An Integrated Review of Uterine Activity Monitoring for Evaluating Labor Dystocia.
Katherine J Kissler, Nancy K Lowe, Teri L Hernandez
PMID 32478978WHAT IT FOUND
No single uterine contraction measure was reliably linked to labor dystocia or cesarean birth.
Nurses should treat uterine activity signs as clues, not proof, and watch for patterns over time when oxytocin titration is used.
Key findings
01In the included studies, uterine activity below 200 Montevideo units was associated with cesarean birth, but it had low predictive value because many women with lower values gave birth vaginally.
02An increased fall-to-rise ratio was associated with cesarean birth and self-reported fatigue, but its sensitivity, specificity, positive predictive value, and negative predictive value for cesarean birth were low.
03A follow-up study did not support fundal dominance measured by uterine EMG as a differentiator between cesarean birth for labor dystocia and vaginal birth.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included English-language original research from 2000 to 2019 and excluded reviews and older studies. The included studies used very different measurement methods and outcomes, so results are hard to compare. Many measures were not tested for reliability or validity for labor dystocia. The measures are proxies, not direct measures of uterine action on the cervix and fetus. Important covariates, including maternal age, obesity, fetal position, epidural use, and induction, were not consistently included in analyses. Some key studies had small samples or few events.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that a single uterine activity measure, such as a Montevideo unit count, diagnoses labor dystocia or predicts cesarean birth. The review found low predictive value and inconsistent results.