Pregnancy is a time associated not only with the happy expectation of the appearance of crumbs, but the period of adaptation of the woman's body to the state of gestation and the fight against gestational complications. One of these pathological conditions, which seems to be the most common during pregnancy, is increased uterine tone. In this article, we will consider the problem of uterine hypertonicity during pregnancy, highlight the pathogenesis, clinical picture, present the diagnosis and methods of dealing with this problem.

What is uterine tone?

The tone of the uterus is a normal state of the female reproductive organ, which is characterized by a short-term contraction of the myometrium (middle muscle layer of the uterus) in response to various kinds of influences. For example, the motor activity of the embryo, and after 22 weeks - the fetus, a filled bladder, increased intestinal motility. The tone of the uterus without pregnancy may increase before and during menstruation.

How to determine the tone of the uterus?

The tone of the uterus must necessarily be present during pregnancy, since this is a muscular organ and it must contract. Otherwise, if the uterus did not come into tone, then it would not be able to complete such a difficult task as a rather long period of contractions - the first period of childbirth, as well as the second period - the period of attempts. During a normal pregnancy, there should be a tone of the uterus, the symptoms of which should not cause any discomfort to the woman.

What is uterine hypertonus?

Hypertonicity is a pathological condition that characterizes the presence of a diagnosis of threatened abortion before 22 weeks, and after - the threat of premature birth.
How to distinguish uterine tone during pregnancy from hypertonicity? How to understand that the uterus is in good shape and this condition is physiological in nature?

The most important differences in tone are:

• Absence of pain.
• The absence of a long period of the uterus being in good shape (no more than one minute).
• Feeling the tone of the uterus up to 5 times a day.
• The absence of productive contractions, which lead to a shortening of the cervix, as well as to its wedge-shaped transformation. This item is the most important in the diagnosis of increased uterine tone.

Symptoms of uterine tone

An important point is the question "how to determine the tone of the uterus during pregnancy?". In order to understand when pregnancy proceeds physiologically, and when it is necessary to seek medical help, it is necessary to understand how to independently determine the tone of the uterus. Quite often, primigravid women cannot understand what this condition includes. Below we present the main symptoms that help to find out the answer to the question "how to understand the tone of the uterus."

Diagnosis of uterine tone during pregnancy

When examined by a doctor of a pregnant woman, the uterus is determined with an increased tone, characterized by a dense consistency. At the same time, the female reproductive organ is well controlled through the anterior abdominal wall and is in this state for a long time. For the diagnosis of hypertonicity, ultrasound is used, during which hypertonicity of the posterior wall of the uterus, as well as the anterior one, can be detected. However, this symptom may not always indicate the threat of termination of pregnancy. The uterus can come into tone in response to the passage of an ultrasonic wave through its wall. Also on ultrasound when performing cervicometry (measuring the length of the cervix), isthmic-cervical insufficiency is diagnosed (shortening of the cervix, opening of its internal pharynx).

How does uterine tone appear on cardiotocography? (KTG)

Increased uterine tone can be determined by cardiotocography. The resulting film will graphically depict a curve parallel to the fetal heart rate curve, indicating hypertonicity.

Reasons for the appearance of tone in the first trimester

The tone of the uterus in the early stages can be caused by various factors, among which 80% is assigned to congenital malformations. Women must be compulsorily aware of this fact and, while maintaining a pregnancy in a hospital, must give written consent to continue the pregnancy. Also, the tone of the uterus in early pregnancy can be caused by hormonal dysfunction in the form of progesterone deficiency, the impact of stress factors on the female body.

Reasons for the appearance of tone in the II trimester

In the second trimester, a woman can also be diagnosed with increased uterine tone during pregnancy, the causes of which lie in the low level of progesterone (the main hormone of pregnancy), which has a relaxing effect, the presence of an infection of various etiologies, and disruption of the intestines in the form of its increased peristalsis.

Reasons for the appearance of tone in the III trimester

Unfortunately, in the third trimester there is an increased tone of the uterus in pregnant women. Its causes include a low level of progesterone, which can be aggravated by the development of placental dysfunction, its aging, because it is the placenta that produces the main amount of progesterone. With the appearance of violations, its hormonal function also suffers. Polyhydramnios, multiple pregnancy, infectious factors can serve as a trigger in the development of such complications as the threat of premature birth. Also, at any gestational age, the cause of hypertonicity may be the presence of concomitant pregnancy pathologies, such as uterine fibroids, endocrine diseases, and hematological pathologies.

What is the danger of uterine tone and hypertonicity?

