This document discusses abnormal uterine action and precipitate labor, highlighting that normal labor involves coordinated contractions resulting in cervical dilation, while abnormalities can lead to complications. It outlines uterine inertia, hypotonic dysfunction, and incoordinate uterine action, emphasizing the risks associated with precipitate labor, such as extensive lacerations and fetal injuries. Management strategies include careful monitoring, use of tocolytic agents, and controlled delivery techniques.

1. PRECIPITATE LABOR

2. Abnormal Uterine Action
• Normal labor is characterized by coordinated
uterine contractions associated with progressive
dilatation of the cervix and descent of fetal head.
• Normal labor is associated with cervical dilatation
more than or equal to 0.5-0.7cm/hr in a
nulliparous women, 1.3cm/hr for a multiparous
women.

3. • Any deviation of the normal pattern of uterine
contractions affecting the course of labor is
designated as disordered or abnormal uterine
action.

4. Uterine Inertia
(Hypotonic Uterine Dysfunction)
• Uterine inertia is the common type of abnormal
uterine contraction but is less comparatively
serious.
• It may complicate any stage of labor.
• It may be present from the beginning of labor or
may develop subsequently after a variable
period of effective contractions.

5. Hypotonic Uterine Dysfunction
• The intensity is diminished
• Duration is shortened
• Intervals are increased
• Good relaxation in between contractions
• Intrauterine pressure during contraction is less
than 25mm Hg.

6. • Less painful uterine contractions
• Less hardening of uterus during contractions
• Uterus becomes relaxed after contraction.
• Poor dilatation of cervix.
• Presence of cephalo-pelvic
disproportion
• Intact membranes

7. Incoordinate Uterine action
• It usually appears in active stage of labor.
• The hypertonic state of the uterus arises from any
of the conditions such as spastic lower uterine
segment, colicky uterus, asymmetrical uterine
contraction, constriction ring or generalized tonic
contraction of the uterus and all these states are
collectively called incoordinate uterine action.

9. • Increased frequency and/or duration of
uterine contractions cause rise in baseline
tone and thereby diminish circulation in the
placenta intervillous space.
• These contractions fail to make progressive
cervical effacement and dilatation.

10. Precipitate Labor and Delivery
• A labor is called precipitate when the
combined duration of the first and second
stage is less than 3 hours.

11. Incidence
• Prevalence is about 2%

12. Causes
• Placental Abruption
• Uterine tachysystole
• Hyperactive Uterine contractions
• Diminished soft tissue resistance

13. Maternal Risks

14. Maternal Risks
• Extensive laceration of cervix, Vagina and
Perineum.
• PPH-Post partum hemorrhage
• Inversion
• Uterine Rupture
• Infection
• Amniotic fluid Embolism

16. Fetal/Neonatal Risks

17. Fetal/Neonatal Risks
• Intracranial hemorrhage
• Apgar score is low
• Fetal Hypoxia
• Fetal injuries
• Bleeding from cord tear/rupture
• Skull injury
• Brachial plexuses injury

19. • Hospitalization of women with previous history
of precipitate labor, before onset of true labor.
• Tocolytic agents can be administered to reduce
the intensity of uterine contractions.
• Delivery of the head should be controlled.
• Episiotomy should be done liberally.
• Oxytocin augmentation is avoided.