Abnormal Uterine contractions can lead to various maternal and fetal complications during labor. So proper management is necessary.

1. UTERINE INERTIA
PRECIPITATE LABOUR
UTERINE TETANY
LIPI MONDAL
M.SC NURSING 2ND YEAR
CON, JIPMER

2. OBJECTIVES
• Normal uterine contraction
• Types of abnormal uterine contraction
• Details regarding uterine inertia,
precipitate-labor & uterine tetany
• Nursing management.

3. NORMAL UTERINE ACTION
• Regular interval
• Interval become shorten
• Intensity gradually increases
• Discomfort in the back and abdomen
• Associated with cervical dilatation
• Discomfort not relieve by sedation

5. NORMAL
UTERINE ACTION
• Coordinated uterine contractions
• Associated with progressive dilatation of the
cervix
• Decent of the fetal head

6. QUESTIONS???
• Polarity of the uterus?
• Pacemakers?
• Pattern of contractions?

7. PARAMETERS OF UTERINE CONTRACTION
• Basal tone Peak
pressure
Frequency of contraction

8. ABNORMAL UTERINE ACTION
Any deviation of the normal pattern of uterine
contractions affecting the course of labor is designated
as disordered or abnormal uterine action.
Nulliparous?
Multipara?
INCIDENCE

9. CLASSIFICATION OF ABNORMAL
UTERINE ACTION

10. UTERINE INERTIA
• Weak, infrequent, inefficient uterine action
• Uterine contraction……..
Interval_________
Intensity_________
Duration ___________
Relaxation ______ in between contractions.

11. ETIOLOGY

12. Primary Secondary
TYPES:

13. SIGNS AND SYMPTOMS
Patient feels less pain and discomfort during pain.
Per abdomen:
Less hardening of uterus
Uterine wall easily indictable
Fetal parts well palpable
FHR normal
Per vaginal:
Poor cervical dilatation, membrane intact
Associated contracted pelvis, malpresentation

14. COMPLICATIONS

15. MANAGEMENT
OF UTERINE INERTIA

16. PRECIPITATE LABOR
• Precipitate delivery refers to a
delivery which results after an
unusually rapid labor (combined 1st
stage and second stage duration is
<2hrs) and culminates in the rapid,
spontaneous expulsion of the infant.

18. QUESTIONS
• It is common in _____________para.
• Due to ______uterine contraction and
__________ soft tissue resistance.

19. CAN BE HAPPEN?
PERINEAL TEAR UTERINE RUPTURE
PPH INVERSION
INFECTION AMNIOTIC
FLUID EMBOLISM

20. INTRACRANIAL HEMMORHAGE
SKULL INJURY CORD TORN

21. • It is a retrospective diagnosis.
• Partogram will show rapid progress of cervical
dilatation and effacement.

22. MANAGEMENT
• If past history ,early admission
• Maintaining partograph.
• During delivery, rarely administration of
nitrous oxide or sedation.

23. • AFTER DELIVERY---
Exploration of birth canal and manage
accordingly
Prophylactic antibiotics
Proper examination of fetus

24. UTERINE TETANY
• Generalized tonic contraction.
• Pronounces retraction occurs involving whole of the
uterus up to the level of internal os.
• So there is no physiological differentiation of the
active upper segment and the passive lower
segment of the uterus.
• As there is no thinning of the lower segment , there
is no chance of rupture of the uterus.
• Uterine contraction ceases and the whole uterus
undergoes a sort of tonic muscular spasm holding
the fetus inside (active retention of the fetus)

25. A condition characterized by uterine contractions
that are extremely prolonged. This condition may be
life threatening to the fetus.

26. CAUSES
• Failure to overcome uterine contractions.
• Injudicious administration of oxytocin.
• Irritation caused by instrumental delivery.

27. FEATURES
Subjective:
Per abdominal examination:
• Uterus smaller than size,
tender, tense
• Fetal parts ?
• FHR ?

28. Per vaginal examination--
• Dry edematous vagina
• Jammed head with
big caput

29. MANAGEMENT
• Pain relief
• Correction dehydration
• Tocolytic agent administration
• Antibiotics
• Cesarean section

30. NURSING MANAGEMENT

31. JOURNAL ARTICLE
• Morphological features of the myometrium in
connective tissue dysplasia in women with uterine
inertia
Konovalov PV1, Mitrofanova LB1, Gorshkov
AN1, Ovsyannikov FA1.
OBJECTIVE:
To reveal the morphological features of the
lower uterine segment myometrium in connective
tissue dysplasia (CTD) in women with uterine inertia.

32. MATERIAL AND METHODS:
Histological, immunohistochemical, electron
microscopic, and electron immunocytochemical
studies with morphometry of myometrial fragments
from 15 parturient women with CTD and uterine
inertia (a study group) and those from 10 women
without CTD (a control group).
RESULTS:
The myometrium in CTD exhibited the decreased
expression of connextin-43, fibulin-5, TIMP-1,
collagens types I and III with collagen type III.
CONCLUSION:
A set of found myometrial changes in women
with uterine inertia is a manifestation of CTD.

33. •CHECKPOINT??????/

34. BIBLIOGRAPHY
•
• Jacob A. “Mannual Midwifery and gynaecological Nursing”. New delhi,jaypee
brothers:2012, pg:381-3.
• Mckinney ES, James SR, Murray SS, Ashwill JW. “Matrnal child Nursing”.canada,
Elsevier: 2009,pg:509-30.
• Dutta’s DC. “Text book of obstetrics”. west Bengal, India: New Central Book of
Agency:2011,pg :444-6.
• Salhan S. “Text book of Obstetrics”. New Delhi, India: jaypee
brothers:2014,pg:509-13
• Saili A, Bhat S, Shenoi A, “ obstetrics principles and practice”. New delhi, jaypee,
3rd edition;2005.
• Pg:439-54.