OBG

1. AMANDEEP KAUR

2. DEFINITION
Any deviation of
normal pattern
uterine contractions
affecting the course of
labour is designated
as disordered or
abnormal uterine
action.

3. ETIOLOGY
 Prevalent in first birth
 Advancing age of mother
 Prolonged pregnancy
 Over distension of uterus
 Psychological factor
 Contracted pelvis
 Malpresentation
 Injudicious administration of sedatives,
analgesics and oxytocics.

4. Normal polarity
 Uterine inertia
 Excessive
contraction-
a) Precipitate labour
b) Tonic uterine
contraction and
retraction
Abnormal polarity
 Spastic lower
segment
 Cervical dystocia
 Constriction ring
 Generalized tonic
contraction

5. UTERINE INERTIA
A common type of disordered uterine
contractions but is comparatively less
serious.
Uterine Contractions-: Intensity is
diminished, duration is shortened, good
relaxation in between contractions and
the intervals are increased.

6. DIAGNOSIS-:
1. Less pain during contractions.
2. Less hardening of uterus
3. Uterus becomes relaxed after contraction,
fetal parts are well palpable and FHR
remains good.
4. Internal examination reveals-
a) poor dilatation of cervix
b) membranes usually remain intact.

7. Effects on mother and fetus-
Maternal exhaustion
 fetal distress are unusual and appear
late.

8. MANAGEMENT
1. Caesarian Section- if presence of contracted
pelvis, malpresentation and evidence of fetal
or maternal distress.
2. Vaginal delivery-
Active measures-
Acceleration of uterine contractions by
low rupture of membranes followed by
oxytocin drip.

9. PRECIPITATE LABOUR
A labour is precipitate when the
combined duration of first and second
stage is less than 2 hours associated with
hyperactive uterine contractions
Labour is short as the rate of cervical
dilatation is 5cm/hr or more.

10. Maternal Risks-
Extensive laceration of vagina,
cervix and perineum.
PPH due to hypotonia that
develops subsequently.
Inversion
Uterine rupture
Infection

11. Fetal Risks-
Intra cranial stress or hemorrhage
Injuries from torn cord or direct hit
on skull

12. MANAGEMENT
 Patient having previous history of precipitate
labour should be hospitalized prior to labour.
 Administer ether or magnesium sulphate to
suppress contractions.
 Oxytocin augmentation should be avoided.
 Carefully conduct the delivery. Delivery of
head should be controlled.
 Episiotomy should be done liberally.

13. TONIC UTERINE CONTRACTION &
RETRACTION
This type of uterine contraction is
predominantly due to obstructed labour.
Pathological anatomy of uterus-
Gradual increase in intensity, duration and
frequency of contractions
Relaxation phase becomes less and less;
ultimately state of tonic contractions develop.
Retractions continues
Lower segment elongates and becomes thin

14. A circular groove encircling the uterus is
formed between the active upper segment
and distended lower segment, called
pathological retraction ring (bandl’s ring).

15. CLINICAL FEATURES
 Patient is agony and exhausted
 Abdominal palpation reveals-
a) hard and tender upper
segment
b) tender and distended lower
segment
 Bandl’s ring is placed obliquely
b/w umblicus and symphysis
pubis and rises upward with
course of time
 FHS usually absent

17.  Internal examination reveals-
a) dry and hot vagina
b) offensive discharge
c) cervix fully dilated
d) membranes absent

18. TREATMENT
 Rupture of uterus is to be excluded
 Correction dehydration and keto-
acidosis by RL infusion
 Adequate pain relief
 Antibiotics
 Caesarean section

19. SPASTIC LOWER SEGMENT
Uterine Contraction-
1. Fundal dominance is
lacking.
2. Inadequate
relaxations in between
contractions.
3. Basal tone is raised
above the critical level
of 20mm Hg.

