The uterine contraction pattern should be evaluated every time the FHR is assessed. The contraction pattern can be evaluated using external or internal methods.
External Methods
If intermittent assessment techniques are used, the pattern is evaluated by palpation. If electronic fetal monitoring (EFM) is used, a tocodynamometer (toco) is used to measure contraction frequency and duration.
External monitoring is not as reliable as internal monitoring, because a change in maternal or fetal position can interfere with the quality of tracing.
Internal Method
Infrequently, an intrauterine pressure catheter is used. The physician places the catheter tip above the presenting part in a pocket of amniotic fluid, and then the catheter is connected to the fetal monitor. In addition to recording the frequency and duration of contractions, the internal catheter accurately measures the intensity of uterine activity.
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