Wearable Electrohysterography Systems: A Systematic Review of Electrode Topology, Design Considerations, and Clinical Feasibility

Electrohysterography (EHG) is an advanced, noninvasive technique for characterizing myometrial activity from the maternal abdominal surface. Despite its clinical relevance, the adoption of EHG in wearable systems is hindered by variability in electrode configurations and a lack of integrated system design. A PRISMA 2020-based systematic review of publications from September 1997 to January 2026 was conducted using IEEE Xplore, PubMed, Semantic Scholar, ScienceDirect, SpringerLink, MDPI, IOP, and Frontiers, supplemented by Crossref searches via Publish or Perish and manual citation tracking. Of the 1084 records identified, 91 publications were included in the evidence synthesis. The analysis examined electrode configurations, wearable design, and measurement methodologies, focusing on the effects of electrode density and placement on signal quality and clinical usability. The reviewed literature indicates that configurations employing approximately 8-16 electrodes represent a practical range for balancing spatial characterization and clinical usability. However, the findings reveal persistent challenges related to the limited integration of electrode design, signal acquisition, and analytical methods. This evidence underscores the need for an integrated approach that considers flexible electrode interfaces, standardized electrode configurations, and adaptive signal processing techniques. By aligning technological improvements with clinical requirements, this study identifies practical considerations for developing wearable maternal-fetal monitoring systems.