IUPC Intrauterine Pressure Catheter: Your Guide

The IUPC intrauterine pressure catheter is an indispensable tool for obstetricians when managing labor, particularly in cases of dystocia or when induced labor requires careful monitoring; its design allows clinicians to measure uterine contractions accurately in millimeters of mercury (mmHg), providing crucial data that external tocodynamometry often cannot. Cook Medical provides several models of the IUPC, each tailored for different clinical scenarios, ensuring healthcare providers have options to suit individual patient needs. Interpretation of the data obtained through the IUPC intrauterine pressure catheter requires a thorough understanding of normal labor patterns as defined by Friedman's curve, enabling timely intervention if abnormalities are detected.

Intrauterine Pressure Catheters (IUPCs) are indispensable tools in modern obstetric care.

Their function extends beyond simple monitoring, offering critical insights into uterine activity. These insights are vital for ensuring maternal and fetal well-being throughout the labor process.

Defining the Intrauterine Pressure Catheter

An Intrauterine Pressure Catheter (IUPC) is a sterile, flexible catheter. It is inserted transcervically into the amniotic space to directly measure the pressure within the uterus during labor.

Unlike external tocodynamometry, which only provides a relative measure of contraction frequency and duration, an IUPC provides quantitative data on the intensity of uterine contractions.

This direct measurement is crucial when precise assessment is needed.

Purpose of IUPC Monitoring: A Comprehensive Evaluation

The primary purpose of IUPC monitoring is to comprehensively evaluate uterine activity. This involves assessing several key parameters:

• Contraction Force: IUPCs provide a precise measurement of the pressure generated during each contraction, typically measured in millimeters of mercury (mmHg).

• Contraction Frequency: The frequency of contractions is measured by observing the number of contractions within a specific time frame, usually a 10-minute period.

• Contraction Duration: IUPCs allow for accurate determination of how long each contraction lasts, providing valuable information about the efficiency of uterine activity.

• Montevideo Units (MVUs): IUPCs enable the calculation of Montevideo Units (MVUs), a quantitative measure of uterine activity. MVUs are calculated by summing the amplitude (in mmHg) of each contraction over a 10-minute period. MVUs help clinicians determine if uterine activity is adequate for labor progress. Typically, 200 MVUs or more is considered adequate for active labor in the active phase.

Importance of IUPCs in Obstetric Management

IUPCs play a pivotal role in obstetric management by providing essential data. This data enables informed clinical decision-making and improves patient outcomes.

• Monitoring Labor Progress: IUPCs offer a clear picture of uterine activity, helping to identify dysfunctional labor patterns early on.

• Identifying Complications: IUPCs can help in the early detection of potential complications such as uterine hyperstimulation or tachysystole, which can compromise fetal oxygenation.

• Guiding Interventions: The data obtained from IUPC monitoring guides interventions such as the administration of oxytocin. This is carefully titrated to achieve optimal contraction patterns and cervical dilation.

• Assessing Fetal Well-being: By providing insight into the adequacy of uterine activity, IUPCs indirectly aid in assessing fetal well-being. This is in conjunction with fetal heart rate monitoring.

In conclusion, IUPCs are essential tools. They offer direct, quantitative data on uterine activity. This is vital for effective labor management and improved maternal and fetal outcomes.

Key Clinical Roles in IUPC Monitoring

Intrauterine Pressure Catheters (IUPCs) are indispensable tools in modern obstetric care. Their function extends beyond simple monitoring, offering critical insights into uterine activity. These insights are vital for ensuring maternal and fetal well-being throughout the labor process. Therefore, various clinical personnel play unique roles in the effective application of IUPC technology.

This section outlines the specific responsibilities and contributions of obstetricians, labor and delivery nurses, and midwives. It highlights how each professional leverages IUPC data to optimize patient care and ensure positive outcomes during labor and delivery.

Obstetricians/OB-GYNs: Decision-Makers in Labor Management

Obstetricians, also known as OB-GYNs, serve as the primary users of IUPC data in managing labor. They are responsible for synthesizing IUPC readings with other clinical indicators to make informed decisions. These decisions impact labor augmentation and potential interventions.

The primary role of the obstetrician is to interpret IUPC data to determine if labor is progressing adequately. This involves assessing the strength, frequency, and duration of uterine contractions.