20. Diagnosis-
a) patient is agony with unbearable pain
referred to back.
c) Premature attempts to bear down.

21. Examination
 Abdominal palpation reveals –
-tender uterus
-palpation of fetal parts is difficult.
-fetal distress appears early.
 Internal examination reveals-
 Thick, oedematous cervix
Inappropriate cervix dilatation
Absence of membranes
varying degree of caput

22. MANAGEMENT
Caesarean section is done in majority of
cases.
Pain management
Correction of dehydration
Avoid oxytocin augmentation

23. CONSTRICTION RING
It is the form of
incoordinate uterine action
where there is localized
spastic contraction of a ring
of circular muscle fibres of
uterus.
Usually situated at the
junction of upper and lower
segment around the
constricted part of fetus
usually around neck.

24. DIAGNOSIS
Ring is not felt per abdomen. It is revealed
LSCS in first stage, during forcep
application in second stage and during
mannual removal in third stage.

25. MANAGEMENT
Based on stage at which diagnosis is
made.
1st stage- cut vertically to deliever the
baby
2nd stage-LSCS section may be
performed
3rd stage- deepening the plane of
anaesthesia

26. CERVICAL DYSTOCIA
Abnormal labour as a result of
ineffectual cervical dilatation.
OR
It is the failure of the cervical dilatation .

27. CAUSES
Inefficient uterine contractions
Malpresentation
Malposition
Spasm of cervix
Previous trauma

28. TYPES
PRIMARY UTERINE
DYSTOCIA
SECONDARY
UTERINE DYSTOCIA

29. Primary cervical dystocia
Structurally normal cervix that does not
open and relax associated with tension
and pain due to failure of external os to
dilate and ineffective uterine
contractions.

30. TREATMENT
1) LSCS- in presence associated complications
2) If head is low down with only thin rim of
cervix left behind, rim may be pushed up
mannually during contraction or traction is
given by ventouse.
3) In others, where cervix is much thinned out
but only half dilated, duhrssen’s incision at 2
and 10’o clock positions followed by forceps
or ventouse extaction is quite safe and
effective.

31. SECONDARY CERVICAL DYSTOCIA
This type of cervical dystocia result from
excess scarring or rigidity of cervix from
previous births, operations or cancer.
Treatment –
Usually L.S.C.S

32. GENERALISED TONIC CONTRACTION
In this pronounced
retraction occurs
involving whole of the
uterus upto the level of
internal os. Thus there
is no physiological
differentiation of active
upper segment and
passive lower segment
of uterus.

33. CAUSES
Failure to overcome the obstruction by
powerful contractions of uterus
Injudicious administration of oxytocics

34. CLINICAL FEATURS
Prolonged labour having severe and
continuous pain.
Tense and tender uterus, small in size
Fetal parts not palpable and FHR not
audible

35. EXAMINATION
On vaginal examination, caput
formation, dry and oedematous vagina

36. TREATMENT
Correction of dehydration and
ketoacidocis- by rapid infusion of RL
Antibiotics
Analgesic
Tocolytics
Caesarean section when obstruction
suspected.

38. CONSTRICTION RING
 Manifestation of localized
in-coordinate uterine
action.
 Undue irritability of
uterus.
 Present at the junction of
upper & lower segment
usually at constricted part
 Upper segment contract &
retract with relaxation in
between; lower segment
remains thick & loose.
RETRACTION RING
 End result of tonic
uterine contraction &
retraction.
 Following obstructed
labour.
 Always situated at
junction of upper &
lower segment.
 Upper segment is
tonically contracted
with no relaxation

39. Constriction Ring
Maternal condition is
almost unaffected
unless labour is
prolonged.
Uterus feels normal.
Fetal parts are easily
felt.
Ring is not felt.
F.H.S is usually present.
Retraction Ring
Features of maternal
exhaustion & sepsis
appear early.
Uterus is tense & tender.
Not easily felt.
Ring is felt as a groove
placed obliquely.
Usually absent