Women quite often do not take the increased tone seriously and do not take any measures to stop it. This is due to the ignorance of the fair sex, which is dangerous for the tone of the uterus. Serious complications of myometrial hypertonicity include:

Methods of treatment of uterine tone and prevention of its manifestation

Due to the development of information technology and the Internet, many pregnant women begin to look for answers to the question "how to remove the tone of the uterus" in the open spaces of the forums. The most frequently discussed topic on such pages is the tone of the uterus, how to remove such a condition at home. This is the most basic mistake that can be fatal. How to remove the tone of the uterus during pregnancy, depending on the etiology, only obstetrician-gynecologists know and only in a hospital setting.

How to remove the tone of the uterus with the help of drug therapy?

Preventive measures in the development of uterine hypertonicity are:

If any symptom of a pathological course of pregnancy occurs, you should immediately seek help from a medical institution!

Consequences and complications of pregnancy with uterine hypertonicity

As can be seen from the above, the main consequences of increased uterine tone are conditions that aggravate the course of this pregnancy and can lead to the death of both the fetus at birth with signs of deep prematurity, and to the death of the woman herself, if we are talking about detachment of a normally located placenta or central presentation due to the occurrence of pathological uterine tone.

Serious consequences can result in uterine tone during pregnancy, the symptoms of which every pregnant woman should know in order to protect herself and her unborn child from the complications of this condition

Often, while waiting for a child, women have to deal with such a condition as excessive tension of the muscles of the uterus (hypertonicity). What is it, and how can it affect the process of bearing a child?

What is uterine muscle hypertonicity?

The uterus is an organ designed to bear a baby, lined with smooth muscles. Normally, the muscles of this organ are in a relaxed state, and begin to contract immediately with the onset of labor, pushing the fetus out. If for some reason the muscles of the uterus begin to contract before the expected date of birth or are in constant tension, then doctors talk about hypertonicity.

Why is this condition dangerous?

Increased tension in the muscles of the uterus at any period of gestation is a danger to the development of the child. Most often, of course, hypertonicity occurs in the early stages, but the contractile activity of the uterus in the second and third trimesters is not excluded. The consequences and danger of tension of the uterine muscles while waiting for the child are:

• Difficulty implanting the zygote into the uterine cavity, as a result of which the pregnancy may end at this stage or the fetal egg is implanted in the fallopian tube;
• Spontaneous miscarriage - with hypertension up to 12 weeks of pregnancy;
• Insufficient supply of oxygen to the fetus, since as a result of constant muscle tension, blood does not flow well through the vessels of the placenta into the uterus;
• Antenatal death of the fetus as a result of oxygen deficiency against the background of hypertonicity;
• premature birth.

With an increase in muscle tension after the 30th week of gestation, we can say that the body is preparing for the upcoming birth of a child, that is, the expectant mother has training contractions. However, if uterine contractions are accompanied by pain in the lower back and lower abdomen, bloody or other discharge from the genital tract, then you should seek medical help as soon as possible, since such symptoms may indicate the onset of premature labor.

Causes of hypertension in expectant mothers

An increase in the tension of the muscles of the uterus during the bearing of a baby can occur for various reasons, most often this is facilitated by:

• Insufficiency of the hormone progesterone - most characteristic of hypertonicity in the early stages;
• Congenital anomalies in the structure of the uterus;
• Multiple pregnancy;
• Severe course of early toxicosis - along with intense vomiting, the body naturally tries to get rid of a foreign object by contracting the muscles of the uterus;
• Diarrhea caused by toxicosis or poisoning - synchronously with the contraction of the muscles of the intestine, the muscles of the uterus also begin to contract, which can lead to hypertonicity;
• Rhesus conflict between mother and fetus - more often with negative Rh in the mother and positive in the child;
• Infectious diseases of the pelvic organs;
• Previous abortions, as a result of which the lining of the uterus was damaged.

Symptoms: we determine the tone of the uterus on our own

It is not difficult for a woman to independently identify tension in the uterus.

Symptoms of tone in the 1st trimester

In the early period of expectation of a child, the main sign of increased uterine tension is a pulling pain in the lower abdomen, which may resemble pain during critical days and radiate to the lower back and sacrum.

Symptoms of excessive tone in the second trimester

The tension of the uterus in the second half of the term can be seen even with the naked eye - the stomach shrinks into a lump and becomes hard, while the expectant mother may also be disturbed by pulling pains in the abdomen. If such symptoms appear, a woman should contact her gynecologist in order to maintain the pregnancy and not harm the baby.

Symptoms of tone in the third trimester

With the beginning of the last trimester, the expectant mother can be observed daily, which are accompanied by tension in the muscles of the uterus and "petrification" of the abdomen for several seconds several times a day. This condition is normal and should not cause pain. If, during uterine contraction, the expectant mother feels pain in the lower abdomen and lower back, or the stomach remains firm all the time, you should definitely consult a doctor. This condition can threaten the health and even life of the fetus.

