Focus on cardiotocography: Intrapartum monitoring of uterine contractions

Abstract

When undertaking training on electronic fetal monitoring, much is discussed about the fetal heart rate and less on the uterine contractions. This is also reflected when discussing the history of both fetal heart rate monitoring and uterine contraction monitoring.Adequately monitoring the uterine contractions is an essential part of cardiotocography. It allows for an assessment of the fetal heart rate in relation to the uterine contractions, especially when there is a non-reassuring or an abnormal trace. When oxytocin is used in induced or augmented labours, it is imperative to ensure that there is no evidence of uterine hyperstimulation and that sufficient resting phases occur between contractions. However, assessing contractions adequately can be challenging in practice, especially in cases of obese parturients.This article explores the methods used to assess uterine contractions, using clinical skills in conjunction with external tocodynamometry and electrohysterography, as well as exploring some of the background to monitoring uterine contractions.