The quality of intrapartum uterine activity monitoring

Bakker, Petra C.A.M.; Zikkenheimer, M.; Geijn, Herman van

doi:10.1515/jpm.2008.027

Cited by 31 publications

(28 citation statements)

References 13 publications

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“…These concerns notwithstanding, IUP measurement is considered the best of the available techniques (although this would be difficult to prove because there is no “gold standard” with which to compare it). IUP measurement is the de facto standard by which other methods are judged, despite the fact that up to 40% of recordings have been reported as not being of good quality …”

Section: Measurement Techniquesmentioning

confidence: 99%

Clinical assessment of uterine contractions

Cohen

2017

Intl J Gynecology & Obste

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The assessment of uterine contractions is important in clinical decision-making, but the precise role for appraising contractions remains controversial. Four clinical approaches to assessing contractions are available: manual palpation; intrauterine pressure determination; external tocodynamometry; and electrohysterography. Palpation is inexpensive and harmless but requires the constant bedside presence of a trained observer. Intrauterine pressure measurement is considered the most sensitive and specific technique, and has become the standard by which other methods are judged; however, its quantitative measurements are not always precise or reproducible. Moreover, the availability of intrauterine pressure measurements does not seem to improve maternal or neonatal outcomes in most situations. External tocodynamometry is the most widely used technique. It is easy to apply and provides reasonably accurate information about the frequency and duration of contractions, but not their amplitude. It can require frequent adjustment during labor and might not work well in patients who are obese. Electrohysterography is a recently available noninvasive technology that detects uterine electrical activity using electrodes placed on the mother's abdominal wall. This approach is at least as reliable and accurate as tocodynamometry.

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Section: Measurement Techniquesmentioning

confidence: 99%

Clinical assessment of uterine contractions

Cohen

2017

Intl J Gynecology & Obste

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“…Bakker et al 3 describe some period of “inadequate registration” (no tracing or unreliable pattern due to inadequate calibration) in 98% of 41 labors, for an average of 35% of stage-one duration and 33% of stage-two. They also report “inadequate registration” in 60% of 151 patients monitored with IUPC, for 28% of stage one and 30% of stage two durations.…”

Section: Introductionmentioning

confidence: 99%

Monitoring uterine activity during labor: a comparison of 3 methods

Euliano

Nguyen

Darmanjian

et al. 2013

American Journal of Obstetrics and Gynecology

152

103

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Objective Tocodynamometry (Toco—strain gauge technology) provides contraction frequency and approximate duration of labor contractions, but suffers frequent signal dropout necessitating re-positioning by a nurse, and may fail in obese patients. The alternative invasive intrauterine pressure catheter (IUPC) is more reliable and adds contraction pressure information, but requires ruptured membranes and introduces small risks of infection and abruption. Electrohysterography (EHG) reports the electrical activity of the uterus through electrodes placed on the maternal abdomen. This study compared all three methods of contraction detection simultaneously in laboring women. Study Design Upon consent, laboring women were monitored simultaneously with Toco, EHG, and IUPC. Contraction curves were generated in real-time for the EHG and all three curves were stored electronically. A contraction detection algorithm was used to compare frequency and timing between methods. Seventy-three subjects were enrolled in the study; 14 were excluded due to hardware failure of one or more of the devices (12) or inadequate data collection duration(2). Results In comparison with the gold-standard IUPC, EHG performed significantly better than Toco with regard to Contractions Consistency Index (CCI). The mean CCI for EHG was 0.88 ± 0.17 compared to 0.69 ± 0.27 for Toco (p<.0001). In contrast to Toco, EHG was not significantly affected by obesity. Conclusion Toco does not correlate well with the gold-standard IUPC and fails more frequently in obese patients. EHG provides a reliable non-invasive alternative regardless of body habitus.

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“…Ultrasound has the advantage of providing a noninvasive and continuous visualization of the uterus as compared with other techniques previously used for evaluating the third stage of labor as: intrauterine pressure catheter (26, 73-76), tocodynamometry (77) and electrical uterine myography (78). …”

Section: Discussionmentioning

confidence: 99%

Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications

Patwardhan

Hernández‐Andrade

Ahn

et al. 2015

Gynecol Obstet Invest

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Objective: To investigate dynamic changes in myometrial thickness during the third stage of labor. Methods: Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n = 30), postpartum hemorrhage (n = 4), preterm delivery (n = 7) and clinical chorioamnionitis (n = 4). Differences between myometrial thickness of the uterine segments and as a function of time were evaluated. Results: There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p < 0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p < 0.0001). In women with postpartum hemorrhage, preterm delivery, and clinical chorioamnionitis, an uncoordinated pattern among the uterine segments was observed. Conclusion: A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk of postpartum hemorrhage.

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The quality of intrapartum uterine activity monitoring

Abstract: Intrapartum UA monitoring in daily practice via the direct mode provides a more recognizable UA trace.

Cited by 31 publications

References 13 publications

Clinical assessment of uterine contractions

Clinical assessment of uterine contractions

Monitoring uterine activity during labor: a comparison of 3 methods

Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications

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