Biomarker identification based on human electrohysterography for the early detection of risk in different obstetric scenarios: preterm birth, induction of labour and postpartum
- Autores: María del Alba Díaz Martínez
- Directores de la Tesis: Yiyao Ye Lin (dir. tes.), Gema Prats Boluda (dir. tes.)
- Lectura: En la Universitat Politècnica de València ( España ) en 2024
- Idioma: inglés
- Tribunal Calificador de la Tesis: Daniel Ruiz Fernández (presid.), Antonio Martínez Millana (secret.), Miha Lucovnik (voc.)
- Programa de doctorado: Programa de Doctorado en Tecnologías para la Salud y el Bienestar por la Universitat Politècnica de València
- Materias:
- Enlaces
- Tesis en acceso abierto en: RiuNet
- Resumen
During pregnancy, women undergo physiological, metabolic, and morphological changes that could lead to significant maternal-foetal risks. Firstly, preterm birth is the leading cause of infant mortality, with a prevalence 10% in single (SG) and 50% in multiple gestations (MG). The characterisation of uterine activity, as well as the comparison between SG and MG, may thus help to better understand and manage this pathology. Secondly, induction of labour (IOL) is associated with an increased risk of maternal mortality and morbidity when the latent phase of labour is excessively prolonged, especially in nulliparous women. However, the literature is sparse and the uterine electrophysiological response to the IOL drug has not been clearly observed. In this sense, the study of biomarkers based on electrohysterography (EHG) could help to early detect the risk of IOL failure and guide clinical decisions accordingly. Thirdly, postpartum haemorrhage (PPH) constitutes one of the main causes of maternal mortality in the world. Its prevalence is 2-6%, causing the death of 75,000 women each year. The main cause is uterine atony, so EHG becomes the ideal tool to assess the state of the uterus and indicate the PPH risk based on the absence or not of activity. Therefore, the aim of the present doctoral thesis is the identification of EHG-biomarkers for the early detection of high-risk obstetrical situations. For this purpose, the EHG signal and obstetric databases were generated for each scenario at University and Polytechnic Hospital La Fe. The greater impulsivity and predictability in MG compared to SG during the third trimester, in addition to the significant correlation between EHGbiomarkers and foetal weight, suggested an electromechanical coupling between overdistension and surface recorded myoelectric activity. As for IOL, the successful group showed a significant increase in the number of contractions and cellular excitability, along with reduced complexity, from 2-3 hours after the IOL drug administration. No significant changes from baseline activity were observed in the failed group. Parity-based comparison reported a higher progression ratio of signal amplitude for the parous group. Myoelectric activity in vaginal postpartum was found to be more frequent and intense, in addition to exhibit a greater cellular excitability than in caesarean deliveries. Discriminatory capacity of EHGbiomarkers for early risk detection in various obstetric contexts has advanced current electrophysiological knowledge of the uterus in vivo. The translation of the EHG to clinical practice will entail the signal processing automation, culminating in the creation of generalised and robust predictive models that support clinical decision-making, improve birth planning and management, prevent maternal and foetal complications and optimise the allocation of hospital resources.
