Authors' Reply

Abstract

We sincerely thank Drs. Qi and Yang [1] for their interest in our work [2]. The observations shared in their correspondence raised valuable points for further clarification.

We appreciate that the infection risk associated with the use of an intrauterine pressure catheter (IUPC) was highlighted in the comments. Evidence from two large RCTs (combined n≈3000 deliveries) comparing IUPC with external monitoring did not demonstrate an increased risk of infection in the IUPC group [3, 4]. However, most of the studies addressing this risk, including the one referenced in the comment letter [1], have been retrospective. As IUPC placement is typically recommended when external monitoring is inadequate or to guide oxytocin augmentation [5], the independent risk attributable to IUPC use remains difficult to determine in a retrospective setting. To minimise procedural risks, IUPC insertion should always avoid the caesarean scar site and the placenta, reducing the potential for uterine perforation or injury to fetal vessels.

The potential of alternative strategies for oxytocin administration, such as amniotomy in cases of reduced uterine activity associated with chorioamnionitis, was raised in the comments. While amniotomy is a prerequisite for IUPC placement, it did not demonstrate specific relevance to uterine activity in our study. Additionally, we wish to emphasise that although the absence of placental histology may be considered a limitation, it represents a retrospective diagnosis and therefore does not support clinical decision-making. A key objective of our clinical study was to support evidence-based decisions during labour, where real-time assessments are essential.

Drs Qi and Yang pointed out how prolonged labour itself poses risks to both maternal and neonatal outcomes. We agree that future research should highlight this. As our analysis of uterine activity was limited to the final 4 h preceding delivery, this could not be addressed within the scope of the current study.

M.J. Is the principal author of the manuscript. T.H., O.P. and J.U. contributed to the study planning and provided critical revisions to the manuscript.

The authors declare no conflicts of interest.