Use Of Intrauterine Pressure Catheter Research Articles

Experiences with intrapartum fetal monitoring in the Netherlands: A survey study

IntroductionWorldwide, cardiotocography is used for continuous monitoring of fetal heart rate (FHR) and uterine contractions during labour. Different methods for FHR registration and registration of contractions are available. Literature about the frequency of use of different fetal monitoring methods is lacking. ObjectiveTo evaluate the use of and preferences for fetal monitoring methods for intrapartum fetal monitoring among Dutch obstetric care providers. Study designBetween October and November 2020 the Dutch Society of Obstetrics and Gynaecology sent an email invitation to all secondary care midwives and gynaecologists (in training) in the Netherlands to complete an online survey regarding the use and personal experience with fetal monitoring methods. The survey mainly consisted of multiple choice questions. Descriptive statistics are reported. Continuous variables were presented as median with interquartile ranges (IQR). Categorical variables were expressed as numbers with percentages. ResultsThe response rate was 29 % (n/N = 510/1748). All Dutch hospitals were represented. The respondents estimated the use of fetal scalp electrode (FSE) at 71 % (IQR 58–85 %) of deliveries. The most common indication for use of the FSE was inadequate external FHR registration (94 %). More than half (54 %) of the respondents reported to use intrauterine pressure catheter with an estimated use of 5 % (IQR 2–8 %) of deliveries. The most common indication for use of intrauterine pressure catheter was inadequate external contraction registration (75 %). The use of ST-analysis was reported in 25 % of the respondents with an estimated use of 60 % (IQR 30–72 %) of deliveries. Almost all respondents (99 %) reported to use fetal blood sampling with an estimated use of 15 % (IQR 10–23 %) of deliveries. Ninety percent of respondents would prefer a valid and reliable external monitoring technique during labour. Thirty-one percent of respondents assume that external fetal monitoring with non-invasive fetal electrocardiography and electrohysterography will become standard care within the next 5 years. ConclusionsCurrently, the FSE is the most used technique for FHR monitoring during labour in the Netherlands. The most common indication for use of FSE is inadequate external FHR registration. Obstetric care providers would prefer a non-invasive external registration method that provides reliable data.

Preventing the Primary Cesarean: Adherence to SMFM/ACOG Guidelines by Use of Intrauterine Pressure Catheter [29P

INTRODUCTION: In order to reduce the primary Cesarean delivery (CD) rate, SMFM and ACOG offer guidelines for diagnosing arrest of dilation (AOD) and failed induction of labor (FIOL). At our institution, adherence to these guidelines is low, at 28%, but there is limited understanding of contributing factors. The intrauterine pressure catheter (IUPC) is a recognized, helpful component of labor induction protocols, but few studies have examined whether its use is related to CD rates and adherence to labor guidelines. The objective of this study is to evaluate IUPC utilization and its relationship to SMFM/ACOG guideline adherence rates. METHODS: A retrospective cohort analysis was conducted at our institution of all singleton primary CDs performed for AOD or FIOL between March 1st 2014 and July 3rd 2018. Cases were defined as being adherent or non-adherent to published guidelines. A chi square test was used to compare the association of guideline adherence to IUPC use. RESULTS: Baseline characteristics were similar between adherent and non-adherent groups. For CDs that were non-adherent to ACOG guidelines, IUPCs were utilized in 208/767 cases (27.1%). For CDs that were adherent to ACOG guidelines, IUPCs were utilized in 123/295 cases (41.7%) (P less than 0.001). CONCLUSION: We observed a significantly greater rate of IUPC use in CDs that were adherent to SMFM/ACOG guidelines. Overall, adherent physicians performed fewer CDs. This finding suggests that IUPC utilization may be a helpful adjunct for improving labor management and lowering primary CD rates. Interventions around physician education are needed to increase appropriate IUPC use.

Intrauterine Pressure Catheter Use Is Associated with an Increased Risk of Postcesarean Surgical Site Infections.

