CEBU DOCTORS’ UNIVERSITY

COLLEGE OF NURSING

Ineffective Uterine Force, Hypotonic

Contraction, and
Hypertonic Contraction

BSN 2A | Group 1

Alvarez, Justine Sheene T.

De Vera, Jo Andre M.

Lim, Gabrielle Marie A.

Yared, Caitlin Lilli M.

Instructor:

Mrs. Ramas

I. Definition

● Ineffective Uterine Force

 - Ineffective labor occurs when uterine contractions become abnormal or
ineffective, as uterine contractions are the basic force behind moving the fetus
through the birth canal.
- This occurs when the uterine contractions can no longer effectively cause
cervical dilatation and effacement, resulting in a failure in fetal descent.

II. Etiology

● Ineffective uterine force can be caused by:

1. Administration of analgesia

- May cause maternal side effects (feeling drowsy, having trouble concentrating)
which may compromise the mother’s ability to push her baby out. It also affects
the baby’s breathing and heart rate for a short time.

2. Bowel or bladder distention

- A full bladder or presence of fecal matter in the body can hinder the uterus from
contracting efficiently and may obstruct the passageway of the fetus.

3. Overstretched uterus
- An overstretched uterus may alter the effects of the contractions and render the
contractions unable to progress the labor process.

4. Little relaxation of the uterus

- Little to no relaxation time between contractions can render the succeeding
contractions to be ineffective because the body (along with the hormones
needed) is unable to prepare itself for the next contraction. Endorphins needed
may also not be able to release itself therefore causing more pain.

5. Multiple contractions occuring

5. MULTIPLE CONTRACTIONS OCCURRING

III. Types of Ineffective Uterine Force

1. Hypotonic Uterine Contractions

- The number of uterine contractions is unusually slow and infrequent.
- There are only 2 or 3 contractions in a 10 minute period.
- The strength of contractions does not rise above 10 mmHg, and they occur
mostly during the active phase of labor.
- Cervical dilatation and descent of the fetus slow greatly or stop.

2. Hypertonic Contractions
- Marked by an increase in resting tone to more than 15 mmHg
- They tend to occur more frequently and in the latent stage of labor.
 - Contractions are uncoordinated and extremely painful because of uterine cell
anoxia but are ineffective in dilating and effacing the cervix, which leads to
maternal exhaustion.
- Contractions may interfere with uteroplacental exchange and lead to fetal
distress and even death.

IV. Signs and Symptoms

● Hypotonic:
- Contractions with a strength no more than 10 mmHg
- Slow, infrequent contractions
- Prolonged active phase
- Slowed or cessation of cervical dilatation and fetal descent.

● Hypertonic:
- An increase in resting tone of more than 15 mmHg
- Very painful contractions resulting in ineffective breathing techniques
- Single contraction lasting 2 minutes or more or a contraction frequency of five or
more within 10 minutes.
- Contractions may be uncoordinated and involve only portions of the uterus.
- Ineffective cervical dilatation and effacement
- Prolonged latent stage

V. Diagnosis

- Risk for ineffective tissue perfusion related to excessive loss of blood with complication
of labor
- Risk for fetal injury related to prolonged labor
- Risk for maternal injury related to cessation in fetal descent
- Altered comfort: pain score of 8/10 related to ineffective uterine contractions
- Knowledge deficit: ineffective coping related to lack of knowledge

VI. Management for Ineffective Uterine Force

A. Medical and Pharmacologic

1. Administer Oxytocin to strengthen the contractions

B. Surgical
1. Cesarean section - it is done when fetal distress is detected

C. Nursing
 1. Monitor fetal heart heart during the induction of oxytocin to determine for any signs of
fetal distress
2. Monitor the mother’s vital signs to assess her responses to the medications given
3. Monitor the infusion time of the oxytocin given carefully to make sure there are no
complications
4. Encourage the mother in proper positioning such as a left side lying position

VII. Pictures
VIII. Nursing Care Plan

Needs/ Diagnosis Objectives of Nursing Rationale Evaluation

Problems/ Care Actions
Cues

Physiologic Altered After 8 1. Explain to 1. Knowledge

overload comfort: pain hours of SN- the client the will help ease
score of 8/10 patient nature of client’s anxiety
Objective related to discomfort 2. To provide
interaction,
cues: ineffective 2. Provide relief
uterine the patient comfort 3. To help
-primigravida contractions will be able measures relieve pain
mother to: such as back and provide
- facial rubs comfort
grimace Manifest a 3. Encourage 4. To help
- irritability decrease of the patient to distract the
- labor for do deep mother from
pain score
more than 19 breathing the pain
hours from 8/10 to exercises 5. To have
- pain score 6/10 4. Provide better
of 8/10 diversional circulation
activities between the
Subjective such as mother and
Cues: reading a her baby
“My back is book
hurting so 5. Encourage
much” as the client to
verbalized by position
the patient herself in a
left side lying
position
Hypotonic Uterine Contractions

I. Definition
○ The number of contractions is unusually infrequent (not more than 2 or 3
contractions within 10 minutes)
○ Resting tone of the uterus is less than 10 mmHg and the strength of contractions
do not go above 25 mmHg
○ Usually occur during the active phase of labor
II. Etiology / Cause
○ Inappropriate use of analgesia (too much or too early)
○ Distended bowel or bladder (prevents descent or firm engagement)
○ Failure of the uterine muscles to contract
○ Overstretched uterus from multiple gestation, macrosomic fetus, hydramnios, or
lax from grand multiparity
○ Cephalopelvic disproportion , malpresentation, and malpositions
○ Deficiency of hormones such as prostaglandins or oxytocin

