{"paper_id":"d7c2a3f8-5dd3-4913-bd39-01b6e42dbb6b","body_text":"Abstract\nPurpose\nContractions in non-pregnant uterine can be assessed by visual inspection of transvaginal ultrasound (TVUS). Many authors have used this method to extract features like contraction frequency and direction. However, visual inspection is a subjective method and the outcome is dependent on the sonographers and video analysts. In this study, we wanted to see which uterine feature is reproducible enough, in terms of inter-observer agreement, to serve as a reliable control for future research.\nMethods\nSix observers assessed 80 TVUS videos, and rated video quality, contraction frequency, direction and timing. One observer assessed operating time. A Fleiss’ kappa (κ) or an intra-class correlation (ICC) was calculated to determine the inter-observer agreement of all features.\nResults\nThe inter-observer agreement in frequency was substantial (ICC = 0.68). Conversely, there was just slight to fair agreement in contraction timing and direction and in video quality: ICC = 0.26, κ = 0.17 and κ = 0.16, respectively. Overall, agreement among technical engineers was better than between medical professionals. The level of agreement was correlated with video quality, phase of the menstrual cycle and individual patient (all χ2 with p < 0.00). The time to analyze one video ranged between 6 and 20 min.\nConclusions\nThis study shows that visual inspection of TVUS videos is a fairly reproducible method to assess contraction frequency. However, the operating time is too extensive to implement this method in daily practice. Automated methods could offer a solution for this problem in the future.\nSimilar content being viewed by others\nReferences\nDickinson R (1937) The technic of timing human ovulation by palpable changes in ovary, tube, and uterus. Am J Obstet Gynecol 33:1027–1033\nBulletti C, De ZD, Polli V et al (2000) Uterine contractility during the menstrual cycle. HumReprod 15(Suppl 1):81–89\nMartinez-Gaudio M, Yoshida T, Bengtsson LP (1973) Propagated and nonpropagated myometrial contractions in normal menstrual cycles. Am J Obstet Gynecol 115:107–111\nBulletti C, de Ziegler D (2006) Uterine contractility and embryo implantation. Curr Opin Obstet Gynecol 18:473–484. https://doi.org/10.1097/01.gco.0000233947.97543.c4\nKunz G, Beil D, Deininger H et al (1996) The dynamics of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy. Hum Reprod 11:627–632\nLeyendecker G, Kunz G, Wildt L et al (1996) Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility. Hum Reprod 11:1542–1551\nKido A, Togashi K, Nakai A et al (2005) Oral contraceptives and uterine peristalsis: evaluation with MRI. J Magn Reson 22:265–270\nKido A, Togashi K, Kataoka ML et al (2008) Intrauterine devices and uterine peristalsis: evaluation with MRI. Magn Reson 26:54–58\nKido A, Ascher SM, Kishimoto K et al (2011) Comparison of uterine peristalsis before and after uterine artery embolization at 3-T MRI. AJR Am J Roentgenol 196:1431–1435. https://doi.org/10.2214/AJR.10.5349\nNakai A, Reinhold C, Noel P et al (2013) Optimizing cine MRI for uterine peristalsis: a comparison of three different single shot fast spin echo techniques. J Magn Reson Imaging 38:161–167. https://doi.org/10.1002/jmri.23946\nWatanabe K, Kataoka M, Yano K et al (2015) Automated detection and measurement of uterine peristalsis in cine MR images. J Magn Reson Imaging 42:644–650. https://doi.org/10.1002/jmri.24817\nAbramowicz JS, Archer DF (1990) Uterine endometrial peristalsis—a transvaginal ultrasound study. Fertil Steril 54:451–454\nChalubinski K, Deutinger J, Bernaschek G (1993) Vaginosonography for recording of cycle-related myometrial contractions. Fertil Steril 59:225–228. https://doi.org/10.1016/s0015-0282(16)55644-1\nde Vries K, Lyons EA, Ballard G et al (1990) Contractions of the inner third of the myometrium. Am J Obstet Gynecol 162:679–682\nFanchin R, Righini C, Olivennes F et al (1998) Uterine contractions at the time of embryo transfer alter pregnancy rates after in vitro fertilization. Hum Reprod 13:1968–1974\nFanchin R, Ayoubi JM, Olivennes F et al (2000) Hormonal influence on the uterine contractility during ovarian stimulation. Hum Reprod 15(Suppl 1):90–100\nFanchin R, Righini C, De ZD et al (2001) Effects of vaginal progesterone administration on uterine contractility at the time of embryo transfer. Fertil Steril 75:1136–1140\nFanchin R, Ayoubi JM, Righini C et al (2001) Uterine