Internal Contraction Monitoring

August 29, 2008

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Internal Contraction Monitoring

by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D.
reviewed by Marjorie Greenfield, M.D.

When a woman is in labor, her healthcare team may find it helpful to watch her contractions closely. This is particularly important if labor is being induced with pitocin or if it is progressing slowly. Usually, the hospital or birth-center staff may start by using an external fetal monitor, but while this device indicates the timing of the contractions, it doesn't accurately measure their intensity. When a more complete picture of the contractions is needed, your practitioner may recommend internal monitoring.

The internal-pressure monitor
During labor, a thin, flexible tube with a small, pressure-sensing device on the tip can be placed into the uterus next to the baby. This intrauterine-pressure catheter (IUPC), which is usually used in combination with fetal heart-rate monitoring, measures the actual pressure within the uterus and indicates the frequency and intensity of contractions. This information helps the healthcare team assess how well labor is progressing and if the baby is in any distress.

In order to place the IUPC, the bag of waters must already be broken and the cervix already dilated slightly so that the catheter can be passed through it. The procedure is typically no more uncomfortable than having a normal internal exam.

Amnio-infusion: another use for the IUPC
The IUPC also can be used to infuse sterile fluid into the uterus. This can be helpful if an infant has had a bowel movement inside the womb before birth, which is known as meconium staining. This process, called amnio-infusion, can be used to dilute the amniotic fluid and consequently decrease the likelihood that the baby will suffer complications from inhaling thick, meconium-stained fluid at birth.

Sometimes there is evidence of compression of the umbilical cord during labor, leading to slowing of the fetal heart rate. Amnio-infusion may help cushion the cord and diminish the stress on the baby.

Risks and benefits of the IUPC
If your practitioner recommends using the internal-pressure monitor during labor, he must think that it would benefit you, your baby, or your labor. These devices have been extensively studied and found to be safe in the vast majority of cases. Here are some facts to consider:

Uterine or fetal injury. Rarely, the tips of the instrument have been reported to lodge in, or even poke through, the wall of the uterus. The newer designs have decreased the chances of this happening. Also, although they also could poke into the baby or placenta, the rounded tips make injury from this highly unlikely.

Infection. In some studies, labors in which catheters were required had a higher-than-average chance of being complicated by intrauterine infection. However, research has shown that it wasn't the catheters themselves that caused the infections; rather, it was the fact that these labors were already prolonged that predisposed a woman to infection.

Decreased chance for cesarean. Some studies noted that cesarean sections were more common among women who used an IUPC during labor. But more rigorous studies have shown that much of the time, the information the IUPC provides actually prevents the practitioner from acting too soon to deliver by cesarean.


RELATED INFORMATION

			Complications Related to Amniotic Fluid
			Examination during Labor
			Fetal Monitoring in Labor
			Events of Labor
			Fetal Assessment

	Labor and Delivery
	Birth: Methods and Options

Created October 26, 2001
Reviewed April 15, 2003

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