Making Critical Decisions Based on IUPC Data

Based on IUPC data, obstetricians decide whether to augment labor with interventions such as oxytocin. If contractions are insufficient, oxytocin can stimulate stronger and more frequent contractions.

However, the decision to use oxytocin is carefully weighed against the potential risks of hyperstimulation. Continuous monitoring via IUPC allows obstetricians to closely titrate oxytocin dosage to achieve optimal contraction patterns.

In cases of abnormal labor progress or signs of fetal distress, obstetricians may consider interventions like operative vaginal delivery or cesarean section. IUPC data provides critical information to support these decisions. The comprehensive understanding provided by IUPC monitoring allows for a more nuanced approach to labor management.

Labor and Delivery Nurses: Continuous Monitoring and Vigilance

Labor and delivery nurses play a crucial role in the administration and continuous monitoring of IUPCs. They are responsible for inserting the IUPC, ensuring its proper function, and meticulously recording and interpreting IUPC readings.

Nurses are the frontline observers, providing constant vigilance over both maternal and fetal well-being.

Key Responsibilities in IUPC Management

One of the core responsibilities of labor and delivery nurses is the continuous monitoring of IUPC readings. They must accurately document the baseline uterine pressure, contraction intensity, frequency, and duration. They calculate Montevideo Units (MVUs) to quantify the adequacy of uterine activity.

Furthermore, nurses are trained to recognize abnormal patterns or concerning trends in IUPC data.

Acting as a Liaison Between Technology and Physician

If nurses detect any worrisome signs, such as hyperstimulation or inadequate labor progress, they are responsible for promptly notifying the obstetrician. This timely communication ensures that the physician can make informed decisions and implement appropriate interventions without delay.

The labor and delivery nurse acts as a critical liaison, bridging the gap between the technology and the physician’s decision-making process. Their vigilance and expertise are invaluable in maintaining a safe and effective labor process.

Midwives: Integrating IUPCs in Holistic Care

Midwives also utilize IUPCs in specific settings and protocols, particularly in hospitals or birth centers where such monitoring is standard practice. Their approach often integrates IUPC data with a holistic view of the laboring woman.

They consider physical, emotional, and psychological factors influencing labor progress.

Utilizing IUPCs within a Defined Scope of Practice

Midwives carefully monitor uterine contractions and fetal heart rate in conjunction with IUPC readings to assess the progress and well-being of both mother and baby.

They adhere to specific protocols and guidelines for IUPC usage, ensuring that interventions are appropriate and evidence-based.

Collaboration and Referral

Midwives collaborate closely with obstetricians. This collaboration ensures a seamless transition of care if complications arise that require medical intervention beyond the scope of midwifery practice. This collaborative approach optimizes the safety and well-being of the laboring woman and her baby.

Understanding the Core Concepts of IUPC Readings

Intrauterine Pressure Catheters (IUPCs) are indispensable tools in modern obstetric care. Their function extends beyond simple monitoring, offering critical insights into uterine activity. These insights are vital for ensuring maternal and fetal well-being throughout the labor process. Therefore, various clinical parameters must be understood to interpret the data effectively and translate it into actionable clinical decisions.

Decoding Uterine Contractions

Uterine contractions are the driving force of labor, and their assessment is paramount.

An IUPC provides an objective measurement of contraction force (intensity), frequency (how often they occur), and duration (how long each contraction lasts).

Normal vs. Abnormal Contraction Patterns

Normal labor contractions exhibit a pattern of increasing intensity and frequency as labor progresses, leading to cervical dilation and fetal descent.

Abnormal patterns, however, such as hypotonic (weak) or hypertonic (excessively strong) contractions, can impede labor progress and compromise fetal well-being. Differentiating between these patterns is crucial for guiding interventions.

Intrauterine Pressure: A Key Indicator

Intrauterine pressure (IUP) refers to the pressure within the uterus, both at baseline and during contractions.

Baseline pressure represents the resting tone of the uterus between contractions. Elevated baseline pressure may indicate uterine irritability or concealed abruption.

The pressure generated during contractions reflects the strength of uterine muscle activity. Assessing both baseline and contraction pressures is essential for a comprehensive evaluation.

Impact on Fetal Well-being

Elevated intrauterine pressure can reduce uterine blood flow, potentially leading to fetal hypoxia.

