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OBSTETRICS

Defining uterine tachysystole: how much is too much?

Robert D. Stewart, MD; April T. Bleich, MD; Julie Y. Lo, MD; James M. Alexander, MD;
Donald D. McIntire, PhD; Kenneth J. Leveno, MD
OBJECTIVE: We sought to determine if uterine tachysystole, 6 con-

RESULTS: Adverse infant outcomes showed no association with in-

tractions per 10 minutes, within the first 4 hours of labor induction, is

associated with adverse infant outcomes.

creasing number of contractions per 10 minutes. Six or more contractions in 10 minutes were significantly associated with fetal heart rate
decelerations (P .001). Analysis was performed using the maximum
number of contractions per 30 minutes with similar results.

STUDY DESIGN: This was a prospective cohort study of 584 women

37 weeks gestation undergoing induction of labor with 100 g of

oral misoprostol. Fetal heart rate tracings were analyzed for contractions per 10 minutes during the initial 4 hours after misoprostol administration. Patients were analyzed based on the maximum number of
contractions per 10 minutes. Infant condition at birth was assessed using the fetal vulnerability composite.

CONCLUSION: Uterine tachysystole, as currently defined, when occurring

remote from delivery is not associated with adverse infant outcomes.

Key words: abnormal labor, misoprostol, uterine hyperstimulation,
uterine tachysystole

Cite this article as: Stewart RD, Bleich AT, Lo JY, et al. Defining uterine tachysystole: how much is too much? Am J Obstet Gynecol 2012;207:290.e1-6.

n 2008, the Eunice Kennedy Shriver

National Institute of Child Health
and Human Development (NICHD)
proposed definitions for the interpretation of fetal heart rate (FHR) tracings.
Within these definitions, uterine activity
was quantified as the number of contractions present in a 10-minute window, averaged over 30 minutes. Uterine tachysystole was defined as 6 contractions in
10 minutes. Subsequently, in July 2009,
the American Congress of Obstetricians
and Gynecologists (ACOG) affirmed
this definition of uterine tachysystole.1,2
This definition of excessive uterine activity is the standard for current clinical
practice, despite the fact that little evi-

From the Department of Obstetrics and

Gynecology, University of Texas Southwestern
Medical Center, Dallas, TX.
Received April 30, 2012; revised June 21,
2012; accepted July 25, 2012.
The authors report no conflict of interest.
Presented at the 32nd annual meeting of the
Society for Maternal-Fetal Medicine, Dallas, TX,
Feb. 6-10, 2012.
Reprints: Robert D. Stewart, MD, Department
of Obstetrics and Gynecology, University of
Texas Southwestern Medical Center, 5323
Harry Hines Blvd., Dallas, TX 75390-9032.
Robert.Stewart@UTSouthwestern.edu.
0002-9378/$36.00
2012 Mosby, Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ajog.2012.07.032

290.e1

dence exists as to the clinical utility of

this definition. Current clinical concerns
regarding uterine tachysystole include
the possibility of decreased fetal oxygenation due to inadequate relaxation time
between contractions.3,4 It has been suggested that this decreased oxygenation
during excessive contractions would result in a progressive decline in fetal oxygenation to a critical level. Based on fetal
oxygenation studies some investigators
have advocated changing the definition
of uterine tachysystole to a more restrictive 5 contractions in a 10-minute
epoch.5
The purpose of our study was to determine if uterine tachysystole, as currently
defined by ACOG, 6 contractions in 10
minutes, when occurring within the first
4 hours of labor induction, is associated
with adverse infant outcomes. We also
sought to determine at what threshold of
uterine activity these adverse infant outcomes occurred.

