Abstract：
Normal labor and delivery are dependent on the presence of regular and effective contractions of the uterine myometrium. The mechanisms responsible for the initiation and maintenance of adequate and synchronized uterine activity that are necessary for labor and delivery result from a complex interplay of hormonal, mechanical, and electrical factors that have not yet been fully elucidated. Monitoring uterine activity during term labor and in suspected preterm labor is an important component of obstetrical care because cases of inadequate and excessive uterine activity can be associated with substantial maternal and neonatal morbidity and mortality. Inadequate labor progress is a common challenge encountered in intrapartum care, with labor dystocia being the most common indication for cesarean deliveries performed during labor. Hereafter, an accurate assessment of uterine activity during labor can assist in the management of protracted labor by diagnosing inadequate uterine activity and facilitating the titration of uterotonic medications before a trial of labor is prematurely terminated. Conversely, the ability to diagnose unwanted or excessive uterine activity is also critical in cases of threatened preterm labor, tachysystole, or patients undergoing a trial of labor after cesarean delivery. Knowledge of uterine activity in these cases may guide the use of tocolytic medications or raise suspicion of uterine rupture. Current diagnostic capabilities are less than optimal, hindering the medical management of term and preterm labor. Currently, different methods exist for evaluating uterine activity during labor, including manual palpation, external tocodynamometry, intrauterine pressure monitoring, and electrical uterine myometrial activity tracing. Legacy uterine monitoring techniques have advantages and limitations. External tocodynamometry is the most widespread tool in clinical use owing to its noninvasive nature and its ability to time contractions against the fetal heart rate monitor. However, it does not provide information regarding the strength of uterine contractions and is limited by signal loss with maternal movements. Conversely, the intrauterine pressure catheter quantifies the strength of uterine contractions; however, its use is limited by its invasiveness, risk for complications, and limited additive value in all but few clinical scenarios. New monitoring methods are being used, such as electrical uterine monitoring, which is noninvasive and does not require ruptured membranes. Electrical uterine monitoring has yet to be incorporated into common clinical practice because of lack of access to this technology, its high cost, and the need for appropriate training of clinical staff. Further work needs to be done to increase the accessibility and implementation of this technique by experts, and further research is needed to implement new practical and useful methods. This review describes current clinical tools for uterine activity assessment during labor and discusses their advantages and shortcomings. The review also summarizes current knowledge regarding novel technologies for monitoring uterine contractions that are not yet in widespread use, but are promising and could help improve our understanding of the physiology of labor, delivery, and preterm labor, and ultimately enhance patient care.
摘要：
正常的分娩和分娩取决于子宫肌层的常规和有效收缩的存在。负责启动和维持足够和同步的子宫活动的机制是分娩和分娩所必需的，这是由于激素的复杂相互作用而产生的。机械,和尚未完全阐明的电气因素。在足月分娩和可疑早产期间监测子宫活动是产科护理的重要组成部分，因为子宫活动不足和过度的情况可能与大量的孕产妇和新生儿发病率和死亡率有关。产程进展不足是产时护理中遇到的共同挑战,分娩难产是分娩期间进行剖宫产的最常见指征。此后，对分娩期间子宫活动的准确评估可以通过诊断子宫活动不足并在分娩试验提前终止之前促进子宫收缩药物的滴定来帮助治疗长期分娩.相反，在先兆早产的情况下，诊断子宫不必要或过度活动的能力也至关重要，心动过速收缩,或剖宫产后接受分娩试验的患者。在这些情况下，子宫活动的知识可能会指导使用保胎药物或引起子宫破裂的怀疑。当前的诊断能力低于最佳水平，阻碍了足月和早产的医疗管理。目前,有不同的方法来评估分娩期间的子宫活动，包括手工触诊,外部分娩力测量法，宫内压监测,和子宫肌层电活动追踪。传统的子宫监测技术具有优势和局限性。外部分娩力测量法是临床使用中最广泛的工具，因为它具有非侵入性和对胎儿心率监测器进行定时收缩的能力。然而,它不提供有关子宫收缩强度的信息，并且受到母体运动信号丢失的限制。相反，宫内压力导管可量化子宫收缩的强度；然而，它的使用受到其侵入性的限制，并发症的风险，在除了少数临床方案之外的所有临床方案中，累加价值有限。正在使用新的监测方法，如子宫电监测，这是非侵入性的，不需要破裂的膜。由于缺乏这项技术，子宫电监测尚未纳入常规临床实践。它的高成本，以及需要对临床工作人员进行适当的培训。需要做进一步的工作，以增加专家对这种技术的可访问性和实施性，需要进一步研究以实施新的实用和有用的方法。这篇综述描述了当前用于分娩期间子宫活动评估的临床工具，并讨论了它们的优缺点。该综述还总结了目前尚未广泛使用的有关监测子宫收缩的新技术的知识。但是很有希望，可以帮助我们提高对劳动生理学的理解，delivery,和早产，并最终加强患者护理。
