The Impact of Maternal Body Mass Index and Gestational Age on the Detection of Uterine Contractions by Tocodynamometry: A Retrospective Study.
OBJECTIVE
To examine the impact of maternal body mass index (BMI) and gestational age (GA) on uterine contraction detection by tocodynamometry.


METHODS
Gravidas with preterm labor (PTL) complaints who were evaluated by tocodynamometry, discharged from Labor and Delivery triage, and subsequently readmitted for preterm delivery were studied. Forty-six patients in whom contractions were detected (group 1) were compared to 49 women in whom contractions were not detected (group 2) with respect to BMI and GA at both evaluation and delivery. Multivariable logistic regression was used to adjust for confounders.


RESULTS
Group 2 had a higher mean BMI (31.7 vs 26.1, P < .001), were more likely to be obese (57.1% vs 19.6%, P < .001), and were more likely to have been evaluated in the mid-trimester (36.7% vs 17.4%, P = .04) compared to group 1. Independent risk factors for the inability of the tocodynamometer to detect contractions were obesity (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.07-0.46) and evaluation in the mid-trimester (OR 0.33, 95% CI 0.13-0.84).


CONCLUSIONS
Our study provides evidence that the effectiveness of tocodynamometry diminishes with increasing maternal BMI. Efficacy of tocodynamometry is also decreased at earlier GA, most pronounced below 25 weeks. To evaluate women with PTL symptoms in the mid-trimester or symptomatic obese women at any GA, a modality other than tocodynamometry could be valuable to more accurately assess uterine activity.
Division of Maternal Fetal Medicine, Department of Gynecology/Obstetrics, Johns Hopkins University School of Medicine Baltimore, MD, USA aaina1@jhmi.edu.
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Aina-Mumuney
Department of Biomedical Engineering, Johns Hopkins University Baltimore, MD, USA.
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Hwang
Department of Biomedical Engineering, Johns Hopkins University Baltimore, MD, USA.
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Sunwoo
Division of Maternal Fetal Medicine, Department of Gynecology/Obstetrics, Johns Hopkins University School of Medicine Baltimore, MD, USA.
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Burd
Division of Maternal Fetal Medicine, Department of Gynecology/Obstetrics, Johns Hopkins University School of Medicine Baltimore, MD, USA.
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Blakemore
D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D007752:Obstetric Labor, Premature / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000502:physiology; D012189:Retrospective Studies; D014590:Uterine Contraction / Q000502:physiology*; D018590:Uterine Monitoring / Q000379:methods*; D055815:Young Adult
body mass index; effectiveness of tocodynamometer; midtrimester loss; preterm labor; uterine monitoring