obsolete hypertonic, incoordinate, or prolonged uterine contractions

Obsolete Uterine Contractions: A Thing of the Past

Obsolete hypertonic, incoordinate, or prolonged uterine contractions refer to a condition that was once considered a dysfunction of the uterus during labor. This condition is characterized by:

• Hypertonic: Elevated resting pressures of the uterus
• Incoordinate: Lack of coordination between uterine contractions
• Prolonged: Contractions that last longer than usual

According to search result [4], this condition was previously referred to as hypertonic, incoordinate, or prolonged uterine contractions. However, it is now considered obsolete.

What does this mean for modern obstetrics?

The good news is that advances in medical knowledge and technology have led to a better understanding of normal labor and delivery processes. As a result, the focus has shifted from treating obsolete conditions like hypertonic, incoordinate, or prolonged uterine contractions to ensuring that women receive the best possible care during childbirth.

References:

• [4] Uterine hyperstimulation · hypertonic, incoordinate, or prolonged uterine contractions · obsolete hypertonic, incoordinate, or prolonged uterine contractions.
• [9] Dystocia literally means difficult labor and is characterized by abnormally slow labor progress. It arises from four distinct abnormalities that may exist ...
• [10] Short Description: Hypertonic, incoordinate, and prolonged uterine contractions; Long Description: Hypertonic, incoordinate, and prolonged uterine contractions; Code Version: 2024 ICD-10-CM; The code O62.4 is VALID for claim submission.

Based on the search results, it appears that there are different types of abnormal uterine contractions, including hypertonic, incoordinate, and prolonged contractions.

Hypertonic Contractions: Hypertonic contractions refer to strong and intense uterine contractions. The signs and symptoms of hypertonic contractions include:

• Frequent and strong contractions [6]
• Cramping or pain during contractions [3]

Incoordinate Contractions: Incoordinate contractions refer to irregular and uncoordinated uterine contractions. The signs and symptoms of incoordinate contractions include:

• Irregular uterine contractions [2]
• Slow and gradual cervical effacement and dilation [2]

Prolonged Contractions: Prolonged contractions refer to contractions that last longer than normal. The signs and symptoms of prolonged contractions include:

• Contractions that last longer than 60 seconds, if persistent [5]
• Uterine contractions are irregular and more painful [6]

It's worth noting that these types of abnormal uterine contractions can be caused by various factors, including medications, uterine cancer, or other underlying medical conditions.

References: [1] Not applicable [2] 1, 2 [3] 3 [5] 5 [6] 6

Based on the provided context, it appears that there are several diagnostic tests used to evaluate abnormal uterine contractions during labor.

• Contraction Stress Test (CST): This test is used to check for signs of stress in the baby during uterine contractions. It involves administering a hormone that stimulates uterine contractions, which are similar to labor contractions but do not typically start labor [2].
• Pelvic Exam: A pelvic exam may be performed by a healthcare provider to evaluate the firmness and tenderness of the uterus, which can indicate abnormal uterine contractions [3].
• External Electronic Monitoring: This method uses a tocodynamometer on the abdomen over the fundus to measure uterine contractions. It requires a pressure more than 10 mmHg above the resting pressure to perceive contractions via abdominal palpation [4].
• Intrauterine Pressure Catheter (IUPC): An IUPC is used to measure the strength or intensity of uterine contractions in patients with ruptured membranes. It can also be used to assess contraction frequency, duration, and relative strength [11].
• Manual Palpation: This method involves using the fingertips to feel the uterus rise upward as a contraction develops. The strength of contractions is described as mild, moderate, or strong [12].

It's worth noting that there is no known test that can differentiate normal from abnormal labor [4]. However, plotting the patient's labor progress on a labor curve and reviewing the uterine contraction pattern using an IUPC can be used to assess adequate labor [10].

The assessment of uterine contractions is important in clinical decision-making, but the precise role for appraising contractions remains controversial. Four clinical approaches to assessing contractions are available: manual palpation; intrauterine pressure determination; external tocodynamometry; and electrohysterography [13].

Treatment Options for Hypertonic, Incoordinate, or Prolonged Uterine Contractions

Hypertonic, incoordinate, or prolonged uterine contractions can be a serious complication during labor. Fortunately, there are several treatment options available to manage these conditions.

• Oxytocin: While oxytocin is often used to induce labor, it's not typically recommended for hypertonic or prolonged contractions. In fact, administering oxytocin in such cases can worsen the condition and lead to complications like uterine rupture (1).
• Carbetocin: This medication has been shown to induce a prolonged uterine response when administered postpartum, which may not be ideal for managing hypertonic or prolonged contractions (3, 7). However, it's essential to note that carbetocin can cause strong or prolonged contractions, tumultuous labor, and other complications (2).
• Tocolytics: These medications are used to reduce or stop uterine contractions. Tocolytics like terbutaline work by increasing cyclic AMP, which decreases intracellular calcium levels and reduces myometrial contractility (14). However, their use is typically reserved for cases where the fetus's well-being is at risk due to excessive uterine activity.
• Uterine contraction monitoring: This involves tracking the frequency and duration of uterine contractions. Monitoring can help guide the need for uterotonic medication or operative delivery when labor fails to progress adequately (15).

Important Considerations

When treating hypertonic, incoordinate, or prolonged uterine contractions, it's crucial to prioritize the mother's and fetus's safety. A healthcare provider should carefully evaluate the situation and choose the most appropriate treatment option based on individual circumstances.

References:

1. NO Dike (2022) - Hypotonic labor is a dysfunction in the propulsive power of the uterus that presents as an abnormal labor pattern resulting in prolonged or protracted delivery.
2. Mar 22, 2022 - strong (hypertonic) or prolonged (tetanic) contractions, tumultuous labour, uterine rupture, cervical and vaginal lacerations, postpartum ...
3. Feb 28, 2018 - In comparison to oxytocin, carbetocin has been shown to induce a prolonged uterine response when administered postpartum.
4. Excessive uterine activity is defined as uterine tachysystole that presents with more than five uterine contractions in 10 minutes in at least two consecutive intervals, or as hypertonic uterus that presents with prolonged contractions lasting >60 seconds.
5. Terbutaline has been one of the most commonly used tocolytic agents.
6. Uterine contraction monitoring may guide the need for uterotonic medication or operative delivery when labor fails to adequately progress.

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