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Suggest Treatment For Painful And Irritable Uterus During Pregnancy
Question: Hi Doctor,
my wife is 25 years old, pregnant at 35 and 4 days. Her last period was on December 31st. our first visit to Obstetrician was when she was 7 weeks and based on her last period date and ultrasound her expected due date is 4th of October 2016
We have one son who was born in 31st of September 2014, she gave birth with c-section when she was 36 weeks, the c-section was emergency c-section because she developed Hydronephrosis and according to NST they saw fetal heart stress.
Coming back to her situation now, she visited OBG couple of times because she has to painful Irritable Uterus. at 32 weeks she couldn't feel the baby move for almost whole day so we went to OBG immediately and the OBG said the baby heart is ok and she put her on NST which showed normal and the baby started to move later.
at 33 weeks we went for another visit which showed 3rd-degree calcification of the Placenta, the Doctor said to visit her every once a week to make sure if the calcification is not getting worse. she told her to stop VitD, Calcium Supplement as that could make it worse. The baby growth was normal and according to the gestational age.
and the Doctor gave her Primolut depot injection and nifedipine to help her with painful non-stop contractions of the Uterus but still it's not helping much .
Now she is 35+ weeks she will be 36 weeks on Saturday. her chief complaint since yesterday until today is painful non-stop contractions that comes back every 15 minutes and continues for more than 3 minutes and sometimes she said she feels as if the contractions is not stopping, She said she felt the baby move 15 times today from 5am to 12pm. since 12pm until now 8pm she couldn't feel any baby movement. I told her to drink something sweet and lie on her left side and see if she will move, i'm waiting for her to do that now.
1-What should we do about these contractions (irritable uterus)? can I give her nifedipine ? what dosage is best to give her? her blood pressure is quite low can I still give her nifedipine?
2-what should we do about the baby not moving until now? I will take her to Doctor tomorrow? anything that can help make the baby move?
this is my second time asking about my wife condition at Healthcare magic. as we are very concerned.
Thank you
my wife is 25 years old, pregnant at 35 and 4 days. Her last period was on December 31st. our first visit to Obstetrician was when she was 7 weeks and based on her last period date and ultrasound her expected due date is 4th of October 2016
We have one son who was born in 31st of September 2014, she gave birth with c-section when she was 36 weeks, the c-section was emergency c-section because she developed Hydronephrosis and according to NST they saw fetal heart stress.
Coming back to her situation now, she visited OBG couple of times because she has to painful Irritable Uterus. at 32 weeks she couldn't feel the baby move for almost whole day so we went to OBG immediately and the OBG said the baby heart is ok and she put her on NST which showed normal and the baby started to move later.
at 33 weeks we went for another visit which showed 3rd-degree calcification of the Placenta, the Doctor said to visit her every once a week to make sure if the calcification is not getting worse. she told her to stop VitD, Calcium Supplement as that could make it worse. The baby growth was normal and according to the gestational age.
and the Doctor gave her Primolut depot injection and nifedipine to help her with painful non-stop contractions of the Uterus but still it's not helping much .
Now she is 35+ weeks she will be 36 weeks on Saturday. her chief complaint since yesterday until today is painful non-stop contractions that comes back every 15 minutes and continues for more than 3 minutes and sometimes she said she feels as if the contractions is not stopping, She said she felt the baby move 15 times today from 5am to 12pm. since 12pm until now 8pm she couldn't feel any baby movement. I told her to drink something sweet and lie on her left side and see if she will move, i'm waiting for her to do that now.
1-What should we do about these contractions (irritable uterus)? can I give her nifedipine ? what dosage is best to give her? her blood pressure is quite low can I still give her nifedipine?
2-what should we do about the baby not moving until now? I will take her to Doctor tomorrow? anything that can help make the baby move?
this is my second time asking about my wife condition at Healthcare magic. as we are very concerned.
Thank you
Brief Answer:
Foetal safety first; definitely no Nifedipine of your own
Detailed Answer:
Dear XXXX,
I do empathize your stress, particularly considering her history and the previous finding of grade 3 calcification of placenta. However, I must complement you for such a comprehensive history you have provided.
Now that she is 35+ weeks, any Obstetrician would have the first aim of taking the pregnancy upto 37 weeks when the growth of the baby is fair enough to allow it survive outside the uterine environment without much difficulty. However, when such complications are found, every Obstetrician tries to balance the risk between continuation of intrauterine life and the risk in extrauterine life. This is achieved by NST and Manning's score by Ultrasonography and NST. I am sure, your Obstetrician should be following it closely. If not, you may suggest this to him/her. With grade 3 calcification of the placenta, I would rather opt for inducing labour or Caesarean section at completion of 37 weeks. Please upload the images and reports for my review.
Yes XXXX, diminution of the foetal movements is a first symptom of risk to the foetus the expectant mother perceives. By and large, if the foetal movements are perceived for 10 times during 12 hours, the baby is healthy. So 15 movements from 5 am to 12 pm (do you mean noon?) is a good foetal movement count. However, no movement what so ever for next 8 hours is rather an issue of concern. The baby does sleep inside the uterus when you do not feel any movements. Still you have to assess the safety of baby by foetal movements. At home, you can do it by one of the following ways:
1. Initiate foetal movements by stimulating foetus. This you can do by creating a loud sound around the mother or call the foetus loudly. Alternatively, you may gently shake the baby manually (please do not do this when the uterus is contracting) and then try to feel the foetal movements.