M ATERIALS AND M ETHODS

This is a prospective cohort study of
women undergoing misoprostol induction of labor at Parkland Hospital from
March 17, 2009, through December 31,
2010. This study was approved by the institutional review board of the University of Texas, Southwestern Medical
Center. Written informed consent was

American Journal of Obstetrics & Gynecology OCTOBER 2012

waived because this study was limited to

observations during standard clinical
care.
During the study period, our standard
practice of misoprostol induction was to
give 100 g of oral misoprostol for a
maximum of 2 doses, 4 hours apart.6 All
consecutive women who qualified for
misoprostol induction according to our
standard criteria were eligible for this
study. Those women with a fetal demise
or those who had incomplete data were
excluded from study. A woman qualified
for the initial dose of misoprostol if the
pregnancy was a singleton, cephalic,
term gestation (37 weeks) without evidence of active labor, defined a cervical
dilatation of 4 cm, with 30 minutes of
reassuring FHR tracing without decelerations and 6 contractions per 10 minutes prior to receiving misoprostol. After
4 hours the woman was evaluated to assess if she qualified to receive the second
dose of misoprostol. She did not receive
the second dose if during the preceding 4
hours there were 6 contractions in any
10-minute epoch, any FHR decelerations, or if she had progressed to active
labor. Those women who were unable to
receive a second dose of misoprostol but
needed further stimulation of labor received oxytocin infusion. Misoprostol
has previously been shown to be an effective induction agent, with a reported

Obstetrics

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TABLE 1

Demographic characteristics in
584 women undergoing labor
induction
Characteristic

No. of women,
n 584

Parity

..................................................................................................

288 (49)

112 (19)

..................................................................................................
..................................................................................................

184 (32)

...........................................................................................................

Epidural

370 (63)

...........................................................................................................

Maternal age, y

25.9 6.3

...........................................................................................................

Race/ethnicity

..................................................................................................

Hispanic

465 (80)

..................................................................................................

African American

70 (12)

White

32 (5)

Other

17 (3)

..................................................................................................
..................................................................................................
...........................................................................................................

Pregnancy
complications

..................................................................................................

Diabetes

63 (11)

..................................................................................................

Hypertension

141 (24)

Severe
preeclampsia

89 (15)

..................................................................................................

..................................................................................................

Abruption

..................................................................................................

Premature ruptured
membranes

164 (28)

Postterm induction

151 (26)

..................................................................................................
...........................................................................................................

All data shown as n (%) or mean SD.

Stewart. Defining uterine tachysystole. Am J Obstet
Gynecol 2012.

rate of uterine tachysystole of 25% (6

contractions in 10 minutes without decelerations spanning 20 minutes).6 Our
standard practice for treatment of tachysystole with associated prolonged decelerations was cesarean delivery for nonreassuring FHR. In those women with
tachysystole and late decelerations, the
woman was placed in the lateral decubitus position with administration of oxygen. If the late decelerations persisted,
cesarean delivery was performed for
nonreassuring FHR. If the tachysystole
was associated with variable decelerations, the woman was placed in the lateral decubitus position with oxygen administration if needed. In both of these
circumstances, the second dose of misoprostol would not be administered. If the
woman had uterine tachysystole without

associated decelerations, we would continue to monitor for evidence of fetal distress, however the second dose of misoprostol would not be administered.
At the conclusion of labor, the paper
copy of the FHR tracing was collected.
The contraction patterns were recorded
with tocodynamometer unless an intrauterine pressure catheter was placed for
obstetrical indications. These tracings
were subsequently analyzed by visual assessment for the number of contractions
per each 10-minute epoch during the
initial 4 hours of misoprostol induction.
In addition, for each 10-minute epoch
the presence of uterine hypertonus, defined as a contraction lasting 120 seconds, was recorded. Similarly, variable,
late, or prolonged decelerations and fetal
tachycardia or bradycardia were recorded, using standard definitions as
outlined by ACOG.2 The time and mode
of delivery was also recorded. All FHR
tracing analysis was conducted by 1 investigator (R.D.S.) who was blinded to
the infant outcomes.
Obstetric and infant clinical outcome
data were obtained using the preexisting
Parkland Hospital obstetric database.
Nurses attending each delivery complete
an obstetric data sheet, and research
nurses assess the data for completeness
and consistency before electronic storage. Data on infant outcomes are also abstracted from discharge records and entered into a separate database. The
outcome of interest for this study was infant condition at birth assessed using a
composite outcome termed the fetal vulnerability composite, which included:
5-minute Apgar scores 3, umbilical artery blood pH 7.1, intubation in the
delivery room, neonatal seizures, admission to intensive care, or perinatal death.
These results were electronically linked
to the previously collected FHR tracing
analyses. Patients were then divided into
4 groups based on the greatest number of
contractions within any 10-minute epoch during the initial 4 hours of labor
induction: 4, 5, 6, 7 contractions per
10 minutes. Analysis was also performed
using the maximum number of contractions per 10 minutes averaged over 30
minutes.

