No benefit of internal monitoring for induction of labor

January 01, 0001

No benefit of internal monitoring for induction of labor

These Dutch investigators 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).

They found: "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 (NS). 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 (NS). No serious adverse events associated with use of the intrauterine pressure catheter were reported."

The authors concluded: "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."

External monitoring for induction of labor should be the routine approach.

For the full abstract, click here.

N Engl J Med 362(4):306-313, 28 January 2010
© 2010 to the Massachusetts Medical Society
Outcomes after Internal versus External Tocodynamometry for Monitoring Labor. Jannet J.H. Bakker, Corine J.M. Verhoeven, Petra F. Janssen, et al. Correspondence to Dr. Bakker:

Category: W. Pregnancy, Childbirth, Family Planning, Keywords: induction of labor, tocodynamometry, cesarean delivery, operative vaginal delivery, neonatal outcomes, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 16 February 2010

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