Can someone explain the toco to me?

  1. 0
    I just had a baby (fourth) two months ago, and it was the worst labor ever. The fastest at 4 hours, but yeah, the worst. At the time, my nurse kept shaking her head, telling me that my contractions were off the charts.

    That got me wondering, when I got home, what was normal. A few places sited tocodynamometer readings of 120-140 were the average. With the last three kids, I remember the readings got as high as 180/190, and labor was still painfully bearable. But this time, the contractions were measuring 240 PLUS and the nurses were shocked.

    So, my question is: Is there ever a reason to worry that the reading is TOO HIGH? I mean, risk of rupture or anything? And would would make them so strong? Any thoughts?

    What's truly the normal range?

    Thanks!
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  3. 5 Comments so far...

  4. 6
    Unless you have INTERNAL uterine pressure monitoring....the intensity of the contraction is pretty meaningless. The external toco is affected by how tight it is applied. Apply it tightly and the height of the contraction "appears" higher (stronger).....apply it loosely, and the height will be lower ("appear" milder). The external toco is good for duration, and frequency of contractions.....but not all that useful for accurate measurement of intensity.

    Hope that answers your question.
    MichelleB34, tvccrn, mitchsmom, and 3 others like this.
  5. 0
    I was about to post the same thing, iteachob.

    I've had patients having moderate to strong contractions (that I palpated) that showed absolutely zip on the monitor. The real hard part (at least for me) is getting docs to believe me when I say she's contracting and nothing's showing up on the EFM.
  6. 1
    Quote from elvish
    i was about to post the same thing, iteachob.

    i've had patients having moderate to strong contractions (that i palpated) that showed absolutely zip on the monitor. the real hard part (at least for me) is getting docs to believe me when i say she's contracting and nothing's showing up on the efm.

    i have found sometimes that switching out the toco cable from another monitor will usually correct this problem.
    MichelleB34 likes this.
  7. 2
    As far as tocodynamics are concerned there can really be no "normal". I tell every labor pt and most of my triage pts that the height of the "hills" means absolutely nothing to me when I look at a strip. There are so many extraneous variables it is not even funny. For example. Position of the toco, position of the baby, position of the mother, size of the baby, size of the mother, thickness of the uterine wall, thickness of the fat layer, how tightly the straps are applied, how old the toco is, how sensitive the toco is, how old the monitor is and how sensitive the monitor is.

    The only thing I care about with external monitoring is when are the contractions happening and what the fetal heart rate does when one happens. I can get that information with my hand better than a toco.

    I am sorry this was your worst labor, but am glad it was your fastest!

    You don't mention how you and your youngest child are doing, I hope all is well.:heartbeat
    jenrninmi and MichelleB34 like this.
  8. 0
    Quote from ragingmomster
    I am sorry this was your worst labor, but am glad it was your fastest!

    You don't mention how you and your youngest child are doing, I hope all is well.:heartbeat
    All is wonderful. Thank you for asking!

    And thanks all for the good replies - I really was quite worried!


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