gemelares em uso da progesterona natural e de placebo. Método: Estudo randomizado, duplo-cego, placebo controlado, realizado no período de 01 de junho de 2007 a 31 de outubro de 2013. Participaram do estudo 341 gestantes, com 170 randomizadas no grupo progesterona e 171 no grupo placebo. Todas as gestantes realizaram exame de tocografia no período de 24 a 34 semanas e 6 dias, com duração de trinta minutos, a cada três semanas. A contração uterina foi definida como uma elevação da linha de base com amplitude acima de 5 mm e duração mínima de trinta segundos. Na comparação da frequência das contrações uterinas entre os grupos, nas diferentes idades gestacionais, utilizou-se o teste t de Student. O modelo de análise GEE - modelo generalizado de equações de estimação - foi utilizado na comparação, entre os grupos, da frequência das contrações uterinas em relação à idade gestacional no parto, e também na avaliação da interação da frequência das contrações uterinas com a medida do colo uterino e a corionicidade. Resultados: As características epidemiológicas e gerais das gestantes foram semelhantes nos dois grupos. A frequência média das contrações uterinas diferiu entre os grupos apenas na 34ª semana (P = 0,005), com frequência maior de contrações no grupo progesterona (4,81±3,24) em relação ao grupo placebo (2,73 ± 2,06). Não houve diferença significativa na comparação da frequência média das contrações uterinas e a idade gestacional no parto (< 28 sem, < 32 sem, < 34 sem e < 37 semanas) entre os grupos. Não foi observada interação da frequência das contrações uterinas com a medida do colo uterino ou com a corionicidade da gestação, em relação aos grupos progesterona ou placebo. Conclusão: O uso da progesterona natural não interfere na frequência das contrações uterinas nas gestações gemelares abaixo de 34 semanas gestacionais / Objectives: The aim of this study was to comparate uterine contraction frequency in twin pregnancies in use of natural progesterone and placebo. Methods: Randomized, double-blind, placebo-controlled study, conducted between June 1, 2007 to October 31, 2013. The study included 341 twin pregnancies, with 170 randomized in the progesterone group and 171 in the placebo group. All pregnancies had uterine contraction registration by tocodinamometry every three weeks, during 30 minutes between 24 to 34 weeks and 6 days. Uterine contraction was defined as an amplitude greater than 5 mm, from baseline registration, and a duration longer than 30 seconds. Comparison of contraction frequency between the groups at different gestational ages was examined using the parametric student t test. The model GEE - generalized estimating equation model - was used in the comparison, between the groups, the uterine contraction frequency according gestational age at delivery, and also for evaluating the interaction of the frequency contractions with cervical length and chorionicity. Results: Epidemiological and general characteristics of the pregnant woman were similar in both groups. At the 34 weeks, was only gestational age that presented difference (P = 0.005) in the mean uterine contraction frequency between progesterone (4.81 ± 3.24) and placebo (2.73 ± 2.06) groups. No difference in the mean uterine contraction frequency was observed between progesterone and placebo groups in relation to gestational age at delivery. Cervical length measurement and chorionicity did not influence the uterine contraction frequency according to progesterone or placebo. Conclusion: The use of natural progesterone in twin pregnancies does not affect the uterine contraction frequency before 34 weeks gestation

Orientador: José Ricardo de Arruda MIranda / Resumo: A contração uterina é um processo fisiológico espontâneo com impacto direto no ciclo menstrual/estral e na gestação. Disfunções na atividade uterina estão relacionadas com infertilidade, abortos e partos prematuros, sendo este último a maior causa de mortalidade e morbidade infantil no mundo. Sendo assim, se faz necessário o desenvolvimento de metodologias in vivo para monitorar o processo mecânico uterino. O objetivo deste trabalho foi aplicar a técnica de Biosusceptometria de Corrente Alternada para avaliação in vivo da atividade mecânica uterina em ratas prenhes. Foram utilizadas 40 ratas fêmeas Wistar prenhes com idade entre 10 e 15 semanas