Clinical Use of Electrohysterography During Term Labor: A Systematic Review on Diagnostic Value, Advantages, and Limitations.

ABSTRACT

IMPORTANCE Real-time electrohysterography (EHG)-based technologies have recently become available for uterine monitoring during term labor. Therefore, obstetricians need to be familiar with the diagnostic value, advantages, and limitations of using EHG. OBJECTIVE: The aims of this study were to determine the diagnostic value of EHG in comparison to (1) the intrauterine pressure catheter (IUPC), (2) the external tocodynamometer (TOCO), and (3) in case of maternal obesity; (4) to evaluate EHG from users' and patients' perspectives; and (5) to assess whether EHG can predict labor outcome. EVIDENCE ACQUISITION A systematic review was performed in the MEDLINE, EMBASE, and Cochrane library in October 2017 resulting in 209 eligible records, of which 20 were included. RESULTS: A high sensitivity for contraction detection was achieved by EHG (range, 86.0%-98.0%), which was significantly better than TOCO (range, 46.0%-73.6%). Electrohysterography also enhanced external monitoring in case of maternal obesity. The contraction frequency detected by EHG was on average 0.3 to 0.9 per 10 minutes higher compared with IUPC, which resulted in a positive predictive value of 78.7% to 92.0%. When comparing EHG tocograms with IUPC traces, an underestimation of the amplitude existed despite that patient-specific EHG amplitudes have been mitigated by amplitude normalization. Obstetricians evaluated EHG tocograms as better interpretable and more adequate than TOCO. Finally, potential EHG parameters that could predict a vaginal delivery were a predominant fundal direction and a lower peak frequency. CONCLUSIONS AND RELEVANCE Electrohysterography enhances external uterine monitoring of both nonobese and obese women. Obstetricians consider EHG as better interpretable; however, they need to be aware of the higher contraction frequency detected by EHG and of the amplitude mismatch with intrauterine pressure measurements.