Wiki.assessment of uterine contractions 2011
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Assessment of Uterine ContractionsAugust 2011
Inpatient Review Course
Sandy Warner RNC-OB, MSN
Electronic Assessment of Uterine Contractions
Electronic assessment monitoring of Contractions is done with: Tocodynamometer when placed on upper portion
of uterus frequency and duration of contractions can be determined
Intrauterine pressure catheter (IUPC) catheter placed in uterus measures pressures in the uterus before during and after contraction is over in mmHg. Palpation between contractions still necessary.
Timing Contractions: Frequency, Duration & Intensity To assess (time) frequency of UC
beginning of one contraction until beginning of next contraction
To assess duration from beginning of contraction until end of
contraction To assess intensity
palpate fundus of uterus to determine firmness of contraction
Tracing of Uterine Activity
Relaxation
Intensity
TOCO placed on upper part of uterus to assess frequency and duration of contractions. Palpation done to determine intensity And relaxation. .
duration
frequency
Timing Contractions:Uterine Resting Tone
To assess relaxation
Palpate fundus of uterus (between UC). Uterus should be very relaxed (soft). If not soft, then not relaxed. Between UC is when fetus gets blood through spiral arteries of uterus. Resting tone palpation needs to be done with either external or internal UC monitoring
Malinowski, 1989 6
Assessment – Uterine Contractions by Palpation
Contraction
Intensity
Mild Moderate Strong
Corresponds to Palpation of
Body Part
Tip of nose Chin Forehead
Place hand on fundus of uterus to assess uterine contractions. Keep hand on fundus throughout several contractions to determine difference between relaxation and contraction increasing in intensity to peak and then decreasing in intensity to relaxation. Use key above.
Intrauterine Pressure Catheter
Requires ROM Pressure of
contractions measured in mm Hg
Provides measurement of strength of UC
Notation must be made of resting tone (should be below 20 mm Hg)
Can be re-zeroed if baseline increases
More accurate due to direct measurement of intrauterine pressure
Terminology for Describing Uterine Activity
Normal Hypotonus and Hypertonus Multiphasic – dysfunctional Tachysystole
Normal, Hypotonic & Hypertonic Contractions
Bell shaped
Uncoordinated contraction pattern
Weak contraction
Uterine Hypertonus
Hypertonus - insufficient relaxation between contractions. Uterus not soft between contractionsIf IUPC in place pressure between UC is 20-25 mmHg.
Multiphasic Contractions – (coupling or tripling) - may be caused by over saturation of uterine oxytocin
receptor sites
Tachysystole
> 5 in 10 minutes contractions averaged over a 30 minute window
Always in relation to the presence or absence of decelerations.
Applies to both spontaneous or stimulated labor
Interventions MUST be performed AND documented
Appropriate management of pitocin is essential
Tachysystole
Administer Oxytocin drip as ordered by Primary Care Provider to achieve cervical dilation and adequate contraction pattern while maintaining a normal Fetal Heart
Rate pattern.
If Tachysystole develops:Contractions lasting > 2 minutes over a 10 minute period
or
>5 (6 or more) Contractions in 10 minutes averaged over a 30 minute periodor
Contractions occurring within 1 minute of each other over a 10 minute period
Is the FHR reassuring?(Moderate variability and absence of recurrent late/variable decelerations)
Category I(Reassuring FHR Tracing)
Continue to observe for approximately 30 minutes as long as FHR is reassuringConsider the following interventions:Maternal position changeIV Fluid hydrationIncreased frequency of observationDocument and report interventions
Did Uterine Tachysystole resolve?
YES NO
Continue increasing Pitocin as ordered
Decrease the Pitocin by ½. Continue to observe for an additional 30 minutes providing the FHR remains reassuring
If uterine Tachysystoledoes not resolve after 60
minutes, notify the provider
Category II / III(Indeterminate/Abnormal FHR Tracing)
Discontinue the Oxytocin administration Notify the provider and document report and interventions used to resolve the clinical situationInterventions:Maternal position changeIVF bolusOxygen at 10-12 LpmIncreased frequency of observationDocument and report interventions
Observe for 10-30 minutes, Pitocinmay be restarted at ½ the previous dose if FHR is reassuring and uterine activity is inadequateConsider IUPC placement
If uterine Tachysystole reoccurs, notify provider
YES NO
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