III. Types
○ Primary uterine inertia
■ Contractions are inadequate from the onset of labor. The contractions are
too seldom, too weak and too infrequent.
■ Cause: obesity, overdistended uterus.
○ Secondary uterine inertia
■ Contractions are effective awhile, but begin to subside in the course of
labor; they become shorter and weaker, the intervals between them
become longer.
■ main cause is tiring of the uterus and abdominal musculature, due to the
strenuous work of labor,which causes hypotonic contractions and
ineffective labor due to exhaustion
■ It can be functional or due to an obstruction:
a) CPD due to contracted pelvis, malposition or malpresentation
b) Rigid soft tissues, scarring and stenosis of the cervix, acute pubic
arch angle, prominent tailbone or iliac spine.
IV. Signs and Symptoms
○ Weak and infrequent contractions
○ Slow cervical dilation
○ Prolonged labor
○ Anxiety or fatigue from mother due to prolonged labor
○ Susceptibility for placental fragments and postpartal hemorrhage due to an
exhausted uterus

V. Nursing Diagnosis
○ Acute pain: facial grimace r/t uterine contractions
○ Fatigue:alteration in concentration r/t prolonged labor
○ Risk for maternal injury r/t prolonged labor
○ Risk for fetal injury r/t prolonged labor

VI. Management
○ Medical and Pharmacologic
■ Administer oxytocin to strengthen contractions
■ Perform examinations to detect disproportion, malpresentation, or
malposition
○ Surgical
■ Amniotomy (if vaginal delivery is viable)
■ Cesarean section
○ Nursing
■ Perform labor watch in order to assess the contractions regarding its
frequency, interval, duration, and strength
■ Assess the dilation and effacement of the cervix
■ Teach proper breathing techniques
■ Monitor the vital signs of the mother and the fetal heart tone
■ Perform nipple stimulation to increase levels of oxytocin in the body
■ Perform catheterization to empty the bladder
■ Administer oxytocin through IVF as per doctor’s order
■ Monitor the flow rate and infusion time of the IVF
VII. Pictures
 VIII. Nursing Care Plan

Needs/Problems Nursing Diagnosis Objective of Care Nursing Evaluation

/Cues Intervention

Fatigue Fatigue: patient looks After 8 hours of Measures to After 8 hours

Physiologic deficit exhausted r/t student nurse and reduce fatigue: of student
prolonged labor client interaction, the 1. Maintain a calm nurse and
Objective Cues: patient will be able to and peaceful client
-mother is in active express their improved environment interaction,
stage of labor wellbeing 2.stimulate the mother
-less than 3 contractions verbalized
contractions in 10 naturally with that her
minutes nipple stimulation condition and
-resting tone is below 3.Help mother wellbeing has
10mmHg and does and her partner improved.
not go above cope with their
25mmHg frustration
-cervical dilation at 5 regarding the
cm lengthy duration
-is on 9th hour of of labor
labor (multipara) 4. Regulate the
flow of IVF as
Subjective Cues: ordered
-mother looks 5.Prepare and
exhausted administer
-”How much longer oxytocin solution
will this go on? I’m so as ordered by the
tired of being in physician
labor” 7.monitor the
pattern of
contractions and
uterine resting

Hypertonic Uterine Contractions:

I. Definition:
- Hypertonic contractions are marked by an increase in the resting BP to more
than 15mmHg
- Hypertonic contractions occur more frequently and during the latent phase of
labor
- They are much more painful than the usual
- More often Hypertonic contractions will occur in first time mothers
- Contractions are ineffectual, erratic, uncoordinated, and involve only a portion of
the uterus
- Increase in frequency of the contractions, but don't bring about dilation and
effacement of the cervix

II. Etiology and Cause

- Occurs because the muscle fibers of the myometrium do not relax after
contraction. Which means there is no new pacemaker stimulus, or reset of the
muscle for a new contraction.
III. Signs and Symptoms
- Painful contractions related to uterine muscle anoxia, causing painful cramping
pains
- No dilation and effacement of the cervix
- A prolonged latent phase
- Fetal distress occurs early-uterine resting tone is high, which decreases the
placental perfusion
- Anxious and discouraged
IV. Nursing diagnosis
- Fatigue: decreased response from mother r/t inability to relax and rest secondary
to hypertonic labor pattern
- Acute pain: pain score of 8/10 r/t dysfunctional uterine contraction pattern.
V. Management
Medical/Pharmacological:
● Morphine Sulfate
Surgical:
● Cesarean Birth would be necessary if there late deceleration of contraction, an
abnormally long first stage of labor, or a lock of progress with pushing
● Amniotomy
 Nursing
● A uterine and fetal external monitor should be applied for at least 15 minutes to
check the resting phase of the contraction and that the fetal pattern is not
showing a late deceleration
● Explain to the woman that although the contractions are very strong, they are not
effective due to the mother not achieving cervical dilation
● Provide comfort measures such as back rubs
VI. Pictures

VII. NCP

Assessment Nursing Objective Care Nursing Evaluation

Diagnosis Interventions

Physiologic Acute pain: pain After 8 hours of 1. Promote After 8 hours of

Overload score of 8/10 student nurse comfort student nurse
related to and client measures, do and client
Acute Pain: dysfunction of interaction, the back rubs and interaction, the
uterine patient will be effleurage patient
Objective Cues: contraction able to verbalize 2. Provide a verbalized a
- Mother is in pattern a less painful quiet sense of
prolonged latent contraction environment comfort.
phase of labor 3. Encourage
- Increase in breathing and
resting tone top relaxation
more than techniques
15mmHg 4. Place patient
- Pain score 8/10 in a comfortable
position, left side
Subjective Cues lying
“DMD GG na 5. Keep the
dzae” as mother informed
verbalized by the about the
mother progress of the
labor and the
baby’s condition
6. Administer
morphine sulfate
as ordered