e com peso médio de 250 g. Através da Biosusceptometria de Corrente Alternada, 18 animais foram utilizados para avaliação da contratilidade uterina durante a prenhez e 8 foram usadas para avaliação da atividade uterina frente à ação da ocitocina. Na primeira etapa foi realizada uma cirurgia de fixação do marcador magnético em três posições da serosa uterina: próximo ao ovário; na região média entre o ovário e a cérvice; e próximo à cérvice. A atividade uterina foi monitorada nos dias 0, 7, 14, 20 e 21 de prenhez para cada posição do marcador. Na segunda etapa, foi realizado o implante do marcador magnético somente próximo à cérvice, e a atividade foi avaliada antes e depois da administração de ocitocina no dia 20 de prenhez. Os resultados obtidos foram perfis de contração para cada situação proposta, os quais apresentaram contrações ba... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Uterine contraction is a spontaneous physiologic process with direct impact on menstrual/estrous cycle and pregnancy. Uterine activity dysfunction are related with infertility, abortion and premature birth, in which the last is the major cause of childish mortality and morbidity in the world. Therefore, in vivo methods to assess the mechanical process of the uterus under real physiologic condition remains necessary to be developed. The aim of this study was to apply Alternate Current Biosusceptometry to assess in vivo mechanical uterine activity of pregnant rats. Forty Wistar female pregnant rats with 10 to 15 weeks age and weighing 250 g were used. Through Alternate Current Biosusceptometry, 30 animals were used for uterine contraction analysis during pregnancy and 10 were used to evaluate uterine contractility due to oxytocin action. On the first part, an implant surgery was performed to fix the magnetic marker on uterus serous at three different position: near ovary; middle distance between ovary and cervix, and near cervix. Uterine peristalsis were measured at days 0, 7, 14, 20 and 21 of pregnancy. On the second part, magnetic marker was implanted only on near cervix and uterine activity was evaluated before and after the oxytocin administration on day 20 of pregnancy. Contraction profiles were obtained as results to each proposed analysis, in which presented high frequency and low frequency basal contraction and intense contractions. During pregnancy evolution, was obser... (Complete abstract click electronic access below) / Doutor

Objetivos: O presente estudo teve como objetivo comparar a frequência das contrações uterinas em gestações gemelares em uso da progesterona natural e de placebo. Método: Estudo randomizado, duplo-cego, placebo controlado, realizado no período de 01 de junho de 2007 a 31 de outubro de 2013. Participaram do estudo 341 gestantes, com 170 randomizadas no grupo progesterona e 171 no grupo placebo. Todas as gestantes realizaram exame de tocografia no período de 24 a 34 semanas e 6 dias, com duração de trinta minutos, a cada três semanas. A contração uterina foi definida como uma elevação da linha de base com amplitude acima de 5 mm e duração mínima de trinta segundos. Na comparação da frequência das contrações uterinas entre os grupos, nas diferentes idades gestacionais, utilizou-se o teste t de Student. O modelo de análise GEE - modelo generalizado de equações de estimação - foi utilizado na comparação, entre os grupos, da frequência das contrações uterinas em relação à idade gestacional no parto, e também na avaliação da interação da frequência das contrações uterinas com a medida do colo uterino e a corionicidade. Resultados: As características epidemiológicas e gerais das gestantes foram semelhantes nos dois grupos. A frequência média das contrações uterinas diferiu entre os grupos apenas na 34ª semana (P = 0,005), com frequência maior de contrações no grupo progesterona (4,81±3,24) em relação ao grupo placebo (2,73 ± 2,06). Não houve diferença significativa na comparação da frequência média das contrações uterinas e a idade gestacional no parto (< 28 sem, < 32 sem, < 34 sem e < 37 semanas) entre os grupos. Não foi observada interação da frequência das contrações uterinas com a medida do colo uterino ou com a corionicidade da gestação, em relação aos grupos progesterona ou placebo. Conclusão: O uso da progesterona natural não interfere na frequência das