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Cochrane Database of Systematic Reviews

Internal versus external tocodynamometry during induced or augmented labour

Overview of attention for article published in Cochrane database of systematic reviews, August 2013
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Internal versus external tocodynamometry during induced or augmented labour
Published in
Cochrane database of systematic reviews, August 2013
DOI 10.1002/14651858.cd006947.pub3
Pubmed ID

Jannet JH Bakker, Petra F Janssen, Karlijn van Halem, Birgit Y van der Goes, Dimitri NM Papatsonis, Joris AM van der Post, Ben Willem J Mol


Uterine contractions can be registered by external tocodynamometry (ET) or, after rupture of the membranes, by internal tocodynamometry (IT). Monitoring of the frequency of contractions is important especially when intravenous oxytocin is used as excessive uterine activity (hyperstimulation or tachysystole) can cause fetal distress. During induction of labour as well as during augmentation with intravenous oxytocin, some clinicians choose to monitor frequency and strength of contractions with IT rather than with ET as an intrauterine pressure catheter measures intrauterine activity more accurately than an extra-abdominal tocodynamometry device. However, insertion of an intrauterine catheter has higher costs and also potential risks for mother and child. To assess the effectiveness of IT compared with using ET when intravenous oxytocin is used for induction or augmentation of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013) and PubMed (1966 to 6 April 2013). We included all published randomised controlled trials with data from women in whom IT was compared with ET in induced or augmented labour with oxytocin. We excluded trials that employed quasi-randomised methods of treatment allocation. We found no unpublished or ongoing studies on this subject. Two review authors independently assessed trial eligibility and risk of bias, and independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information. Three studies involving a total of 1945 women were included. Overall, risk of bias across the three trials was mixed. No serious complications were reported in the trials and no neonatal or maternal deaths occurred. The neonatal outcome was not statistically different between groups: Apgar score less than seven at five minutes (RR 1.78, 95% CI 0.83 to 3.83; three studies, n = 1945); umbilical artery pH less than 7.15 (RR 1.31, 95% CI 0.95 to 1.79; one study, n = 1456); umbilical artery pH less than 7.16 (RR 1.23, 95% CI 0.39 to 3.92; one study, n = 239); admission to the neonatal intensive care unit (RR 0.34, 95% CI 0.07 to 1.67; two studies, n = 489); and more than 48 hours hospitalisation (RR 0.92, 95% CI 0.71 to 1.20; one study, n = 1456). The pooled risk for instrumental delivery (including caesarean section, ventouse and forceps extraction) was not statistically significantly different (RR 1.05, 95% CI 0.91 to 1.21; three studies, n = 1945). Hyperstimulation was reported in two studies (n = 489), but there was no statistically significant difference between groups (RR 1.21, 95% CI 0.78 to 1.88). This review found no differences between the two types of monitoring (internal or external tocodynamometry) for any of the maternal or neonatal outcomes. Given that this review is based on three studies (N = 1945 women) of moderate quality, there is insufficient evidence to recommend the use of one form of tocodynamometry over another for women where intravenous oxytocin was administered for induction or augmentation of labour.

Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 182 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 <1%
Canada 1 <1%
Unknown 180 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 29 16%
Student > Ph. D. Student 26 14%
Student > Bachelor 17 9%
Researcher 15 8%
Other 10 5%
Other 27 15%
Unknown 58 32%
Readers by discipline Count As %
Medicine and Dentistry 65 36%
Nursing and Health Professions 18 10%
Social Sciences 9 5%
Psychology 7 4%
Agricultural and Biological Sciences 4 2%
Other 17 9%
Unknown 62 34%