Diagnostics

At an early stage, increased tension of the uterus is determined by ultrasound. A bimanual examination on a gynecological chair is not carried out if an increased tone is suspected, so as not to provoke an even greater contraction of the muscles of the organ.

In the second and third trimesters, the tension of the uterus is determined even with the help of palpation of the abdomen. You can evaluate the reaction of the fetus to muscle fiber contractions by listening to its heartbeat with a special wooden tube, as well as by ultrasound.

Treatment of pathology

Treatment of increased tension of the uterus is relevant at any gestational age, because otherwise a miscarriage or labor activity may begin and the life of the child cannot be saved. In severe cases, the expectant mother is sent to the hospital. Depending on the gestational age and the causes of muscle tension, appropriate treatment is prescribed:

• Progesterone preparations - with tone in the first trimester, due to progesterone deficiency;
• Sedative drugs for stress relief;
• Antispasmodics - Papaverine or No-shpa;
• Psycho-emotional peace;
• Magne-B6;
• In the presence of bloody discharge and a slight detachment of the placenta - hemostatic drugs by injection or in the form of droppers;
• Sometimes they are prescribed to relieve tension in the uterus.

According to the testimony of a woman, acupuncture is performed and consultations with a psychologist are prescribed.

Is it possible to eliminate the increased tone on my own?

If uterine tension is detected, it is still better for a woman to consult a doctor, and not to self-medicate. The specialist must necessarily assess the condition of the fetus and, if necessary, conduct additional studies.

Products for uterine tone

It is believed that an increase in the tension of the uterine muscles can contribute to a magnesium deficiency in the body of a pregnant woman. To prevent this condition and relax smooth muscles, dates and bananas can be included in the diet. These products contain a large number of trace elements, including magnesium, which has a positive effect not only on muscle contractility, but also on the state of the nervous system. But the use of hot spices should be abandoned, as they can provoke a rush of blood to the small pelvis and, accordingly, increase contractions of smooth muscles.

Papaverine for uterine tone

Exercises for uterine tone

Any physical activity can provoke even more muscle contraction. It is for this reason that pregnant women should always consult a doctor before engaging in any sports. With excessive contraction of the uterus, yoga and breathing exercises are best for expectant mothers - these exercises help to relax the body and saturate the tissues of the body with oxygen, which the fetus needs so much.

Sex with increased tension of the muscles of the uterus

If the expectant mother was diagnosed with excessive contraction of the uterus, then sex will have to be abandoned for a while. Remember that the most important thing is to bring to term and give birth to a healthy baby, and you can resume sexual activity after childbirth!

Irina Levchenko, obstetrician-gynecologist, specially for the site site

The tone of the uterus, what it is, the symptoms and causes of this phenomenon are of interest to almost all expectant mothers. After all, at least once during pregnancy, they will definitely hear from their doctor that they have an increased tone of the uterus and receive recommendations for taking multivitamins, antispasmodics and other drugs. Do you need to treat this "diagnosis", how it can be dangerous and how to improve your well-being on your own, read in our article.

The tone of the uterus symptoms is not always pronounced. It may be a sensation of uterine petrification, but this sensation usually occurs in the second half of pregnancy. In the first trimester, the stomach can only “pull” or the lower back whine a little. Most often, the tone of the uterus has a physiological cause. The uterus has a muscular layer, which means that it contracts under certain circumstances. Yes, the hormones produced during pregnancy minimize the likelihood of uterine contractions, but still not completely. Moreover, not all women know why the tone of the uterus occurs during pregnancy, what their actions provoke this phenomenon.

It is worth dwelling on this in more detail. Myometrium, the muscular layer of the uterus, contracts under the influence of many stimuli. An irritant can be, for example, such natural phenomena as coughing, sneezing. Tone can occur as a reaction to a gynecological examination or even palpation by a doctor of the abdomen. Almost always, localized tone appears during an ultrasound examination. In the second half of pregnancy, the uterus can contract, reacting to the active movements of the child, stroking the abdomen. And all this is the norm. It is not the norm if the tone does not pass for more than a few minutes, if it becomes painful, and not only the petrification of the uterus is already felt, but also cramping pains, including in the lumbar region, abundant vaginal discharge appears - this should alert, this is a reason to urgent visit to the doctor. As a rule, the treatment of uterine tone is carried out in 2 cases:

• if there is a real risk of miscarriage or premature birth (local uterine tone on ultrasound is not a sign of a threat of spontaneous abortion);
• uterine contractions occur frequently and interfere with a normal existence.

