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Use of intrauterine pressure catheters

Authors
Jaimey M Pauli, MD
John T Repke, MD
Section Editor
Vincenzo Berghella, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

The frequency, duration, and strength of uterine contractions are important factors in the assessment of labor progress and in the interpretation of fetal heart rate patterns. Four methods to evaluate contractions are available: manual palpation, external tocodynamometry, internal tocodynamometry, and electrohysterography [1].

External palpation and external tocodynamometry are common methods of assessing uterine activity, and provide adequate information in most patients. However, external palpation is subjective and requires the physical presence of a clinician to perform frequent examinations. Although external tocodynamometry provides an objective record of the frequency and duration of contractions without requiring the physical presence of a clinician, the tracing can be interrupted by maternal movement, and contraction strength cannot be quantified. Internal tocodynamometry utilizing an intrauterine pressure catheter (IUPC) (picture 1) overcomes these limitations, as it provides a reliable, quantitative measure of uterine activity with minimal artifacts [2,3]. Electrohysterography is a noninvasive technology that detects uterine electrical activity using electrodes placed on the mother's abdominal wall. It may be as reliable and accurate as internal tocodynamometry, but it has not been studied extensively.

This topic will discuss the clinical use of IUPCs for monitoring uterine activity during labor. Diagnosis of normal and abnormal intrapartum uterine activity and management of protraction and arrest disorders are reviewed separately. (See "Normal and abnormal labor progression".)

CLINICAL USES

IUPCs are not routinely used for monitoring uterine activity during spontaneous labor, induction, or augmentation because routine use does not lead to improved maternal or fetal outcomes while increasing costs, complexity, and complications compared with external methods (see 'Complications' below). In a 2013 systematic review of three randomized trials comparing internal versus external tocodynamometry in almost 2000 women undergoing induction or augmentation of labor, internal tocodynamometry did not improve any maternal or neonatal outcome (eg, Apgar score, umbilical artery pH <7.15, neonatal intensive care unit admission, operative delivery, hyperstimulation) [4].

There are, however, clinical situations in which use of an internal monitor is preferable to external tocodynamometry. For example, we use an IUPC when:

                
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Literature review current through: Oct 2017. | This topic last updated: Oct 25, 2017.
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References
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