HYPOTONIC UTERINE CONTRACTIONS
UTERINE INERTIA
• Etiology and Pathophysiology:
– Overstretching of the uterus --large baby, multiple babies, polyhydramnios, multiple parity
– Bowel or bladder distention preventing descent
– Excessive use of analgesia
• Signs and Symptoms of HYPOTONIC UTERINE INERTIA:
– Weak contractions – become mild
– Infrequent (every 10 – 15 minutes +) and brief,
– Can be easily indented with fingertip pressure at peak of contraction.
– Prolonged ACTIVE Phase
– Exhaustion of the mother
– Psychological trauma - frustrated
Therapeutic Interventions:
1. Ambulation – getting up and walking will increase contractions
2. Nipple Stimulation –causes release of endogenous Pitocin which can stimulate contractions
3. Enema--warmth of enema may stimulate contractions
4. AMNIOTOMY – artificial rupture of the membranes
• Advantages of doing this before Pitocin
– Contractions are more similar to those of spontaneous labor
– Usually no risk of rupture of the uterus
– Does not require as close surveillance
• Disadvantages of an Amniotomy
– Delivery must occur
– Increase danger of prolapse of umbilical cord
– Compression and molding of the fetal head (caput)
• Nursing Care:
– # 1-Check the fetal heart tones
– Assess color, odor, amount
– Provide with perineal care
– Monitor contractions
– Check temperature every 2 hours
5. Pitocin – for augmentation of labor
• Use only if CPD is not present
• Give 20 units / 1000 cc. fluid and hang as a secondary infusion, never as primary
GOAL:
Achieve contractions every 2 - 3 minutes of good intensity with relaxation between
• Nursing Care:
– Assess contractions--are they increasing but not tetanic
– Assess dilation and effacement
– Monitor vital signs and FHT’s