However, in the first case, as you might guess, doctors are often reinsured. Pregnancy pathology departments in hospitals are filled, perhaps, mainly by women with the threat of abortion.

It remains to figure out how to remove the tone of the uterus, because you will not call an ambulance every time when the uterus is a little tense. If you feel muscle spasm in the abdomen - do not rush to drink No-shpa and insert antispasmodic rectal suppositories, sometimes it is enough to drink warm weak tea and eat something delicious, that is, relax and stop worrying. You can drink a couple of valerian tablets if you can’t calm down. Healthy women who are not at risk for preterm birth can take a warm bath. It is very important to relax, and relaxation should begin with the muscles of the face. If you think hard, get angry, you won't be able to relax them.

It will be very good to rest lying down. But only lying not on your back, but on your side. For comfort, you can put pillows under your back and between your legs. Try to sleep.

Breathing exercises show very good results. She should master all expectant mothers, as she will also be useful to them in childbirth.

If the tone bothers you often, be sure to wear a bandage for pregnant women. It will help to find the uterus in a calm, physiological position and thereby reduce the risk of

Hypertonicity can be defined as involuntary uterine movements that occur before the expected time of delivery. Often this phenomenon occurs in the initial stages of gestation. Usually, the tone of the uterus during pregnancy can be felt or diagnosed instrumentally. In the absence of adequate therapy, the tone threatens premature birth and loss of the child.

When does hypertension occur?

Uterine tone without pregnancy is rare and can be triggered by drugs or human activities. Several reasons can provoke the appearance of tone during pregnancy. But one should distinguish between a normal tone and an increased one, since the danger is only the second type.

The uterus has a three-layer structure, the middle level is represented by muscle muscles, which means it is able to contract. The fertilized egg is attached to its inner mucous layer. Normally, muscle fibers should not be tense. The tone of this type is called normal, or "normotonus".

Note. A pathological condition occurs when the fibrous layer of the uterus begins to contract intensively, being in a stressed state. In this case, we should talk about the high tone of the uterus. What nature of the tone of the uterus during pregnancy - in an increased or normal form - can be established by ultrasound.

It should be remembered that only uterine hypertonicity is dangerous, and with normal tone there is definitely no reason for concern.

Causes

You can talk about uterine hypertonicity if the muscles of the uterus involuntarily contract and move. There are various reasons for the development of this condition. The main ones include:

1. an increase in the concentration of male sex hormones in the blood (if the first trimester);
2. a decrease in the level of the hormone that supports pregnancy - progesterone;
3. large size of the fetus;
4. bad habits;
5. multiple pregnancies;
6. numerous abortions;
7. wrong type of food;
8. the age of the pregnant woman;
9. abnormal structure of the female genital organs from birth;
10. inflammatory processes;
11. improper functioning of the thyroid gland;
12. increased physical activity (second trimester and above);
13. polyhydramnios (significantly increases the risks);
14. diseases of the endocrine type;
15. infantilism of the uterus (structure of the child type);
16. the appearance of tumors;
17. infectious diseases.

In some cases, we can talk about the development of hypertonicity due to nervous or psychological overstrain, lack of sufficient sleep, or complications during pregnancy. This condition can also be caused by impaired functioning of the kidneys, liver, or development. Also, the causes of hypertonicity are the appearance of benign or malignant neoplasms.

Each of these conditions and pathologies can provoke the appearance of symptoms of uterine tone during pregnancy.

What foods can cause hypertension

Among the products that can cause an increase in uterine tone, we can distinguish:

• coffee (due to the invigorating effect, the removal of fluid from the body, the increase in blood pressure and the deterioration of sleep; in some, cardiac activity increases);
• black tea (strong).

Also among the unsafe foods to eat are moldy cheese (contains special types of fungi that can cause tone), raw, smoked, dried or uncooked meat. It is necessary to reduce the consumption of liver products, lard and pâtés.

Advice. Fish for pregnant women is allowed, with the exception of dishes where half-baked raw materials are used. It is better to replace wheat bread with rye bread, and give up alcohol completely.

Manifestations

The most obvious symptoms include the following signs of uterine tone during pregnancy:

• nausea;
• feeling of dizziness;
• weighting of the lower abdomen;
• bloody discharge;
• palpable pain in the lower abdomen;
• feeling that the pregnant belly is hard.

Advice. If at least one of the symptoms manifests itself, you should consult a doctor to decide what to do.

Diagnostic methods

There are several approaches to how to determine the tone of the uterus during pregnancy - diagnostics include finger palpation, ultrasound, tonusometry.

