M.D., Ph.D.LOGINOVA Olga
Hypertonia of the uterus during pregnancy
Expectant mothers may often hear maternity doctors or ultrasound specialists say that the muscle tone of the uterus is raised. Olga Loginova MD., PhD, an obstetrician and gynaecologist at the Gynecology and Gynecologic Oncology Clinic of the EMC told the magazine 9 Months if the concept of hypertonia actually exists, whether it is dangerous, if a woman can tell this for herself and what needs to be done in this case.
To begin with it must be understood that the most powerful layer of the uterus is the muscle layer. During pregnancy these muscles gradually expand as the child constantly grows and the volume of the uterus dramatically increases. With these feelings that are new to the body, especially in the first pregnancy, a woman may realise that something unusual is happening. Pregnant women usually also feel a certain bloating or stretching, drawing pains in the lower abdomen or sometimes in the lower back.
Expectant mothers should remember that tension in the uterus is not an illness, but a condition of the uterus whereby its muscles contract involuntarily during pregnancy, i.e. before childbirth. Stress, depression, anxiety and any concerns, increased levels of fatigue and short duration of sleep during pregnancy cause malfunctions in the central nervous system and, as a result, disrupt the regulation of uterine muscle tone. Physical exertion, such as running, jumping and carrying heavy loads or wearing jeans that are tight at the waist, tight-fitting belts, or high-heeled shoes may also lead to increased muscle tension in the anterior abdominal wall. Physiological overstretching of the uterine muscles in the case of multiple pregnancies, a large foetus or foetal hydrops is also highlighted as a cause. Smoking and drinking alcohol during pregnancy can also raise the sensitivity of the uterus.
It is necessary to distinguish between physiological tension of the muscles of the anterior abdominal wall with non-productive contractions of the uterus and true contractions with a danger of causing a premature birth. This may only be determined by a doctor after an examination and additional tests. Therefore if you experience cramping pains in the lower abdomen, pain in the lower back or a feeling as if there has been a leakage of amniotic fluid, you should seek urgent medical attention. In an examination the doctor will assess the condition of the foetus, feel the abdomen and check the condition of the cervix and the amount of amniotic fluid. If necessary the doctor will conduct a cardiotocography for an accurate differential diagnosis of true contractions from false contractions, and also, if necessary, perform a test for the presence of fibronectin in the vagina of the pregnant woman (a test to determine the risk of a premature birth). If there are no true contractions and the cervix is long and closed, the cramping pains will be considered as false or non-productive contractions that will not lead to a premature birth. This condition does not require treatment. The administration of anti-spasmodic drugs or painkillers in such cases is only symptomatic treatment. If the contractions are true or the cervix is shortened the doctor will recommend hospitalization.
In order to avoid painful tension in the muscles of the anterior abdominal wall and increased sensitivity of the uterus, pregnant women must follow a proper sleep pattern, rest fully and avoid stress. All expectant mothers in employment should reconsider their priorities in favour of their child, i.e. try not to stay late at work and travel less on busy public transport if possible.Excess physical strain should be avoided. Engaging in sport during pregnancy is not contraindicated, but the specific types of sport, the frequency and level of exertion must be coordinated with the doctor supervising the pregnancy. It is advisable to wear comfortable clothing and flat footwear, or shoes with a heel no higher than 4 cm.