Outcomes after internal versus external tocodynamometry for monitoring labor

Jannet J H Bakker, Corine J M Verhoeven, Petra F Janssen, Jan M van Lith, Elisabeth D van Oudgaarden, Kitty W M Bloemenkamp, Dimitri N M Papatsonis, Ben Willem J Mol, Joris A M van der Post

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose of oxytocin effectively, resulting in fewer operative deliveries and less fetal distress. However, few data are available to test this hypothesis.

METHODS: We performed a randomized, controlled trial in six hospitals in The Netherlands to compare internal tocodynamometry with external monitoring of uterine activity in women for whom induced or augmented labor was required. The primary outcome was the rate of operative deliveries, including both cesarean sections and instrumented vaginal deliveries. Secondary outcomes included the use of antibiotics during labor, time from randomization to delivery, and adverse neonatal outcomes (defined as any of the following: an Apgar score at 5 minutes of less than 7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of longer than 48 hours).

RESULTS: We randomly assigned 1456 women to either internal tocodynamometry (734) or external monitoring (722). The operative-delivery rate was 31.3% in the internal-tocodynamometry group and 29.6% in the external-monitoring group (relative risk with internal monitoring, 1.1; 95% confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not differ significantly between the two groups. The rate of adverse neonatal outcomes was 14.3% with internal monitoring and 15.0% with external monitoring (relative risk, 0.95; 95% CI, 0.74 to 1.2). No serious adverse events associated with use of the intrauterine pressure catheter were reported.

CONCLUSIONS: Internal tocodynamometry during induced or augmented labor, as compared with external monitoring, did not significantly reduce the rate of operative deliveries or of adverse neonatal outcomes. (Current Controlled Trials number, ISRCTN13667534; Netherlands Trial number, NTR285.)

Original languageEnglish
Pages (from-to)306-313
Number of pages8
JournalNew England Journal of Medicine
Volume362
Issue number4
DOIs
Publication statusPublished - 28 Jan 2010

Cite this

Bakker, J. J. H., Verhoeven, C. J. M., Janssen, P. F., van Lith, J. M., van Oudgaarden, E. D., Bloemenkamp, K. W. M., ... van der Post, J. A. M. (2010). Outcomes after internal versus external tocodynamometry for monitoring labor. New England Journal of Medicine, 362(4), 306-313. https://doi.org/10.1056/NEJMoa0902748
Bakker, Jannet J H ; Verhoeven, Corine J M ; Janssen, Petra F ; van Lith, Jan M ; van Oudgaarden, Elisabeth D ; Bloemenkamp, Kitty W M ; Papatsonis, Dimitri N M ; Mol, Ben Willem J ; van der Post, Joris A M. / Outcomes after internal versus external tocodynamometry for monitoring labor. In: New England Journal of Medicine. 2010 ; Vol. 362, No. 4. pp. 306-313.
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abstract = "BACKGROUND: It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose of oxytocin effectively, resulting in fewer operative deliveries and less fetal distress. However, few data are available to test this hypothesis.METHODS: We performed a randomized, controlled trial in six hospitals in The Netherlands to compare internal tocodynamometry with external monitoring of uterine activity in women for whom induced or augmented labor was required. The primary outcome was the rate of operative deliveries, including both cesarean sections and instrumented vaginal deliveries. Secondary outcomes included the use of antibiotics during labor, time from randomization to delivery, and adverse neonatal outcomes (defined as any of the following: an Apgar score at 5 minutes of less than 7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of longer than 48 hours).RESULTS: We randomly assigned 1456 women to either internal tocodynamometry (734) or external monitoring (722). The operative-delivery rate was 31.3{\%} in the internal-tocodynamometry group and 29.6{\%} in the external-monitoring group (relative risk with internal monitoring, 1.1; 95{\%} confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not differ significantly between the two groups. The rate of adverse neonatal outcomes was 14.3{\%} with internal monitoring and 15.0{\%} with external monitoring (relative risk, 0.95; 95{\%} CI, 0.74 to 1.2). No serious adverse events associated with use of the intrauterine pressure catheter were reported.CONCLUSIONS: Internal tocodynamometry during induced or augmented labor, as compared with external monitoring, did not significantly reduce the rate of operative deliveries or of adverse neonatal outcomes. (Current Controlled Trials number, ISRCTN13667534; Netherlands Trial number, NTR285.)",
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Bakker, JJH, Verhoeven, CJM, Janssen, PF, van Lith, JM, van Oudgaarden, ED, Bloemenkamp, KWM, Papatsonis, DNM, Mol, BWJ & van der Post, JAM 2010, 'Outcomes after internal versus external tocodynamometry for monitoring labor' New England Journal of Medicine, vol. 362, no. 4, pp. 306-313. https://doi.org/10.1056/NEJMoa0902748

Outcomes after internal versus external tocodynamometry for monitoring labor. / Bakker, Jannet J H; Verhoeven, Corine J M; Janssen, Petra F; van Lith, Jan M; van Oudgaarden, Elisabeth D; Bloemenkamp, Kitty W M; Papatsonis, Dimitri N M; Mol, Ben Willem J; van der Post, Joris A M.

