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Physiology and Pathology of

Uterine Contractions
Michael G. Halaka, M.D.
Department of Obstetrics and Gynaecology
of 2nd Medical Faculty

Physiology
myometrium smooth muscle
enlargment of the muscle cells
basal tonus
first contractions from 20thweek of gravidity
Braxton-Hick contractions

Physiology

Montevid Units
Montevid Units addition of amlitudes of
contractions in 10 minutes
pacemaker contraction wave 2cm/s
amplitude of an contraction
1st stage 40-60 mm Hg
2nd stage 80 mm Hg

closure of blood-vessels
veins : 20 mm Hg
artery: 60 mm Hg

Physiology
basal tonus 10 mm Hg
1. stage of labour 30-40 mm Hg - 120 MU
2. stage of labour 50-60 mm Hg - 250 MU
resting time >30 s

Physiology
Proper shape of the contractions

1. stage

2. stage

3. stage

Physiology starting factors


mechanical - pressure, volume
2. endocrine
1.

3.

estrogen - number of estro receptors,


membrane potential, ATP in myocytes
oxytocine - membrane potential, PG
prostaglandins preparing of cervix, contract.

neurogen

Fergusson reflex
Parasympaticus reflex

Recording the contractions


absolute intrauterine
- intrauterine catheter
relative external
- using piesoelectric
effect

Indications and contraindications


Type of
sensor

Conditions

Indications

Contraindicatio
ns

External

anytime
non-ivasive

as CTG

none
not
recommended
- obesity

Internal

cervix dilatated at
least 2-3 cm,
ruptured
membranes,

tonus of the uterus


mostly scientific
use

placenta
praevia,
face
presentation,
intraovulatory
infection

Pathology
1.
2.
3.
4.
5.

hypertonus
hyperactivity
hypoactivity
dystokia
failure of the abdominal muscle

Pathology
1.
2.
3.
4.
5.

hypertonus
hyperactivity
hypoactivity
dystokia
failure of the abdominal muscle

Pathology - hypertonus
etiology: macrosomy, multiple pregnancy,
premature separation of placenta
pathophysiology: basal tonus - blood in
veins hypoxy
clinics: palpable,
changes on CTG
treatment:
tocolysis

Pathology
1.
2.
3.
4.
5.

hypertonus
hyperactivity
hypoactivity
dystokia
failure of the abdominal muscle

Pathology - hyperactivity
> 390 MU, >7 contrac/min, resting time <30 s
etiology: hypersensitivity, overstimulation of
the uterus
clinics: CTG changes
therapy: less oxytocine, tocolysis

Pathology
1.
2.
3.
4.
5.

hypertonus
hyperactivity
hypoactivity
dystokia
failure of the abdominal muscle

Pathology - hypoactivity
< 100 MU, < 30 mm Hg, < 2 contract/min
type:
primary from the beginning
secondary during the labour
etiology: primary: hypoplasia of U., dystokia
secondary: prolonged labour,
overstimulation by oxytocine,
exhaustion of the mother
clinics: CTG, no postup of the labour
therapy: oxytocine, tocolysis, rest

Pathology
1.
2.
3.
4.
5.

hypertonus
hyperactivity
hypoactivity
dystokia
failure of the abdominal muscle

Pathology - dystokia
etiology: hypertonus of the cervix, failure of
pacemakers, exhaustion of uterus
clinics: CTG, no postup of the labour
therapy: tocolysis, S.C.

Pathology
1.
2.
3.
4.
5.

hypertonus
hyperactivity
hypoactivity
dystokia
failure of the abdominal muscle

Pathology - failure of abd. muscle


etiology:
disease of the muscle or inervation
disease which unables higher activity ( heart,
eyes .. )
epidural anesthesia
exhaustion of the mother
obesity
not cooperating mother

therapy: forceps, VEX, S.C.