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Potential New Treatment for Post-Partum Hemorrhage: A Pilot Study Testing the Ability of an Electric Stimulator to Increase Uterine Tone During Cesarean Delivery.
Abstract Number: TW-1
Abstract Type: Original Research
Introduction. Post-partum hemorrhage, as a result of uterine atony, is a significant cause of maternal morbidity. In some cases, hemorrhage is resistant to uterotonic drugs. Endogenous electrical activity generated within the uterus normally plays a role in initiating uterine muscle contraction.* It is possible that an electrical stimulator, applied to the uterus, could produce uterine contractions and be used to control hemorrhage. Therefore, we tested the ability of an electrical stimulator to produce uterine contractions during, uncomplicated, cesarean delivery.
Methods. Following IRB approval, we studied ten healthy patients undergoing elective cesarean delivery under spinal block. After delivery of the placenta, four spiral electrodes (Cadwell Labs) were attached to the anterior+posterior surfaces of the uterine fundus. The study was divided into three, sequential, time periods : 1. One minute pre-stimulation baseline period; 2. Two minute experimental period during which time the stimulator was activated in seven patients and remained inactive in three patients (control group); 3. One minute recovery period, after which the study was complete. No patient received oxytocin prior to the recovery period. Starting with the baseline period, uterine tone was measured at the end of each period by two surgical staff by palpation, using a visual analogue scale (VAS, 10= maximum, 0=flaccid). Staff were unaware of the time of stimulator activation. Data are presented as mean± SD. Results were analyzed using linear regression analysis; p<0.05 considered significant. In one patient, uterine tone was also measured using an IUPC. The stimulator (Vectra Genisys, Chattanooga Group) delivered 10mA @ 6Hz using a Russian waveform.
Results. Our results demonstrated a significant increase in uterine tone after two minutes of stimulator activation, compared to baseline (n=7, VAS pre-stimulator baseline= 3.6±1.1 vs. VAS post-stimulator = 7.1±1.5, p<0.05). In one patient, IUPC measurement confirmed this effect (Data not shown). Following stimulation, alone, uterine tone was judged clinically adequate by the obstetrician in 4/7 patients. In contrast, uterine tone did not increase in control patients, after two minutes, without stimulator activation ( n=3, VAS pre-stimulator baseline= 3.5±1.1 vs. VAS post-inactive-stimulator =3.3 ±1.3, p=0.12). For comparison, oxytocin infusion (10 IU/L) was given in the recovery period to all patients. After one minute, uterine tone further increased (n=10, VAS= 9.9±0.3). Following oxytocin, uterine tone was judged to be clinically adequate in all patients.
Conclusion. Our pilot study demonstrated that uterine electric stimulation, alone, produces a significant increase in uterine tone, during cesarean delivery. Further study will be necessary to maximize this effect in order for electrical stimulation to be used clinically to treat drug resistant post partum hemorrhage.
*Garfield,RE, Maner,WL. Sem Cell Dev Biol 2007;18:289