There are already three actively used methods for checking the tone of the uterus, and which one to choose - you decide on your own or on the recommendation of a doctor

Palpation

During palpation, the specialist feels the uterus through the anterior wall of the abdominal cavity - while the pregnant woman lies with her legs bent at the knees. This position of the body allows you to eliminate the tone of the abdominal muscles, and, if there is a tone of the uterus, the doctor can feel the compaction of the muscles of the organ. Typically, this type of diagnosis is used in the second trimester based on the patient's history.

Ultrasound examination

Ultrasound is used as an additional way to study the condition of the muscles of the uterus. This method of determining tone helps to establish the degree of risk and the type of muscle tension.

The tone of the uterus during pregnancy in the 2nd or 3rd trimester can be general or local (located only in selective areas of the organ), posterior or anterior (depending on which wall tension is observed, the tone of the anterior wall of the uterus during pregnancy is more common). Only an ultrasound examination can accurately reflect these characteristics of the condition. On ultrasound, the doctor can also assess the degree of risk of complications, premature birth, or - this is what the uterine tone is dangerous during pregnancy and what it can provoke. When ultrasound detects tone, hospitalization is usually prescribed.

Ultrasound gives a quick and clear answer, removing any errors

Tonusometry

With tonusometry, special sensors can reflect the tension of the uterus. This method is rarely used compared to palpation and ultrasound.

How can you diagnose uterine tone at home

There are methods for determining the condition of the uterus during pregnancy, which are carried out independently. They can be used before a visit to the doctor, since only a specialist can confirm the diagnosis.

First of all, it is possible to assume the presence of hypertonicity if a feeling of tension, pulsation is manifested in the uterus. You may also feel numbness or stiffness in your abdomen. The pain when the tone of the posterior wall of the uterus is observed during pregnancy can be compared with the sensations that often appear during menstruation.

To diagnose the tone, you need to lie on your back. One of the hands is placed on the upper part of the femoral region, and the second on the lower abdomen, where the uterus is supposed to be located. If the hands feel the same tension on both parts of the body, there is no hypertonicity. But if increased toning of the uterus is present, the lower abdomen will appear firmer. If this condition is detected, you should visit a specialist and undergo an ultrasound to avoid complications. Uterine tone is common during pregnancy in the 1st trimester.

It is not difficult to determine the tone at home, but you should not panic ahead of time, because. a doctor with experience will give an accurate answer, unlike a patient who is not experienced in diagnosing

How to relieve the condition before visiting a doctor

If hypertonicity is suspected, it is advisable to ensure complete rest for the pregnant woman and bed rest before visiting a doctor. You can also take antispasmodics that are allowed for pregnant women. If there is a pulling sensation from behind, you should:

• stop any activity;
• kneel down, bend your back, while raising your head, and then slowly return to the starting position;
• relieve the tension of the facial muscles and muscles of the whole body.

Note. Treatment of uterine tone during pregnancy usually includes a number of measures at once.

Treatment

The first thing to do with the tone of the uterus is to ensure complete rest for the pregnant woman and stop vigorous activity. Sex is excluded.

Medical treatment

All drugs that help alleviate this condition should be prescribed by a doctor based on the patient's condition. Common means to combat tone are:

1. sedative preparations of plant origin (motherwort, valerian);
2. vitamin and mineral complexes for pregnant women;
3. drug "Magne B6";
4. antispasmodic drugs (Baralgin, Papaverine with uterine tone).

When choosing hormone therapy, doctors prefer products with progesterone - for example, Duphaston. If heavy bleeding is detected, the patient is hospitalized. In the hospital, hemostatic drugs such as Etamzilat and Dicinon can be used

In the 2nd trimester, the tone of the uterus during pregnancy can be eliminated by the appointment of diathermy, if hypertonicity is not a normal physiological phenomenon (in this case, it does not have a pronounced or prolonged character).

Tension in the uterine muscles can help relieve drugs such as:

1. sulfate;
2. antispasmodic drugs ();
3. "Nifedipine";
4. "Ginipral";
5. "Hexoprenaline";
6. "Verapamil".

In addition to the usual rest, specialized medications are used, the intake of which must be coordinated with your doctor.

Ways to eliminate tone at home

Uncomplicated forms of uterine hypertonicity can be eliminated at home, and therapy may not even include drug treatment.

Exercises

In some cases, the tone of the uterus in early pregnancy can be helped to eliminate simple physical exercises - for example, "Cat". To perform it, you should get on all fours and alternately bend your back up and down a certain number of times - about 5-10. This will help relax the uterine muscles and relieve spasm. After performing the movements, it is useful to lie down for an hour (especially if it is the 3rd trimester).

