Journal of Neonatal Biology

Electrical inhibition (EI) of preterm uterine electrical activity, uterine mechanical activity and preterm birth

20^th International Conference on Neonatology and Perinatology

December 04-06, 2017 | Madrid, Spain

Jeffrey Karsdon

University of Florida Health Shands Hospital, USA

Scientific Tracks Abstracts: J Neonatal Biol

Abstract:

Background: Uterine smooth muscle electrical activity precedes and controls the preterm uterine mechanical contractions. This is monitored with electromyogram (EMG), electrohysterogram (EHG) and tocodynamometry (TOCO). EHG is a more objective measure of contraction force than the TOCO. Objective: EI of preterm uterine EMG and subsequent inhibition of mechanical activity (frequency and force). Study Design: Women in preterm labor at 24-34 weeks gestation had standard monitoring of TOCO and fetal heart rate (FHR) with simultaneous external monitoring (OBMedical, Gainsville, FL) of EHG and fetal electrocardiogram (fECG). An electrical pacemaker gave EI to an electrode catheter placed into the vaginal posterior fornix next to the cervix. EI was a bipolar constant current square wave pulse: 0-10mA, 0-28ms/pulse, 0-30 Hz. There were 3 groups of EI: 20, 40 or 80 minutes. EI was a 10-second burst only during a monitored contraction. Each group had 20 minutes of pre-EI sham control (C1) and post-EI sham control (C2). Outcome measures were TOCO and EHG contraction frequency or peak-to- peak (P-P) interval and EMG power spectral density (PSD). Differences in the estimated means of P-P and PSD for the C1, EI, and C2 periods used a mixedmodel analysis of variance and a paired t-test with a 0.05 two-sided significance level. Results: Electrical PSD and mechanical TOCO and EHG P- P all decreased during EI compared to C1 and C2. FHR and fECG were unchanged. Also, EI decreased uterine resting tone. Conclusions: This is the first EI study of human preterm uterine electrical and mechanical activity i.e. contraction frequency and force. EI is an electroceutical tocolytic with no systemic side- effects on mother or baby. The EI mechanism is unknown, but may produce membrane hyperpolarization. EI decreased preterm uterine resting tone that may increase placental blood flow. EI may decrease the resting tone of other smooth muscles in certain neonatal pathologies e.g. persistent pulmonary hypertension of the newborn. Recent Publications 1. Bregar T A, Lucovnik M, Verdenik I, Jager F, Gersak K, Garfield R E (2016) Uterine electromyography during active phase compared with latent phase of labor at term. Acta Obstetricia et Gynecologica Scandinavica. 95(2):197-202. 2. Euliano T Y, Nguyen M T, Darmanjian S, Busowski J D, Euliano N, Gregg AR (2016) Monitoring uterine activity during labor: clinician interpretation of electrohysterography versus intrauterine pressure catheter and tocodynamometry. American Journal of Perinatology 33(9):831-838. 3. Karsdon J, Garfield R E, Shi S Q, Maner W, Saade G (2005) Electrical Inhibition (EI) of preterm birth: inhibition of uterine contractility in the rabbit and pup births in the rat. American Journal of Obstetrics and Gynecology. 193:1986-1993. 4. Karsdon J, Manal E D, Huang W M, Ashmead G G (2012) Electrical pacemaker as a safe and feasible method for decreasing the uterine contractions of human preterm labor. Journal of Perinatal Medicine. 40(6):697-700. 5. Wolfs G M J A and Rottinghuis H (1970) Electrical and mechanical activity of the human uterus during labour. Archiv für Gynäkologie. 208(4):373-385.

Biography :

Jeffrey Karsdon completed his medical education at the Free University of Brussels, Belgium. After completing his pediatric residency in New York and neonatology fellowship in San Francisco he worked at the University of Leiden, the Netherlands for 7 years before returning to the United States. He is a Clinical Neonatologist and Scientist with a passion for preventing preterm birth. His innovative approach to inhibiting the uterine contractions of a preterm birth with an electrical pacemaker is a paradigm shift in preventing preterm birth. It allows for a very localized and rapid inhibitory effect with no systemic side-effects. He is pioneering the way to an electroceutical tocolytic and into a new era of interventional uterine electrophysiology. His unique method of inhibiting smooth muscle contractions and tone paves the way for treating other pathologies caused by increased smooth muscle tone.