SYSTEMATIC REVIEW article
Front. Med.
Sec. Obstetrics and Gynecology
This article is part of the Research TopicReviews in Obstetrics and Gynecology 2025View all 19 articles
Objective monitoring of postpartum uterine activity: a systematic scoping review
Provisionally accepted
Phebe B.Q. Berben1,2,3*
Marion W.E. Frenken1
Annemarie F. Fransen4Eugenie J.L.G. Delvaux5
Myrthe van der Ven1,3,6
M. Beatrijs Van Der Hout-van Der Jagt1,2,3,6
Guid Oei1,2,3Judith O.E.H. van Laar1,2,3- 1Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, Netherlands
- 2Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- 3Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, Netherlands
- 4Department of Obstetrics and Gynecology, Zuyderland Medical Center, Sittard-Geleen, Netherlands
- 5Department of Science and medical innovation, Máxima Medical Center, Veldhoven, Netherlands
- 6Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Objective: To minimize risks of postpartum hemorrhage, understanding normal postpartum uterine activity is essential. This scoping review summarizes literature on postpartum uterine activity to provide insight into: uterine activity (patho)physiology, characteristics of objective postpartum uterine monitoring methods and the effect of uterotonics on postpartum uterine activity. Data sources: A systematic search was conducted in PubMed, Embase and Cochrane in August 2024 and repeated in January 2025. No filter restrictions were applied. Systematic article selection was performed by two independent reviewers. Eligibility criteria: Articles were included if study participants were ≥ 18 years old and had external tocography (TOCO), intrauterine pressure catheter (IUPC) and/or electrohysterography (EHG) monitoring postpartum. Reviews, case reports, conference papers, technical modeling methods, guidelines, grey literature and duplicates were excluded, as were articles describing non-pregnant, non-human, non-labor studies and intrapartum studies. Study appraisal and synthesis methods: The Newcastle-Ottawa Quality Assessment Scale and the revised Cochrane risk-of-bias tool were conducted to assess study quality. Data was collected and systematically organized by two independent reviewers. Results: 29 articles were included after evaluation of 5826 articles. Data analysis included 23 articles (IUPC n=16, EHG n=6 and TOCO n=1) after risk of bias selection. Uterine contraction frequency without uterotonics ranges between 2.4 and 2.8 contractions per ten minutes and between 3.7 and 4.6 contractions per ten minutes with oxytocin, both decreasing over time. Normal baseline activity after childbirth is ≤ 15 mmHg and normal uterine intensity varied between 51-58 mmHg and 336-396 Montevideo Units. Studies conducted prior to 2020, measuring uterine activity with IUPC or TOCO, report no significant correlation between uterine activity and total blood loss. However, a small study using EHG conducted in 2024, cautiously suggests a positive relationship. This review highlights the need for a uniform and objective method to monitor postpartum uterine activity , to adequately investigate the impact of different uterotonics on uterine activity. Conclusion: The (patho)physiology of postpartum uterine activity remains largely underexplored. EHG shows potential in enhancing our understanding of normal postpartum uterine activity as well as in postpartum hemorrhage recognition and prediction.
Keywords: Myometrial activity, Postpartum, Third stage of labor, uterine contraction (MeSH), uterine monitoring (MeSH)
Received: 11 Sep 2025; Accepted: 21 Jan 2026.
Copyright: © 2026 Berben, Frenken, Fransen, Delvaux, van der Ven, Van Der Hout-van Der Jagt, Oei and van Laar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Phebe B.Q. Berben
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