Wiki.assessment of uterine contractions 2011Presentation Transcript
Assessment of Uterine Contractions August 2011Inpatient Review CourseSandy 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 frequency Intensity duration RelaxationTOCO placed on upper part of uterus to assess frequencyand duration of contractions. Palpation done to determine intensityAnd relaxation.
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
Assessment – Uterine Contractions by Palpation Contraction Corresponds to Palpation of Intensity Body Part Mild Tip of nose Moderate Chin Strong ForeheadPlace hand on fundus of uterus to assess uterine contractions. Keep hand on fundus throughoutseveral contractions to determine difference between relaxation and contraction increasing in intensity to peak and then decreasing in intensity to relaxation. Use key above. Malinowski, 1989 6
Intrauterine Pressure Catheter Requires ROM More accurate due to Pressure of direct measurement of contractions measured intrauterine pressure 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
Terminology for Describing Uterine Activity Normal Hypotonus and Hypertonus Multiphasic – dysfunctional Tachysystole
Uterine HypertonusHypertonus - 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
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 period or 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) YES NO Category I Category II / III (Reassuring FHR Tracing) (Indeterminate/Abnormal FHR Tracing)Continue to observe for approximately 30 Discontinue the Oxytocin administrationminutes as long as FHR is reassuring Notify the provider and document reportConsider the following interventions: and interventions used to resolve theMaternal position change clinical situationIV Fluid hydration Interventions:Increased frequency of observation Maternal position changeDocument and report interventions IVF bolus Oxygen at 10-12 Lpm Increased frequency of observation Did Uterine Tachysystole resolve? Document and report interventions YES NO Continue Decrease the Pitocin by Observe for 10-30 minutes, Pitocin increasing ½. Continue to observe may be restarted at ½ the previous Pitocin as for an additional 30 dose if FHR is reassuring and ordered minutes providing the uterine activity is inadequate FHR remains reassuring Consider IUPC placement If uterine Tachysystole If uterine Tachysystole reoccurs, does not resolve after 60 notify provider minutes, notify the provider