You can also not perform any movements, but simply kneel with a short time of emphasis - the uterus in a position on all fours with an elbow rest is in a suspended state, which contributes to its relaxation. After performing, you should always rest in a supine position. This is important in how to remove uterine spasms.

Note. The tension of the muscles of the uterus may depend on the tension of the facial muscles. To reduce hypertonicity, sometimes it is enough to relax the facial muscles. To do this, tilt your head and completely relax the muscles of the face and neck. Breathing in this position is carried out through the mouth. This can help relieve symptoms of uterine tone during pregnancy in the 2nd trimester.

As an additional therapy for uterine tone, you can use specialized exercises that will only accelerate the effect of recovery.

Medications

You can supplement exercises at home by taking mild antispasmodics. In mild forms of hypertension, these measures may be sufficient. But if the discomfort or lack of benefit from exercise increases, you should undergo a medical examination.

It is important to eat right during pregnancy - the products must be natural. You need to eat more legumes, nuts, bran, green vegetables, cereals (especially buckwheat and oatmeal).

If a pregnant woman has it, it is necessary to get rid of this phenomenon using the means recommended by the doctor. If the increased tone of the uterus during pregnancy caused premature labor, doctors stop this process with medication by the 40th week of pregnancy.

Preventive measures

To reduce the risk of occurrence or remove the tone of the uterus, it is recommended to follow these tips:

1. provide sleep for at least 8 hours a day;
2. eat right (food should be non-aggressive);
3. reduce physical and motor activity;
4. limit the lifting of heavy objects (especially if there is uterine tone in the third trimester of pregnancy);
5. limit sex;
6. breathe fresh air, but give up long walks;
7. minimize stress;
8. stop using tobacco or alcohol;
9. reduce the frequency of trips in the car or transport (in the second trimester).

All sexually transmitted infections, if present, should be treated before pregnancy. It is important, if the uterus is in good shape during pregnancy, to maintain a good psychological state and avoid stressful situations - natural soothing herbs and essential oils (for example, mint, chamomile or lotus) will help with this. Pregnant women should also undergo regular gynecological examinations to eliminate the risk of developing pathologies.

Prevention is always more effective than treatment, so after completing the course of taking medications, you can safely use the list of recommendations above.

Uterine tone during pregnancy is a rather dangerous condition during pregnancy if left untreated. The risk of developing this phenomenon can be significantly reduced by observing the right lifestyle and lack of stress. The tone is easily treatable, but it can not always be cured on its own. If you suspect the development of spasms of the muscles of the uterus, you should visit a doctor and accurately determine the severity of the condition in order to choose the right treatment. How to remove the tone of the uterus during pregnancy in a certain case and what to do, the specialist decides.

In recent years, the diagnosis of "uterine tone" has become quite common. It is put by gynecologists in almost 60% of pregnant women who visited the antenatal clinic in order to diagnose pregnancy and monitor its development. What does “uterus in good shape” mean and what are the consequences of this condition if, at the time of diagnosis, a woman is often offered hospitalization in an inpatient department in order to maintain her pregnancy?

Validity of the diagnosis

The uterus is a hollow organ, the main wall thickness of which falls on the middle, muscular layer (myometrium). The latter consists of smooth muscle fibers that contract involuntarily, at will, like striated muscles, but under the influence of hormones and nerve impulses coming from the spinal cord.

"Live" muscles are never completely relaxed. They are always in a certain reduced state, tension, or tone. Thanks to this, a certain form and functioning of the organ is preserved, its normal blood circulation and other physiological processes are ensured. Therefore, one can speak of an increased or decreased tone only conditionally, that is, with respect to certain conditions and needs of the body.

For example, the degree of contraction of the myometrium depends on the age of the woman, many external and internal causes. As a physiological reaction, as a result of the release of a significant amount of catecholamines and other biologically active substances into the blood, increased uterine tone (hypertonicity) can occur with excitement, physical stress, and sexual intimacy. Before and during menstrual bleeding, after curettage of the uterine cavity or abortions, during childbirth, contraction of the myometrium also occurs as a protective response to stress, which helps to stop bleeding, give birth, etc.

From the beginning of pregnancy, tension and contractions of muscle fibers are less intense, which is a physiological manifestation of the preservation of pregnancy and the life of the fetus. As the duration of pregnancy increases, especially after 11-12 weeks, the number of contractions increases, and after 20 weeks they may be accompanied by short-term (seconds) pain, abdominal discomfort and a feeling of tightening of the uterus.

