Focus on cardiotocography: Intrapartum monitoring of uterine contractions
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.
Uterine contraction monitoring is most often ignored when discussing the benefits of fetal monitoring (Bakker 2007a; Freeman et al, 2012). Monitoring the uterine contraction (UC) and the fetal heart rate (FHR) enables the assessment of the relationship between the UC and the FHR (Bakker et al, 2007a). When using oxytocin in augmented or induced labours, intrapartum guidelines recommend that UCs should be monitored continuously (National Institute for Health and Care Excellence (NICE), 2014). Inadequate UC monitoring without clinical oversight could allow excessive contractions to occur unrecognised, delaying appropriate action. This involves either reducing or discontinuing an oxytocin infusion (Reinhard et al, 2011; Ayres-de-Campos et al, 2015).
The maintenance of normal UCs and sufficient recovery time is essential to restore the supply of well-oxygenated maternal blood to the intervillous space and to ensure that the fetal cerebral oxygen saturation remains stable (Bakker and van Geijn, 2008).
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