1. Hypotonic contractions
- Number of contractions is usually low or infrequent. Its strength does not rise above 25mmHg.
- This type of contractions are most apt to occur during the active phase of labor.
- It may occur when analgesia has been administered too early (before cervical dilatation of 3-4 cm) or when there is bowel or bladder distention obstructing effective descent of firm engagement.
- Predisposing factors include:
- multiple gestations
- larger than usual fetus
- hydramnios
- multiparity resulting to lax uterus
- Hypotonic contractions lengthen the labor process since intensity is less. Much of these ineffective contractions are needed to dilate cervix.
- Complications include:
- Hemorrhage - due to the inability of the uterus to contract postpartum.
- Infection related to prolonged cervical dilation.
- Management: - Oxytocin may be given to augment labor.
- Amniotomy (artificial rupturing of membranes) to speed up labor.
- Continuous monitoring especially of uterus and lochia to ensure adequate post-partal contractions.
2. Hypertonic contractions
- Intensity of these contractions may not be stronger than that of hypotonic contractions but they occur more frequently.
- This type of contractions tends to be painful due to resultant anoxia to the uterine cells.
- The myometrium does not relax adequately after contractions resulting to inadequate uterine artery filling, which can result to fetal anoxia.
- Management: - Rest.
- Analgesia with morphine sulfate and possibly sedation.
- Decreasing environmental stimulation is also helpful.
- CS may be scheduled as necessary.
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