Research

Prior to commencing the study now

reported, we assessed the rate of the primary outcome composite using a pilot
study of 187 cases meeting the criteria for
this study now reported. The fetal vulnerability composite occurred in 5% of
the pilot cohort. These 187 cases were
not included in the analysis of outcomes
now reported because inclusion of this
previously analyzed cohort could potentially bias our final results.
Using 80% power for a 2-sided test of
.05 significance, we estimated that 584
women receiving misoprostol would
need to be examined to detect a significant difference in the fetal vulnerability
composite. Statistical analysis included
Pearson 2, Cochran-Mantel-Haenszel
2 for trend, and analysis of variance.
P values .05 were considered significant. Analysis was performed using SAS
9.2 (SAS Institute Inc, Cary, NC).

R ESULTS
A total of 584 women undergoing induction of labor with misoprostol were analyzed. Maternal demographic characteristics and pregnancy complications are
shown in Table 1.
Of the women undergoing induction,
253 (43%) had at least one 10-minute
epoch with 6 contractions during the
initial 4 hours of induction; however
when averaged over 30 minutes, 129
(22%) of the 584 women met this criteria
for uterine tachysystole. Of the 584
women within the cohort, 253 (43%) required oxytocin infusion. Intrauterine
pressure catheters were placed in 519
women (89%) during their labor. Infant
outcomes, both the composite and individual components of the composite, according to number of uterine contractions per 10 minutes during the first 4
hours of induction are shown in Table 2. The fetal vulnerability composite
showed no association with increasing
number of uterine contractions, and no
individual component was significantly
associated with increasing number of
uterine contractions. Route of delivery
similarly showed no association with the
number of contractions per 10 minutes.
When the infant outcomes were analyzed
using the number of contractions averaged

OCTOBER 2012 American Journal of Obstetrics & Gynecology

290.e2

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TABLE 2

Infant outcomes related to contractions per 10 minutes

Maximum contractions per 10 min
Outcome
Fetal vulnerability composite:

<4, n 152

5, n 179

6, n 134

>7, n 119

P value

5 (3)

6 (3)

2 (1)

6 (5)

.86

5-min Apgar 3

1 (1)

.86

Umbilical artery pH 7.1

1 (1)

4 (2)

2 (1)

6 (5)

.06

Seizures

Intubation at delivery

1 (1)

.11

Stillborn

Neonatal death

NICU admission

5 (3)

3 (2)

1 (1)

.03

9.5 [4.9, 15.0]

8.9 [4.3, 13.2]

.18

.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................

................................................................................................................................................................................................................................................................................................................................................................................
a

Misoprostol to delivery time, h

10.3 [6.7, 15.5]

10.6 [5.9, 15.0]

................................................................................................................................................................................................................................................................................................................................................................................

Route of delivery

.......................................................................................................................................................................................................................................................................................................................................................................

Cesarean

31 (20)

35 (19)

26 (19)

17 (14)

.34

121 (80)

144 (81)

108 (81)

102 (86)

.28

.......................................................................................................................................................................................................................................................................................................................................................................

Vaginal

................................................................................................................................................................................................................................................................................................................................................................................

All data shown as n (%) unless otherwise indicated. P value is for Mantel-Haenszel 2 for trend.
NICU, neonatal intensive care unit.
a

Kruskal-Willis test. Data shown as median [1st quartile, 3rd quartile].

Stewart. Defining uterine tachysystole. Am J Obstet Gynecol 2012.

over 30 minutes, there was still no significant association between an increasing

number of contractions and infant outcome, as reflected by the fetal vulnerability
composite or any individual component of

the composite (Table 3). However, admission to neonatal intensive care was
associated with decreasing uterine contractions when analyzed per 10 minutes
or per 30 minutes (P .03 and P .04).

Of those infants without uterine tachysystole admitted to intensive care, 1 was

due to a previously undiagnosed palate
abnormality, 1 due to a hypoplastic left
heart, and 1 for observation for an at-

TABLE 3

Infant outcomes related to contractions per 30 minutes

Maximum contractions per 30 min
Outcome
Fetal vulnerability composite

<13, n 292

14-16, n 163

10 (7)

17-19, n 83

>20, n 46

P value

3 (2)

2 (1)

4 (3)

.82

.......................................................................................................................................................................................................................................................................................................................................................................

