Colicky Uterus

Subject: Midwifery II (Theory)

Overview

In the colicky uterus, distinct regions of the uterus contract independently, causing pain at the fundus and a lower segment. When the fundal gradient is gone, a significant gradient of uterine activity begins at the lower segment and progresses to the fundus and cervix. However, the cervix fails to dilate. One type of in-coordinate uterine activity is the constriction ring, which is characterized by localized spastic contraction of a ring of uterine circular muscle fibers. It is usually located at the intersection of the upper and lower uterine segments, around a restricted region of the fetus, and commonly around the neck in cephalic presentation.

In a colicky uterus, different regions of the uterus contract separately, causing pain at the fundus and a lower segment.

Hyperactive Lower Segment

A fundal gradient is lost, and a significant gradient of uterine activity begins in the lower segment and progresses to the fundus and cervix. However, the cervix does not dilate.

Constriction Ring

It is a type of incoordinate uterine action characterized by localized spastic contraction of the uterus's ring of circular muscle fibers. It is normally located near the confluence of the upper and lower uterine segments, commonly around the fetus's neck in cephalic presentation. It can occur at any stage of labor. It is usually full and reversible. Typically, the constriction ring is related with:

  1. Injudicious administration of oxytocin.
  2. Premature rupture of the membrane
  3. Premature attempt at instrumental delivery

Diagnosis

  1. Diagnosis is challenging. Suspicious is the failure to exhibit a portion of the progress even during effective contractions with the cervix laying slack.
  2. It is disclosed during the first stage of a cesarean section, the second stage of forceps application, and the third stage of manual removal.
  3. The ring is not felt through the abdomen.

Management

  1. First stage: After accessing the uterine cavity during a cesarean section, the diagnosis is made. To birth the baby, the ring may need to be cut vertically.
  2. Second stage: Failure to deliver the head despite accurate and judicious use of forceps suggests a constriction ring. After withdrawing the forceps blade, confirm the ring by palpating it. Even if the body is in good shape, a Cesarean section should be performed.
  3. Third stage: During an attempt at manual removal, the diagnosis is made. Increasing the depth of plane anesthetic is usually beneficial. Adrenaline can also be given as an alternative.

References

Things to remember
  • In the colicky uterus, different regions of the uterus contract separately, causing pain at the fundus and a lower segment.
  • When the fundal gradient is gone, a significant gradient of uterine activity begins in the lower segment and progresses to the fundus and cervix. However, the cervix does not dilate.
  • A constriction ring is a type of in-coordinate uterine activity that involves the spastic contraction of a ring of uterine circular muscle fibers.
  • It is normally located near the confluence of the upper and lower uterine segments, commonly around the fetus's neck in cephalic presentation. It can occur at any stage of labor. It is usually full and reversible.
  • The constriction ring is frequently accompanied by inappropriate oxytocin administration, premature membrane rupture, and premature attempts at instrumental delivery.
Questions and Answers

Colicky uterus

With a sense of pain at the fundus and a lower segment, the uterus contracts in different ways independently when it is colicky.

Hyperactive lower segment

A significant gradient of uterine activity begins at the lower segment and moves towards the fundus and cervix when the fundal gradient is lost. Cervix does not, however, dilate.

Constriction ring

It is a type of uncoordinated uterine movement in which a ring of circular muscle fibers in the uterus contracts locally and spasmodically. It is typically located near the intersection of the upper and lower uterine segments, commonly around the neck of the fetus in cephalic presentation. It might show up at any point throughout labor. Usually, it is both complete and reversible.

Diagnosis:

  • It is tough to diagnose. Suspicious behavior includes failing to present a portion of the progress even during active contractions with the cervix slack.
  • The first stage involves a caesarean section; the second stage involves the use of forceps; and the third stage involves manual removal.
  • Per abdomen, the ring is not felt.

Management:

  • First stage: After the uterine cavity is opened through a caesarean section, the diagnosis is made. To birth the baby, the ring might need to be cut vertically.
  • Second stage: Inability to deliver the head despite the proper and prudent application of forceps, leading to suspicion of a constriction ring. After withdrawing the forceps blade, the ring is palpated to confirm the identification. Even at this point, when the body is healthy, a caesarean section should be done.
  • Third stage: During an attempt at manual removal, the diagnosis is made. Usually, increasing the plane's anesthetic is effective. Adrenaline can also be given as a substitute.

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