Uterine hypertonus is a pathological condition accompanied by increased contractility of the myometrium, which appears before the due date of delivery. Among the clinical signs, there is a visible tension of the anterior abdominal wall, pulling pains in the lower abdomen. For the diagnosis of uterine hypertonus, an objective examination of a woman and ultrasound scanning are used. Additionally, blood tests can be performed to determine hormones. Treatment consists in providing complete rest, the appointment of sedatives, antispasmodic drugs, vitamin therapy.
Hypertonus of the uterus is an increased excitability of the smooth muscles of the uterus, provoked by hormonal changes or negative factors of a psychophysiological nature. This condition is more often diagnosed in women younger than 18 and older than 30 years. In the first case, uterine hypertonicity is due to the underdevelopment of the sexual sphere and the unwillingness of the organ to bear a fetus. As for patients over 30 years of age, hyperexcitability usually develops against the background of frequent abortions, infections and other obstetric and gynecological pathologies. Hypertonus of the uterus poses a real threat to the life and health of the baby, as it can provoke not only hypoxia, but also miscarriage, the onset of premature birth, stillbirth.
In most cases, uterine hypertonus develops against the background of reduced production of progesterone, a hormone that ensures the normal course of pregnancy. Under its influence, there is a decrease in the contractility of the myometrium, the excitability of the receptors of the uterus and spinal cord, which together makes it possible to deliver a fetus to 38-40 weeks and give birth to a healthy baby. Progesterone deficiency in uterine hypertonus manifests itself in the form of spontaneous miscarriages, fetal hypoxia, miscarriage or premature birth. Therefore, when treating, the main goal should be to influence these etiological links of the pathological condition.
Uterine hypertonus develops more often when a woman has hyperandrogenism, a condition in which there is an increased production of male sex hormones. This diagnosis is also possible with genital infantilism. In this case, an underdeveloped uterus in response to excessive enlargement may respond with increased hyperexcitability. Hyperprolactinemia is also a common cause of uterine hypertonus. The condition is accompanied by increased production of prolactin, which blocks the production of progesterone and leads to an increase in the contractility of smooth muscles.
Often, uterine hypertonus is caused by hormone-dependent diseases that a woman suffered from even before conception. Among them are fibroids, endometriosis. Previously transferred inflammatory processes that spread to the uterine cavity and appendages also increase the likelihood of developing increased excitability of the myometrium. Hypertonus of the uterus may be due to a violation of the regulation of the central nervous system, which manifests itself in an increase in contractility, the inability to maintain optimal muscle tone. Women with multiple pregnancies, polyhydramnios, and in the presence of a large fetus are more susceptible to this pathology. These factors contribute to excessive overgrowth of the myometrium.
The risk group for the development of uterine hypertonus includes patients with genetic abnormalities, thyroid diseases, who have had viral infections in the early stages of pregnancy. When the body of the expectant mother is exposed to negative factors (harmful working conditions, lack of sleep, daily work), the probability of this condition also increases. Often hypertonicity of the uterus is caused by psychoemotional experiences, stress, bad habits. Therefore, such factors should definitely be excluded from the patient’s life.
Depending on which part of the myometrium is tense, in obstetrics, there are 1 and 2 degrees of uterine hypertonicity. In the first case, there is a reduction only of the posterior wall of the organ, which is most often not accompanied by pathological manifestations. In the third trimester of pregnancy, grade 1 uterine hypertonus may manifest itself with minor pulling pains in the lower back, a feeling of heaviness in the sacrum. There are usually no other symptoms.
Hypertonus of the uterus of the 2nd degree implies tension of the myometrium of the anterior wall of the organ and is accompanied by a more pronounced clinical picture. The main sign is pulling pains in the lower abdomen, similar to those that occur in women in the premenstrual period. Often, with hypertonicity of the uterus, the pain spreads to the perineum, there may be a feeling of bursting in the external genitals. At the same time, there is an increase in urination, a contraction of the muscle fibers of the rectum, similar to the urge to defecate.