Close monitoring of IUP helps clinicians identify and address situations that may compromise fetal oxygenation.

Montevideo Units (MVUs): Quantifying Uterine Work

Montevideo Units (MVUs) provide a quantitative measure of uterine activity, calculated by summing the amplitude (peak pressure minus baseline pressure) of contractions within a 10-minute period.

Generally, MVUs of 200 or more are considered adequate for active labor in the first stage.

Clinical Significance

MVUs help predict labor progress and outcomes. Inadequate MVUs may indicate the need for labor augmentation, while excessively high MVUs may increase the risk of uterine hyperstimulation or rupture.

The monitoring of MVUs is especially important in the context of induced labor and the administration of oxytocin.

Integrating Fetal Heart Rate Monitoring

Fetal heart rate (FHR) monitoring, especially when using a Fetal Scalp Electrode (FSE) in conjunction with an IUPC, provides invaluable information about fetal response to contractions.

FHR patterns, such as decelerations, can indicate fetal distress related to uterine contractions.

Assessing Fetal Response

The correlation between FHR patterns and IUPC data helps clinicians assess fetal reserve and identify potential hypoxic events.

This integrated approach is vital for timely intervention and optimization of fetal outcomes.

Identifying and Managing Hyperstimulation and Tachysystole

Hyperstimulation refers to excessive uterine activity, characterized by either excessively frequent contractions (tachysystole) or prolonged contractions, often associated with fetal heart rate abnormalities.

Tachysystole is defined as more than five contractions in 10 minutes, averaged over a 30-minute window.

Management Strategies

Prompt identification and management of hyperstimulation and tachysystole are crucial to prevent fetal compromise.

Management strategies may include reducing or discontinuing oxytocin, administering tocolytic agents to relax the uterus, and providing supportive care to the mother.

Clinical Applications of IUPCs: When and Why They're Used

Understanding the Core Concepts of IUPC Readings Intrauterine Pressure Catheters (IUPCs) are indispensable tools in modern obstetric care. Their function extends beyond simple monitoring, offering critical insights into uterine activity. These insights are vital for ensuring maternal and fetal well-being throughout the labor process. Therefore, various clinical scenarios mandate the use of IUPCs.

This section explores the specific circumstances under which IUPCs are most beneficial. We will cover the indications for their use, particularly when assessing abnormal labor progress or high-risk pregnancies. Furthermore, we will delve into their crucial role in labor augmentation and induction. Lastly, a detailed comparison will be provided between IUPCs and external fetal monitoring methods.

Indications for IUPC Use

IUPCs are not employed in every labor scenario. Instead, specific conditions warrant their use to provide a more comprehensive understanding of uterine activity. These include situations where external monitoring proves inadequate or when complications arise.

Abnormal labor progress is a primary indication. When a woman's labor stalls or progresses slower than expected, an IUPC can help determine the adequacy of uterine contractions.

This is crucial for differentiating between inadequate uterine activity and other potential causes of slow progress, such as fetal malposition. The data from the IUPC guides clinical decisions regarding intervention strategies.

Assessing the effectiveness of augmentation or induction is another key area where IUPCs are valuable. During labor augmentation or induction with oxytocin, accurate monitoring of contraction strength and frequency is paramount.

An IUPC provides precise data, ensuring that the oxytocin dosage is appropriately adjusted to achieve effective contractions without causing hyperstimulation. This minimizes risks to both mother and fetus.

IUPCs are also frequently used in high-risk pregnancies. Certain maternal or fetal conditions elevate the risk of complications during labor.

In these cases, the continuous, objective data provided by an IUPC helps clinicians make informed decisions and respond swiftly to any deviations from the expected labor course.

Role in Labor Augmentation and Induction

Labor augmentation and induction are common interventions in modern obstetrics. IUPCs play a significant role in guiding these processes and optimizing outcomes.

During labor augmentation, oxytocin is administered to enhance uterine contractions. The goal is to achieve consistent and effective contractions that lead to cervical dilation and fetal descent.

IUPC readings are crucial for determining the appropriate oxytocin dosage. By precisely measuring contraction strength and frequency, clinicians can adjust the dosage to achieve the desired effect. This avoids overstimulation and maintains fetal well-being.

Similarly, in labor induction, IUPCs help guide the use of oxytocin to initiate labor. The objective is to establish a normal labor pattern and achieve vaginal delivery.

