Abnormal Uterine Action
an upset in the normal uterine action – lac k of polarity.
Psychological influence – fear
Disproportion and malpresentation/Malposition e.g.
Breech, occipito posterior position.
Parity: there is always more resistance in first
pregnancy – Primigravida and lasity in the uterine muscle tones in multiparous
women can also give rise to poor neuro-muscular reflex.
Age: Common in elderly primigravidae than in young
Maturity of the pregnancy: Failure in the formation
of the lower uterine segment.
Uterine over-distension as in Twins and
is used when the uterine contractions are weak, short lived (duration),
infrequent, irregular and shallow. The contractions are less painful and the
uterus is well relaxed between contractions. The labour may begin with this
type of contraction and continue throughout the stage of labour. This is known
as “primary uterine inertia”. Usually common with the primigravidae. It is a
faint shadow of normal pattern of labour – so called “False labour.” It has
less effect on cervical dilatation . It leads to prolonged labour, but becomes
stronger in the second stage of labour.
condition may develop during labour when the contractions start well but later
become weak, irregular and infrequent. This is known as “secondary uterine ine
rtia” it is basically uterine exhaustion or uterine fatique. It may occur in
first or second stage of labour. Usually follows excessive uterine action.
Common in impending rupture of uterus e.g. disproportion. (Is a nature’s way of
preventing uterine obstruction or rupture).
third state: It is characterized by flabby and inexcitable state of the uterus.
It gives rise to delay in the separation of placenta or post partum haemorrhage
from partial placental separation and a failure of uterine contraction.
ARM, Syntocinon-small dose 2.5 unit in 450mls at 15
drops per minute.
Correct electrolyte imbalance or loss.
Monitor maternal and fetal conditions (Prevent
7. Fetal blood sampling (P.H) if necessary.
C/S or forceps/vacuum in 2nd stage of
Antibiotic – if membranes have ruptured up to 12hrs
Reassure the patient
Observation of: Vital sign.
Contraction – Frequency, strength
& duration. Effec t on descent of the presenting part.
Vaginal examination, Liquor amni – colour, amount
Accurate fluid balance chart. Urinalysis
is used when there is persistent high tone of uterine contractions during and
in between contractions. Contractions are usually frequent strong without
relaxation and usually very painful with sudden effect on cervical dilatation.
So it may give rise to erratic uterine contraction leading to precipitate
labour. Cervical and perineal tear may occur. Fetal hypoxia may occur, injuries
to the baby’s head. Umbilical cord may tear or cult leading to haemorrhage .
Small dose of oxytocin – 5 unit/litre – To
correctthe rhythm of contractions.
Relief of pain – sedation, Narcotic e.g. valium 10m
g, pethidine100mg /Pethilorfan 2ml.
Correct dehydration and dectrolyte inbalance –
C/S if no progress in cervical dilatation in 4-6hrs
– forceps/vacuum in 2nd stage.
Frequent vaginal examination review.
Early admission with subsequent deliveries.
General nursing care in labour
of vital signs, contractions, urinalysis.
input and output chart.
occurs as a result of lack of polarity (Neuro muscular disharmony) between the
upper and the low pole of the uterus. The contractions are irregular in term of
strength. There is an increase muscle tone in the lower uterine segment, in
some cases even between contractions. This increases the intral uterine
experiences pains or discomfort more than the strength of contraction and it
be a reversal of the uterine action, when the lower segment is contracting
strongly and pains are felt at the back and lower abdomen. The patient feels
pains at the onset, in between and at the termination of the contractions. It
may not be effective thereby leading to prolonged labour. The cervical
dilatation may be very slow; cervical may be very thick, tight and unyielding.
The uterus is tender to touch. There may be early rupture of membranes and
signs of maternal or fetal distress or both.
localized spasm of a ring of circular muscle fibres of the uterus. This occurs
between the two poles at the isthmus. Rare, less than 1-1000. It usually forms
around a narrow part of the fetus (neck) preventing descent but occasionally at
the level of the internal OS. It is a physiological ring but exaggeration of it
is known as BANDL’S RING.
occur in any stage of labour, when it occurs in 3rd stage it is
known as hour glass contraction.
Hypertonic uterine Action
Early rupture of membranes
Interference – Use of oxytocin or manipulation unde
r light or no anaesthesia – Internal version.
No advancement of the presenting part.
Tenderness of the upper uterine segment to touch –
Action is meeting with obstruction.
Could be felt on palpation.
Anaesthesia: before attempting delivery
Sedation – To calm patient and relief pains (but no
effect on the contriction ring).
10mls of 20% solution of magnesium sulphate i.v.
Amyl Nitrite 1 ample to inhale – vasodilator – to r
elieve the muscle spasm.
This is a
condition when there is slow or no dilatation of the cervix even in the
presence of good uterine contractions. It may result from cervical stenosis as
a result of previous cervical tear or infection, amputation, irradiation or
cauterization (cervical erosion).
Cervix feels thin, tight, rigid and unyielding
first then later becomes thick and oedematous.
There may be caput on the presenting part.
Labour is marked with severe back ache.
hypertonic uterine Action.