A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman’s labor?
A.
She is exhibiting hypertonic uterine dysfunction.
B.
She is experiencing a normal latent stage.
C.
She is experiencing precipitous labor.
D.
She is exhibiting hypotonic uterine dysfunction.
The Correct Answer and Explanation is:
The correct answer is A. She is exhibiting hypertonic uterine dysfunction.
Explanation:
In the scenario described, the woman is in the first stage of labor, specifically in the latent phase, where the cervix dilates from 0 to 3-4 cm. Normally, during this phase, contractions are mild to moderate and help in the gradual dilation of the cervix. However, in this case, the woman is experiencing very painful contractions that are occurring frequently, every 1.5 to 2 minutes, yet her cervix has only dilated 2 cm and has not changed in 3 hours. This lack of cervical change despite frequent and painful contractions indicates a labor dysfunction.
Hypertonic uterine dysfunction is characterized by strong, frequent, and painful uterine contractions that are ineffective in causing significant cervical dilation or progression in labor. These contractions can be disorganized, and they do not allow the uterus to relax completely between contractions. This can lead to ineffective labor because the uterus is working too hard without achieving the desired effect, which is cervical dilation. As a result, the cervix does not dilate at the expected rate, and the labor becomes prolonged.
The fact that the woman is in significant pain, crying, and requesting an epidural also suggests that her contractions are more intense than typically expected in early labor, further supporting the diagnosis of hypertonic uterine dysfunction.
This condition is more common in primigravidas (women who are pregnant for the first time) and can lead to maternal exhaustion and fetal distress if not managed appropriately. Management typically involves pain relief measures such as an epidural, hydration, and sometimes the use of medications to help coordinate and regularize the contractions. In some cases, labor may need to be augmented with oxytocin if the contractions are strong but ineffective.
This scenario is different from hypotonic uterine dysfunction (option D), where contractions are infrequent and weak, leading to inadequate cervical dilation. Precipitous labor (option C) is rapid labor lasting less than 3 hours, which is not the case here. Normal latent stage (option B) would involve less frequent and less painful contractions with progressive cervical dilation.
Therefore, the most appropriate diagnosis for this woman is hypertonic uterine dysfunction.