IUPC data helps in titrating the oxytocin infusion, ensuring adequate uterine activity while avoiding tachysystole or hyperstimulation. This helps reduce the risk of adverse outcomes.

Optimizing contraction patterns is essential for successful labor. IUPCs provide the data needed to achieve this optimization, leading to more efficient cervical dilation and a reduced need for cesarean delivery.

IUPC vs. External Fetal Monitoring (EFM)

External Fetal Monitoring (EFM), specifically tocodynamometry, is a non-invasive method commonly used to monitor uterine contractions during labor. While EFM is convenient and widely available, it has limitations compared to IUPC monitoring.

EFM uses a pressure transducer placed on the mother’s abdomen to detect uterine contractions. However, EFM only provides an estimate of contraction strength and is subject to variability based on maternal body habitus and the position of the transducer.

IUPCs, on the other hand, offer direct and accurate measurements of intrauterine pressure. This provides a more objective and reliable assessment of contraction strength and frequency.

One of the major advantages of IUPCs is the ability to quantify uterine activity using Montevideo Units (MVUs). MVUs are calculated by summing the amplitude of each contraction over a 10-minute period.

MVUs provide a standardized measure of uterine work and can help predict labor progress.

EFM cannot provide this quantitative measure. The limitations of EFM can make it difficult to accurately assess labor progress and guide interventions.

Another advantage of IUPCs is their ability to differentiate between true labor and false labor. By measuring intrauterine pressure, clinicians can determine whether contractions are strong enough to cause cervical change.

This can help avoid unnecessary interventions in women experiencing prodromal labor. Despite the advantages of IUPCs, it's important to note that they are invasive and carry a small risk of infection or uterine perforation.

Therefore, the decision to use an IUPC should be based on a careful assessment of the risks and benefits in each individual case.

Potential Risks and Complications Associated with IUPCs

Intrauterine Pressure Catheters (IUPCs) are indispensable tools in modern obstetric care. Their function extends beyond simple monitoring, offering critical insights into uterine activity. These insights are vital for ensuring maternal and fetal well-being during labor. However, like any invasive medical procedure, IUPC use is not without potential risks. It's crucial for clinicians to be acutely aware of these risks and to implement strategies to mitigate them effectively.

This section will explore the recognized risks and complications associated with IUPCs, focusing on infection and uterine perforation. We'll delve into preventive measures and the recommended management strategies for these potential adverse events.

Infection Risk with IUPCs

The insertion of an IUPC, by its very nature, introduces a foreign body into the uterine cavity. This creates a potential pathway for bacteria to ascend and cause infection.

While the risk of infection is generally considered low, it is a serious concern that warrants vigilant attention.

Prevention Strategies for Infection

• Strict Adherence to Aseptic Technique: The cornerstone of infection prevention is meticulous adherence to sterile technique during IUPC insertion. This includes using sterile gloves, drapes, and antiseptic solutions to cleanse the insertion site.
• Limiting Insertion Attempts: Repeated attempts at insertion can increase the risk of introducing bacteria. Healthcare providers should strive for successful insertion on the first attempt or minimize subsequent attempts.
• Prophylactic Antibiotics: In specific clinical scenarios, such as prolonged rupture of membranes or known maternal infections, prophylactic antibiotics may be considered to reduce the risk of ascending infection.

Signs and Symptoms of Infection

Prompt recognition of infection is critical for timely intervention. Healthcare providers should be vigilant for the following signs and symptoms:

• Maternal Fever: An elevated maternal temperature is a key indicator of potential infection.
• Uterine Tenderness: Pain or tenderness upon palpation of the uterus may suggest infection.
• Foul-Smelling Amniotic Fluid: An unusual or offensive odor to the amniotic fluid can be a sign of infection.
• Maternal Tachycardia: An elevated maternal heart rate may also indicate infection.

Uterine Perforation

Uterine perforation, while a rare complication, is a serious risk associated with IUPC insertion. This occurs when the catheter penetrates the uterine wall.

Risk Factors for Uterine Perforation

Several factors can increase the risk of uterine perforation:

• Inexperience of the Operator: Less experienced healthcare providers may be at higher risk of causing perforation.
• Abnormal Uterine Anatomy: Conditions such as uterine fibroids or prior uterine surgeries can distort the uterine anatomy and increase the risk of perforation.
• Uterine Scarring: Previous Cesarean sections or other uterine procedures can lead to scarring, making the uterus more susceptible to perforation.