5-min Apgar 3

1 (1)

.33

Umbilical artery pH 7.1

4 (3)

3 (2)

2 (1)

4 (3)

.06

Seizures

Intubation at delivery

1 (1)

.33

Stillborn

Neonatal death

NICU admission

8 (3)

1 (2)

.04

9.7 [5.0, 14.8]

8.8 [4.4, 15.7]

8.8 [3.9, 11.8]

.03

.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................................................................................................................................................
a

Misoprostol to delivery time, h

10.8 [6.7, 15.7]

................................................................................................................................................................................................................................................................................................................................................................................

Route of delivery

.......................................................................................................................................................................................................................................................................................................................................................................

Cesarean

65 (22)

26 (15)

12 (14)

6 (13)

.02

137 (85)

71 (86)

40 (87)

.04

.......................................................................................................................................................................................................................................................................................................................................................................

Vaginal

227 (78)

................................................................................................................................................................................................................................................................................................................................................................................

All data shown as n (%) unless otherwise indicated. P value is for Mantel-Haenszel for trend.
NICU, neonatal intensive care unit.
2

Kruskal-Willis test. Data shown as median [1st quartile, 3rd quartile].

Stewart. Defining uterine tachysystole. Am J Obstet Gynecol 2012.

290.e3

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Research

TABLE 4

Fetal heart rate decelerations related to uterine contractions

Contractions per 10 min
Decelerations

<4,
n 152

5,
n 179

Contractions per 30 min

a

6,
n 134

>7,
n 119

P value

<13,
n 292

14-16,
n 163

17-19,a
n 83

>20,
n 46

P value

Any

61 (40)

88 (49)

77 (57)

69 (58)

.001

125 (43)

94 (58)

48 (58)

28 (61)

.001

Variable

48 (32)

78 (44)

64 (48)

62 (52)

.001

102 (35)

84 (52)

41 (49)

25 (54)

.001

Late

24 (16)

38 (21)

34 (25)

31 (26)

.02

54 (18)

38 (23)

24 (29)

11 (24)

.05

Prolonged

10 (7)

16 (9)

17 (33)

19 (16)

.017

24 (8)

19 (12)

9 (11)

10 (22)

.03

................................................................................................................................................................................................................................................................................................................................................................................
a
a
................................................................................................................................................................................................................................................................................................................................................................................
a
a
................................................................................................................................................................................................................................................................................................................................................................................
a
a
................................................................................................................................................................................................................................................................................................................................................................................

All data shown as n (%). P value is for Mantel-Haenszel 2 for trend.

a

Cutpoint for threshold of most significant P value based on minimum P value technique and adjusted with Bonferroni technique.

Stewart. Defining uterine tachysystole. Am J Obstet Gynecol 2012.

tempted maternal naproxen overdose

prior to presentation to labor and delivery. The remaining cases were admitted
to intensive care for unanticipated reasons, including sepsis evaluation and respiratory distress syndrome. Route of
delivery was found to be associated with
the number of contractions per 30 minutes, with vaginal delivery being more
likely with increasing number of contractions per 30 minutes (P .04). Overall, 109 (19%) of the women underwent
cesarean delivery. The most common
reason for cesarean delivery was labor
dystocia (n 54, 50%), followed by FHR
abnormalities (n 52, 47%). Time from
misoprostol administration to delivery
was significantly less with increasing
numbers of contractions per 30 minutes
(P .03).
FHR decelerations were associated
with increasing number of contractions
(Table 4). Analysis of decelerations of
any configuration in relation to 4
through 7 contractions per 10 minutes
showed a significant trend. A significant
similar trend was also observed when
contractions 13 through 20 per 30
minutes were analyzed. We then reanalyzed these data looking for a cutpoint,
a threshold that provides the best discrimination for decelerations. We used
the minimum P value method for this
analysis.7 We then used a Bonferroni
correction to adjust the P values.8 Based
on this statistical technique, we found
that 6 contractions per 10 minutes, as
well as 17-19 per 30 minutes, were the
cutpoints at which the most significant

P value for all possible cutpoints was

observed.
A total of 89 women (15%) experienced 1 episodes of uterine hypertonus. Uterine hypertonus was not associated with any measure of adverse infant
outcome (Table 5). Those women who
had 2 episodes of uterine hypertonus
within the first 4 hour of induction were
significantly more likely to undergo cesarean delivery (P .013), and were significantly more likely to have FHR tracings with late or prolonged decelerations
(P .001).

