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Review
. 2024 Aug;131(Suppl 2):49-57.
doi: 10.1111/1471-0528.16727. Epub 2022 Apr 12.

Clinical management of uterine contraction abnormalities; an evidence-based intrapartum care algorithm

C Gülümser  1 , M Yassa  2 ; WHO Intrapartum Care Algorithms Working Group
Collaborators, Affiliations
Review

Clinical management of uterine contraction abnormalities; an evidence-based intrapartum care algorithm

C Gülümser et al. BJOG. 2024 Aug.

Abstract

Aim: To develop algorithms as decision support tools for identifying, managing and monitoring abnormal uterine activity during labour.

Population: Women with singleton, term (37-42 weeks) pregnancies in active labour at admission.

Setting: Institutional birth settings in low- and middle-income countries (the algorithm may be applicable to any health facility).

Search strategy: PubMed was searched up to January 2020 using keywords. We also searched The Cochrane Library, and international guidelines from World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG) and French College of Gynaecologists and Obstetricians (CNGOF).

Case scenarios: Algorithms were developed for two case scenarios: uterine hypoactivity and excessive uterine contractions. Key themes in the algorithm are: diagnosis, identification of probable causes, assessment of maternal and fetal condition and labour progress, monitoring and management.

Conclusion: The algorithms for uterine hypoactivity and excessive uterine contractions have been developed to facilitate safe and effective management of abnormal uterine activity during labour. Research is needed to assess the views of healthcare professionals and women accessing healthcare to explore the feasibility of implementing these algorithms, and impact on labour outcomes.

Tweetable abstract: An evidence-based algorithm to support clinical management of abnormal uterine activity during labour.

Keywords: Abnormal uterine activity; clinical algorithm; labour; uterine contractions; uterine hypoactivity; uterine tachysystole; vaginal birth.

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References

    1. Leathersich SJ, Vogel JP, Tran TS, Hofmeyr GJ. Acute tocolysis for uterine tachysystole or suspected fetal distress. Cochrane Database Syst Rev 2018;(7):CD009770.
    1. Thornton JM, Browne B, Ramphul M. Mechanisms and management of normal labour. Obstet Gynaecol Reprod Med 2020;30:84–90.
    1. Intrapartum care for healthy women and their babies. NICE Clinical Guideline CG 190. National Institute for Health and Clinical Excellence, 2014. 2017 [cited 2020 Dec 20]. Available from: https://www.nice.org.uk/cg190/history/
    1. Lee L, Dy J, Azzam H. Management of spontaneous labour at term in healthy women. J Obstet Gynaecol Can 2016;38:843–65.
    1. World Health Organization. Pocket Book of Hospital Care for Mothers, Guidelines for Management of Common Maternal Conditions. New Delhi: World Health Organization, Regional Office for South‐East Asia; 2017.

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