Preventive Measures

• Proper Training and Supervision: Adequate training and supervision of healthcare providers performing IUPC insertions are essential.
• Careful Insertion Technique: Gentle and controlled insertion technique, with attention to anatomical landmarks, can help minimize the risk of perforation.
• Consideration of Ultrasound Guidance: In cases where uterine anatomy is uncertain or distorted, ultrasound guidance may be considered to facilitate accurate IUPC placement.

Management Protocols for Perforation

If uterine perforation is suspected or confirmed, prompt action is crucial. Management protocols may include:

• Immediate Removal of the IUPC: The catheter should be removed immediately to prevent further injury.
• Observation and Monitoring: Close observation of the patient for signs of bleeding, infection, or other complications is necessary.
• Surgical Intervention: In some cases, surgical intervention may be required to repair the uterine perforation and address any associated complications.

The risks of infection and uterine perforation, while relatively uncommon, must be carefully considered in the context of the benefits IUPCs offer in monitoring and managing labor. A comprehensive understanding of prevention strategies and management protocols allows clinicians to utilize IUPCs safely and effectively, ultimately contributing to improved maternal and fetal outcomes.

Guidelines and Recommendations from Professional Organizations

Intrauterine Pressure Catheters (IUPCs) are indispensable tools in modern obstetric care. Their function extends beyond simple monitoring, offering critical insights into uterine activity. These insights are vital for ensuring maternal and fetal well-being during labor. However, like any invasive medical procedure, the use of IUPCs is governed by strict guidelines and recommendations from leading professional organizations. These directives ensure responsible and evidence-based application of the technology.

ACOG Recommendations on IUPC Use

The American College of Obstetricians and Gynecologists (ACOG) provides comprehensive guidance on the appropriate utilization of IUPCs. These recommendations emphasize the importance of using IUPCs in cases where external monitoring is insufficient. Such situations typically include assessing labor progress in the setting of maternal obesity, or when fetal heart rate tracings are non-reassuring and require further evaluation of uterine activity.

ACOG highlights that IUPCs can be particularly useful in diagnosing and managing dystocia, or abnormal labor progress. By providing precise measurements of contraction strength and frequency, clinicians can make informed decisions regarding the need for labor augmentation with oxytocin or other interventions. It is critical, however, to balance the potential benefits with the inherent risks, such as infection and uterine perforation.

ACOG also stresses the significance of proper training and competency in the insertion, maintenance, and interpretation of IUPC data. Healthcare providers must possess a thorough understanding of uterine physiology and the factors that can influence intrauterine pressure.

This knowledge allows for accurate interpretation of IUPC readings. Accurate interpretation ensures that clinical decisions are based on reliable and valid information.

SMFM Guidelines and the Management of Specific Obstetric Conditions

The Society for Maternal-Fetal Medicine (SMFM) complements ACOG's recommendations. SMFM offers focused guidance on the use of IUPCs in managing specific obstetric conditions. These conditions often include pregnancies complicated by fetal growth restriction, preeclampsia, or other high-risk factors. In these scenarios, IUPCs can play a crucial role in assessing fetal well-being during labor.

SMFM emphasizes the importance of integrating IUPC data with other clinical information. Clinical information includes fetal heart rate patterns, maternal vital signs, and overall clinical context. This holistic approach ensures that management decisions are tailored to the unique needs of each patient.

Moreover, SMFM actively promotes research aimed at refining the use of IUPCs and improving obstetric outcomes. Current research is focused on utilizing IUPC data to develop predictive models for labor progress. The research also includes identifying early warning signs of potential complications.

Navigating the Nuances: Best Practices in IUPC Monitoring

Both ACOG and SMFM advocate for a collaborative approach to IUPC monitoring. This collaboration involves obstetricians, nurses, and other healthcare professionals. This interdisciplinary collaboration should promote a shared understanding of the clinical goals. It should also promote the interpretation of IUPC data.

The use of standardized protocols and checklists can further enhance patient safety and ensure consistent application of best practices. Regular audits of IUPC usage can help identify areas for improvement and promote ongoing quality assurance.