This study aimed to determine if intrapartum placement of an intrauterine pressure catheter (IUPC) is associated with an increased rate of surgical site infections in women undergoing a cesarean delivery. This was a secondary analysis of the prospective observational Maternal-Fetal Medicine Units Network Vaginal Birth after Cesarean Registry. We compared patients with and without IUPC use. A multivariable logistic regression was performed to evaluate for an association between IUPC use and postcesarean surgical site infections. The study included 16,887 women: 7,441 with IUPC use and 9,446 without IUPC use. After adjustment for potential cofounders, IUPC use was associated with an increased risk of postcesarean infections compared with those without IUPC use (adjusted odds ratio: 1.28; 95% confidence interval: 1.10-1.50; p = 0.002). IUPC use is associated with an increased risk of postcesarean surgical site infections. This supports the judicious use of IUPC for limited clinical indications and provides a potential area of focus for reduction in postcesarean infections.

667: Internal monitoring in obese patients: maternal and neonatal outcomes

Intrauterine pressure catheters (IUPC) and fetal scalp electrodes (FSE) are commonly used in labor management to aid monitoring. Maternal body habitus limits external monitoring of fetal heart rate and contractions in obese women. The objective of this study was to describe the frequency of internal monitoring in obese patients and investigate maternal and neonatal outcomes associated with use of internal monitors by BMI classification. This was a secondary analysis of a retrospective cohort of all women with a singleton gestation admitted for labor at ≥37 weeks gestation from 2004-2014. The cohort was stratified into 5 groups of BMI classification and frequency of internal monitor use in each BMI group calculated. Primary maternal obstetric outcomes were cesarean delivery and peripartum maternal fever. Neonatal outcomes were 5 minute Apgar <7, neonatal acidemia (umbilical artery pH <7.1), and NICU admission. Outcomes were compared between patients with internal monitors and those without, stratified by obesity (BMI ≥30 kg/m2). Multivariable logistic regression was used to estimate the association between internal monitor use and outcomes while adjusting for confounders. Interaction analysis was used to test whether the relationships between internal monitor use and obstetric outcomes were modified by obesity. Of the total 20,592 patients in cohort, 10,893 (52.9%) were obese. Increasing category of BMI was associated with increasing use of IUPC, FSE, or both (P for trend <0.01; aOR1.42, 95%CI 1.39-1.46; Table 1). Internal monitor use was associated with increased cesarean delivery rate and risk of maternal fever, however these associations were not modified by the presence of obesity (Table 2). Internal monitor use was significantly associated with higher rates of NICU admission among obese patients, but not among non-obese patients (P for interaction 0.02; Table 2). Internal monitor use in obese and non-obese patients was not associated with low Apgars or neonatal acidemia. Internal monitors are used more frequently as patient BMI increases. While internal monitors were associated with an increased risk of maternal fever, obese patients did not appear to have an additional increased risk. These data suggest that obesity alone does not increase the risks associated with internal monitors and that use of IUPC or FSE should not be altered based on BMI alone.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

370: Non-invasive Uterine Monitoring: Comparison of Electrical Uterine Myography (EUM) and Intrauterine Pressure Catheter (IUPC)

To validate the accuracy and clinical usefulness of the EUM device by comparing it with simultaneous use of IUPC among laboring patients. This was a prospective observational study of laboring women at Montefiore Medical Center from February 2017 to April 2018. Inclusion criteria: maternal age >18 years old, singleton pregnancy, gestational age > 24 weeks. Exclusion criteria: allergy to silver, implanted electronic device and irritated skin/open wound on the abdominal wall. Patients were monitored simultaneously with the EUM device, EUM300 (OB Tools, Migdal HaEmek, Israel), and by IUPC for at least 30 minutes. Two blinded obstetricians reviewed the tracings. The primary outcome of the study was continuous, interpretable tracing and secondary outcomes were total number of contractions, onset of contractions and duration of contractions. Based on McNemar’s test to compare proportion of discontinuity between the two methods, enrolling 55 patients provided 80% power to detect an odds ratio of 3.2 with a two-sided type I error rate of 5%. A total of 68 patients were monitored for 2,749 minutes via simultaneous EUM and IUPC devices: 55 (80.8%) patients were obese. 56 (82.35%) of the patients were receiving oxytocin at the time of the recordings and 67 (98.5%) had epidurals. On average, the EUM was no different with regards to interpretability/continuity when compared to IUPC on a 30-minute tracing (Effect estimate 0.95 (CI= -0.18, 2.08) p=0.10). This finding was similar among obese and nonobese women [Effect estimate 0.50 (CI=0.19, 1.19) p=0.16 and Effect estimate 2.85 (CI= -2.16, 7.85) p=0.27, respectively]. Overall, EUM was no different in its ability to detect contractions among obese and non-obese patients [Effect estimate 1.06 (CI= .99, 1.13) p=0.11 and Effect estimate 1.12 (CI=0.95, 1.33) p=0.17, respectively]. 84% of the patients preferred the EUM device over the IUPC. We were unable to demonstrate a difference between when EUM and IUPC monitoring with regards to interpretability and contraction frequency regardless of maternal obesity. Given that the EUM device is noninvasive and can also monitor contraction strength, future noninferiority studies should be conducted to determine if the EUM device can replace IUPC monitoring.

