Eiji Ryo

A new method for long-term home monitoring of fetal movement by pregnant women themselves

Fetal movement is one index of fetal well-being. We designed and built a new recorder based on fetal movement acceleration measurement (FMAM). The FMAM recorder has a newly developed, capacitive acceleration sensor that can detect the oscillations of the maternal abdominal wall caused by fetal movements. In this study, the recorder was examined for its suitability for long-term home monitoring of fetal movement by pregnant women themselves. Experiment I: Fourteen pregnant women underwent 45 examinations in the laboratory at gestational 20-39 weeks. We simultaneously recorded fetal movement as detected by the recorder, ultrasonography, and maternal perception, and then calculated agreement among the three methods. We evaluated agreement using prevalence-adjusted bias-adjusted kappa (PABAK). Agreement for gross fetal movement as detected by FMAM and ultrasonography was substantial or almost perfect, while agreement between maternal perception and ultrasonography was moderate or substantial. Experiment II: Six pregnant women undertook 53 experiments at home by themselves. Fetal movement during maternal nocturnal sleep was successfully recorded 50 out of 53 times at home. In conclusion, there was high agreement for gross fetal movement between FMAM and ultrasonography. The recorder is promising for objective, accurate, and long-term home monitoring of gross fetal movement by pregnant women themselves.

Fetal movement counting at home with a fetal movement acceleration measurement recorder: a preliminary report.

Objective: Fetal Movement Acceleration Measurement (FMAM) recorder was developed to facilitate gross fetal movement counting. The aim was to assess its reliability. Methods: Using the recorder, six pregnant women recorded fetal movements by themselves when they slept at their home weekly from 30 weeks to term. The recorder has 2 acceleration sensors; 1 for fetal movement (FM sensor) and another for maternal movement (MM sensor). Before sleeping, each subject attached the FM sensor to her abdomen, and the MM sensor to her thigh. All the recorded data were divided into 10-sec epochs, and presence of fetal movements was judged for all epochs (total epoch). The epoch was judged as positive for movement (positive epoch) when the FM sensor detected abdominal wall oscillations and the MM sensor did not detect maternal movements. The percentage of positive epoch number to total epoch and the maximum consecutive negative epoch number was calculated. Results: The mean percentage was approximately 20–25% at 30–34 weeks and 10–15% at 35–38 weeks. The negative epoch number linearly increased after approximately 33–34 weeks of gestation. Conclusions: The FMAM recorder was reliable for long-duration recording of gross fetal movements at home.

Automated Software Analysis of Fetal Movement Recorded during a Pregnant Woman's Sleep at Home.

Fetal movement is an important biological index of fetal well-being. Since 2008, we have been developing an original capacitive acceleration sensor and device that a pregnant woman can easily use to record fetal movement by herself at home during sleep. In this study, we report a newly developed automated software system for analyzing recorded fetal movement. This study will introduce the system and compare its results to those of a manual analysis of the same fetal movement signals (Experiment I). We will also demonstrate an appropriate way to use the system (Experiment II). In Experiment I, fetal movement data reported previously for six pregnant women at 28-38 gestational weeks were used. We evaluated the agreement of the manual and automated analyses for the same 10-sec epochs using prevalence-adjusted bias-adjusted kappa (PABAK) including quantitative indicators for prevalence and bias. The mean PABAK value was 0.83, which can be considered almost perfect. In Experiment II, twelve pregnant women at 24-36 gestational weeks recorded fetal movement at night once every four weeks. Overall, mean fetal movement counts per hour during maternal sleep significantly decreased along with gestational weeks, though individual differences in fetal development were noted. This newly developed automated analysis system can provide important data throughout late pregnancy.

Diagnostic usefulness of intraoperative ultrasonography in avoiding unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma.

Objective: To evaluate the usefulness of intraoperative ultrasonography (IU) in reducing the number of unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma. Methods: Computed tomography (CT) and IU were used to assess whether para-aortic lymph nodes were enlarged in 91 women with endometrial carcinoma. All women underwent hysterectomy and systematic pelvic and para-aortic lymphadenectomy. On the basis of the intrauterine pathological findings (IPF) of the removed uterus, the women were classified into low- and high-risk groups. It was assumed that para-aortic lymphadenectomy would be performed only when enlarged nodes were detected by CT or IU or only when women were classified into the high-risk group. The numbers of women who would have had missed metastases and who could have avoided para-aortic lymphadenectomy were calculated. Results: Eighteen women had pathological para-aortic node metastases. Theoretically, the number of women who would have had missed metastases on the basis of CT, IU, and IPF were 11, 2, and 2, respectively; more metastases were missed with CT than with the other 2 methods. The number of women who could have avoided para-aortic lymphadenectomy on the basis of CT, IU, and IPF were 84, 59, and 29, respectively; compared to IPF, IU helped avoid para-aortic lymphadenectomy in more women. Conclusions: Intraoperative ultrasonography is the most efficient method for avoiding both unnecessary para-aortic lymphadenectomy and missed para-aortic node metastases in women with endometrial carcinoma.

Decreased fetal movements at home were recorded by a newly developed fetal movement recorder in a case of a non-reassuring fetal status

Abstract A fetal movement acceleration measurement (FMAM) recorder was developed for home monitoring of fetal movements. We provided a 32-year-old pregnant woman with the FMAM recorder to home monitor fetal movements, thereby self-recording decreased fetal movements at 30 weeks’ gestation. On routine checkup, a non-stress test revealed scant fetal heart rate accelerations. At 31 weeks’ gestation, the woman underwent an emergent caesarean delivery because of a non-reassuring fetal heart rate pattern, and delivered a female neonate weighing 1312 g, whose umbilical cord was slightly narrowed at the umbilicus. Our experience with the present case suggests the usefulness of the FMAM recorder.

Counting fetal hiccups using a fetal movement acceleration measurement recorder

Abstract Objective: To clarify the degree of fetal hiccup occurrence by using a fetal movement acceleration measurement recorder. Methods: A total of 23 pregnant women recorded fetal movements weekly or biweekly between 28 and 39 gestational weeks at home with the recorder. Fetal hiccups were defined as regular sharp oscillations – which occurred at 2–4 second intervals, more than 15 times per minute – on the maternal abdomen. The duration and frequency of the hiccup bouts were counted. The data were classified into an early (28–33 weeks) gestational group and a late (34–39 weeks) group, and compared between the two. Results: A total of 164 records were obtained, and the total time analyzed amounted to 1035 hours. The mean incidence of a fetal hiccup bout at an early group was 0.19 times per hour, and it decreased to 0.15 at a late group (p = 0.02). The durations of fetal hiccup bouts were 8.17 and 7.88 minutes at an early and a late group, respectively, with no significant difference (p = 0.64). Conclusions: The duration of a fetal hiccup bout did not change after 28 gestational weeks; however, incidence slightly decreased from an early to a late group.

Postoperative concurrent chemoradiotherapy for the high-risk uterine cervical cancer.

Aim:  To determine whether concurrent chemoradiotherapy (CCRT) can improve the survival rate of high‐risk uterine cervical cancer.