Uterine Hyperstimulation

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Definition

- Uterine hyperstimulation during pregnancy noted by any one of of the following

-  5 or more uterine contractions in 10min over 30min period

-  Contractions lasting >2min

-  Contractions of normal duration occurring within 60sec of each other

 

Features

- Obstetric emergency

- May occur w or wo fetal heart rage changes on CTG

- Early recognition essential

- Causes poor utero-placental perfusion & decreased fetal oxygenation

-  Fetus requires 60-90sec between each contraction to restore normal oxygen levels

 

Causes

-  Syntocinon infusion

-  Prostin

 

DDx

- Placental abruption

 

Complications

- Ruptured uterus

 

Ix

- Continuous CTG

- Abdo palp: correlate w CTG

 

Mx

- If Cervidil in situ consider removal

- If Prostin in situ consider Terbutaline 250mcg IV or S/C

- Normal CTG

-  Decrease Syntocinon if infusion running

-   Halve rate if uterine activity not reduced by 30min

- Suspicious CTG

-  Decrease Syntocinon if infusion running

-   If CTG improves after 30min can continue w caution

-   If CTG does not improve cease infusion

-  Postion to left lateral

-  IV fluids

- Abnormal CTG

-  Cease Syntocinon infusion

-  VE to assess progress

-  Exclude placental abruption

-  Left lateral position

-  IV fluids

-  +/- scalp lactate

-  If Hypersimulation persists

-   Terbutaline 250mcg IV or S/C

-  +/- Expediated birth if CTG does not improve or scalp lactate >4.7mol/L

 

 

 

References

 

Uterine Hyperstimulation: Fetal Management Guidelne, Southern Health, August 2009