Use of Intrauterine Pressure Catheters (IUPC) Increases Risk of Post-Cesarean Surgical Site Infection [9B

INTRODUCTION: Surgical site infection (SSI) rates are increasingly being linked to payment incentives for hospitals and represent an important clinical quality indicator of care. Clinical interventions aimed to significantly reduce cost and morbidity can be designed through identification of key predisposing obstetrical risk factors for SSI. Studies conducted in a limited number of subjects suggest an association between IUPC and post-partum endomyometritis. Our objective was to examine the relationship between intra-partum use of IUPC and risk of post-cesarean SSI. METHODS: We performed a secondary analysis using data from Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry (1999-2002). Patients included in this analysis had a singleton viable pregnancy and a cesarean delivery following labor for recognized obstetrical indication from 24 to 42 weeks gestational age (GA). A multivariable logistic regression model was used to control for GA, race, BMI at delivery, smoking, limited prenatal care, length of labor, length of membrane rupture, PPROM, pre-gestational diabetes, hypertensive diseases, physical health status assessed using American Society of Anesthesiologists established categories, and maternal clinical chorioamnionitis. RESULTS: 25,986 women were included in this analysis. The rate of SSI was 12.9% (1,542 of 11,941) in the patients with IUPC and 7.8% (1,099 of 14,045) in the patients without IUPC (P= &lt; 0.001). The adjusted Odds Ratio for SSI among patients who had IUPC was 1.40, (95% CI=1.26-1.57, P= &lt; 0.001). CONCLUSION: We present compelling data that in laboring women undergoing cesarean delivery, the use of IUPC is an independent risk factor for post-cesarean SSI.

Chorioamnionitis

Chorioamnionitis most often occurs during labor, affecting as many as 10% of laboring women. When intrapartum chorioamnionitis occurs, women are at peripartal risk for endometritis, cesarean birth, and postpartum hemorrhage; and the neonate is at significant risk for sepsis, pneumonia, respiratory distress, and death. The impact is greater for preterm infants where the incidence of chorioamnionitis is nearly 30%. When chorioamnionitis is believed to be present, antibiotics are administered, but not without potential adverse consequence to the mother/fetus, as well as significantly increased healthcare cost. A number of factors increase the risk of chorioamnionitis, including use of intrauterine pressure catheters and fetal scalp electrodes, urogenital tract infections, prolonged rupture of membranes, digital vaginal examinations, and the nature of perineal hygiene. This article presents key intrapartum factors and those nursing actions that can help to reduce rates of chorioamnionitis and improve perinatal outcomes.

Mode de déclenchement du travail et conduite du travail en cas d’utérus cicatriciel

To evaluate the benefits and risks of labor induction in patients previously delivered by at least one low transverse cesarean section. To define how labor should be managed in patients attempting a vaginal birth after cesarean section (VBAC). A literature search was performed using the Pubmed(®) and Cochrane(®) databases. Foreign societies guidelines were also consulted. Labor induction is associated with an increased risk of uterine rupture that could be estimated at 1% with oxytocine and 2% with vaginal prostaglandins (Level 2). Mechanical methods have been insufficiently studied. Misoprostol seems to dramatically increase the risk of uterine rupture (Level 3). The routine use of intrauterine pressure catheter does not prevent uterine rupture (Professional agreement). A moderate increase of uterine rupture was also found with augmentation (Level 3). The risk of uterine rupture increases when cervical dilatation is arrested for 3 hours or more when a good uterine dynamic is obtained (Professional agreement). The use of epidural analgesia should be encouraged (Grade C). Routine digital exploration of the uterine scare postpartum is not necessary (Grade C). Women attempting a VBAC should be aware of the modalities of labor management. When labor induction is warranted, women should also be informed of the indication and the increased risk of uterine rupture. The choice of labor induction method should take into consideration maternal and obstetrical characteristics.

