Update: October 2018
Virtually every woman who will become a mother
at least once, but faced with such a state as elevated
uterine tone. Uterine hypertonus during pregnancy is not
diagnosis, it is only a symptom that indicates
the threat of miscarriage. But this feature is considered sufficient
serious and requires urgent action.
What is the uterus?
The uterus is a muscular organ and is therefore able to contract,
what is necessary for the implementation of labor activity. Outside
the uterus is covered with a serous membrane, which is called perimetry.
The middle layer is the most pronounced and consists of smooth muscle
In the process of carrying the fetus muscle layer (myometrium)
thickens and expands due to the increase in the amount and volume
muscle fibers. By the end of pregnancy, the uterus “occupies”
almost completely abdominal cavity. Preparing the fruit pit to
contractions during labor is accumulated in the myometrium
calcium, glycogen and enzymes that stimulate contraction
In addition, by the end of pregnancy in myometrium increases
protein production – actimiosin (activates contractions). Interior
the fruit layer is the mucous membrane or the endometrium, in
which implanted fertilized egg.
Types of uterine tone
The tone of the uterus characterizes the state of myometrium, its
- hypotonia of the uterus is a pathology and is indicative of
excessive muscle relaxation, occurs in the first 2 hours
postpartum and manifest hypotonic uterine bleeding
(uterine vessels are not reduced due to relaxed muscular
- the normal tonus of the uterus – the physiological state of the uterus, independently
whether or not there is a pregnancy, the myometrium is in
- hypertonus or increased uterine tone – speaks of
tension / contraction of the uterine muscles, it is constant (which
talks about the threat of interruption) or periodical (contractions in
In addition, there is a local hypertonus (voltage
myometrium in a certain place) and total hypertonus – uterus
Support for normal uterine tone
Signals of nerve receptors located in the uterus enter the
the central and autonomic nervous system of the woman, resulting in
the dominant of pregnancy is formed in the cerebral cortex. Function of this
dominant is to suppress nerve processes not
associated with the preservation and development of pregnancy.
But in the case of nervous overstrain in the brain are formed
other foci of arousal that weaken the effect of the dominant
pregnancy, which causes an increased tone of the uterus. Over the entire period
fetal gestation excitability, both spinal cord and uterine
receptors is minimal, which ensures normal flow
of pregnancy. In turn, a generic
dominant responsible for the contractile activity of the uterus – contractions
(см. обезболивание при childbirth).
In addition, in maintaining the normal tone of the uterus is responsible
progesterone, which is first (up to 10 weeks) produced by yellow
body, and later the placenta. Estriol required for regulation
uteroplacental blood flow, also produced in the placenta from
hormone produced by the adrenal glands of the fetus and the woman. Besides
relaxation of the smooth muscles of the uterus, intestines and ureters,
progesterone inhibits the excitability of the central nervous system as
бы защищая доминанту of pregnancy.
Calcium ions are necessary for the contractile activity of the uterus.
Progesterone and Estriol maintain proper cell permeability.
myometrium, and do not allow excess calcium to penetrate into
What causes uterine hypertonus?
Causes that can lead to an increase in uterine tone,
numerous and varied. As a rule, in the development of hypertonus
uterus involved not one, but several factors. To the main
The perpetrators of uterine hypertonia include:
First of all, it means sexual infections (ureaplasmosis,
chlamydia, genital herpes, cytomegalovirus infection and
other). They cause inflammation of the genitals, in particular
endometritis, as a result of which they begin to synthesize biologically
active substances or cytokines that increase contractile
activity of myometrium. And also possible intrauterine infection
- Lack of progesterone will certainly adversely affect
tonus of the uterus, will cause its increase, especially in the first 14 weeks
gestation when a fertilized egg is attached and
formation of the placenta.
- Deficiency of the main pregnancy hormone leads to
spontaneous miscarriage or chorion abruption (future
плаценты) и неразвивающейся of pregnancy.
- Progesterone deficiency is also observed with hyperandrogenism.
(an excess of male sex hormones), with hyperprolactinemia, and
with sexual infantilism. Genital infantilism is characterized by
genital hypoplasia organs, in particular the uterus, which in response
on stretching with increasing gestation begins
shrink what ends in miscarriage.
- In addition, increased uterine tone may be caused
thyroid pathology (hyperthyroidism and hypothyroidism).
Structural changes in the uterine walls
As a rule, increasing the tone of the uterus cause tumors and
tumor diseases of the uterus (polyps, fibroids, adenomyotic nodes),
which not only interfere with normal implantation and embryo growth,
but also prevent stretching of the fruit tree as it increases
the duration of pregnancy, which causes hypertonia.
In addition, these diseases are due to hormonal
disruptions that can not affect the level of progesterone.
Different curettage of the uterus and abortions (complications) cause
inflammatory reaction in the endometrium, which leads to the formation of
intrauterine adhesions, and the uterine walls are made incapable of
Often raising the tone of the uterus while waiting for a child
due to chronic maternal diseases (arterial
hypertension, diabetes, overweight and others).
Various anomalies in the structure of the uterus cause
inferiority of the uterine walls, which leads to an increase
uterine tone. Such pathologies include double uterus or
uterus with an additional horn, intrauterine septum, and
existing uterine scar after surgery (cesarean
This group of factors is the largest and most numerous. These include:
age of the woman (less than 18 and more than 35 years old), low income, heavy
physical labor, constant stress, occupational hazards,
marital status (divorced or unmarried woman),
malnutrition, neglect, chronic
lack of sleep, bad habits, other.