In: New England Journal of Medicine, Vol. 362, No. 4, 28.01.2010, p. 306-313.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Outcomes after internal versus external tocodynamometry for monitoring labor

AU - Bakker, Jannet J H

AU - Verhoeven, Corine J M

AU - Janssen, Petra F

AU - van Lith, Jan M

AU - van Oudgaarden, Elisabeth D

AU - Bloemenkamp, Kitty W M

AU - Papatsonis, Dimitri N M

AU - Mol, Ben Willem J

AU - van der Post, Joris A M

N1 - 2010 Massachusetts Medical Society

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N2 - BACKGROUND: It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose of oxytocin effectively, resulting in fewer operative deliveries and less fetal distress. However, few data are available to test this hypothesis.METHODS: We performed a randomized, controlled trial in six hospitals in The Netherlands to compare internal tocodynamometry with external monitoring of uterine activity in women for whom induced or augmented labor was required. The primary outcome was the rate of operative deliveries, including both cesarean sections and instrumented vaginal deliveries. Secondary outcomes included the use of antibiotics during labor, time from randomization to delivery, and adverse neonatal outcomes (defined as any of the following: an Apgar score at 5 minutes of less than 7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of longer than 48 hours).RESULTS: We randomly assigned 1456 women to either internal tocodynamometry (734) or external monitoring (722). The operative-delivery rate was 31.3% in the internal-tocodynamometry group and 29.6% in the external-monitoring group (relative risk with internal monitoring, 1.1; 95% confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not differ significantly between the two groups. The rate of adverse neonatal outcomes was 14.3% with internal monitoring and 15.0% with external monitoring (relative risk, 0.95; 95% CI, 0.74 to 1.2). No serious adverse events associated with use of the intrauterine pressure catheter were reported.CONCLUSIONS: Internal tocodynamometry during induced or augmented labor, as compared with external monitoring, did not significantly reduce the rate of operative deliveries or of adverse neonatal outcomes. (Current Controlled Trials number, ISRCTN13667534; Netherlands Trial number, NTR285.)

AB - BACKGROUND: It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose of oxytocin effectively, resulting in fewer operative deliveries and less fetal distress. However, few data are available to test this hypothesis.METHODS: We performed a randomized, controlled trial in six hospitals in The Netherlands to compare internal tocodynamometry with external monitoring of uterine activity in women for whom induced or augmented labor was required. The primary outcome was the rate of operative deliveries, including both cesarean sections and instrumented vaginal deliveries. Secondary outcomes included the use of antibiotics during labor, time from randomization to delivery, and adverse neonatal outcomes (defined as any of the following: an Apgar score at 5 minutes of less than 7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of longer than 48 hours).RESULTS: We randomly assigned 1456 women to either internal tocodynamometry (734) or external monitoring (722). The operative-delivery rate was 31.3% in the internal-tocodynamometry group and 29.6% in the external-monitoring group (relative risk with internal monitoring, 1.1; 95% confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not differ significantly between the two groups. The rate of adverse neonatal outcomes was 14.3% with internal monitoring and 15.0% with external monitoring (relative risk, 0.95; 95% CI, 0.74 to 1.2). No serious adverse events associated with use of the intrauterine pressure catheter were reported.CONCLUSIONS: Internal tocodynamometry during induced or augmented labor, as compared with external monitoring, did not significantly reduce the rate of operative deliveries or of adverse neonatal outcomes. (Current Controlled Trials number, ISRCTN13667534; Netherlands Trial number, NTR285.)

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KW - Cesarean Section/statistics & numerical data

KW - Extraction, Obstetrical/statistics & numerical data

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Labor, Induced

KW - Labor, Obstetric

KW - Pregnancy

KW - Pregnancy Outcome

KW - Statistics, Nonparametric

KW - Uterine Monitoring/instrumentation

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JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

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Bakker JJH, Verhoeven CJM, Janssen PF, van Lith JM, van Oudgaarden ED, Bloemenkamp KWM et al. Outcomes after internal versus external tocodynamometry for monitoring labor. New England Journal of Medicine. 2010 Jan 28;362(4):306-313. https://doi.org/10.1056/NEJMoa0902748