External monitoring
TOCO
The biggest advantage of cardiotocography (CTG) is that it is an external device. The disadvantage is its inability to give an accurate reading on intrauterine pressure. Without intrauterine pressure capability the CTG is not an indicated device for augmentation of labor. The CTG’s readings can not only be influenced by intra-amniotic pressure but by local uterine muscle tension and abdominal wall flexing, breathing, vomiting, coughing and normal movement of the mother. It is hampered by the thickness of the abdominal wall, which is why there is a high rate of failure in high BMI Moms.
Overall, in high BMI moms the accuracy in CTG is poor. Furthermore, the best position for CTG is supine, which is not desirable for the patient and limits mobility. The technology has remained essentially unchanged since 1968.
TOCO Fails Frequently in High BMI Moms
In a comparison of Toco monitoring in obese (BMI >35) and non-obese (BMI 20-25) women, Ray et al. [7] describe 30% rate of “difficult monitoring” in obese group (0% non-obese), requiring 26% rate of internal monitoring (0% non-obese).
Vanner et al. [8] similarly report poor quality Toco during more than one quarter of the monitoring time in 36% of obese parturients (16% non-obese).
[1] Ray A, Hildreth A, Esen UI. Morbid Obesity and Intrapartum Care. Journal of Obstetrics & Gynaecology. 2008; 28:301–04. [PubMed: 18569473]
[2] Vanner T, Gardosi J. Intrapartum Assessment of Uterine Activity. Bailliere’s Clinical Obstetrics and Gynaecology. 1996; 10:243–57.
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