TY - JOUR
T1 - The risks and benefits of internal monitors in laboring patients
AU - Harper, Lorie M.
AU - Shanks, Anthony L.
AU - Tuuli, Methodius G.
AU - Roehl, Kimberly A.
AU - Cahill, Alison G.
PY - 2013/7
Y1 - 2013/7
N2 - OBJECTIVE: The purpose of this study was to estimate the impact of internal monitors (fetal scalp electrode [FSE] and intrauterine pressure catheter [IUPC]) on maternal and neonatal outcomes. STUDY DESIGN: The study comprised a retrospective cohort of all women who were admitted for labor from 2004-2008. Women with internal monitors (FSE, IUPC, or both) were compared with women without internal monitors. Maternal outcomes were maternal fever and cesarean delivery. Neonatal outcomes were a composite of 5-minute Apgar score of ≤3, cord pH <7.1, cord base excess ≤-12, or admission to level 3 nursery. Logistic regression was performed to estimate the impact of internal monitors with adjustment for confounding variables, including time in labor. RESULTS: Of 6445 subjects, 3944 women (61.2%) had internal monitors. Women with internal monitors were more likely to have a fever than women without internal monitors (11.7% vs 4.5%; adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.6e2.5). FSE alone was not associated with an increased risk of fever (AOR, 1.5; 95% CI, 1.0e2.1), but IUPC alone was (AOR, 2.4; 95% CI, 1.8e3.2). The risk of cesarean delivery was higher in women with internal monitors (18.6% vs 9.7%; AOR, 1.3; 95%CI, 1.0e1.5). Risk of cesarean delivery was lower in women with an FSE alone (AOR, 0.5; 95% CI, 0.4e0.7) but higher in women with both an FSE and an IUPC (AOR, 1.6; 95% CI, 1.4e2.0). Risk of the composite neonatal outcome was not higher in women with internal monitors (3.3% vs 3.6%; AOR, 0.8; 95% CI, 0.6e1.1). CONCLUSION: Routine use of an IUPC in laboring patients should be avoided because of an increased risk of maternal fever.
AB - OBJECTIVE: The purpose of this study was to estimate the impact of internal monitors (fetal scalp electrode [FSE] and intrauterine pressure catheter [IUPC]) on maternal and neonatal outcomes. STUDY DESIGN: The study comprised a retrospective cohort of all women who were admitted for labor from 2004-2008. Women with internal monitors (FSE, IUPC, or both) were compared with women without internal monitors. Maternal outcomes were maternal fever and cesarean delivery. Neonatal outcomes were a composite of 5-minute Apgar score of ≤3, cord pH <7.1, cord base excess ≤-12, or admission to level 3 nursery. Logistic regression was performed to estimate the impact of internal monitors with adjustment for confounding variables, including time in labor. RESULTS: Of 6445 subjects, 3944 women (61.2%) had internal monitors. Women with internal monitors were more likely to have a fever than women without internal monitors (11.7% vs 4.5%; adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.6e2.5). FSE alone was not associated with an increased risk of fever (AOR, 1.5; 95% CI, 1.0e2.1), but IUPC alone was (AOR, 2.4; 95% CI, 1.8e3.2). The risk of cesarean delivery was higher in women with internal monitors (18.6% vs 9.7%; AOR, 1.3; 95%CI, 1.0e1.5). Risk of cesarean delivery was lower in women with an FSE alone (AOR, 0.5; 95% CI, 0.4e0.7) but higher in women with both an FSE and an IUPC (AOR, 1.6; 95% CI, 1.4e2.0). Risk of the composite neonatal outcome was not higher in women with internal monitors (3.3% vs 3.6%; AOR, 0.8; 95% CI, 0.6e1.1). CONCLUSION: Routine use of an IUPC in laboring patients should be avoided because of an increased risk of maternal fever.
KW - Cesarean delivery
KW - Chorioamnionitis
KW - Endometritis
KW - Internal monitor
KW - Labor
UR - http://www.scopus.com/inward/record.url?scp=84880133711&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2013.04.001
DO - 10.1016/j.ajog.2013.04.001
M3 - Article
C2 - 23562354
AN - SCOPUS:84880133711
SN - 0002-9378
VL - 209
SP - 38.e1-38.e6
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 1
ER -