Can I prevent extraovular placement?

The rate of extraovular placement can be minimized if several steps are taken. The practitioner should pay careful attention to make an adequate amniotomy and direct the catheter into that opening. Also, when advancing the catheter, minimal resistance should be encountered (unless the fetal head is wedged in the maternal pelvis at the outlet). Thus, if resistance is encountered, the catheter should be withdrawn and redirected.

The best way to confirm proper placement is to watch for a flashback of amniotic fluid in the IUPC amniolumen. If a flashback of frank-red blood is seen, the operator should withdraw and redirect the catheter. A study has shown that 86% of the time, after a blood flashback is seen and the catheter is withdrawn and repositioned up to three (3) times, the catheter will be positioned correctly within the amniotic sac.

To do this use an IUPC with a clear amniolumen or remove the amnioport cap from catheters with opaque amniolumens so fluid can be seen flowing from the amnioport. If you are using a fluid-filled system, insert the catheter without pre-priming it and allow the flashback of amniotic fluid to fill the lumen. If the catheter is not specifically designed for amniotic fluid flashback, make sure you leave the cap off the amnioport or fluid cannot flashback.

Does any blood flashback indicate improper placement?

It is important to decipher between frank blood (bright red blood) and blood-tinged fluid. The majority of the time frank blood flashback will be consistent with extraovular placement. However, other possibilities could be the cause of blood-tinged fluid in the catheter, such as blood present in the vagina or at the cervix secondary to labor changes of the cervix. This small amount of blood can be introduced into the catheter upon insertion and when mixed with amniotic fluid, appear to be a significant "blood flashback". Thus, when considering repositioning the catheter, it is important to consider the ease of insertion.

Upon catheter removal, the catheter tip can also be examined for evidence of blood or placental tissue-consistent with extraovular placement, or vernix-consistent with intraamniotic placement.

Are all catheters susceptible to extraovular placement?

It is important to remember that ALL intrauterine pressure catheters have a tendency for extraovular placement and that it happens regardless of operator experience unless steps are taken to prevent it.

If there is blood in the catheter can I reposition it?

Yes, the amniolumen where the blood flashback is seen is separate from the closed-system measuring the pressure within the uterine cavity. The only concern is that if a significant amount of blood is introduced into the lumen and is not flushed appropriately, the blood may clot and make amnioinfusions difficult or impossible. But, if the catheter is repositioned within the amniotic sac and communicating freely with amniotic fluid, the pressure readings will be accurate, regardless of the presence of blood.

What catheters are designed for fluid flashback?

The Koala’s clear amniolumen and hydrophobic amnioport cap allow practitioners to verify proper placement, by observing flashback of amniotic fluid.  The catheter is marked to remind the practitioner to pause for flashback while inserting when only 10-12 cm of the catheter has been introduced within the uterine cavity, limiting the placental violation before it is withdrawn and redirected if it has been placed extraovular.

What the Koala IUPC offers, unlike any other catheter on the market, is the ability to confirm placement.  This feature may prevent dangerous amnioinfusions, placental abruptions and perforations, fetal heart rate abnormalities and artifactual waveforms when making important clinical decisions.