Department of Obstetrics and Gynaecology, Central Hospital of Central Finland, Jyväskylä, Finland.
Department of Obstetrics and Gynaecology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
BJOG. 2020 Dec;127(13):1677-1686. doi: 10.1111/1471-0528.16343. Epub 2020 Jul 16.
To investigate whether the use of intrauterine tocodynamometry versus external tocodynamometry (IT versus ET) during labour reduces operative deliveries and improves newborn outcome. As IT provides more accurate information on labour contractions, the hypothesis was that it may more appropriately guide oxytocin use than ET.
Randomised controlled trial.
Two labour wards, in a university tertiary hospital and a central hospital.
A total of 1504 parturients with singleton pregnancies, gestational age ≥37 weeks and fetus in cephalic position: 269 women with uterine scars, 889 nulliparas and 346 parous women with oxytocin augmentation.
Participants underwent IT (n = 736) or ET (n = 768) during the active first stage of labour.
Primary outcome: rate of operative deliveries.
duration of labour, amount of oxytocin given, adverse neonatal outcomes.
Operative delivery rates were 26.9% (IT) and 25.9% (ET) (odds ratio 1.05, 95% CI 0.84-1.32, P = 0.663). The ET to IT conversion rate was 31%. We found no differences in secondary outcomes (IT versus ET). IT reduced oxytocin use during labours with signs of fetal distress, and trial of labour after caesarean section.
IT did not reduce the rate of operative deliveries, use of oxytocin, or adverse neonatal outcomes, and it did not shorten labour duration.
IT (versus ET) reduced oxytocin use in high-risk labours but did not influence operative delivery rate or adverse neonatal outcomes.
研究分娩时使用宫内胎儿宫缩压监测仪（intrauterine tocodynamometry，IT）与外部胎儿宫缩压监测仪（external tocodynamometry，ET）相比，是否能降低剖宫产率并改善新生儿结局。由于 IT 能更准确地提供宫缩信息，因此假设它比 ET 更能适当地指导催产素的使用。
随机对照试验。
一所大学附属医院和一所中心医院的两个产房。
共有 1504 名单胎妊娠、孕周≥37 周、胎头朝下的产妇：269 名有子宫瘢痕的产妇、889 名初产妇和 346 名经产妇（因催产素引产）。
产妇在活跃的第一产程中接受 IT（n=736）或 ET（n=768）监测。
主要结局：剖宫产率。
产程时间、催产素用量、新生儿不良结局。
剖宫产率分别为 IT 组 26.9%（736/2736）和 ET 组 25.9%（768/3002）（比值比 1.05，95%可信区间 0.84-1.32，P=0.663）。ET 转为 IT 监测的比例为 31%。我们在次要结局方面未发现差异（IT 组与 ET 组）。在有胎儿窘迫征象和剖宫产后试产的产妇中，IT 减少了催产素的使用。
IT 并未降低剖宫产率、催产素的使用或新生儿不良结局的发生率，也未缩短产程时间。
TWITTER 摘要：IT（与 ET 相比）减少了高危产程中催产素的使用，但并未影响剖宫产率或新生儿不良结局。
