How to identify uterine irritability from contractions?

Specialties Ob/Gyn

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Hello,

I am wondering if somebody can answer my stupid question. I know it is a basic question, but I just can't find the answer from my OB reference books.

When I took care of my G1P0, GA 34 weeks pt last shift, I had an order to give Terbutaline if pt had contractions. However, I couldn't see any typical bell shaped contractions in EFM. Instead, I saw some irregular, low amplitude, high frequency waves. I palpated the abdomen, I could feel the uterus tightening during some of higher amplitudes waves.

I am wondering how you identify uterine contractions from irritability. If preterm labor pt only has uterine irritability, and no obvious contraction (No cervix change), will you give Terbutaline? Thanks

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Specializes in L&D.

HFLA contractions often precede the onset of preterm labor. I'd get the patient up to empty her bladder and make sure she wasn't on her back, perhaps hydrate her a little more as all these things can cause the irritability pattern. If it goes away, no Terb. If it doesn't go away, I'd probably check with the doc to see if he/she wants it given for that pattern.

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Thank you so much NurseNora for your information. I really appreciate that. Actually the pt was on IV. When I saw those irritability, I gave her some IV bolus, and assist her to the bathroom frequently, but she still had those HFLA. I didn't know that lying on her back would also cause irritability. Why lying on her back will cause irritability? can you please explain more to me? Thanks.

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Specializes in L&D.

I'm not sure of the exact mechanism of back lying causing irritability. It's probably related to the decreased uterine perfusion secondary to reduced cardiac output secondary to compression of the great vessles by the gravid uterus. Long before you see any changes in the mother's vital signs, you'll see responses in the fetus and the uterus.

Sorry I can't explain the exact mechanism to you.

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Dear NurseNora,

Don't feel sorry. I really appreciate that you tried to explain those relationships to me. Thanks a lot!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Poor oxygenation of the uterus while laying on her back can cause uterine irritibility (low amplitude contractions) as well as fetal heart rate decelerations. Vena cava syndrome.

Nora explained it well.

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Thank you so much SmilingBluEyes. It makes sense to me now. I really appreciate your explanations.

Now I think I know how I can deal with those irritability. Go back to my original question, can you please tell me how you will identify uterine irritability from contractions (especially hyperstimulation)? Thanks.

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