C OMMENT
Increasing uterine activity during the
first 4 hours of labor induction, quantified as the maximum number of contractions in 10 minutes, or per 30 minutes,
had variable effects depending upon the
outcome of interest. For example, adverse infant outcomes were not related to
the number of uterine contractions per
time period. On the other hand, increased number of contractions per 30
minutes was associated with a significantly increased rate of vaginal birth, and
consequently the opposite effect on cesarean delivery. Time from misoprostol
administration to delivery was also significantly shorter with increased number
of contractions per 30 minutes. Similarly, increased uterine activity, defined
as 6 contractions per 10 minutes and
17-19 per 30 minutes, was associated
with increased FHR decelerations.
Lastly, uterine hypertonus was associated with increased late and prolonged

FHR decelerations, as well as cesarean

delivery.
Previous reports regarding excessive
uterine activity have focused on the effects of uterine contractions on fetal oxygenation.3-5,9 It was found that the average drop in fetal oxygenation, as
measured by pulse oximetry during uterine tachysystole, defined as at least 1 contraction every 2 minutes, was 18%, from
a fetal oxygen saturation of 54-36%, and
that recovery is incomplete if the contraction interval is 2 minutes.4 Using
changes in the concentration of oxyhemoglobin and deoxyhemoglobin measured by infrared spectroscopy as surrogate markers for cerebral oxygen
saturation during labor, Peebles et al3
determined, using regression line analysis, that a contraction interval of 2-3
minutes was the threshold below which
oxyhemoglobin levels consistently fell.
The authors concluded that a short contraction interval, 2-3 minutes, was associated with a decrease in fetal cerebral
oxygen saturation. Expanding upon
these studies, Simpson et al5 evaluated
the effects of uterine contractions on fetal oxygen saturation as measured by
pulse oximetry in 56 healthy nulliparous
women undergoing oxytocin induction
of labor. In patients with 5 contractions
per 10 minutes, a negative 20% change in
fetal oxygen saturation from 52-42% was
found. In patients with 6 contractions
per 10 minutes, a negative 29% change in
fetal oxygenation from 52-37% was
found. These findings led the authors to
conclude that a definition of uterine
tachysystole as 5 contractions per 10

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TABLE 5

Selected outcomes in relation to uterine hypertonus events

Uterine hypertonus events
Outcome
Cesarean delivery

0, n 495

1, n 70

85 (17)

17 (24)

2, n 19
7 (37)

P value
.013

..............................................................................................................................................................................................................................................

Decelerations

.....................................................................................................................................................................................................................................

Any

237 (48)

46 (66)

12 (63)

.006

Variable

208 (42)

38 (54)

6 (32)

.54

Late

93 (19)

23 (33)

11 (58)

.001

Prolonged

38 (7)

20 (29)

4 (21)

.001

.....................................................................................................................................................................................................................................
.....................................................................................................................................................................................................................................
.....................................................................................................................................................................................................................................
..............................................................................................................................................................................................................................................

5-min Apgar 3

1 (0.2)

.69

1 (1)

.69

..............................................................................................................................................................................................................................................

Umbilical artery pH 7.1

12 (2)

..............................................................................................................................................................................................................................................

NICU admission

9 (2)

.23

Intubation at delivery

1 (0.2)

.69

..............................................................................................................................................................................................................................................
..............................................................................................................................................................................................................................................

All data shown as n (%). P value is for Mantel-Haenszel 2 for trend.

