Optimization of monitoring of contractile uterus activity and fetus status in women with the threat of preterm birth





pretermpreterm birth, fetal distress, non-invasive fetal electrocardiography, uterine activity


Research objective: to study the use of uterine activity and variables of acceleration capacity (AC) and deceleration capacity (DC) in uterine contractile activity and fetal well-being monitoring in women at risk of preterm birth.
Materials and methods. 292 pregnant women were included in the prospective study. All involved women underwent ultrasound cervicometry at 16 weeks. 124 pregnant women with a “short cervix” of the III (main) group were observed in the dynamics, as well as uterine activity and fetal AC/DC at 26, 32 and 38 weeks of gestation, and during labor were studied. In 112 women of group II the variables of fetal AC/DC were detected at these terms of pregnancy. They were monitored via conventional cardiotocography during labor. 56 pregnant women in group I with normal cervicometry were monitored.
Results. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the main group was 97.30% and 94.74% respectively. Diagnostic accuracy in the case of uterine activity according to fetal non-invasive electrocardiography was 96.18%. Sensitivity and specificity of the diagnosis of the threatened preterm birth in the comparison group were significantly lower: 89.29% and 87.80% respectively. The diagnostic accuracy was 88.41%.
Patients in all clinical groups at 26 weeks had low AC/DC values. However, later in women of group I was found highest AC/DC level. AC/DC values in patients with risk of preterm birth were reduced compared with controls (p < 0.05). Sensitivity and specificity of the diagnosis of fetal distress if AC/DC was used were 91.67% and 99.12% respectively. Diagnostic accuracy of the test was 98.41%. In the comparison group the sensitivity was 77.78%, and the specificity was 89.22%. Diagnostic accuracy of intranatal cardiotocography was 86.82%.
Conclusions. Uterine activity extracted from the maternal abdominal signal can significantly improve the diagnosis of the threatenedpreterm delivery. Patients at risk of preterm birth have a delayed fetal neurological, which leads to fetal distress. AC/DC variables obtained via fetal non-invasive electrocardiography allow increasing the accuracy of fetal distress diagnosis.

Author Biographies

S.V. Korovai, Kharkiv Medical Academy of Postgraduate Education; Municipal Perinatal Center, Kharkiv

PhD, associate professor;

Head of the Gynecological Department

I.V. Lakhno, V.N. Karazin Kharkiv National University, Kharkiv

MD, professor, Department of Obstetrics and Gynecology, Medical Faculty

O.V. Gryshchenko, Kharkiv Medical Academy of Postgraduate Education, Kharkiv

MD, professor, head of the Perinatology, Obstetrics and Gynecology Department

K.V. Drogovoz, V.N. Karazin Kharkiv National University, Kharkiv

PhD, associate professor, Department of Obstetrics and Gynecology, Medical Faculty