contrações uterinas nas gestações gemelares abaixo de 34 semanas gestacionais / Objectives: The aim of this study was to comparate uterine contraction frequency in twin pregnancies in use of natural progesterone and placebo. Methods: Randomized, double-blind, placebo-controlled study, conducted between June 1, 2007 to October 31, 2013. The study included 341 twin pregnancies, with 170 randomized in the progesterone group and 171 in the placebo group. All pregnancies had uterine contraction registration by tocodinamometry every three weeks, during 30 minutes between 24 to 34 weeks and 6 days. Uterine contraction was defined as an amplitude greater than 5 mm, from baseline registration, and a duration longer than 30 seconds. Comparison of contraction frequency between the groups at different gestational ages was examined using the parametric student t test. The model GEE - generalized estimating equation model - was used in the comparison, between the groups, the uterine contraction frequency according gestational age at delivery, and also for evaluating the interaction of the frequency contractions with cervical length and chorionicity. Results: Epidemiological and general characteristics of the pregnant woman were similar in both groups. At the 34 weeks, was only gestational age that presented difference (P = 0.005) in the mean uterine contraction frequency between progesterone (4.81 ± 3.24) and placebo (2.73 ± 2.06) groups. No difference in the mean uterine contraction frequency was observed between progesterone and placebo groups in relation to gestational age at delivery. Cervical length measurement and chorionicity did not influence the uterine contraction frequency according to progesterone or placebo. Conclusion: The use of natural progesterone in twin pregnancies does not affect the uterine contraction frequency before 34 weeks gestation

Durante a amamentação ocorre a liberação de ocitocina para a ejeção do leite, que desencadeia a contração uterina, associada a processo doloroso. A Eletroestimulação Nervosa Trânscutânea (TENS) é um recurso fisioterapêutico que tem como função o alívio da dor. O objetivo principal deste estudo foi avaliar a efetividade da TENS para alívio de dor de contração uterina durante a amamentação em multíparas após o parto vaginal. Como objetivo específico visou mensurar e caracterizar a dor de contração uterina e identificar queixas álgicas durante a amamentação. Trata-se de um estudo clínico controlado e randomizado, composto por 32 multíparas após o parto vaginal, durante a amamentação. O estudo foi desenvolvido dentro dos padrões éticos, sendo aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto - USP. O estudo foi realizado em uma maternidade no interior do estado de São Paulo. As participantes foram alocadas de maneira aleatória, no alojamento conjunto. As participantes foram divididas em dois grupos, o grupo experimental (GE) que recebeu a aplicação de TENS convencional e o grupo controle (GC). Para o GE os eletrodos da TENS convencional foram posicionados na região paravertebral (T10-L1 e S2- S4), programado para gerar frequência de 80Hz, duração de pulso de 100?s e amplitude ajustada para produzir sensação forte e tolerável. O aparelho foi aplicado por 40 minutos. As puérperas foram avaliadas pela Escala de Categoria Numérica (NRS) e pela Intensidade de Dor Presente (PPI), em duas mamadas, correspondentes a primeira e segunda avaliação. Durante a primeira avaliação as puérperas foram questionadas quanto as características da dor e a presença de outras queixas dolorosas. Na segunda avaliação, o GE recebeu a TENS convencional durante a amamentação e o GC foi apenas acompanhado pelo mesmo período. Após a retirada da TENS do GE e acompanhamento do GC, as mulheres foram questionadas novamente em relação ao nível de dor. Ao final, as puérperas do GE responderam sobre a satisfação do tratamento e desconforto da corrente. Foi realizada análise descritiva para apresentação dos dados e análise comparativa entre os grupos, por meio de teste nãoparamétrico, com nível de significância p<=0,05. A dor de contração uterina apresentou as seguintes características: profunda, localizada em região de baixo ventre e ritmada. O início e diminuição da dor associaram-se com o início e término da sucção, respectivamente. As queixas dolorosas associadas foram