Inefficient uterine activity

Question 1

Insufficient uterine activity
- Definition
- Types

Answer 1

uterine contraction might be weak (hypotonic) or strong (hypertonic) resulting in lack of progression in labor.

• Types: Hypo and hypertonic uterine activity

Question 2

Hypotonic uterine activity

Answer 2

1. Characterized by

a. Low resting tone
b. Irregular contractions.
c. Slow labor progression

2. Complications
   a. Usually no fetal or maternal distress but
   b. Exhaustion
   c. Infection
   d. Hemorrhage

e. Psychologic trauma

Question 3

Hypertonic uterine activity

Answer 3

1. Characterized by

a. High resting tone
B. Increased frequency and duration and decreased intensity (painful contractions)
c. Commonly initiated in the lower uterine segment.

d. Slow labor progression

2. Complications
   a. Exhaustion
   b. Infection
   c. Hemorrhage
   d. Fetal distress (disruption of uteroplacental circulation)
3. Associated with placental abruption

Question 4

Management Insufficient uterine activity

Answer 4

1. Identify lack of progression of labor (slow rate)
2. Exclude cephalopelvic disproportions (assessment of fetal size and maternal pelvis)
3. IV fluid infusion
4. In case of hypotonic

a. Mobilization of the mother and uterine massage.

b. AROM (if membranes are intact)c. Oxytocin.5. In case of hypertonic

a. Analgesics (especially epidural

b. AROM (if membranes are intact)

c. Low dose oxytocin (might reverse uterine activity to normal)

d. C-section in case fetal distress develops and progression is still slow.