Y.S. Blazhko, V.N. Karazin Kharkiv National University, Kharkiv

Assistant, Department of Obstetrics and Gynecology, Medical Faculty

A.S. Lutskyi, Kharkiv National Medical University, Kharkiv

Assistant, Department of Obstetrics and Gynecology No. 2


  1. Berghella, V., Saccone, G. “Cervical assessment by ultrasound for preventing preterm delivery.” Cochrane Database Syst Rev. 9 (2019): CD007235.
  2. Di Renzo, G.C., Giardina, I., Rosati A., et al. “Maternal risk factors for preterm birth: A country-based population analysis.” Eur J Obstet Gynecol Reprod Biol 159 (2011): 342–6.
  3. Ples, L., Sima, R.M., Ricu, A., et al. “The efficacy of cervical cerclage combined with a pessary for the prevention of spontaneous preterm birth.” J Matern Fetal Neonatal Med 21 (2019): 1–5.
  4. Care, A., Jackson, R., O'Brien, E., et al. “Cervical cerclage, pessary, or vaginal progesterone in high-risk pregnant women with short cervix: a randomized feasibility study.” J Matern Fetal Neonatal Med 34 (2019): 49–57.
  5. Roman, A., Suhag, A., Berghella V. “Overview of Cervical Insufficiency: Diagnosis, Etiologies, and Risk Factors.” Clin Obstet Gynecol 59 (2016): 237–40.
  6. Velayo, C.L., Funamoto, K., Silao, J.N., et al. “Evaluation of Abdominal Fetal Electrocardiography in Early Intrauterine Growth Restriction.” Front Physiol 8 (2017): 437.
  7. Fuchs, T., Grobelak, K., Pomorski, M., Zimmer, M. “Fetal heart rate monitoring using maternal abdominal surface electrodes in third trimester: can we obtain additional information other than CTG trace?” Adv Clin Exp Med 25 (2016): 309–16.
  8. Lakhno, I., Behar, J.A., Oster, J., et al. “The use of non-invasive fetal electrocardiography in diagnosing second-degree fetal atrioventricular block.” Matern Health Neonatol Perinatol 3 (2017): 14.
  9. Hoyer, D., Zebrowski, J., Cysarz, D., et al. “Monitoring fetal maturation-objectives, techniques and indices of autonomic function.” Physiol Meas 38 (2017): 61–88.
  10. Lakhno, I. “Non-invasive fetal electrocardiography ameliorates fetal outcome in chorioangioma: A case report.” J Neonatal Perinatal Med 14 (2021): 149–52.
  11. Behar, J., Bonnemains, L., Shulgin V., et al. “Noninvasive fetal electrocardiography for the detection of fetal arrhythmias.” Prenat Diagn 39 (2019): 178–87.
  12. Fanelli, A., Magenes, G., Campanile, M., Signorini, M.G. “Quantitative assessment of fetal well-being through CTG recordings: a new parameter based on phase rectified signal average.” IEEE J Biomed Health Inform 17 (2013): 959–66.
  13. Rivolta, M.W., Stampalija, T., Frasch M.G., et al. “Theoretical value of Deceleration Capacity Points to Deceleration Reserve of Fetal Heart Rate.” IEEE Trans Biomed Eng 67 (2020): 1176–85.
  14. Sletten, J., Kiserud, T., Kessler, J. “Effect of uterine contractions on fetal heart rate in pregnancy: a prospective observational study.” Acta Obstet Gynecol Scand 95 (2016): 1129–35.
  15. Behar, J., Andreotti, F., Zaunseder, S., et al. “A practical guide to non-invasive foetal electrocardiogram extraction and analysis.” Physiol meas 37 (2016): R1–R35.
  16. Vullings, R., van Laar, J.O.E.H. “Non-invasive Fetal Electrocardiography for Intrapartum Cardiotocography.” Front Pediatr 8 (2020): 599049.
  17. Sentilhes, L., Sénat, M.V., Ancel, P.Y., et al. “Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF).” Eur J Obstet Gynecol Reprod Biol 210 (2017): 217–24.
  18. Di Renzo, G.C., Cabero Roura, L., Facchinetti, F., et al. “Preterm labor and birth management: Recommendations from the European Association of Perinatal Medicine.” J Matern Fetal Neonatal Med 30 (2017): 2011–30.
  19. Rasmark Roepke, E., Hellgren, M., Hjertberg, R., et al. “Treatment efficacy for idiopathic recurrent pregnancy loss – systematic review and meta-analysis.” Acta Obstet Gynecol Scand 97 (2018): 921–41.
  20. Caughey, A.B., Zupancic, J.A., Greenberg, J.M., et al. “Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth.” AJP Rep 6 (2016): e407–e416.
  21. Timofeev, J. “Use of Cervical Pessary in the Management of Cervical Insufficiency.” Clin Obstet Gynecol 59 (2016): 311–9.
  22. Wang, S, Wang, Y, Feng, L. “Pregnancy outcomes following transvaginal cerclage for cervical insufficiency: Results from a single-center retrospective study.” J Huazhong Univ Sci Technolog Med Sci 37.2 (2017): 237–42.
  23. Jarde, A., Lutsiv, O., Park, C.K., et al. “Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis.” BJOG 124 (2017): 1176–89.
  24. Romero, R., Conde-Agudelo, A., Da Fonseca, E., et al. “Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data.” Am J Obstet Gynecol 218.2 (2018): 161–80.
  25. Saccone, G., Ciardulli, A., Xodo, S., et al. “Cervical Pessary for Preventing Preterm Birth in Singleton Pregnancies with Short Cervical Length: A Systematic Review and Meta-analysis.” J Ultrasound Med 36 (2017): 1535–43.



How to Cite

Korovai, S., Lakhno, I., Gryshchenko, O., Drogovoz, K., Blazhko, Y., & Lutskyi, A. (2021). Optimization of monitoring of contractile uterus activity and fetus status in women with the threat of preterm birth. REPRODUCTIVE ENDOCRINOLOGY, (59), 32–34. https://doi.org/10.18370/2309-4117.2021.59.32-34



Pregnancy and childbirth