3.3 - Hyperstimulation

Question 1

Describe the difference between hypertonus, tachysystole and hyperstimulation.

Answer 1

• Tachysystole is a uterine contraction rate of more than 5:10 active labour contractions within 10 minutes
  without fetal heart rate abnormalities
• Uterine hypertonus is contractions lasting longer than 2 minutes or occurring within 60 seconds of each other
  without fetal heart rate abnormalities
• Uterine hyperstimulation is tachysystole or uterine hypertonus with fetal heart rate abnormalities

Question 2

What is the normal SpO2 for a well oxygenated fetus?

Answer 2

In uncompromised and adequately breathing infants, SpO2 increases from 50–60% in the fetus

Question 3

What are the effects over 30 minutes to fetal SpO2 when contractions are 5:10 , 6 or >:10.

Answer 3

Question 4

What implications does this have on your midwifery management of labour?

Question 5

What are the implications to the fetus and potentially the mother when uterine activity is excessive?

Question 6

How are these conditions of uterine abnormal action managed?

Question 7

Melanie a multigravida being induced for postdates and has continuous fetal monitoring. It is noted she is contracting 6 in 10 with contractions lasting 45 seconds with resting time of 45 seconds, fetal heart rate pattern is normal. This demonstrates which aspects of excessive uterine activity?

Answer 7

Tachysystole and hypertonus

Question 8

Cervical Dystocia

Answer 8

failure of the cervix to dilate despite presence of uterine contractions

Question 9

Precipitate Labour

Answer 9

expulsion of the fetus within 3 hours of the commencement of contractions

Question 10

Obstructed labour

Answer 10

despite effective uterine contractions, there is no advance of the presenting part.

Question 11

Bandl’s ring

Answer 11

is an exaggerated retraction ring seen as an oblique ridge between the upper and lower segments. This is a sign of obstructed labour.

Question 12

Obstetric Fistula

Answer 12

Is an abnormal opening (usually as a result of ruptured tissues) between the:

Vagina and the urinary bladder, Vagina and rectum, Vagina and urethra, Vagina and ureter.

Question 13

Incoordinate labour

Answer 13

Defective polarity between the upper and lower segments of the uterus, resulting in inefficient, ineffective uterine action that causes prolongation of labour.

Question 14

Sui a multigravida being induced for postdates and has continuous fetal monitoring. It is noted she is contracting 4 in 10 with contractions lasting 90 seconds with resting time of 40 seconds, fetal heart rate pattern is normal. This demonstrates which aspects of excessive uterine activity?

Answer 14

Hypertonus

Question 15

Chen a multigravida being induced for postdates and has continuous fetal monitoring. It is noted she is contracting 5 in 10 with contractions lasting 60 seconds with resting time of 40 seconds, fetal heart rate pattern is abnormal. This demonstrates which aspects of excessive uterine activity?

Answer 15

Hyperstimulation

Question 16

On an intrapartum vaginal examination of a woman in the active phase of labour, four hours after a previous examination, despite uterine activity being assessed as effective, you find that the presenting part has not descended, the presenting part is poorly applied to the cervix with significant moulding and caput and the cervix has not dilated any further. The likely reason for these findings is

Answer 16

obstructed labour

Question 17

On an abdominal palpation of a woman in the active phase of labour, you note an oblique ridge running across her abdomen, that was not noted on previous abdominal examination. The likely reason for this finding is

Answer 17

obstructed labour

Question 18

While assessing a woman in the active phase of labour, you note her to be tachycardic, pyrexic and her urinary catheter bag to contain blood stained urine. The most likely reason

Answer 18

obstructed labour