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Uterine Hyperstimulation : LGH Protocol 2.

23-09WACS
P2010/0528-001 Management of uterine hyperstimulation. Tonic uterine contraction, Description: tocolysis Audience: LGH Clinical staff Approved By: Sue McBeath Megan Parr Northern Area Health Service, Launceston General Custodian: Hospital 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 o 5 or more contractions in 10 minute Contractions lasting longer than 90 seconds to 2 minutes

SDMS ID:

Uterine hyperstimulation may result in decelerations in the fetal heart rate and/or other signs of fetal compromise.

Risk Factors:
Administration of oxytocics or prostaglandin Spontaneous or artificial rupture of membranes Placental abruption Obstructed labour 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 woman dehydrated 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 last dose.

Management of hyperstimulation with signs of fetal compromise:

Continuation of tonic contraction and/or foetal distress:

Delivery should be expedited. Decrease or discontinue the oxytocin infusion rate. Inform midwife in-charge and registrar or consultant.

Management of hyperstimulation without fetal compromise:

Evaluation of compliance with guideline to be achieved through Performance Indicators: medical record audit annually by clinical Quality improvement Midwife WACS Annually verified for currency or as changes occur, and Review Date: reviewed every 3 years Stakeholders: Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director Developed By: (Nursing & Midwifery) Womens & Childrens Services Dr A Dennis Sue McBeath Co-Director (Medical) Co-Director (Nursing & Midwifery) Womens & Childrens Services Date: 3 September 2009

REFERENCES:
King Edward Memorial Hospital 2008 Oxytocin Infusion Clinical Guideline 5.1.3 viewed on 23 March 2009, online, http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/ind ex.htm Kulier R, Hofmeyr, GJ. Tocolytics for suspected intrapartum fetal distress. Cochrane Database 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

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