In other words, at times, sporadically, irregularly, there are individual signs of "tone" of the uterus during pregnancy. They don't pose any danger. These phenomena represent the physiological activity of the uterus, its reaction in response to fetal movements, touching the abdomen, medical examinations, irritation of the nipples, etc. and do not pose any threat to the child and mother.

At the same time, the relative weakness of the myometrium during the period of expulsion of the fetus leads to a delay in its stay in the birth canal and the threat of asphyxia, and after expulsion - to retention of the placenta and uterine bleeding.

The increased tension of muscle fibers can be widespread (before childbirth and during childbirth) or local, local. For example, an increased local “tonus” of the uterus is observed during an ultrasound examination. This is a natural physiological reaction to irritation during manipulation of the sensor of the device in the region of the anterior abdominal wall or when using an intravaginal sensor that causes irritation of the receptors of the vagina and cervix.

At the site of the introduction of villi and implantation of the ovum into the endometrium, an aseptic (non-infectious) inflammatory reaction of tissues normally occurs, where biologically active substances that promote implantation are delivered with the bloodstream. As a result of inflammation, there is a slight limited swelling of tissues and local contraction of muscle fibers, which is perceived by insufficiently experienced doctors during ultrasound examination as local hypertonicity of the posterior wall and the threat of miscarriage.

In addition, the diagnosis of “tone” of the uterus in early pregnancy, regardless of its nature (common or local), as a rule, indicates only an erroneous interpretation of some subjective sensations of a pregnant woman and ultrasound data, an insufficient understanding of the processes and causes of the dynamics of muscle fibers.

Thus, such a formulation of the diagnosis during pregnancy is erroneous, and it is generally absent in the generally accepted classification of diseases. Of the 60% of women who received it, only 5% needed treatment. Therefore, we can only talk about the physiological or pathological variant of muscle hypertonicity.

In this case, how to understand the presence of a pathological condition, how it manifests itself and how to distinguish it from a physiological one?

Causes of uterine tone during pregnancy

Some of the reasons for the physiological contraction of the muscle layer are mentioned above. What is the danger of pathological hypertonicity? Its result is an increase in pressure in the uterine cavity and a displacement of its walls in relation to the child's place. This can lead to a violation of the blood supply to the fetus, a deterioration in the conditions of its life, to a missed pregnancy, to or to a premature termination of pregnancy - to a spontaneous abortion or to premature birth.

Pathological hypertonicity can be caused by many reasons, among which the main ones are:

1. Hormonal deficiency or imbalance of sex hormones. So, progesterone not only prepares the mucous membrane (endometrium) for the implantation of a fertilized egg, but also reduces the tone of the myometrium, reduces the number of contractions of muscle fibers, and therefore contributes to the preservation and development of pregnancy, especially in the early stages. Its absolute or relative deficiency occurs in various diseases or dysfunctions of the endocrine glands, in which hyperandrogenism (increased synthesis of androgens by the adrenal glands or ovaries) or hyperprolactinemia (increased blood levels of prolactin produced by the pituitary gland) can develop.
2. Increased or decreased thyroid function, diabetes mellitus.
3. Congenital malformations of the uterus.
4. , chronic inflammatory processes of the internal genital organs, isthmic-cervical insufficiency.
5. Rhesus conflict and autoimmune processes.
6. Pronounced.
7. Large fetus, multiple pregnancy, polyhydramnios, oligohydramnios, preeclampsia, dysfunction of the autonomic nervous system. A particularly negative role of these factors affects the late stages of pregnancy.
8. Inadequate sleep, prolonged negative psycho-emotional stress, stressful conditions, heavy physical exertion, smoking.
9. Magnesium deficiency in the body. Magnesium is a calcium antagonist at the level of cell membranes, thus it plays an important role in muscle relaxation and promotes the accumulation and preservation of calcium in bone tissue, preventing osteoporosis. Its deficiency in the second trimester may be associated with an increased need for a woman's body and fetal growth, stressful situations, excessive sweating, a lack of food, bowel dysfunction, and the use of alcoholic beverages.
10. Age under 18 or over 30, especially in first pregnancy.
11. Acute infectious diseases (influenza, acute respiratory viral infections, tonsillitis, etc.), especially accompanied by elevated body temperature, and chronic foci of inflammation (chronic tonsillitis, rhinosinusitis, pyelonephritis).

How to determine the tone of the uterus during pregnancy

Its physiological contractions are manifested by more or less pronounced soreness in the abdomen, sometimes resembling contractions and passing within a few minutes.

The main symptoms of uterine tone during pregnancy:

1 trimester

Pain in the lower abdomen, above the pubis, sometimes radiating to the groin, sacrum, lumbar region, a feeling of discomfort in the lateral parts of the abdomen and lumbar region, a feeling of fatigue in the back, a feeling of abdominal tightness, unusual discharge (with an admixture of blood, even a slight one) from genital tract. Subjective sensations persist for a relatively long time (more than a few minutes).

