Generalized Tonic Contraction (uterine tetany)

Subject: Midwifery II (Theory)

Overview

In this syndrome, the entire uterus retracts up to the level of the internal os. As a result, there is no physiological distinction between the active upper portion and the passive lower segment of the uterus. There is no risk of uterine rupture because the lower segment is not thinning. The uterine contractions stop, and the entire uterus enters into a tonic muscle spasm, trapping the fetus inside. The uterus is smaller, tight, and painful on abdominal inspection. Vaginal examination reveals a jammed head with a large caput, as well as a dry and edematous vagina. Antibiotics should be administered as needed.

In this situation, there is severe retraction including the entire uterus up to the level of the internal os. As a result, there is no physiological distinction between the active upper and passive bottom segments of the uterus. There is no risk of uterine rupture because there is no thinning of the lower segment. The uterine contraction stops, and the entire uterus enters into a tonic muscle spasm, trapping the fetus inside.

The fetus will overcome the barrier with forceful uterine contractions.
The irritation is produced by multiple failed attempts at artificial delivery.
Inadequate oxytocin delivery, particularly after intramuscular oxytocin treatment.

Signs and Symptoms

The patient is in lengthy labor and is in excruciating agony.
There is evidence of dehydration and ketoacidosis on examination.
An abdominal examination reveals that the uterus is slightly smaller, tight, and sensitive.
Fetal components are not properly defined, and FHR is not heard.
A vaginal examination reveals a jammed head with a large caput, as well as a dry and edematous vagina.

Management

Intramuscular morphine 15 mg or morphine/pethidine drip (200mg pethidine in 500ml) for deep sedation The drop rate is around 50-60 drops/min with 5% dextrose.
To prevent and treat dehydration and ketoacidosis, infuse N/S and R/L.
Antibiotics should be given as needed.

References

nursingcontentbank.blogspot.com/2013/03/abnormal-uterine-actions.html
Tuitui, Roshani, and S. N. Dr. Suwal. Manual of Midwifery II (Intrapartum Care). Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar, 2014.
https://wisesteps.wordpress.com/2011/11/01/normal-and-abnormal-uterine-contractions/
https://www.slideshare.net/NirsubaGurung/abnormal-uterine-contraction

Things to remember

In this condition, pronounced retraction occurs involving the whole of the uterus up to the level of the internal os.
Thus, there is no physiological differentiation of the active upper segment and the passive lower segment of the uterus.
As there is no thinning of the lower segment, there is no chance of rupture of the uterus. The uterine contraction ceases and the whole uterus undergoes a sort of tonic muscular spasm holding the fetus inside.
The patient is in prolonged labor having severe and continuous pain. Abdominal examination reveals the uterus to be somewhat smaller in size, tense and tender.
Vaginal examination reveals a jammed head with a big caput and a dry and edematous vagina.
Deep sedation by intramuscular morphine 15 mg or morphine/pethidine drip (200mg pethidine in 500ml 5% dextrose, the drop rate is about 50-60 drops/min.
Administer antibiotics as per need.
Deep sedation with injectable morphine 15 mg or morphine/pethidine drip (200mg pethidine in 500ml 5% dextrose, drop rate 50-60 drops/min).
Antibiotics should be given as needed.

Questions and Answers

Define tonic contraction?

In this situation, there is severe uterine retraction that extends all the way to the internal os. As a result, the active upper portion and the passive lower segment of the uterus cannot be distinguished physiologically. There is no possibility of uterine rupture because the lower segment is not thinned. The uterine contraction stops, and the fetus is held inside by a kind of tonic muscular spasm that spreads over the entire uterus.

List the sign and symptoms of tonic contraction?

Signs and symptoms:

The patient is in intense, ongoing pain as a result of the protracted labor.
Dehydration and ketoacidosis are visible on examination.
A physical examination of the abdomen indicates a smaller, more tight, and sensitive uterus.
Neither the FHR is audible nor are the fetal components well delineated.
A vaginal examination reveals an edematous, dry, and jammed head with a large caput.

How can we manage tonic contraction?

Management:

Intramuscular morphine 15 mg or a morphine/pethidine drip (200 mg pethidine in 500 cc) for deep sedation 50–60 drips per minute with 5% dextrose is the drop rate.
To avoid and treat ketoacidosis and dehydration, provide N/S and R/L.
Provide antibiotics as necessary.