Complications of this pregnancy
Improper position and presentation of the fetus often causes
hypertonicity of the uterus due to its overstretching (for example, transverse
position). It also contributes to the extention of the uterus and
multiple fetus Disturbance of placental blood flow during preeclampsia or
Placenta previa also causes hypertonicity of the uterus.
How to identify hypertonicity of the uterus
Increased uterine tone, as already mentioned, is not
an independent disease, but just one of the signs
невынашивания of pregnancy. Symptoms that accompany
hypertonus of the uterus, may appear in any period of gestation (see
pregnancy duration calculator):
- With increasing uterine tone in the first 14 weeks, the woman
notes the appearance of pain in the lower abdomen, or in the lumbar region and
sacrum, especially after some physical exertion.
- Irradiation of pain in the perineum is possible. Nature of pain
sensations are different. It may be a sore or aching pain,
similar to discomfort during menstruation.
- A woman should be alerted by the fact of the appearance of bloody,
brownish, pinkish or streaked with blood secretions that
testifies to the begun miscarriage.
In subsequent trimesters, pregnant women are already independent.
determines the intensity of the uterus that may occur locally
or capture the entire uterus. In this case, the woman is compared
hypertonia of the uterus with “stone”.
- For a gynecological examination, a first-trimester doctor readily
diagnoses uterine hypertonus, as it determines its reduction and
tension during palpation. At a later time elevated
тонус определяется при пальпации частей fetus.
- Ultrasound – also in the diagnosis of hypertonus of no small importance
has an ultrasound. At the same time, the uzist sees a local or total thickening.
It should be noted that the local hypertonus of the uterus may
appear in response to any actions taken in the present
moment. For example, movement of the fetus, full bladder and so on.
That is, each case of a fixed increased tone
individual, and the decision on the need for treatment is made after
taking into account all causal factors, risk assessment by
miscarriage, existing pregnancy complications and
Uterine hypertonus: what to do?
Treatment of hypertonicity of the uterus is prescribed only when, in addition to
tension of the uterus during palpation or ultrasound there are additional
indications of threatened abortion
(pain syndrome: abdominal and / or lower back pain, discharge from
admixture of blood, the formation of cervical insufficiency).
In the event of any symptoms, the pregnant woman should
rather, contact a doctor who will decide on the issue of hospitalization.
Perhaps the appointment of outpatient treatment with moderate
hypertonia when tension or “petrification” of the uterus is felt
only in certain situations, periodically.
To successfully reduce hypertonicity during pregnancy
opportunities is determined by the reason that caused the increase
uterine tone. Therapy for increased uterine tone is aimed at
providing psycho-emotional and physical peace, relaxation
uterus and normalization of placental blood circulation:
- Soothing means – in the hospital pregnant is appointed
psycho-emotional rest, as a rule, bed rest and
sedatives (motherwort, valerian, peony tablets
or tinctures). Appointment of sedatives is mandatory so
how worries about a child aggravate the situation.
- Tranquilizers – in case of ineffectiveness of herbal sedatives.
agents are prescribed tranquilizers (diazepam, phenazepam,
- Progesterone – in case of progesterone deficiency
drugs with synthetic progesterone are prescribed (duphaston or
urozhestan rectally or orally) to 14 – 16th term
- Antispasmodics – mandatory recommended
antispasmodics that suppress contractions and improve blood flow
in the uteroplacental-fetal system (no-shpa, papaverine,
dverin). They are prescribed either intramuscularly or in pills or
- Tocolytics – after 16 weeks, the appointment of tocolytics is allowed
– special drugs that relieve uterine spasm (ginipral, partusisten)
intravenously, and then in pill form.
- Calcium channel inhibitors, they prevent penetration
Calcium in muscle cells: Nifedipine, Corinfar.
- Magne B6 or magnesia – also used intravenous infusion
or intramuscular administration of sulfate magnesia – relieves uterine
tonus, causes a sedative effect, lowers blood pressure.
An alternative to a solution of magnesium sulfate are the tablets Magne-B6,
which can be taken in the first trimester (vitamin B6 serves
cage guide for magnesium).
- Improvement of uteroplacental blood flow – parallel
therapy is carried out to improve blood flow
(chimes, aminophylline, trental).
- Means regulating metabolism (Actovegin, Ribboxin)
- Hepatoprotectors (hofitol, Essentiale), see list
To remove the hypertonicity of the uterus at home will help simple
- First, you should maximally relax the facial and cervical
muscle, which leads to a weakening of the tension of the uterus.
- Secondly, the “cat” exercise is effective. Need to get up
on all fours, gently raise the head, arching his lower back.
Breathe should be deep and calm. This posture to keep for 5
What is dangerous hypertonus
The consequences of uterine hypertonus can be very deplorable.
If you ignore the “first bell” – periodic stress
uterus then the pregnancy will end in either a spontaneous abortion or
miscarriage in early terms, or premature
childbirth in the second and third trimester.
In addition, a permanent increase in the tone of the uterus leads to
development of placental insufficiency, which impairs nutrition
the fetus and providing it with oxygen. It provokes the development
intrauterine hypoxia, and subsequently and developmental delay
The prognosis for hypertonicity of the uterus depends on the existing complications.
pregnancy and extragenital diseases, cervical condition
uterus, gestational age and condition of the child, and, of course, from
timely medical care. No less important is the role and
mood of the woman to a favorable outcome.