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| Uterine
hyperstimulation is often unrecognised and
is a common result of current oxytocin use. In
the West Midlands, 58% of units have a 15 minute
incremental interval for Syntocinon infusion,
whereas according to RCOG
recommendations, there is no benefit of using
intervals less than 30 minutes. Less than 40%
of units in this region have a protocol for
dealing with uterine hyperstimulation. |
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Suggested Management of Uterine Hyperstimulation:
STOP & C
- Syntocinon off!
- Turn mother on her side
- Oxygen by mask
- Prepare for possible delivery
and
- Consider Tocolytics if no response
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Indications for tocolytics during labour at term include
fetal distress associated with uterine hypertonus,
cord prolapse and trapped breech. Currently licensed
tocolytics are Beta-sympathomimetics:
Salbutamol Ritodrine ( 1),
and Terbutaline (2).
Magnesium Sulphate and Nitroglycerin ( 03)
have also been trialed. Magnesium
Sulphate ( 4)
is not as effective as Terbutaline, but may be a good
second line drug when ß-sympathomimetics can
not be used. A possible consequence of any tocolytic
therapy is uterine atony post delivery resulting in
postpartum haemorrhage.
References
1. Mendez-Bauer C, Shekarloo A, Cook V, Freese U,
(1987), "Treatment of acute intrapartum fetal
distress by beta 2-sympathomimetics." Am J Obstet
Gynecol 1987 Mar;156(3):638-42, Abstract
2.
- Smith C. "Reversing acute intrapartum fetal
distress using tocolytic drugs." Clinical Obstetrics
and Gynecology 1991;34(2):352-9
- Shekarloo A. "Terbutaline (intravenous bolus)
for the treatment of acute intrapartum fetal distress." Am
J Obstet Gynecol 1989;615-8
- Patriarco M. "A study on intrauterine fetal
resuscitation with terbutaline." Am J Obstet
Gynecol 1987;157:384-7
3. Mercier F. "Intravenous nitroglycerin to relieve
intrapartum fetal distress related to uterine hyperactivity:
a prospective." Anestesea and Analgesia 1997;84(5):1117-20
4. Magann EF, Cleveland RS, Dockery JR, Chauhan SP,
Martin JN Jr, Morrison JC , (1993), "Acute tocolysis
for fetal distress: terbutaline versus magnesium sulphate." Aust
N Z J Obstet Gynaecol 1993 Nov;33(4):362-4, Abstract
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