dor nas mamas, na região perineal, nos membros superiores e inferiores, na região cervical e na coluna. O PPI indicou que as maiorias das participantes tiveram dor avaliada como moderada e o nível de dor pela NRS foi de 5,53. Na análise intragrupo o GE apresentou redução significativa da dor pela NRS (p<0,0001) após o uso da TENS. O GC também mostrou redução significativa da dor entre a primeira e segunda avaliação (p=0,04). Na análise intergrupo, o GE teve redução significativa da dor pelo PPI (p<0,001) e pela NRS (p<0,01) quando comparado ao GC. As puérperas que utilizaram a TENS relataram estar muito satisfeitas ou satisfeitas com o recurso, utilizariam a técnica em puerpério futuro e não sentiram desconforto causado pela corrente da TENS convencional. A intervenção não causou nenhum tipo de efeitos adversos e colaterais no GE. A TENS convencional foi eficaz no alívio de dor de contração uterina após o parto e durante a amamentação, podendo ser método de escolha para alívio deste tipo de dor. / During breastfeeding occurs the release of oxytocin for milk ejection, that cause uterine contractions associated with painful process. The transcutaneous electrical nerve stimulation (TENS) is a physical therapy resource, which aims to pain relief. The main objective of this study was to evaluate the effectiveness of TENS to relief of painful uterine contraction during lactation in multiparous after vaginal delivery. The specific objectives were to measure and characterize the uterine contraction pain and identify pain complaints during breastfeeding. This is a randomized, controlled clinical study, formed by 32 multiparous after vaginal delivery, during breastfeeding. The study was conducted with ethical standards and was approved by the Ethics Committee of the Nursing School of Ribeirão Preto - USP. The study was accomplished in a maternity hospital in the state of São Paulo. The participants were placed randomly. The participants were divided in two groups, the experimental group (EG) received the application of conventional TENS and the control group (CG). For EG, the electrodes were placed in the paravertebral region (T10-L1 and S2-S4), programmed to generate frequency of 80Hz, pulse duration of 100?s and intensity adjusted to cause strong feeling and tolerable. The device was applied for 40 minutes. The women were evaluated by Category Numeric Scale (NRS) and Present Pain Intensity (PPI), in two feedings, corresponding to the first and second evaluation. During the first assessment women were asked about pain characteristics and the presence of other pain complaints. In the second evaluation, EG received conventional TENS during breastfeeding and the CG were only accompanied by the same period. After remove the conventional TENS of the EG and monitoring the CG, the women were asked again in relation to the level of pain. In the end, the participants of the EG responded about treatment satisfaction and discomfort of the current. Descriptive analysis was performed for the presentation of data and comparative analysis between the groups, using non-parametric test, with significance level p <= 0.05. The painful uterine contraction had the following characteristics: deep, located in a lower abdomen and rhythmic. The onset and decreased pain associated with the start and end suction, respectively. The pain complaints were breast pain, perineal, in upper extremity, lower extremity, neck and spine. The PPI indicated that the most participants were assessed as moderate pain and pain level was 5.53 for the NRS. In the EG intragroup analysis showed a significant reduction of pain by the NRS (p <0.0001) after use of TENS. The GC also showed significant reduction in pain between the first and second evaluation (p = 0.04). In the intergroup analysis, the EG had significant reduction in pain by the PPI (p <0.001) and the NRS (p <0.01) when compared to CG. The women who used TENS reported being very satisfied or satisfied with the resource, using the technique in future puerperium and felt no discomfort caused by the current of conventional TENS. The intervention did not cause any adverse effects and side effects in EG. The conventional TENS was effective in relieving of uterine contraction pain after delivery and during breastfeeding, may be the method of choice for this type of pain relief.