Uterine Activity During the Third Stage of Labor

The purpose of this study was to evaluate the use of intrauterine pressure catheters (IUPCs) to measure uterine activity during the third stage of labor. The study was conducted in a tertiary-care center. All births were attended by certified nurse-midwives. Low-risk pregnant women at term gestation had intrauterine monitoring attempted during the third stage of labor. Data were analyzed using descriptive statistics and analysis of variance. Of the 36 women in the study, 19 had clear contractions recorded, 4 had unclear contractions, and 13 had flat tracings. The IUPC was useful for measuring uterine activity in a small number of women during the third stage of labor. When measured, uterine contractions were variable in strength and frequency. Intrauterine pressure catheters can be used as a measurement of uterine activity during the third stage of labor and should be considered for future research about third-stage physiology. Further work is needed to determine the best procedure for placement, and IUPC use before expulsion of the placenta will not be useful in all women. Effective measurement of uterine activity may guide future research on interventions to reduce the risk of postpartum hemorrhage.

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

Insertion of intrauterine pressure catheters is a routine procedure performed in labor and delivery departments, with few associated complications. There are several reports of maternal and neonatal morbidity associated with the use of intrauterine pressure catheters and their rare adverse outcomes. We report an unusual case of uterine hypertonicity resulting in fetal distress, immediately after the placement of an intrauterine pressure catheter. An emergent Cesarean section was performed for fetal distress and revealed a 5 cm vertical rent in the posterior lower uterine segment. The uterine perforation was repaired intraoperatively. Mother and infant did well and were discharged home on postoperative day four.

Oxytocin augmentation in grandmultiparous parturients: to give or not to give?

The present editorial was aimed to determine policies toward the use of oxytocin for labor augmentation among grandmultiparous (above 5 deliveries) parturients (GMPs). A questionnaire regarding attitudes toward oxytocin augmentation during labor among GMPs was distributed to all chairpersons of Ob/Gyn departments throughout the country; 20/23 chairpersons responded to the national survey. In all, 85% (17/20) of the chairpersons allowed the use of oxytocin for augmentation of labor in GMPs. Those answering positively to this question did not choose to limit the use of oxytocin for any level of parity. Moreover, 58% (11/19) of them did not obligate the concurrent use of intrauterine pressure catheter while using oxytocin augmentation in these patients. Only 22% (4/18) of the medical centers surveyed limited the maximal dose of Oxytocin among GMPs. The limited dose of oxytocin ranged from 8 to 16 micro/min. Alternatives for oxytocin augmentation in GMPs were breast stimulation (30%), and surgical induction (15%). Nevertheless, 50% of the chairpersons found no other suitable alternative for labor augmentation among GMPs. Oxytocin seems like an accepted method for labor augmentation among grandmultiparous women. Moreover, the vast majority of chairpersons did not mandate additional safety measures such as internal uterine catheter or limited dose regimens in these patients.

Fetal complications after placement of an intrauterine pressure catheter: A report of two cases and review of the literature

Background. Uterine contractions during labor can be monitored by external tocodynamometry or by the use of an intrauterine pressure catheter (IUPC). Since an IUPC measures the frequency of contractions as well as their strength and duration, it is thought to be more accurate than external tocodynamometry. However, limited evidence on this subject suggests that IUPC may not improve maternal or perinatal outcomes. Moreover, the use of IUPC may cause fetal complications.Cases. We describe the placement of an IUPC during induction of labor with oxytocin in two cases, one presenting with a singleton pregnancy and the other a twin pregnancy. After introduction of the IUPC, both cases were complicated by blood loss and signs of fetal distress on cardiotocography. An emergency cesarean section was performed in both cases. In the first case, extramembranous placement of the IUPC was observed, whereas in the second case, the IUPC had lacerated an arteriovenous anastomosis in the membranes, resulting in perinatal death.Conclusion. Placement of an intrauterine pressure catheter instead of external tocodynamometry has a small risk for serious fetal complications.

The clinical use of intrauterine pressure catheters.

