Arrabal PP, Nagey DA. Is manual palpation of uterine contractions accurate?. Am J Obstet Gynecol. 1996; 174:(1 Pt 1)217-9

Fetal Heart Monitoring Principles and Practices, 3rd Edition. Dubuque, IA: Kendall/Hunt Publishing; 2003

Ayres-de-Campos D, Spong CY, Chandraharan E Consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015; 131:(1)13-24

Bakker PC, Kurver PH, Kuik DJ, Van Geijn HP. Elevated uterine activity increases the risk of fetal acidosis at birth. Am J Obstet Gynecol. 2007a; 196:(4)313.e1-6

Bakker PC, Van Rijswijk S, Van Rijsiwijk S, van Geijn HP. Uterine activity monitoring during labor. J Perinat Med. 2007b; 35:(6)468-77

Bakker PC, van Geijn HP. Uterine activity: implications for the condition of the fetus. J Perinat Med. 2008; 36:(1)30-7

Bakker JJ, Janssen PF, van Halem K, van der Goes BY, Papatsonis DN, van der Post JA, Mol BW. Internal versus external tocodynamometry during induced or augmented labour. Cochrane Database Syst Rev. 2013; 3:(8)

Benoit JC, Graatsma EM, Van Hagen E, Visser GHA. A validation of electrohysterography for uterine monitoring during labour. J Matern Fetal Neonatal Med. 2010; 23:(1)17-22

Burvill S. Midwifery diagnosis of labour onset. British Journal of Midwifery. 2002; 10:(10)600-605

Buhimschi C, Boyle MB, Garfield RE. Electrical activity of the human uterus during pregnancy as recorded from the abdominal surface. Obstet Gynecol. 1997; 90:(1)102-11

Cottrill HM, Barton JR, O'brien JM, Rhea DL, Milligan DA. Factors influencing maternal perception of uterine contractions. Am J Obstet Gynecol. 2004; 190:(5)1455-7

Eri TS, Blystad A, Gjengedal E, Blaaka G. Negotiating credibility: first-time mothers' experiences of contact with the labour ward before hospitalisation. Midwifery. 2010; 26:(6)e25-30

Euliano TY, Nguyen MT, Darmanjian S, McGorray SP, Euliano N, Onkala A, Gregg AR. Monitoring uterine activity during labor: a comparison of 3 methods. Am J Obstet Gynecol. 2013; 208:(1)66.e1-6

Euliano TY, Nguyen MT, Marossero D, Edwards RK. Monitoring contractions in obese parturients: electrohysterography compared with traditional monitoring. Obstet Gynecol. 2007; 109:(5)1136-40

Freeman R K, Garite T J, Nageotte M P, Miller L. Fetal Heart Rate Monitoring, 4th edition. Baltimore: Williams and Wilkins;

Hayes-Gill B, Hassan S, Mirza FG Accuracy and reliability of uterine contraction identification using abdominal surface electrodes. Clinical Medicine Insight: Women's Health. 2012; 5:65-75

Olah KS, Henderson C, Birbeck J. Assessment of uterine contractions: midwife or monitor?. British Journal of Midwifery. 1993; 1:(3)111-18

Larks SD, Assali NS, Morton DG, Selle WA. Electrical activity of the human uterus in labor. J Appl Physiol. 1957; 10:(3)479-83

Maude RM, Skinner JP, Foureur MJ. Putting intelligent structured intermittent auscultation (ISIA) into practice. Women Birth. 2016; 29:(3)285-92

Miller L. Intrapartum Fetal Monitoring: Liability and Documentation. Clin Obstet Gynecol. 2011; 54:(1)50-5

National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies [CG190]. 2014. (accessed 18 July 2017)

Pateman K, Khalil A, O'Brien P. Electronic fetal heart rate monitoring: help or hindrance?. British Journal of Midwifery. 2008; 16:(7)454-7

The effective labour contraction. 2010. (accessed 18 July 2017)

Regan M, McElroy K. Women's perceptions of childbirth risk and place of birth. J Clin Ethics. 2013; 24:(3)239-52

Reinhard J, Hayes-Gill BR, Schiermeier S, Löser H 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

Evidence Based Guidelines for Midwifery-Led Care in Labour: Assessing Progress in Labour.London: The Royal College of Midwives; 2012

Sailing E, Arabin B. Historic landmarks of perinatal medicine in obstetrics. J Perinat Med. 1988; 16:(1)5-21

Simpson KR, Miller L. Assessment and optimization of uterine activity during labor. Clin Obstet Gynecol. 2011; 54:(1)40-9

Smyth CN. The guard-ring tocodynamometer; absolute measurement of intra-amniotic pressure by a new instrument. J Obstet Gynaecol Br Emp. 1957; 64:(1)59-66

Spencer KM. The Primal Touch of Birth: Midwives, Mothers and Massage. Midwifery Today Int Midwife. 2004; Summer:(70)11-3

Tucker SM, Miller L, Miller D. Mosby's Pocket Guide to Fetal Monitoring: A Multidisciplinary Approach, 6th edition. St Louis, MO: Elsevier;

Wolfs G, Rottinghuis H. Electrical and mechanical activity of the human uterus during labour. Arch Gynakol. 1970; 208:(4)373-85

Focus on cardiotocography: Intrapartum monitoring of uterine contractions

02 August 2017
Volume 25 · Issue 8


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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