NICU, neonatal intensive care unit.
Stewart. Defining uterine tachysystole. Am J Obstet Gynecol 2012.

minutes may be more appropriate.5 It

has previously been found that a fetal oxygenation threshold of 30% would be a
reasonable threshold for detection of fetal hypoxemia, and that this threshold
was also useful in detecting fetal compromise.10,11 This threshold, however,
was not met in these prior studies of
uterine tachysystole.3-5 Bakker et al12 examined uterine contractions and their
effect on umbilical artery pH. In their
study of 1433 women, deliveries resulting in an umbilical artery pH of 7.11
were compared to those resulting in an
umbilical artery pH of 7.12. It was
found that those deliveries that resulted
in an umbilical artery pH 7.11 had an
average contraction frequency of 5 contractions per 10 minutes.12 However, no
mention was made in this study of FHR
patterns, and infant outcomes were not
analyzed. In contrast, in a study of 605
women who underwent labor induction
or augmentation, 240 (40%) had excessive uterine contractions, defined as 6
contractions in 10 minutes. Despite excessive uterine contractions, the authors
found that adverse infant outcomes were
rare, with only 4 neonates having an umbilical cord pH of 7.0.13 We are of the
view that the available literature now
cited is problematic as to defining a uterine contraction frequency threshold us290.e5

ing adverse effects on the fetus as the

endpoint.
Our results could also be viewed as
problematic, and certain caveats must be
discussed. The duration of each individual contraction has the potential to alter
the relaxation time, and therefore potentially the fetal outcomes. However, this
was not measured in our study because
the duration of contractions is not included in the current national definition
of uterine tachysystole. Similarly, the
strength of contractions was not studied
as this is also not included in the definition of tachysystole. Importantly we analyzed infant outcomes that occurred
many hours subsequent to the observed
uterine tachysystole. It could be argued
that the elapsed time from the incident of
tachysystole to the outcome of interest
could introduce multiple confounding
variables which weaken our results. On
the other hand, our study was designed
to mimic a frequently encountered labor
management scenario, in which uterine
tachysystole occurs remote from delivery. We chose to analyze uterine tachysystole during the first 4 hours after beginning labor induction for several
reasons. First, analyzing uterine contractions late in labor, ie, during the
second stage, while more proximal to
delivery of the infant, can be techni-

American Journal of Obstetrics & Gynecology OCTOBER 2012

cally quite difficult without the placement of an intrauterine pressure catheter because of the much increased
uterine contraction frequency and intensity. Intrauterine pressure catheters
were only placed for routine obstetrical
indications, and therefore were not
placed in all patients. Secondly, we
wanted to study uterine tachysystole in
the setting of labor stimulation because this is the most common clinical
scenario when attention is focused on
uterine tachysystole, and therefore has
the potential to alter management decisions. Thirdly, we chose the labor
pattern following a single dose of misoprostol stimulation because we presumed that standardization of the misoprostol dose as was done would also
serve to standardize the circumstances
under which we were analyzing uterine
tachysystole. Taken together, all these
aforementioned caveats limit our conclusion that brief periods of uterine
tachysystole do not harm the fetus.
Said another way, our results can be
interpreted to mean that self-limited
episodes of uterine tachysystole occurring as a result of labor stimulation remote from delivery are not harmful.
We cannot address the issue as to
whether uterine tachysystole produced
enough intrapartum compromise to result in long-term neurological compromise. However, we point out that none
of the infants in our study who experienced episodes of tachysystole had an
umbilical artery pH 7.0, which is an
obligate criterion to define an acute intrapartum hypoxic event sufficient
enough to result in long-term neurologic
morbidity.14
Our findings that vaginal delivery increased, and time to delivery decreased,
with increasing uterine contractions also
suggests that 6 contractions per 10
minutes vs 5 per 10 minutes, averaged
over 30 minutes, may have an advantage.
This potential advantage, however, must
be tempered by the fact that increasing
contractions impact the FHR pattern.
We find that 6 contractions per 10
minutes, or 17-19 per 30 minutes, as well
as uterine hypertonus, have FHR consequences compared to less frequent contractions or no hypertonus, and that the

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number of contractions can significantly
modify the route of delivery. Based upon
these findings, we believe our results suggest continued use of the NICHD and
ACOG definitions of uterine tachysystole as 6 contractions in 10 minutes,
averaged over 30 minutes. Our results,
although showing there is no difference
in infant outcomes when uterine tachysystole occurs remote from delivery, do
show that uterine contractions of 6 per
10 minutes have a discernible impact on
FHR patterns, and as such justify the
continued use of this threshold.
f
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