Uterine hypertonicity

Hypertonicity of the uterus is not a disease, but a symptom that means increased tension of the myometrium (smooth muscles of the uterus). Outside of pregnancy, the myometrium goes through various phases of contractile activity every month, which depends on the menstrual cycle.

This process is regulated by many hormones and is provided by the autonomic nervous system, which responds to their signals and “conducts” the activity of all internal organs, vascular tone and muscles.

But hypertonicity of the uterus during pregnancy is caused by other reasons, since the functions of the uterus are controlled by other hormones. The frequency and intensity of tension of the uterine muscles cause natural anxiety in pregnant women, since this can be a harbinger of serious problems for both the expectant mother and the child.

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Causes of uterine hypertonicity

Specific causes of uterine hypertonicity can only be determined by examining the pregnant woman. For this, doctors prescribe blood tests for hormone levels, autoantibodies to phospholipids, antibodies to human chorionic gonadotropin (hCG), conduct ultrasound, etc.

It should be noted that in the absence of pregnancy, the contractile activity of the uterus also depends on the biosynthesis and action of hormones and prostaglandins, which cause contractions of the uterine muscles and the rejection of its inner lining during menstruation.

But during pregnancy, the woman's hormonal and neuroendocrine systems are rebuilt, and the production of many biologically active substances (including the neurotransmitters adrenaline and noradrenaline) decreases. At the same time, the ability of the uterus to contract is blocked by progesterone. This hormone not only ensures the implantation of the fertilized egg into the endometrium, but also, in parallel, stimulates the beta-adrenergic receptors of the myometrium cells, resulting in relaxation of the smooth muscles of the uterus.

So during pregnancy the tone of the uterus is controlled, therefore the main causes of hypertonicity of the uterus are rooted in hormonal imbalance.

Hypertonicity of the uterus in the early stages is often associated with the fact that the woman's ovaries produce too little progesterone. It may also be hyperandrogenism - excessive production of male hormones by the adrenal cortex. In addition, hypertonicity of the uterine wall in the initial period of gestation may indicate alloimmune disorders, that is, when the mother's body attempts to give an immune response to the presence of potentially foreign protein cells of the embryo.

Among the most probable causes of uterine hypertonicity during pregnancy, experts also name: abnormal shape of the uterus; history of multiple abortions or uterine surgeries; endometriosis (pathological proliferation of the inner layer of the uterine wall); myoma (benign tumor of the uterus); multiple ovarian cysts; late toxicosis; diabetes, problems with the thyroid gland or adrenal glands; unhealthy habits (smoking, alcohol).

Hypertonicity of the uterus in the second trimester is often a consequence of autonomic dysfunction (in the form of increased tone of the sympathetic nervous system), lipid metabolism disorders, stress, excessive physical activity, various inflammatory diseases of the genital area, as well as magnesium deficiency in the body. Due to the large size of the fetus, polyhydramnios, or if a woman is pregnant with twins, hypertonicity of the uterus may be observed in the third trimester.

Although, as obstetricians and gynecologists say, after the 37-38th week of gestation, a periodic increase in uterine tone is not considered a pathology. Quite the opposite: the uterus is being “trained” before labor. The fact is that by the end of pregnancy, estrogen production increases again, and this leads to the inevitable activation of the synthesis of oxytocin, a hormone of the hypothalamus. Before labor, this hormone accumulates in the pituitary gland. Firstly, oxytocin is necessary for the normal course of labor, since it stimulates the smooth muscles of the uterus and thereby promotes its contraction. Secondly, this hormone, acting on the muscle cells of the mammary gland, facilitates the flow of milk into the milk ducts.

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What is the danger of uterine hypertonicity?

Hypertonicity of the uterus in the first trimester (up to the 13th week) can lead to the death of the embryo and miscarriage.

Hypertonicity of the uterus in the second trimester (up to the 26th week) is a real threat of late spontaneous abortion. In addition, at such times, frequent increase in the tone of the uterine muscles can cause persistent hypoxia of the fetus, which negatively affects its development. And hypertonicity of the uterus in the third trimester is fraught with premature labor and the birth of a non-viable or premature baby. Or it can lead to so-called isthmic-cervical insufficiency - the inability of the cervix to keep its cavity closed as the size of the fetus increases.

When there is frequently recurring spontaneous local hypertonicity of the uterus, the risk of premature separation (abruption) of the placenta from the uterine mucosa increases many times over (since the placenta does not contract when the uterus contracts). And if a third of the placenta detaches, the fetus may die. However, it should be borne in mind that short-term spontaneous local hypertonicity of the uterus often occurs only during examination of a pregnant woman or ultrasound.

Symptoms of uterine hypertonicity

Increased tone varies in degree: uterine hypertonicity grade 1 and uterine hypertonicity grade 2.

