uterine hyperstimulation
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Uterine Hyperstimulation : LGH Protocol 2.23-09WACS
SDMS ID: P2010/0528-001
Description:Management of uterine hyperstimulation. Tonic uterine contraction,tocolysis
Audience: LGH Clinical staff
Approved By: Sue McBeath
Custodian:Megan Parr Northern Area Health Service, Launceston GeneralHospital
Version:
Effective Date: 2009-09-03 Review Date: 2012-09-01
Replaces: Uterine Hyperstimulation : LGH Protocol 2.23-06WACS
Definition:
Uterine hyperstimulation is defined as:o 5 or more contractions in 10 minuteo Contractions lasting longer than 90 seconds to 2 minutes
Uterine hyperstimulation may result in decelerations in the fetal heart rate and/orother signs of fetal compromise.
Risk Factors:
Administration of oxytocics or prostaglandin Spontaneous or artificial rupture of membranes Placental abruption Obstructed labourManagement of hyperstimulation with signs of fetal compromise:
Discontinue oxytocin infusion Call for help
Initiate/continue electronic fetal heart monitoring Position the woman on her left side Administer oxygen 6L/min - prolonged oxygen therapy maybe harmful to the fetus and
should be avoided.
Consider increasing infusion rate in the main line if blood pressure low or womandehydrated
Consider tocolysis: Terbutaline 250 micrograms administered subcutaneously. Prepare for possible caesarean section if the fetal heart rate does not return to
normal.
If intrauterine resuscitation is successful, re-start oxytocin infusion at half the lastdose.
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Continuation of tonic contraction and/or foetal distress: Delivery should be expedited.Management of hyperstimulation without fetal compromise: Decrease or discontinue the oxytocin infusion rate. Inform midwife in-charge and registrar or consultant.Performance Indicators:
Evaluation of compliance with guideline to be achieved throughmedical record audit annually by clinical Quality improvementMidwife WACS
Review Date:Annually verified for currency or as changes occur, andreviewed every 3 years
Stakeholders: Midwives and medical staff WACS
Developed By:Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director(Nursing & Midwifery) Womens & Childrens Services
Dr A Dennis Sue McBeathCo-Director (Medical) Co-Director (Nursing & Midwifery)Womens & Childrens Services
Date: 3 September 2009
REFERENCES:
King Edward Memorial Hospital 2008 Oxytocin Infusion Clinical Guideline 5.1.3viewed on 23 March 2009, online,http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/index.htm
Kulier R, Hofmeyr, GJ. Tocolytics for suspected intrapartum fetal distress. CochraneDatabase of Systematic Reviews 1998, Issue 2. Art. No.: CD000035. DOI:10.1002/14651858.CD000035.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2006,Intrapartum Fetal Surveillance. Clinical Guidelines Second Edition
Royal Women's Hospital 2006 Acute tocolysis in labour viewed on 23 March 2009,online,http://www.thewomens.org.au/AcuteTocolysisinLabour
http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/index.htmhttp://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/index.htmhttp://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/index.htmhttp://www.thewomens.org.au/AcuteTocolysisinLabourhttp://www.thewomens.org.au/AcuteTocolysisinLabourhttp://www.thewomens.org.au/AcuteTocolysisinLabourhttp://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/index.htmhttp://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/index.htm