2 trimester

During this period, the pains and discomforts described above, especially in the lumbar region and spine, are not uncommon even in a normal state, and therefore many women do not cause concern and can be misleading. With an increased tone of the uterus, they are more intense and prolonged. An alarming symptom, the appearance of which requires an immediate appeal to a gynecologist, are unusual in nature and volume of discharge from the genital tract, especially bloody.

3rd trimester

It is quite difficult for a pregnant woman to determine the signs of hypertonicity on her own, since during this period frequent uterine contractions occur, similar to contractions (). They are preparatory (for the fetus and the woman's body) for childbirth in nature. However, they differ from pathological hypertonicity in their short duration, irregularity, the absence of severe pain in the abdomen, spine and lumbar region, as well as the absence of discharge mixed with blood.

With local hypertonicity, others may be added to the listed symptoms. For example, the tone of the posterior wall of the uterus can lead to a feeling of heaviness in the perineum, to constipation or, conversely, to the appearance of loose stools, frequent urge to defecate in the absence or small amount of feces (“false urges”). However, in many cases, increased myometrial contractility in the region of the posterior wall proceeds without severe symptoms.

The tone of the anterior wall of the uterus is also characterized by the main symptoms of hypertonicity, to which a feeling of pressure over the womb, soreness and a feeling of pressure in the inguinal regions, frequent urination and false urge to urinate can be added.

Accurate diagnosis of the pathological syndrome is carried out through examination by a gynecologist, ultrasound and tonusometry using a special apparatus.

How to determine the pathology yourself?

This is not difficult to do, given that this pathology is extremely rare in early pregnancy, knowing about its general clinical manifestations and using a simple technique. To do this, you need to calm down in a horizontal position on your back, achieve maximum relaxation, bend your legs at the hip and knee joints, and then probe the surface of the abdomen with neat, gentle movements. If its high density is felt, especially if the density of the stomach seems to be "stone", this will indicate a very high tone of the myometrium.

In addition, in the later stages, in the second and third trimesters, you can additionally navigate by other subjective sensations - an increase or, conversely, a decrease in the intensity of fetal movements, an increase or decrease in its activity, that is, by the number of movements (compared to previous days or weeks), discomfort that was not previously noted during fetal movements.

How to reduce the tone of the uterus

In a hospital, physical rest is recommended, up to bed rest. In relatively mild cases, oral hormonal drugs are prescribed, if necessary (Dufaston, Utrozhestan), antispasmodic drugs (No-shpa, Papaverine) and vitamin “B 6”, magnesium preparations - Panangin, especially “MAGNE B 6”.

Psychological peace is achieved by the appointment of light sedatives - tinctures of motherwort, hawthorn, valerian, or a combination of them, infusions of these plants with a decoction of valerian rhizomes. With their inefficiency, Sibazon, Nozepam are prescribed. Vitamins, trace elements, especially magnesium (magnesium sulphate) and sedatives are given by drip into a vein in more severe cases. If necessary, Corinfar or Nifedipine are prescribed inside, blocking calcium channels in cells, as well as tocolytics, which reduce the contractility of the myometrium and reduce the degree of its tension (Ginipral).

What to do if there are signs of hypertonicity and how to remove the tone of the uterus at home?

If pathological symptoms occur, it is necessary to call an ambulance, and before the doctor arrives, stop mental and physical work, even light work, go to bed and try to relax all the muscles of the body. You can also take No-shpu, Papaverine or Drotaverine and motherwort tincture, drink weak warm tea with lemon balm or mint.

How to lie in these cases? It is necessary to choose a position in which the pressure in the abdominal cavity decreases, for example, on the side or in the knee-elbow position (“on all fours”).

In the absence of severe pain, you can try to perform light exercises to relieve the tone of the uterus. To this end, you must carefully kneel down and rest your palms of outstretched hands on the floor, take a deep breath, gently raise your head and bend slightly at the same time in the lumbar region, exhaling. In this position, you need to linger for 5 seconds. Then slowly lower your head while arching your spine and exhaling. These exercises should be performed calmly and without tension.

Another exercise, simpler - just lie on your side, bend your legs slightly and breathe deeply, but not very intensively, and in the early stages of pregnancy - in the supine position with bent legs, put a pillow under the pelvis.

Most often, with the correct information of a pregnant woman and her timely appeal for medical help, the phenomenon of pathological hypertonicity can be successfully stopped and the pregnancy can be maintained without negative consequences for the unborn child.