HYPOTONIC UTERINE CONTRACTION

Ps of Labor

Powers (contractions)

Passage (pelvis and birth Canal)

Passenger (fetus)

Psyche (response of the woman)

Dystocia

abnormal labor resulting from abnormalities of the 3Ps

First Stage ( Latent Phase)

Mild & Short

20-40 seconds

5 to 10min

1 to 2 contractions/10min

Active Phase

Stronger

40 to 60 seconds

3 to 5 min

2 to 3 contraction/10min

Transition Phase

Strongest

60 to 70 seconds

every 2 to 3 minutes

3 to 5 contractions/10minutes

Second Stage

full dilation & effacement to birth

Third Stage

Placental seperation & placental expulsion

Hypotonic Uterine Contraction

Infrequent contractions (not more than 2-3 occurring in a 10 minute period

Resting tone of Uterus <10mmHg

Strength of contraction does not rise above 25mmHg

Risk Factors (Hypotonic Uterine Contraction)

older primigravida

multiparity (more problems in active phase)

extreme fear release of catecholamines)

anemia

hormonal deficiency (prostaglandins or oxytocin)

improper use of analgesia

Local Factors (Hypotonic Uterine Contractions)

Over distention of uterus

developmental anomalies of the uterus

Myomas of the uterus

Malpresentations, malpositions and cepalopelvic disproportion

full bladder and rectum

Types (Hypotonic Uterine Contractions)

Primary Inertia

Secondary Inertia

Primary Inertia

Weak uterine contractions from the start

Secondary Inertia

Developed after a period of good uterine contractions when it failed to overcome an obstruction so the uterus is exhausted

Clinical Picture

Prolonged Labor

Infrequent uterine contractions

slow cervical dilation

little or no cervical change

less than 0.5 cm/hr progress in cervical dilation

less than 1.0 cm/hr progress in cervical dilation fro a multiparous woman in active labor

membranes are usually intact

more susceptibility for retained placenta and postpartum hemorrhage

increased fear and anxiety levels

Nursing actions

assess uterine activity. Check local discharge every 15 minutes

assess maternal and fetal status. Monitor vital signs every 15 minutes

stimulate uterine activity to achieve a normal labor pattern:

ambulate and change the position of the woman to promote comfort and labor progress

hydrate with IV or PO (dehydration can result in dysfunctional labor)

Administer IV fluids to maximize maternal fluid volume to correct maternal hypotension and improve placental perfusion

augment labor with axytocin

Nursing Action

Evaluate lanor progress with SVE/IE

inform the woman and the family of the progress of labor and explain interventions

provide emotional support

maintain good aseptic technique

minimize vaginal exams

inform the care provider of the woman’s repose and progress in labor

Medical Management

evaluate labor progression

determine the cause of the dysfunction

Medical Management (consider obstetrical interventions)

Augment labor with oxytocin

perform amniotomy

perform cesarean birth when other interventions have failed

vaginal delivery may be done by forceps, vacuum or breech extraction