Ultimately, the responsible and judicious use of IUPCs, guided by the recommendations of ACOG and SMFM, can contribute to improved maternal and fetal outcomes. By adhering to evidence-based guidelines and prioritizing patient safety, healthcare providers can harness the full potential of this valuable monitoring tool.

Practical Considerations for IUPC Implementation

Intrauterine Pressure Catheters (IUPCs) are indispensable tools in modern obstetric care. Their function extends beyond simple monitoring, offering critical insights into uterine activity. These insights are vital for ensuring maternal and fetal well-being during labor. However, like any medical device, effective and safe implementation requires careful consideration of practical factors within the clinical environment.

Hospital Utilization: Availability, Protocols, and Best Practices

The availability of IUPCs within a labor and delivery unit is the first essential consideration. Facilities must ensure an adequate supply to meet the needs of their patient population.

This includes not only having a sufficient number of catheters but also ensuring they are readily accessible to clinical staff when needed. A delay in obtaining an IUPC can compromise timely assessment and intervention.

Beyond availability, standardized protocols for insertion, maintenance, and removal are paramount. These protocols should be evidence-based and regularly reviewed to reflect current best practices.

Insertion Protocols

A well-defined insertion protocol should detail the steps involved in the procedure, including patient preparation, catheter placement, and confirmation of proper functioning. This also includes indications, contraindications, and precautions.

The insertion protocols should also outline documentation requirements, ensuring that all relevant information is accurately recorded in the patient's medical record.

Maintenance and Monitoring

Once an IUPC is in place, ongoing maintenance and monitoring are crucial. Protocols should specify the frequency of pressure readings and the parameters for assessing uterine activity.

Protocols should address the management of potential complications, such as catheter displacement or infection. Proper maintenance also involves ensuring the catheter remains patent and free from obstruction.

Removal Protocols

The removal protocol should delineate the criteria for discontinuing IUPC monitoring, as well as the appropriate technique for catheter removal. The proper technique ensures patient safety and comfort.

This should include assessment for signs of infection or other complications following removal.

Monitoring Equipment: Functionality, Calibration, and Accurate Readings

The accuracy and reliability of IUPC readings depend heavily on the functionality and calibration of the monitoring equipment. Regular maintenance and calibration are essential to ensure that the equipment provides precise measurements of intrauterine pressure.

Equipment Functionality

Clinical staff must be thoroughly trained on the proper use of the monitoring equipment, including how to set up the system, interpret readings, and troubleshoot common issues.

Routine checks should be performed to ensure that all components of the monitoring system are functioning correctly. This includes cables, transducers, and display screens.

Calibration Procedures

Calibration should be performed regularly, according to the manufacturer's instructions. This is typically done using a known pressure source to verify the accuracy of the system.

Documentation of calibration procedures is essential to maintain a record of equipment performance and ensure ongoing reliability.

Ensuring Accurate and Reliable Readings

Beyond calibration, several factors can affect the accuracy of IUPC readings. These include the position of the catheter within the uterus, the patient's body position, and the presence of air bubbles in the system.

Clinical staff must be vigilant in identifying and correcting any issues that may compromise the accuracy of the readings. This requires a thorough understanding of the principles of IUPC monitoring and the potential sources of error.

Sterile Technique: Preventing Infection

Maintaining sterile conditions during IUPC insertion is crucial to prevent infection. Adherence to strict sterile technique minimizes the risk of introducing pathogens into the uterus.

Importance of Sterile Gloves and Drapes

The use of sterile gloves is mandatory during the insertion procedure. Gloves create a barrier between the clinical staff's hands and the patient's sterile field.

Sterile drapes should be used to create a sterile field around the insertion site, minimizing the risk of contamination from the surrounding environment.

Aseptic Practices

In addition to sterile gloves and drapes, other aseptic practices are essential. This includes cleansing the insertion site with an antiseptic solution prior to catheter placement.

Care should be taken to avoid touching non-sterile surfaces during the procedure. Proper hand hygiene practices, including thorough handwashing or the use of alcohol-based hand sanitizers, are also critical.

So, there you have it! Hopefully, this guide has demystified the IUPC (intrauterine pressure catheter) for you. It's a valuable tool in labor and delivery, providing important insights to help ensure the best possible outcome for both mom and baby. If you have any further questions about the IUPC intrauterine pressure catheter, don't hesitate to reach out to your healthcare provider.