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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