The tone of the uterus during pregnancy is of great importance: a low tone can cause a variety of complications during childbirth, and increased tone (hypertonicity) sometimes leads to miscarriage or premature birth Premature birth - Recognize the signals of the body in time .

Generally it is known as a long tone and passive contraction of the muscles, which normally does not cause fatigue. Because of muscle tone, we can maintain the correct posture, and our belly sticks out, but remains flat (unless, of course, the abdominal muscles are sufficiently developed).

Hypertonicity of the uterus

In patients with hypertonic uterus to any gestation can start contractions, which are potentially dangerous to the health and life of the fetus. By itself, increased tone is only a symptom of other health problems in the mother or child. The causes hypertonicity of the uterus may be:

• Hormonal disorders related to the functioning of the reproductive system (hyperandrogenism, progesterone deficiency - a hormone needed for normal development of the pregnancy, and so on);
• Genital infantilism (insufficient development of the female reproductive organs);
• Infectious and viral diseases;
• Inflammatory diseases of the uterus and appendages (endometritis, salpingo);
• Structural anomalies and malformations of the uterus;
• Structural changes in the uterine wall (benign or malignant tumors, endometriosis);
• Excessive stretching of the uterus (polyhydramnios, large fetus, multiple pregnancy);
• Performing heavy physical work during pregnancy;
• Adverse working conditions during pregnancy, exposure to toxic substances (kerosene, gasoline, acetone);
• Smoking (including passive) and alcohol consumption during pregnancy;
• Somatic diseases (heart disease, kidney disease, liver, etc.);
• Multiple abortions in history;
• Age of pregnant women under the age of eighteen years or over thirty years;
• Nervous exhaustion, chronic stress.

The clinical picture .  The first sign of increased uterine tone is often a nagging pain in the abdomen and lower back .  Later begins the real contractions that resemble conventional battle, although there may be much weaker .  Most pregnant women who have been diagnosed hypertonus, noted that shortly before the start of uterine contractions abdomen becomes very hard, and touching it was pretty painful .  If gipertonus began to develop after the fourth or fifth month of pregnancy, a woman may notice that the fetus began to move less often than usual, and his movements are often accompanied by pain or discomfort .  Continual strong muscular tension sometimes leads to the fact that blood flow to the placenta is significantly reduced, the fruit does not get enough nutrients and oxygen, resulting in placental insufficiency, hypoxia and intrauterine growth retardation .  In the end, hypertonicity of the uterus can lead to placental abruption Placental abruption - why is it so dangerous to a woman's life? , Vaginal bleeding, fetal death and miscarriage Miscarriage - is more common than you think .

In some cases, increased uterine tone is detected during ultrasound in patients who prior to the survey did not notice any unusual symptoms.

Decreased uterine tone

This problem usually makes itself felt after giving birth, and can lead to serious health problems. Approximately 90% of severe postpartum bleeding is caused by uterine atony - a condition in which the uterus is unable to contract properly after childbirth.

When, after the baby is born the placenta detaches from the uterine wall, there is damage to the blood vessels feeding the placenta. As a result, the bleeding starts, but normally it is stopped by as the uterus contracts and compresses the vessels. However, if the tone of the uterus is lowered, and it can not be reduced, bleeding continues for a long time, which can result in significant blood loss.

The most common causes of uterine atony are:

• Prolonged labor;
• The use of oxytocin during labor;
• Applications of general anesthesia during childbirth;
• The birth of two or more children;
• The increased amount of amniotic fluid during pregnancy (polyhydramnios);
• The birth of a child is very large;
• More than five pregnancies in the history of women;
• Obstructed labor;
• Infection of membranes - chorioamnionitis.

Fragments of the placenta remaining in uterus after childbirth and benign tumors of the uterus (known as fibroids) are sometimes also reasons that the uterus can not normally be reduced.

Currently, midwives often use oxytocin immediately after birth. It not only hastens the placenta, but stimulates uterine contractions. The study results suggest that this technique can significantly reduce the duration of post-partum hemorrhage, as well as reduce the number of patients who shortly after birth required a blood transfusion. In view of this, the use of oxytocin is becoming more common practice; it is administered by intravenous attention or do intramuscular injection.

If bleeding after childbirth, caused by the low tone of the uterus, is continuing, despite the use of oxytocin may be used other drugs, for example, prostaglandin F2-alpha or metilergonovin (Metergin). In rare cases when bleeding threatens the life of the patient, surgery is carried out, during which tie up large blood vessels or the uterus removed - sometimes it is the only way to stop the bleeding.

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