Increased tone of the uterus in pregnancy - Causes, symptoms and treatment. MF.

Tonus of the uterus is a characteristic of the state of the uterine musculature, which describes the degree of its stress and is measured in millimeters of mercury.

The following options for the state of uterine musculature are distinguished:

- Uterus hypotonic is a pathological condition of the uterus, in which its muscles are excessively relaxed, it is a complication of the early postpartum period, the cause of hypotonic uterine bleeding.
- The uterus in the normotonus of is the physiological condition of both the pregnant and nonpregnant uterus, in which the musculature is at rest.
- Uterus in increased tonus is a state of stress in the uterine musculature, which can be either permanent or temporary( contractions during labor).Increase in the tone of the uterus can be as in one specific place( local), so capture all parts of the uterus( total).
- Hypertension of the uterus is an abnormality of labor, in which the number of fights in 10 minutes is more than four, i.е.this pathology is found only in childbirth.

It should be noted that the expression "hypertension of the uterus", mistakenly used by some specialists and their patients, implying an increase in the tone of the uterus during pregnancy, is incorrect.this term describes one of the types of abnormalities of labor.

Tone of the uterus is normal and with pathology

Normally, the tone of the uterus during pregnancy ranges from 8 to 12 mm Hg. Excess of these values ​​during pregnancy can be both physiological in nature, for example, when it occurs in response to a fetal movement, or pathological when such uterine activity is permanent and / or accompanied by painful sensations, and in this case is a symptom of threatening premature birthor threatening spontaneous abortion. If such uterine activity acquires a periodic character and the reductions repeat after a certain interval of time, leading to the opening of the cervix, then they speak of labor activity, i.e.beginning of premature birth( if the period is 22-37 weeks) or the spontaneous abortion that has begun( up to 22 weeks).

Causes of increased tonus of the uterus

There are many reasons for increasing the tone of the uterus. Among them, the main role is played by infections that exist in the mother's body, such as infections of the oral cavity, the genitourinary system, the gastrointestinal tract, and skin infections. The socioeconomic factors rank second in importance: age( less than 18 and over 35 years), serious background diseases( diabetes, hypertension, obesity), bad habits( alcohol abuse, smoking, drug use), low levelpoor living conditions, the presence of psycho-emotional overload, poor working conditions, non-observance of the work and rest regime - all these factors, individually or together, have a very strong effect on the course of pregnancyti.

In addition, the complications of this pregnancy may be the reasons for the increase in the tone of the uterus: incorrect position of the fetus( pelvic presentation, transverse position of the fetus), placental pathology( placental insufficiency, placenta previa), developmental abnormalities and uterine disease( bicorniform uterus,presence of partitions in the uterus, uterine myoma, uterine scar after previous caesarean section or removal of the myomatous node), complications of this pregnancy( nephropathy of moderate and severe severity), presence in the pastm of premature birth, abortion( both spontaneous and artificial), pregnancy loss in the presence of blood relatives in the family, the presence of congenital fetal malformations( especially, are not compatible with life).

Symptoms of increased uterine tone during pregnancy

Increase in the tone of the uterus is manifested by pain in the abdomen, especially in the lower parts, pulling character, periodic "hardening of the abdomen," a feeling of tension in the abdomen, sometimes frequent urination and sometimes increased motor activity of the fetus.

Diagnostics

In itself, increased uterine tone is not a diagnosis, it is the main symptom of the threat of miscarriage. In order to diagnose an increase in the tone of the uterus, it is sometimes sufficient for normal palpation, but it should be remembered that it is not always objective, in contrast to cardiotocography( one-stage recording of uterine contractions and fetal heartbeats), which objectively assesses the situation and allows a comparison between earlierindicators and later, i.e.evaluate the effectiveness of the treatment and the dynamics of uterine activity.

Treatment of increased uterine tone during pregnancy

To avoid spontaneous abortion in early periods and premature births at late stages, increased uterine tone should be reduced. Most often, with the threat of termination of pregnancy pregnant woman is recommended to go to the hospital and undergo treatment. With increased uterine tone, the supply of fetus to oxygen and food deteriorates, so treatment is necessary .To reduce the uterine activity, special drugs called tocolytics are used.
These are drugs that belong to different pharmacological groups, having a different mechanism of action, but one effect: they reduce the increased uterine activity. To remove the increased tone of the uterus help:

- ginipral, partusisten, salbutamol, terbutaline. Currently, the most effective safe drug from this group is ginipral. In emergency cases, it is prescribed in the form of droppers, after which they switch to a tablet form.

- nifedipine, this drug exists only in the form of tablets.

- magnesium sulfate / magnesium sulfate, only in the form of a solution for intravenous administration, to reduce the increased tone of the uterus, it is currently used only if other drugs are contraindicated for one reason or another.

- indomethacin is administered in the form of rectal suppositories.

Forecast

A favorable outcome depends on many factors: the condition of the birth canal, the gestational age, the condition of the fetus, including its position in the uterus, the integrity of the membranes( the outflow of amniotic fluid), the presence of complications of pregnancy, the presence of concomitant diseases, and also from timelinessaddress to the doctor. Of course, the positive attitude of the patient is very important.

Prevention of increased uterus tone

First of all, it is important to note the importance of preparing for pregnancy, timely treatment of infections of the genitourinary system, sanitation( recovery) of the oral cavity, then you should pay attention to the regime of work and rest, and then take into account the need to accurately implement all the recommendations of the treating doctor.

Doctor obstetrician-gynecologist Kondrashova DV