Effectiveness of manual palpation of uterine activity

Brief review
Maternal pelvis, the contractility of the uterus, and factors related to the fetus that lead to a failure in the progress of labor. Protracted labor is most of the time as a result of inefficient uterine contraction that can be managed pharmacologically. The estimation of the adequacy of the uterine power in preparation for labor is very vital, which can be achieved by conducting an evaluation of uterine contractions. The evaluation can be done traditionally by palpating for uterine contractions by an expert observer also by the use of medical technologies; it can be achieved by the application of the intrauterine pressure catheter. The research paper aimed to ascertain between the two methods of uterine contractions palpation, which one was the most effective method.Positive reflections on the evidence.
46 patients who counted for 236 contractions were used for the experiment. The observation was done on contractions against the intrauterine pressure. Thirty, 105 and 101 contractions were described as mild, moderate and strong respectively. The mild contraction accounted for an intrauterine pressure of 35.2 mm Hg. while the moderate and strong contraction accounted for an intrauterine pressure of 44.9 mm Hg and 55.5 mm Hg. There were an improved Observers were more certain when describing a strong contraction, and then the mild with the moderate contraction getting the least accurate prediction.Concerns/challenges highlighted in the evidence
There was a significant difference on the accuracy of predicting the contraction by palpation between the maternal-fetal medicine staff and the nurses.

Senior and junior residents and nurses exhibited less difference on their accuracy when predicting the contraction via palpation. This shows physician experience in palpation was not a determining factor for an accurate prediction. Key implications for your practice
When insufficient of labor progress is detected, a clinical evaluation of the patient is vital to help ascertain the amount of pressure deficit to take an intervention. For instance, there are cases of hypo- contractility and hence there is the need to conduct an evaluation to quantitate the pressure. Methods like manual palpation and the computerized analysis can be used to quantify the contraction. The problem of experiencing the variation in the contraction by the laboring patient could be linked to the loss of amniotic fluid and at the time is caused by the compartmentalization on the mother by the fetus. The prediction may be affected by the level of training of the physician and sometime the application of oxytocin in the medical practice among other factors.
Discussion points
Systat Evanston 111 was used to analyze the data the measurement of the accuracy to ascertain uterine contraction by the calculation of a “K” statistics for a palpation of uterine contraction against the measurement of the intrauterine pressure. 49 observers were used in the research study and the accuracy of their observation was just 68%. To achieve an accuracy of 75%, the study would have required at least 53 observation, which will help to yield at least a uterine power of 0.80. Body mass index was not a factor that influenced the accurate prediction of the strengths contractions. Also, the predictions were not influenced by the gestation age, the application of oxytocin, and the position the women in labor assumed. The “k” statistic of 0.2 was obtained and it confirmed that the accuracy of predicting a contraction by a palpation was not better than a chance. Ultimately the palpation is infective as compared to the use of the intrauterine pressure catheter
Reference
Arrabal,, P., & Nagey, D. (1996). Is manual palpation of uterine contractions accurate?