Monitoring Uterine Activity during Labor: Clinician Interpretation of Electrohysterography versus Intrauterine Pressure Catheter and Tocodynamometry
04 June 2015
16 December 2015
09 March 2016 (eFirst)
Objective The aim of this article was to compare clinical interpretation of uterine activity tracings acquired by tocodynamometry and electrohysterography with the gold standard, intrauterine pressure.
Study Design Using data from a previous study, subjects who had simultaneous monitoring with all three uterine activity devices were included in this study. These were parturients who required intrauterine pressure catheter (IUPC) placement for obstetric indication. A Web-based application displayed scrolling 30-minute segments of uterine activity. Two blinded obstetricians and two blinded obstetric nurses independently reviewed the segments, marking uninterpretable segments and the peak of each contraction. Interpretability was compared using positive percent agreement. False positives are contractions marked in the noninvasive strip that have no corresponding contraction in the IUPC strip. False negatives are the reverse.
Results A total of 135 segments, acquired during either Stage 1 (active labor) or Stage 2 (pushing), from 105 women, were included in this analysis. For all four observers, both interpretability and sensitivity of electrohysterography exceeded that of tocodynamometry (p < 0.0001). This remained true for the obese population (96 segments).
Conclusion Compared with the IUPC, electrohysterography is more sensitive and provides tracings that are more often interpretable than tocodynamometry for intrapartum monitoring; electrohysterography is also less affected by increasing maternal body mass index.
The study was supported by OBMedical and the University of Florida.
- 1 Williams B, Arulkumaran S. Cardiotocography and medicolegal issues. Best Pract Res Clin Obstet Gynaecol 2004; 18 (3) 457-466
- 2 Ray A, Hildreth A, Esen UI. Morbid obesity and intra-partum care. J Obstet Gynaecol 2008; 28 (3) 301-304
- 3 Vanner T, Gardosi J. Intrapartum assessment of uterine activity. Baillieres Clin Obstet Gynaecol 1996; 10 (2) 243-257
- 4 Harper LM, Shanks AL, Tuuli MG, Roehl KA, Cahill AG. The risks and benefits of internal monitors in laboring patients. Am J Obstet Gynecol 2013; 209 (1) 38.e1-38.e6
- 5 Euliano TY, Nguyen MT, Darmanjian S , et al. Monitoring uterine activity during labor: a comparison of 3 methods. Am J Obstet Gynecol 2013; 208 (1) 66.e1-66.e6
- 6 Jacod BC, Graatsma EM, Van Hagen E, Visser GHA. A validation of electrohysterography for uterine activity monitoring during labour. J Matern Fetal Neonatal Med 2010; 23 (1) 17-22
- 7 Reinhard J, Hayes-Gill BR, Schiermeier S , et al. Uterine activity monitoring during labour—a multi-centre, blinded two-way trial of external tocodynamometry against electrohysterography. Z Geburtshilfe Neonatol 2011; 215 (5) 199-204
- 8 Hayes-Gill B, Hassan S, Mirza F , et al. Accuracy and reliability of uterine contraction identification using abdominal surface electrodes. Clin Med Insights: Women's Health 2012; 5: 11
- 9 Hadar E, Biron-Shental T, Gavish O, Raban O, Yogev Y. A comparison between electrical uterine monitor, tocodynamometer and intra uterine pressure catheter for uterine activity in labor. J Matern Fetal Neonatal Med 2015; 28 (12) 1367-1374
- 10 Bakker JJ, Verhoeven CJ, Janssen PF , et al. Outcomes after internal versus external tocodynamometry for monitoring labor. N Engl J Med 2010; 362 (4) 306-313
- 11 Miles AM, Monga M, Richeson KS. Correlation of external and internal monitoring of uterine activity in a cohort of term patients. Am J Perinatol 2001; 18 (3) 137-140
- 12 Euliano TY, Nguyen MT, Marossero D, Edwards RK. Monitoring contractions in obese parturients: electrohysterography compared with traditional monitoring. Obstet Gynecol 2007; 109 (5) 1136-1140
- 13 Rabotti C, Mischi M, van Laar JOEH, Oei GS, Bergmans JWM. Estimation of internal uterine pressure by joint amplitude and frequency analysis of electrohysterographic signals. Physiol Meas 2008; 29 (7) 829-841
- 14 Euliano T, Skowronski M, Marossero D, Shuster J, Edwards R. Prediction of intrauterine pressure waveform from transabdominal electrohysterography. J Matern Fetal Neonatal Med 2006; 19 (12) 811-816
- 15 Skowronski MD, Harris JG, Marossero DE, Edwards RK, Euliano TY. Prediction of intrauterine pressure from electrohysterography using optimal linear filtering. IEEE Trans Biomed Eng 2006; 53 (10) 1983-1989
- 16 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 (5) 412.e1-412.e5
- 17 Devoe L, Golde S, Kilman Y, Morton D, Shea K, Waller J. A comparison of visual analyses of intrapartum fetal heart rate tracings according to the new national institute of child health and human development guidelines with computer analyses by an automated fetal heart rate monitoring system. Am J Obstet Gynecol 2000; 183 (2) 361-366
- 18 Palomäki O, Luukkaala T, Luoto R, Tuimala R. Intrapartum cardiotocography — the dilemma of interpretational variation. J Perinat Med 2006; 34 (4) 298-302
- 19 Bakker PCAM, Zikkenheimer M, van Geijn HP. The quality of intrapartum uterine activity monitoring. J Perinat Med 2008; 36 (3) 197-201