In the first case, doctors mean partial hypertonicity of the anterior wall of the uterus or hypertonicity of the posterior wall of the uterus, and in the second case, a tense state of the myometrium of the entire uterus.

In most pregnant women, hypertonicity of the posterior wall of the uterus does not manifest itself in any way: doctors detect thickening of muscle fibers on ultrasound. Although closer to the end of pregnancy, painful sensations appear in the lumbar region, as well as nagging pain in the sacral area.

The main symptoms of uterine hypertonicity, which affects its anterior wall, are the tension felt by the woman in the abdominal area (the abdomen hardens); the symptom passes fairly quickly in a lying position and with calm, deep breathing. There may be nagging pain in the lower abdomen, affecting the perineum, as well as more frequent urination, tension in the rectum (similar to the urge to defecate).

The listed symptoms of uterine hypertonicity may vary in intensity, but most often resemble the condition before and during menstruation. Particular concern and immediate medical attention should be caused by any vaginal discharge, especially bloody discharge.

Hypertonicity of the lower segment of the uterus, i.e. the cervix, is practically not observed during pregnancy (before the physiological term of delivery). Unless the cervix was injured in previous births, or there is significant deformation.

As a rule, it is the other way around: with the onset of pregnancy, the lower segment of the uterus becomes shorter, and its muscles become softer. But during labor, with rigidity of the cervix, hypertonicity of the lower segment of the uterus is quite possible.

Treatment of uterine hypertonicity

Symptomatic treatment of uterine hypertonicity during pregnancy consists of its removal with the help of appropriate pharmacological drugs. Therapy is also carried out taking into account the etiology of this symptom complex.

How to treat uterine hypertonicity with identified endogenous progesterone deficiency? Drug treatment of uterine hypertonicity in early pregnancy is carried out using drugs containing hormones. Duphaston for uterine hypertonicity is prescribed in this case by almost all domestic gynecologists. This drug (another trade name is Dydrogesterone) is a synthetic analogue of the female sex hormone progesterone and helps maintain pregnancy in case of its habitual miscarriage. The standard dosage is 20 mg per day (in two doses, according to the scheme prescribed by the doctor), the maximum is 60 mg. However, it is necessary to keep in mind that Duphaston has side effects in the form of headache, weakness, abdominal pain, breakthrough uterine bleeding.

What is prescribed for uterine hypertonicity? First of all, drugs that relieve muscle spasms (antispasmodics). No-shpa for uterine hypertonicity is the most common prescription of obstetricians and gynecologists. The drug is well tolerated, has rare side effects and is completely safe during pregnancy. No-shpa (drotaverine hydrochloride) in tablets of 40 mg is prescribed to adults, one tablet three times a day. The maximum single dose of the drug is 80 mg, daily - 240 mg.

What is prescribed for uterine hypertonicity caused by magnesium deficiency? Of course, magnesium preparations. Magnesium deficiency in the body is often observed during pregnancy and manifests itself in increased nervous excitability of cells - muscle spasms and convulsions. Magnesium helps restore the electrolyte neutrality of smooth muscle cells, significantly reduces the excitability of cellular neurons and normalizes the transmission of impulses of the sympathetic nervous system.

It has been established that taking magnesium supplements by pregnant women from the 4th-5th to the 24th-25th week of gestation reduces the risk of miscarriage by more than 60%, and the threat of premature birth by almost a third.

In hospital conditions, magnesium sulfate or Magnesia is widely used for uterine hypertonicity. The drug in the form of a 20-25% solution of magnesium sulfate is administered parenterally (intramuscularly) at 5-10-20 ml. The specific dosage and duration of the course of treatment are determined by the doctor.

For oral administration, tablet medications are recommended: magnesium citrate, magnesium gluconate, magnesium orotate or magnesium lactate. Magnesium lactate contains the most magnesium - 48 mg in a 0.5 g tablet. The daily dose is about 50 mmol. The frequency and duration of administration is determined by the doctor on an individual basis. In case of renal disorders, this medication is prescribed with caution.

To relieve uterine hypertonicity during pregnancy, Magne B6 (Magnelis B6) is prescribed. The drug is taken 1-2 tablets three times a day (during meals, with a glass of liquid). Side effects of Magne-B6 can be expressed in the form of pain in the epigastric region, constipation, nausea, vomiting and flatulence. It is necessary to take into account that magnesium reduces the level of iron absorption and can lead to anemia.

What should you not do if you have hypertonicity of the uterus?

If during pregnancy the tone of the uterus increases systematically, then in order to preserve the fetus the pregnant woman must not: physically strain (including in terms of everyday household chores); lift heavy objects; walk or stand for a long time; take long car trips; fly; take a bath (or a very hot shower).

The concepts of sex and hypertonicity of the uterus are incompatible, so you will have to do without intimacy for some time: increased contraction of the uterus during sexual intercourse can cause premature termination of pregnancy.