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Physiology and Pathology of Uterine Contractions Michael G. Halaška, M.D. Department of Obstetrics and Gynaecology of 2 nd Medical Faculty.

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Presentation on theme: "Physiology and Pathology of Uterine Contractions Michael G. Halaška, M.D. Department of Obstetrics and Gynaecology of 2 nd Medical Faculty."— Presentation transcript:

1 Physiology and Pathology of Uterine Contractions Michael G. Halaška, M.D. Department of Obstetrics and Gynaecology of 2 nd Medical Faculty

2 Physiology myometrium – smooth muscle enlargment of the muscle cells basal tonus first contractions from 20 th week of gravidity Braxton-Hick contractions

3 Physiology

4 Montevid Units Montevid Units – addition of amlitudes of contractions in 10 minutes pacemaker – contraction wave – 2cm/s amplitude of an contraction 1 st stage – mm Hg 2 nd stage – 80 mm Hg closure of blood-vessels veins : 20 mm Hg artery: 60 mm Hg

5 Physiology basal tonus 10 mm Hg 1. stage of labour mm Hg MU 2. stage of labour mm Hg MU resting time >30 s

6 Physiology Proper shape of the contractions 1. stage 2. stage 3. stage

7 Physiology – starting factors 1. mechanical - pressure, volume 2. endocrine estrogen - number of estro receptors, membrane potential, ATP in myocytes oxytocine - membrane potential, PG prostaglandins – preparing of cervix, contract. 3. neurogen Fergusson reflex Parasympaticus reflex

8 Recording the contractions absolute – intrauterine - intrauterine catheter relative – external - using piesoelectric effect

9 Indications and contraindications Type of sensor ConditionsIndicationsContraindicatio ns External anytime non-ivasive as CTGnone not recommended - obesity Internal cervix dilatated at least 2-3 cm, ruptured membranes, tonus of the uterus mostly scientific use placenta praevia, face presentation, intraovulatory infection

10 Pathology 1. hypertonus 2. hyperactivity 3. hypoactivity 4. dystokia 5. failure of the abdominal muscle

11 Pathology 1. hypertonus 2. hyperactivity 3. hypoactivity 4. dystokia 5. failure of the abdominal muscle

12 Pathology - hypertonus etiology: macrosomy, multiple pregnancy, premature separation of placenta pathophysiology: basal tonus - blood in veins – hypoxy clinics: palpable, changes on CTG treatment: tocolysis

13 Pathology 1. hypertonus 2. hyperactivity 3. hypoactivity 4. dystokia 5. failure of the abdominal muscle

14 Pathology - hyperactivity > 390 MU, >7 contrac/min, resting time <30 s etiology: hypersensitivity, overstimulation of the uterus clinics: CTG changes therapy: less oxytocine, tocolysis

15 Pathology 1. hypertonus 2. hyperactivity 3. hypoactivity 4. dystokia 5. failure of the abdominal muscle

16 Pathology - hypoactivity < 100 MU, < 30 mm Hg, < 2 contract/min type: primary – from the beginning secondary – during the labour etiology: primary: hypoplasia of U., dystokia secondary: prolonged labour, overstimulation by oxytocine, exhaustion of the mother clinics: CTG, no postup of the labour therapy: oxytocine, tocolysis, rest

17 Pathology 1. hypertonus 2. hyperactivity 3. hypoactivity 4. dystokia 5. failure of the abdominal muscle

18 Pathology - dystokia etiology: hypertonus of the cervix, failure of pacemakers, exhaustion of uterus clinics: CTG, no postup of the labour therapy: tocolysis, S.C.

19 Pathology 1. hypertonus 2. hyperactivity 3. hypoactivity 4. dystokia 5. failure of the abdominal muscle

20 Pathology - failure of abd. muscle etiology: disease of the muscle or inervation disease which unables higher activity ( heart, eyes.. ) epidural anesthesia exhaustion of the mother obesity not cooperating mother therapy: forceps, VEX, S.C.


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