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Meta-Analysis
. 2013 Aug 3;2013(8):CD006947.
doi: 10.1002/14651858.CD006947.pub3.

Internal versus external tocodynamometry during induced or augmented labour

Jannet J H Bakker  1 , Petra F Janssen, Karlijn van Halem, Birgit Y van der Goes, Dimitri N M Papatsonis, Joris A M van der Post, Ben Willem J Mol
Affiliations
Meta-Analysis

Internal versus external tocodynamometry during induced or augmented labour

Jannet J H Bakker et al. Cochrane Database Syst Rev. .

Abstract

Background: Uterine contractions can be registered by external tocodynamometry (ET) or, after rupture of the membranes, by internal tocodynamometry (IT). Monitoring of the frequency of contractions is important especially when intravenous oxytocin is used as excessive uterine activity (hyperstimulation or tachysystole) can cause fetal distress. During induction of labour as well as during augmentation with intravenous oxytocin, some clinicians choose to monitor frequency and strength of contractions with IT rather than with ET as an intrauterine pressure catheter measures intrauterine activity more accurately than an extra-abdominal tocodynamometry device. However, insertion of an intrauterine catheter has higher costs and also potential risks for mother and child.

Objectives: To assess the effectiveness of IT compared with using ET when intravenous oxytocin is used for induction or augmentation of labour.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013) and PubMed (1966 to 6 April 2013).

Selection criteria: We included all published randomised controlled trials with data from women in whom IT was compared with ET in induced or augmented labour with oxytocin. We excluded trials that employed quasi-randomised methods of treatment allocation. We found no unpublished or ongoing studies on this subject.

Data collection and analysis: Two review authors independently assessed trial eligibility and risk of bias, and independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information.

Main results: Three studies involving a total of 1945 women were included. Overall, risk of bias across the three trials was mixed. No serious complications were reported in the trials and no neonatal or maternal deaths occurred. The neonatal outcome was not statistically different between groups: Apgar score less than seven at five minutes (RR 1.78, 95% CI 0.83 to 3.83; three studies, n = 1945); umbilical artery pH less than 7.15 (RR 1.31, 95% CI 0.95 to 1.79; one study, n = 1456); umbilical artery pH less than 7.16 (RR 1.23, 95% CI 0.39 to 3.92; one study, n = 239); admission to the neonatal intensive care unit (RR 0.34, 95% CI 0.07 to 1.67; two studies, n = 489); and more than 48 hours hospitalisation (RR 0.92, 95% CI 0.71 to 1.20; one study, n = 1456). The pooled risk for instrumental delivery (including caesarean section, ventouse and forceps extraction) was not statistically significantly different (RR 1.05, 95% CI 0.91 to 1.21; three studies, n = 1945). Hyperstimulation was reported in two studies (n = 489), but there was no statistically significant difference between groups (RR 1.21, 95% CI 0.78 to 1.88).

Authors' conclusions: This review found no differences between the two types of monitoring (internal or external tocodynamometry) for any of the maternal or neonatal outcomes. Given that this review is based on three studies (N = 1945 women) of moderate quality, there is insufficient evidence to recommend the use of one form of tocodynamometry over another for women where intravenous oxytocin was administered for induction or augmentation of labour.

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Conflict of interest statement

As the contact person for this review is also the first author of the largest study (Bakker 2010) that was included, the decision for inclusion and assessment of the Bakker trial for inclusion, risk of bias and data extraction was done by Birgit van de Goes who was not involved in the Bakker trial in any way.

All authors declared no individual conflict of interest.

Figures

1.1
1.1. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 1 Uterine rupture.
1.2
1.2. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 2 Hyperstimulation.
1.3
1.3. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 3 Apgar score less than seven at five minutes.
1.4
1.4. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 4 Umbilical artery pH < 7.15.
1.5
1.5. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 5 Umbilical artery pH < 7.05.
1.6
1.6. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 6 Umbilical artery pH < 7.16.
1.7
1.7. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 7 Admission to neonatal intensive care.
1.8
1.8. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 8 Neonatal admission > 48 hours.
1.9
1.9. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 9 Perinatal mortality.
1.10
1.10. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 10 Serious maternal outcomes (defined as death, coma, cardiac arrest, respiratory arrest, use of a mechanical ventilator, admission to intensive care unit).
1.11
1.11. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 11 Instrumental delivery.
1.12
1.12. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 12 Instrumental vaginal delivery.
1.13
1.13. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 13 Caesarean section.
1.14
1.14. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 14 Mean time to delivery.
1.15
1.15. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 15 Placental or fetal vessel damage.
1.16
1.16. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 16 Indication of infection up to three weeks postpartum in mother or child.
1.17
1.17. Analysis
Comparison 1 Monitoring of contractions with internal tocodynamometry compared to external tocodynamometry, Outcome 17 Signs intrauterine infection during labor.
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Update of

References

References to studies included in this review

Bakker 2010 {published data only}
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