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Use of intrauterine pressure catheters

Authors
Jaimey M Pauli, MD
John T Repke, MD
Section Editor
Susan M Ramin, 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. Internal tocodynamometry utilizing an intrauterine pressure catheter (IUPC) (picture 1) provides a reliable, quantitative measure of uterine activity without requiring palpation and with minimal artifacts [1,2].

Uterine activity during labor can be monitored by external palpation or external tocodynamometry rather than by IUPC. External palpation is subjective, requires the physical presence of a clinician to perform frequent examinations, and does not reduce discomfort in patients undergoing continuous external fetal heart rate monitoring. External tocodynamometry provides an objective record of the frequency and duration of contractions without requiring the physical presence of a clinician, but the tracing can be interrupted by maternal movement, and contraction strength cannot be quantified. Electrohysterography is a newer method of uterine monitoring that measures uterine muscle electrical activity via electrodes placed on the maternal abdomen. Studies have evaluated its use for prediction of preterm labor as well as a potential noninvasive alternative to internal monitoring; however, its clinical utility has yet to be demonstrated in large randomized trials [3-5].

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 "Overview of normal labor and protraction and arrest disorders".)

CLINICAL USE

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 including three randomized trials with almost 2000 women undergoing induction or augmentation of labor, internal versus external tocodynamometry did not impact any maternal or neonatal outcome (eg, Apgar score, umbilical artery pH <7.15, neonatal intensive care unit admission, operative delivery, hyperstimulation) [6].

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

             

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 10 00:00:00 GMT+00:00 2016.
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