Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Use of intrauterine pressure catheters

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


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".)


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:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 25, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Cohen WR. Clinical assessment of uterine contractions. Int J Gynaecol Obstet 2017; 139:137.
  2. Arulkumaran S, Yang M, Tien CY, Ratnam SS. Reliability of intrauterine pressure measurements. Obstet Gynecol 1991; 78:800.
  3. Chua S, Arulkumaran S, Yang M, et al. The accuracy of catheter-tip pressure transducers for the measurement of intrauterine pressure in labour. Br J Obstet Gynaecol 1992; 99:186.
  4. Bakker JJ, Janssen PF, van Halem K, et al. Internal versus external tocodynamometry during induced or augmented labour. Cochrane Database Syst Rev 2013; :CD006947.
  5. Rodriguez MH, Masaki DI, Phelan JP, Diaz FG. Uterine rupture: are intrauterine pressure catheters useful in the diagnosis? Am J Obstet Gynecol 1989; 161:666.
  6. Devoe LD, Croom CS, Youssef AA, Murray C. The prediction of "controlled" uterine rupture by the use of intrauterine pressure catheters. Obstet Gynecol 1992; 80:626.
  7. Menihan CA. Uterine rupture in women attempting a vaginal birth following prior cesarean birth. J Perinatol 1998; 18:440.
  8. Matsuo K, Scanlon JT, Atlas RO, Kopelman JN. Staircase sign: a newly described uterine contraction pattern seen in rupture of unscarred gravid uterus. J Obstet Gynaecol Res 2008; 34:100.
  9. Euliano TY, Nguyen MT, Darmanjian S, et al. Monitoring uterine activity during labor: a comparison of 3 methods. Am J Obstet Gynecol 2013; 208:66.e1.
  10. Euliano TY, Nguyen MT, Darmanjian S, et al. Monitoring Uterine Activity during Labor: Clinician Interpretation of Electrohysterography versus Intrauterine Pressure Catheter and Tocodynamometry. Am J Perinatol 2016; 33:831.
  11. Haran G, Elbaz M, Fejgin MD, Biron-Shental T. A comparison of surface acquired uterine electromyography and intrauterine pressure catheter to assess uterine activity. Am J Obstet Gynecol 2012; 206:412.e1.
  12. Vlemminx MWC, Thijssen KMJ, Bajlekov GI, et al. Electrohysterography for uterine monitoring during term labour compared to external tocodynamometry and intra-uterine pressure catheter. Eur J Obstet Gynecol Reprod Biol 2017; 215:197.
  13. Koala IPC 5000 intrauterine pressure catheter [package insert]. Murray, UT: Clinical Innovations.
  14. Steer PJ, Carter MC, Gordon AJ, Beard RW. The use of catheter-tip pressure transducers for the measurement of intrauterine pressure in labour. Br J Obstet Gynaecol 1978; 85:561.
  15. Dowdle MA. Comparison of two intrauterine pressure catheters during labor. J Reprod Med 2003; 48:501.
  16. Devoe LD, Smith RP, Stoker R. Intrauterine pressure catheter performance in an in vitro uterine model: a stimulation of problems for intrapartum monitoring. Obstet Gynecol 1993; 82:285.
  17. Dowdle M. Evaluating a new intrauterine pressure catheter. J Reprod Med 1997; 42:506.
  18. Sciscione AC, Duhl A, Pollock MA, et al. Extramembranous placement of an air-coupled vs. transducer-tipped intrauterine pressure catheter. J Reprod Med 2005; 50:578.
  19. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/TextSearch.cfm (Accessed on August 16, 2012).
  20. Wilmink FA, Wilms FF, Heydanus R, et al. Fetal complications after placement of an intrauterine pressure catheter: a report of two cases and review of the literature. J Matern Fetal Neonatal Med 2008; 21:880.
  21. Hauth JC, Hankins GD, Gilstrap LC 3rd, et al. Uterine contraction pressures with oxytocin induction/augmentation. Obstet Gynecol 1986; 68:305.
  22. CALDEYRO-BARCIA R, POSEIRO JJ. Oxytocin and contractility of the pregnant human uterus. Ann N Y Acad Sci 1959; 75:813.
  23. Seitchik J, Castillo M. Oxytocin augmentation of dysfunctional labor. II. Uterine activity data. Am J Obstet Gynecol 1983; 145:526.
  24. Schulman H, Romney SL. Variability of uterine contractions in normal human parturition. Obstet Gynecol 1970; 36:215.
  25. CALDEYRO-BARCIA R, SICA-BLANCO Y, POSEIRO JJ, et al. A quantitative study of the action of synthetic oxytocin on the pregnant human uterus. J Pharmacol Exp Ther 1957; 121:18.
  26. Lind BK. Complications caused by extramembranous placement of intrauterine pressure catheters. Am J Obstet Gynecol 1999; 180:1034.
  27. Trudinger BJ, Pryse-Davies J. Fetal hazards of the intrauterine pressure catheter: five case reports. Br J Obstet Gynaecol 1978; 85:567.
  28. Nuttall ID. Perforation of a placental fetal vessel by an intrauterine pressure catheter. Br J Obstet Gynaecol 1978; 85:573.
  29. Chan WH, Paul RH, Toews J. Intrapartum fetal monitoring. Maternal and fetal morbidity and perinatal mortality. Obstet Gynecol 1973; 41:7.
  30. Trudinger BJ, Pryse-Davies J. Fetal hazards of the intrauterine pressure catheter: five case reports. Br J Obstet Gynaecol 1978; 85:567.
  31. Rood KM. Complications associated with insertion of intrauterine pressure catheters: an unusual case of uterine hypertonicity and uterine perforation resulting in fetal distress after insertion of an intrauterine pressure catheter. Case Rep Obstet Gynecol 2012; 2012:517461.
  32. Matsuo K, Lynch MA, Kopelman JN, Atlas RO. Anaphylactoid syndrome of pregnancy immediately after intrauterine pressure catheter placement. Am J Obstet Gynecol 2008; 198:e8.
  33. Harbison L, Bell L. Anaphylactoid syndrome after intrauterine pressure catheter placement. Obstet Gynecol 2010; 115:407.
  34. Mirza FG, Thaker HM, Flejter WL, D'Alton ME. Fetomaternal Hemorrhage following Placement of an Intrauterine Pressure Catheter: Report of a New Association. Case Rep Obstet Gynecol 2015; 2015:348279.