contractility decreases at the time of blastocyst transfers. Hum Reprod 16:1115–1119\nFukuda M, Fukuda K (1994) Physiology: uterine endometrial cavity movement and cervical mucus. Hum Reprod 9:1013–1016. https://doi.org/10.1093/oxfordjournals.humrep.a138625\nIjland MM, Evers JL, Dunselman GA et al (1996) Endometrial wavelike movements during the menstrual cycle. Fertil Steril 65:746–749\nIjland MM, Evers JL, Hoogland HJ (1997) Velocity of endometrial wavelike activity in spontaneous cycles. Fertil Steril 68:72–75\nIjland MM, Hoogland HJ, Dunselman GA et al (1999) Endometrial wave direction switch and the outcome of in vitro fertilization. Fertil Steril 71:476–481\nKunz G, Noe M, Herbertz M, Leyendecker G (1998) Uterine peristalsis during the follicular phase of the menstrual cycle: effects of oestrogen, antioestrogen and oxytocin. Hum Reprod Update 4:647–654\nLeyendecker G, Kunz G, Herbertz M et al (2004) Uterine peristaltic activity and the development of endometriosis. Ann N Y Acad Sci 1034:338–355\nLyons EA, Taylor PJ, Zheng XH et al (1991) Characterization of subendometrial myometrial contractions throughout the menstrual cycle in normal fertile women. Fertil Steril 55:771–774\nPinto V, Matteo M, Tinelli R et al (2015) Altered uterine contractility in women with chronic endometritis. Fertil Steril 103:1049–1052. https://doi.org/10.1016/j.fertnstert.2015.01.007\nSalamanca A, Beltrán E (1995) Subendometrial contractility in menstrual phase visualized by transvaginal sonography in patients with endometriosis. Fertil Steril 64:193–195. https://doi.org/10.1016/s0015-0282(16)57680-8\nvan Gestel I, Ijland MM, Hoogland HJ, Evers JL (2005) Endometrial waves in in vitro fertilization cycles: a validation study. Fertil Steril 83:491–493\nvan Gestel I, Ijland MM, Evers JL, Hoogland HJ (2007) Complex endometrial wave-patterns in IVF. Fertil Steril 88:612–615\nZhu L, Li Y, Xu A (2012) Influence of controlled ovarian hyperstimulation on uterine peristalsis in infertile women. Hum Reprod 27:2684–2689\nZhu L, Che HS, Xiao L, Li YP (2014) Uterine peristalsis before embryo transfer affects the chance of clinical pregnancy in fresh and frozen-thawed embryo transfer cycles. Hum Reprod 29:1238–1243. https://doi.org/10.1093/humrep/deu058\nIjland MM, Evers JL, Dunselman GA, Hoogland HJ (1996) Subendometrial contractions in the nonpregnant uterus: an ultrasound study. Eur J Obstet Gynecol Reprod Biol 70:23–24\nvan Gestel I, Ijland MM, Hoogland HJ, Evers JL (2003) Endometrial wave-like activity in the non-pregnant uterus. Hum Reprod Update 9:131–138\nKuijsters NPM, Methorst WG, Kortenhorst MSQ et al (2017) Uterine peristalsis and fertility: current knowledge and future perspectives: a review and meta-analysis. Reprod Biomed Online 35:50–71. https://doi.org/10.1016/j.rbmo.2017.03.019\nSammali F, Blank C, Xu L et al (2018) Experimental setup for objective evaluation of uterine motion analysis by ultrasound speckle tracking. Biomed Phys Eng Express 4:035012. https://doi.org/10.1088/2057-1976/aab053\nAcknowledgements\nWe would like to thank Rudy de Roon, MSc, Michelle Hendrikx, MD, Rogier Wildeboer, MSc, Christina Caresio, PhD and Ruud van Sloun, PhD, for their help as observers and support in software development. Special thanks to Marcel van ‘t Veer, PhD for statistical support.\nFunding\nThis research was funded by the Netherlands Organisation for Scientific Research (NOW) within the TTW domain (applied and technical sciences) in the form of a High Tech Systems and Materials grant (Grant number 13901).\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare that they have no conflicts of interest.\nEthical approval\nThis research was approved by the medical ethical committee of the Catharina Hospital (MEC-U protocol number NL52466.100.15).\nInformed consent\nInformed consent was obtained from all individual participants included in the study.\nData availability statement\nThe data sets generated during and analyzed during the current study are available from the corresponding author on reasonable request.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nKuijsters, N.P.M., Sammali, F., Rabotti, C. et al. Visual inspection of transvaginal ultrasound videos to characterize uterine peristalsis: an inter-observer agreement study. J Ultrasound 23, 37–44 (2020). https://doi.org/10.1007/s40477-018-00356-z\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s40477-018-00356-z","source_license":"CC0","license_restricted":false}