S
S
S
R
R
R
F
F
F
6
6
6
1
1
1
8
8
8
B
B
B
6
6
6
U
U
U
s
s
s
e
e
e
r
r
r
’
’
’
s
s
s
M
M
M
a
a
a
n
n
n
u
u
u
a
a
a
l
l
l
～38～
transducers are fixed, make sure FH sounds from three channels are clear, three FHR traces and three FHR
numerics are displayed on the screen.
NOTE:
To ensure that three transducers stay at the optimum location, each transducer should be fixed with a separate
belt. The procedures and any contra-indications that apply for twins monitoring also apply for monitoring
triplets. Be aware that monitoring three FHRs is inherently more difficult than monitoring single or twin
FHRs. The nature of the application increases the likelihood that a fetal heart rate is monitored by more than
one transducer. And please refer to section 8.3.1 for Separating FHR Traces.
8.5 Monitoring Uterine Activity Externally
The external Toco transducer measures the frequency, duration and relative strength of contractions, but not
their absolute intensity. Amplitude and sensitivity depend on various factors such as the position of the
transducer, the belt tension and the size of the patient.
8.5.1 Parts Required
TOCO transducer
Belt
8.5.2 TOCO Monitoring Procedure
1) Placing Transducer Belt
Place the transducer belts across the bed, ensuring that the belt will be around the abdomen when it is
fastened. Lay the patient on the bed.
Alternatively, the patient can take a sitting position. Arrange the belt around her abdomen.
2) Fixing the Transducer
Wipe any gel remaining on abdomen around the fundus area.
Place the TOCO transducer on the patient’s abdomen, which is flat and approximately 3 cm away from the
fundus, e.g. slightly above the umbilicus on the left or on the right. The position should be different for
different purposes: place the transducer close to the fetal buttocks for NST, and place it on fetal back in
delivery.
Wrap the abdomen with the belt over the transducer. Fix the transducer by pushing its buckle through the
overlapping section of the belt. Make sure the belt fits the patient snugly but comfortably.
3) Adjusting the Numeric to Zero
Press the ZERO key
to adjust the numeric to the baseline. Make sure this is not done during a
contraction.
The uterine activity reading at this point should be 30 ~ 90. A flat-top aligned with 100 on the TOCO scale
indicates the belt is too tight, and you need to adjust it.
Wipe off any gel presents on abdomen around this area.
NOTE: Do not apply aquasonic coupling gel on a TOCO transducer or its contact area.
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