Visually, with hypertonicity of the uterus, the abdomen becomes dense, rises slightly, acquires more rounded shapes than usual. It is possible to determine the tension of the myometrium through the anterior abdominal wall by palpation. As for the lower segment of the genital organ, that is, the cervix, with hypertonicity of the uterus, its contraction is usually not observed, although such a symptom is sometimes present if a woman has previously had injuries to the cervical canal, for example, during previous childbirth.
Uterine hypertonus is an alarming symptom in obstetrics, which may indicate a possible likelihood of spontaneous abortion or premature birth. Therefore, the health and life of the fetus depends on timely diagnosis and treatment provided. An obstetrician-gynecologist can identify uterine hypertonicity with the help of a normal objective examination of a woman, which is carried out at each appointment. When palpating the abdomen, the tension of the myometrium will be felt, the intensity of such a sign may be different – up to the feeling of “petrification”. At the same time, patients often note discomfort and even pain.
Ultrasound scanning is used as an additional method of diagnosing uterine hypertonus. With the help of this study, it is possible to determine the local or total contraction of the myometrium. At 1 degree of hypertonia, there is a thickening of the muscular layer of the uterus on one side. If such a sign is detected in the area of attachment of the placenta, then there is a high probability of its detachment. With hypertonicity of the uterus of the 2nd degree, the entire myometrium is thickened, there are corresponding clinical symptoms. Also, to determine contractility, tonusometry can be performed – measuring the tone of the uterus using a special sensor that is placed on the anterior abdominal wall and records the level of tension of the muscle layer.
With hypertonicity of the uterus, a pregnant woman, first of all, should be provided with bed rest. It is necessary to eliminate any negative factors (physical exertion, stress) that may cause the aggravation of the pathological condition. If the excessive contractility of the myometrium is not accompanied by pronounced symptoms, treatment can be carried out on an outpatient basis. Hospitalization of a woman is indicated for grade 2 hypertonicity of the uterus, especially if spotting bloody discharge from the vagina is observed. This symptom may indicate an early abortion, premature birth or placental abruption in the 2-3 trimester.
Medical treatment of uterine hypertonus depends on the etiology of the pathological condition. If there is a lack of progesterone production, progesterone drugs are prescribed. If uterine hypertonus has developed against the background of magnesium deficiency, the patient is shown taking tablets based on this trace element or injections of magnesium sulfate in case of medical care in a hospital. Under the influence of this component, the contractility of the myometrium decreases, the transmission of nerve impulses normalizes.
Antispasmodics are prescribed as symptomatic therapy for uterine hypertonus. They reduce the contractility of the myometrium and eliminate pain. Sedatives are also indicated. With hypertonicity of the uterus, mainly herbal preparations are used. Additionally, vitamin complexes are used. Up to 34 weeks of pregnancy, tocolytics are prescribed, which reduce the contractions of the myometrium and suppress the onset of labor. With this diagnosis, specialists always try to maximize the duration of pregnancy and deliver the fetus to 38 weeks.
Prognosis and prevention
In most cases, the prognosis for uterine hypertonus is favorable. With timely medical care, it is possible to suppress the increased excitability of the myometrium and prolong the gestation of the fetus until the expected date of delivery. With the progression of uterine hypertonus, the possibility of having a viable baby appears only at the age of 25-28 weeks. At earlier stages, the fetus simply will not be able to survive in environmental conditions.
Prevention of uterine hypertonus should begin even when planning conception. It is important to detect and treat sexual infections, diseases of hormonal etiology in a timely manner. After the onset of pregnancy, the prevention of uterine hypertonus consists in reducing physical exertion, proper organization of work and rest. Emotional experiences and stresses should also be completely excluded. If there are even minimal signs of uterine hypertonus, you should immediately seek medical help.