We question the need for an intrauterine pressure catheter (IUPC) to monitor uterine contractions during the induction or augmentation of labor with oxytocin, or to verify adequate uterine contractions to support the diagnosis of arrest of labor. There are appropriately conducted clinical trials demonstrating that uterine contraction frequency in spontaneous, induced and augmented labors obtained with the use of external tocography is sufficient for the clinical management of labor. The value of an IUPC is further diluted by the inherent variability of pressure recordings with its use and the potential of the infrequent risks associated with insertion. Particularly pertinent is the fact that the use of an IUPC for this indication has never been proved to have a positive effect on maternal or neonatal outcome.

The clinical use of intrauterine pressure catheters

The clinical use of intrauterine pressure catheters

The use of intrauterine pressure catheters in active management of labor

The use of intrauterine pressure catheters in active management of labor

Is manual palpation of uterine contractions accurate?

OBJECTIVE: The aims of this study were to assess the accuracy of uterine contraction palpation, determine whether the accuracy of palpation improves with experience, determine clinical factors that affect the accuracy of palpation, and evaluate the range of intrauterine pressure present when an observer notes the contraction to be mild, moderate, or strong. STUDY DESIGN: A total of 236 observations were obtained by use of intrauterine pressure catheters on 46 laboring patients in the first stage of labor. The blinded observers (obstetrics and gynecology residents, maternal-fetal medicine fellows and faculty, and labor and delivery nurses) were asked to label a contraction as mild, moderate, or strong. Patient's height, weight, parity, and gestational age, use of oxytocin, use of epidural anesthesia, and laboring position, and the level of training of the observer were noted. RESULTS: Mild, moderate, and strong contractions had intrauterine pressures of 35.2 ± 33.8 mm Hg (±2 SD), 44.9 ± 35.4 mm Hg, and 55.5 ± 28.0 mm Hg, respectively. The observers were accurate in predicting contraction strength 49% of the time. There was no improvement in accuracy with increased physician experience. All physicians as a group were more accurate than nurses ( p < 0.05). Accuracy was not affected by clinical variables. CONCLUSION: Manual palpation of uterine contractions is an inaccurate means of determining contraction strength. (A M J O BSTET G YNECOL 1996;174:217-9.)

Selection of Patients for Antibiotic Prophylaxis in Cesarean Sections

Abstract We conducted a prospective, double-blind, randomized, placebo-controlled study of cefoxitin perioperative prophylaxis in 388 women having cesareen sections after labor or rupture of membranes. Private patients constituted 70% of subjects. Cefoxitin was chosen for its low toxicity and its broad spectrum against common obstetric pathogens including Bacteroides fragilis . Cefoxitin-treated women received 2 gm of drug intravenously at umbilical cord clamping and at 6 and 12 hours after surgery. Demographic and obstetric variables did not differ between the 190 placebo-treated women and the 196 cefoxitin-treated women. The morbidity rate from infection was significantly reduced by cefoxitin prophylaxis. Seven factors were significantly correlated with increased risk of infection after cesarean section: maternal age, socioeconomic status, race, gestational age, duration of internal fetal monitoring, use of intrauterine pressure catheter, and obesity. Cefoxitin prophylaxis resulted in significant decreases in infection incidence in women with one, two, and three risk factors, respectively, but the reduction was not significant in women with no risk factors. Length of hospital stay was not significantly reduced by cefoxitin prophylaxis but antibiotic use was decreased 24%.

Selection of patients for antibiotic prophylaxis in cesarean sections

We conducted a prospective, double-blind, randomized, placebo-controlled study of cefoxitin perioperative prophylaxis in 388 women having cesareen sections after labor or rupture of membranes. Private patients constituted 70% of subjects. Cefoxitin was chosen for its low toxicity and its broad spectrum against common obstetric pathogens including Bacteroides fragilis. Cefoxitin-treated women received 2 gm of drug intravenously at umbilical cord clamping and at 6 and 12 hours after surgery. Demographic and obstetric variables did not differ between the 190 placebo-treated women and the 196 cefoxitin-treated women. The morbidity rate from infection was significantly reduced by cefoxitin prophylaxis. Seven factors were significantly correlated with increased risk of infection after cesarean section: maternal age, socioeconomic status, race, gestational age, duration of internal fetal monitoring, use of intrauterine pressure catheter, and obesity. Cefoxitin prophylaxis resulted in significant decreases in infection incidence in women with one, two, and three risk factors, respectively, but the reduction was not significant in women with no risk factors. Length of hospital stay was not significantly reduced by cefoxitin prophylaxis but antibiotic use was decreased 24%.