📌 NCLEX Topic: Hypertonic Labor & Uncoordinated Contractions

📌 NCLEX Topic: Hypertonic Labor & Uncoordinated Contractions

NCLEX Topic: Hypertonic Labor

Definition:

Hypertonic labor is a dysfunctional labor pattern characterized by excessive, uncoordinated, and frequent uterine contractions that do not effectively dilate the cervix. This condition can lead to maternal exhaustion and fetal distress if not properly managed.

Causes & Risk Factors

  • Maternal anxiety or stress (increased catecholamines)
  • Uterine overstimulation (e.g., excessive oxytocin use)
  • Dehydration or electrolyte imbalances
  • Cephalopelvic disproportion (CPD) (fetus unable to descend)
  • Malpresentation (e.g., breech or occiput posterior position)

Signs & Symptoms

✅ Maternal Findings:

  • Frequent, painful contractions with little or no cervical change
  • Uncoordinated contractions (erratic intensity, duration, and timing)
  • High uterine resting tone between contractions (uterus does not fully relax)
  • Exhaustion due to prolonged labor

✅ Fetal Findings:

  • Fetal distress due to uteroplacental insufficiency
  • Late decelerations on fetal heart monitoring
  • Decreased fetal oxygenation due to excessive contractions

Nursing Interventions & Management

🚨 Priority: Reduce Uterine Hyperstimulation & Promote Effective Labor

  1. Pain relief measures (analgesics, epidural, warm baths) to relax the uterus.
  2. Promote maternal rest (side-lying position, hydration, breathing techniques).
  3. Discontinue oxytocin (Pitocin) if contractions are too frequent.
  4. Administer tocolytics (e.g., terbutaline) if uterine hyperstimulation persists.
  5. Monitor fetal heart rate for signs of distress (late decelerations, tachycardia).
  6. Emotional support to reduce maternal anxiety and stress.

Additional Information:

  • Contractions may be hypotonic or hypertonic.
  • Hypotonic contractions are short, irregular, and weak; amniotomy and oxytocin infusion may be treatment measures.
  • Hypertonic contractions are painful, occur frequently (six or more in a 10-minute time period), and are uncoordinated; treatment depends on the cause and includes pain-relief measures and rest.
  • Can result in maternal dehydration, infection, fetal injury, or death.