The risks and benefits of internal monitors in laboring patients.
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], 1.6-2.5). FSE alone was not associated with an increased risk of fever (AOR, 1.5; 95% CI, 1.0-2.1), but IUPC alone was (AOR, 2.4; 95% CI, 1.8-3.2). The risk of cesarean delivery was higher in women with internal monitors (18.6% vs 9.7%; AOR, 1.3; 95% CI, 1.0-1.5). Risk of cesarean delivery was lower in women with an FSE alone (AOR, 0.5; 95% CI, 0.4-0.7) but higher in women with both an FSE and an IUPC (AOR, 1.6; 95% CI, 1.4-2.0). Risk of the composite neonatal outcome was not higher in women with internal monitors (3.3% vs 3.6%; AOR, 0.8; 95% CI, 0.6-1.1).


CONCLUSION
Routine use of an IUPC in laboring patients should be avoided because of an increased risk of maternal fever.
['Harper|Lorie M|LM|', 'Shanks|Anthony L|AL|', 'Tuuli|Methodius G|MG|', 'Roehl|Kimberly A|KA|', 'Cahill|Alison G|AG|']
D000328:Adult D001034:Apgar Score D002585:Cesarean Section D005260:Female D005323:Fetal Monitoring D005334:Fever D006801:Humans D007231:Infant, Newborn D007743:Labor, Obstetric D016015:Logistic Models D008875:Middle Aged D007744:Obstetric Labor Complications D016017:Odds Ratio D011247:Pregnancy D012189:Retrospective Studies D018570:Risk Assessment D013290:Streptococcal Infections D013292:Streptococcus agalactiae
internal monitor labor cesarean delivery chorioamnionitis endometritis