The interrater reliability and agreement of a 0 to 10 uterine tone score in cesarean delivery

Cole, Naida M.; Abushoshah, Ibrahim; Fields, Kara G.; Carusi, Daniela; Robinson, Julian N.; Bateman, Brian T.; Farber, Michaela K.

doi:10.1016/j.ajogmf.2021.100342

Cited by 8 publications

(9 citation statements)

References 25 publications

(26 reference statements)

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“…Limitations of the study include the subjective method used to assess uterine tone. However, the VNRS has been used in previous studies and has been shown to have good to excellent inter‐rater reliability and good inter‐rater agreement [19]. The process was standardised by giving detailed instructions pre‐operatively to all obstetricians.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The obstetrician was asked to assess uterine tone at 2, 5 and 10 min after completion of the administration of the study drug. Uterine tone was graded by the obstetrician according to a verbal numerical rating scale (VNRS) of 0-10, which has been shown to have good inter-rater reliability [14,19]. The lowest point on the scale was 0 (atonic) and adverse effects after injection of the study drug for up to 2 h post-delivery (hypotension; hypertension; tachycardia; bradycardia; nausea; vomiting; chest pain; shortness of breath; headache; flushing; and dysrhythmias); and estimated blood loss.…”

Section: Methodsmentioning

confidence: 99%

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Carbetocin vs. oxytocin at elective caesarean delivery: a double‐blind, randomised, controlled, non‐inferiority trial of low‐ and high‐dose regimens

et al. 2022

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Carbetocin or oxytocin are given routinely as first-line uterotonic drugs following delivery of the neonate during caesarean delivery to prevent postpartum haemorrhage. Low doses may be as effective as high doses with a potential reduction in adverse effects. In this double-blind, randomised, controlled, non-inferiority trial, we assigned low-risk patients undergoing elective caesarean delivery under spinal anaesthesia to one of four groups: carbetocin 20 lg; carbetocin 100 lg; oxytocin 0.5 IU bolus + infusion; and oxytocin 5 IU bolus + infusion. The study drug was given intravenously after delivery of the neonate. Uterine tone was assessed by the obstetrician 2, 5 and 10 minutes after study drug administration according to an 11-point verbal numerical rating scale (0 = atonic, 10 = excellent tone). The primary outcome measure was uterine tone 2 min after study drug administration. The pre-specified non-inferiority margin was 1.2 points on the 11-point scale. Secondary outcomes included uterine tone after 5 and 10 minutes, use of additional uterotonics, blood loss and adverse effects. Data were available for 277 patients. Carbetocin 20 lg resulting in uterine tone of (median (IQR [range])) 8 (7-8 [1-10]) was non-inferior to carbetocin 100 lg with tone 8 (7-9 [3-10]), median (95%CI) difference 0 (À0.44-0.44). Similarly, oxytocin 0.5 IU with tone 7 (6-8 [3-10]) was non-inferior to oxytocin 5 IU with tone 8 (6-8 [2-10]), median (95%CI) difference 1 (0.11-1.89). Carbetocin 20 lg was also non-inferior to oxytocin 5 IU, and oxytocin 0.5 IU was non-inferior to carbetocin 100 lg. Uterine tone after 5 and 10 minutes, use of additional uterotonics, blood loss and adverse effects were similar in all groups.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Carbetocin vs. oxytocin at elective caesarean delivery: a double‐blind, randomised, controlled, non‐inferiority trial of low‐ and high‐dose regimens

et al. 2022

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“…One of the challenges in both clinical care and in clinical research is consistency in the definition, communication, and assessment of uterine contraction tone. Clinical trials assessing uterotonic agents have historically used a variety of nonstandardized uterine tone assessment tools including satisfactory/nonsatisfactory, grades from A to F, and numeric scores on 0–10, 10–0, and 0–100 scales [7 ▪▪ ] (Fig. 1).…”

Section: Defining and Quantifying Uterine Atonymentioning

confidence: 99%

Uterine atony

Miller

Ansari

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewPostpartum hemorrhage (PPH) is the leading preventable cause of maternal morbidity and mortality worldwide. Uterine atony is identified as the underlying etiology in up to 80% of PPH. This serves as a contemporary review of the epidemiology, risk factors, pathophysiology, and treatment of uterine atony.Recent findingsRates of postpartum hemorrhage continue to rise worldwide with the largest fraction attributed to uterine atony. A simple 0–10 numerical rating score for uterine tone was recently validated for use during cesarean delivery and may allow for more standardized assessment in clinical and research settings. The optimal prophylactic dose of oxytocin differs depending on the patient population, but less than 5 units and as low as a fraction of one unit is needed for PPH prevention, with an increased requirements within that range for cesarean birth, those on magnesium, and advanced maternal age. Carbetocin is an appropriate alternative to oxytocin. Misoprostol shows limited to no efficacy for uterine atony in recent studies. Several uncontrolled case studies demonstrate novel mechanical and surgical interventions for treating uterine atony.SummaryThere is a critical, unmet need for contemporary, controlled studies to address the increasing threat of atonic PPH.

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“…Thus, more research was required. Cole [ 11 ] evaluated, by palpation, and not by imaging, the 0 to 10 numeric rating scale for uterine tone, and showed that it could be a reliable, standardized tool in reporting the degree of uterotonic contraction during cesarean delivery. Although it was a standardized scale, it could be used only in cesarean deliveries, not in vaginal deliveries, and only during labor, not after—not to mention that no imaging method was involved.…”

Section: Introductionmentioning

confidence: 99%

The Importance of the Novel Postpartum Uterine Ultrasonographic Scale in Numerical Assessments of Uterine Involution Regarding Perinatal Maternal and Fetal Outcomes

Covali¹,

Socolov²,

Cărăuleanu³

et al. 2021

Diagnostics

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Background: Uterine involution assessments are critical for the prevention of postpartum hemorrhage. Various methods have been used worldwide. Methods: The PUUS (Postpartum Uterine Ultrasonographic Scale) method evaluates, by transabdominal ultrasonography, the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). A total of 131 consecutive patients admitted for delivery in the Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, were prospectively evaluated using the PUUS method. The mean age was 27.72 years old, and they were examined during the first 24–48 h after vaginal delivery, or in the first 48–72 h after cesarean delivery. For patients with a PUUS grade greater than 1, re-examination was preformed daily in the following days, until the PUUS grade decreased to 1 or 0. Results: By standardizing uterine involution in a numerical fashion, we precisely demonstrate that uterine involution varied with the method of delivery (vaginal/cesarean) and with the number of vials of oxytocin received intrapartum, but not with the number of vials of ergometrine maleate received, and not with the origin of the parturient (rural/urban).

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The interrater reliability and agreement of a 0 to 10 uterine tone score in cesarean delivery

Cited by 8 publications

References 25 publications

Carbetocin vs. oxytocin at elective caesarean delivery: a double‐blind, randomised, controlled, non‐inferiority trial of low‐ and high‐dose regimens

Carbetocin vs. oxytocin at elective caesarean delivery: a double‐blind, randomised, controlled, non‐inferiority trial of low‐ and high‐dose regimens

Uterine atony

The Importance of the Novel Postpartum Uterine Ultrasonographic Scale in Numerical Assessments of Uterine Involution Regarding Perinatal Maternal and Fetal Outcomes

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