Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Intrauterine Pressure Catheter Placement

  • Author: Nan G O'Connell, MD; Chief Editor: Carl V Smith, MD  more...
 
Updated: Dec 28, 2015
 

Background

An intrauterine pressure catheter (IUPC) is a device placed into the amniotic space during labor in order to measure the strength of uterine contractions.

External tocodynamometers are used to measure tension across the abdominal wall and detect only contraction frequency and duration. The appearance of contractions by external monitoring may be affected not only by contraction strength but also by maternal habitus, position, gestational age, and monitor location on the abdomen.

Intrauterine pressure catheters work by directly measuring pressure within the amniotic space using a pressure transducer at the tip of the catheter which allows for quantification of contraction strength. After connection to the appropriate cable, contractions are measured in mm Hg and displayed on the monitor in a graphic fashion (see image below).

IUPC tracing IUPC tracing

With an intrauterine pressure catheter in place, Montevideo units (MVUs) can be calculated to assess for adequacy of labor in cases of suspected labor dystocia or during labor induction. MVUs are calculated by subtracting the baseline uterine pressure from the peak uterine pressure of each contraction in a 10-minute window of time and then taking the sum of these pressures. Two hundred Montevideo units or more is considered adequate for normal labor progression.[1]

Routine use of intrauterine pressure catheters is not recommended. A large randomized trial of internal versus external tocodynamometry for monitoring labor showed no difference in rates of operative delivery or fetal outcomes between the two groups. Internal tocodynamometry is more costly and more invasive so should be reserved for specific circumstances (see Indications).[2, 3]

Next

Indications

An intrauterine pressure catheter is placed when quantification of contraction strength is desired, typically to assess the adequacy of spontaneous contractions in cases of arrested cervical dilation.

It may also be used to facilitate titration of the oxytocin dosage during induction or augmentation of labor.

An intrauterine pressure catheter can provide a more accurate assessment of contraction duration, length, and strength in patients in whom external tocodynamometry does not pick up contractions well, such as in obese patients.

In cases of fetal heart rate decelerations, an intrauterine pressure catheter can be used to clarify the relationship between the timing of the deceleration and the contraction.

Finally, intrauterine pressure catheter placement also allows an amnioinfusion to be performed in cases of severe variable fetal heart rate decelerations.

Previous
Next

Contraindications

An intact fetal membrane is a contraindication to intrauterine pressure catheter placement, as the desired location is within the amniotic space. Amniotomy just prior to intrauterine pressure catheter placement is acceptable in the absence of contraindications to amniotomy.

Previous
 
 
Contributor Information and Disclosures
Author

Nan G O'Connell, MD Assistant Professor, Department of Obstetrics and Gynecology, VCU Medical Center, Virginia Commonwealth University School of Medicine; Medical Director, Obstetrics and Gynecology Services, VCU Medical Center at Stony Point

Nan G O'Connell, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Munter, MD Resident Physician, Department of Obstetrics and Gynecology, Virginia Commonwealth University Health System

Disclosure: Nothing to disclose.

Chief Editor

Carl V Smith, MD The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center

Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association

Disclosure: Nothing to disclose.

References
  1. Cunningham, Leveno, Bloom, Rouse, Spong. Abnormal Labor. Williams Obstetrics. 23rd. United States: McGraw Hill; 2010. Chapter 20.

  2. ACOG Practice Bulletin No. 49. Dystocia and Augmentation of Labor. December 2003, reaffirmed 2011.

  3. Bakker JJ, Verhoeven CJ, Janssen PF, van Lith JM, van Oudgaarden ED, Bloemenkamp KW. Outcomes after internal versus external tocodynamometry for monitoring labor. N Engl J Med. 2010 Jan 28. 362(4):306-13. [Medline].

  4. Lind BK. Complications caused by extramembranous placement of intrauterine pressure catheters. Am J Obstet Gynecol. 1999 Apr. 180(4):1034-5. [Medline].

  5. Wilmink FA, Wilms FF, Heydanus R, Mol BW, Papatsonis DN. Fetal complications after placement of an intrauterine pressure catheter: a report of two cases and review of the literature. J Matern Fetal Neonatal Med. 2008 Dec. 21(12):880-3. [Medline].

  6. Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol. 1989 Sep. 161(3):562-6; discussion 566-8. [Medline].

  7. Clinical Innovations. Koala IPC 5000 Insertion Guide.

  8. Cabrera IB, Quinones JN, Durie D, Rust J, Smulian JC, Scorza WE. Use of intracervical balloons and chorioamnionitis in term premature rupture of membranes. J Matern Fetal Neonatal Med. 2016 Mar. 29(6):967-71. [Medline].

  9. Frey HA, Tuuli MG, Roehl KA, Odibo AO, Macones GA, Cahill AG. Can contraction patterns predict neonatal outcomes?. J Matern Fetal Neonatal Med. 2014 Sep. 27(14):1422-7. [Medline].

 
Previous
Next
 
IUPC tracing
An intrauterine pressure catheter and cable.
An example of a fetal heart rate and contraction monitor.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.