2. Try to feel the head of the foetus. Usually it is at the lower end. It is hard, globular organ which you may shake from side to side (ballottement). Then try tracing upwards the back of the foetus which will be continuous firmness. The lowermost pole of this back is the shoulder of the foetus. Put your ear on this point and you can listen to the heart sounds of the foetus. Usually they are double that of the mother's pulse (around 140-160/min). So you should not mistake them with mother's sounds. Please do this only when the uterus is completely relaxed. Handling the uterus in its contracting phase can create emergency like tonic contraction of the uterus, which is dangerous to the baby.
If you can find the wellness of the foetus by either of these tests, you can rest assured; if not, you would have to report to the Obstetrician ASAP.
The uterus is continuously contracting and relaxing throughout the pregnancy. These contractions are known as XXXXXXX Hick's contractions. They are never felt by the mother. Sometimes, in last few weeks of pregnancy, depending upon the pain threshold of the mother, she may feel them painful. We call it as 'Painful Prelabour'; however these contractions are not progressive and the other symptoms of labour are noticed. If possible, they can be ignored. However, please do not give her any medicine for the irritable uterus by yourself; definitely not Nifedipine. If it causes sudden severe low blood pressure, it is dangerous to mother and even the life of the foetus. You may consult your Obstetrician for intolerable Painful Prelabour.
At present, please concentrate on the safely of the baby. I feel, with this much information, you will be able to figure it out. If not, you may report to the Obstetrician without delay.
For any more information or guidance, I am always available for you, XXXX. You may consider posting a good review with 5 stars rating for me.
Dr. Nishikant Shrotri
Foetal safety first; definitely no Nifedipine of your own
Detailed Answer:
Dear XXXX,
I do empathize your stress, particularly considering her history and the previous finding of grade 3 calcification of placenta. However, I must complement you for such a comprehensive history you have provided.
Now that she is 35+ weeks, any Obstetrician would have the first aim of taking the pregnancy upto 37 weeks when the growth of the baby is fair enough to allow it survive outside the uterine environment without much difficulty. However, when such complications are found, every Obstetrician tries to balance the risk between continuation of intrauterine life and the risk in extrauterine life. This is achieved by NST and Manning's score by Ultrasonography and NST. I am sure, your Obstetrician should be following it closely. If not, you may suggest this to him/her. With grade 3 calcification of the placenta, I would rather opt for inducing labour or Caesarean section at completion of 37 weeks. Please upload the images and reports for my review.
Yes XXXX, diminution of the foetal movements is a first symptom of risk to the foetus the expectant mother perceives. By and large, if the foetal movements are perceived for 10 times during 12 hours, the baby is healthy. So 15 movements from 5 am to 12 pm (do you mean noon?) is a good foetal movement count. However, no movement what so ever for next 8 hours is rather an issue of concern. The baby does sleep inside the uterus when you do not feel any movements. Still you have to assess the safety of baby by foetal movements. At home, you can do it by one of the following ways:
1. Initiate foetal movements by stimulating foetus. This you can do by creating a loud sound around the mother or call the foetus loudly. Alternatively, you may gently shake the baby manually (please do not do this when the uterus is contracting) and then try to feel the foetal movements.
2. Try to feel the head of the foetus. Usually it is at the lower end. It is hard, globular organ which you may shake from side to side (ballottement). Then try tracing upwards the back of the foetus which will be continuous firmness. The lowermost pole of this back is the shoulder of the foetus. Put your ear on this point and you can listen to the heart sounds of the foetus. Usually they are double that of the mother's pulse (around 140-160/min). So you should not mistake them with mother's sounds. Please do this only when the uterus is completely relaxed. Handling the uterus in its contracting phase can create emergency like tonic contraction of the uterus, which is dangerous to the baby.
If you can find the wellness of the foetus by either of these tests, you can rest assured; if not, you would have to report to the Obstetrician ASAP.
The uterus is continuously contracting and relaxing throughout the pregnancy. These contractions are known as XXXXXXX Hick's contractions. They are never felt by the mother. Sometimes, in last few weeks of pregnancy, depending upon the pain threshold of the mother, she may feel them painful. We call it as 'Painful Prelabour'; however these contractions are not progressive and the other symptoms of labour are noticed. If possible, they can be ignored. However, please do not give her any medicine for the irritable uterus by yourself; definitely not Nifedipine. If it causes sudden severe low blood pressure, it is dangerous to mother and even the life of the foetus. You may consult your Obstetrician for intolerable Painful Prelabour.
At present, please concentrate on the safely of the baby. I feel, with this much information, you will be able to figure it out. If not, you may report to the Obstetrician without delay.
For any more information or guidance, I am always available for you, XXXX. You may consider posting a good review with 5 stars rating for me.
Dr. Nishikant Shrotri
Above answer was peer-reviewed by :
Dr. Prasad
Thank you very much, Doctor for the well-detailed answer, makes me feel better indeed. I will do as per your guidance above with caution (such as avoiding during contractions etc). I will definitely avoid Nefidipine until further evaluation by the OBGN.
I told my wife to drink Vimto or something sugary and lie on her left for at least 45 minutes, the fetus moved 1 time which I think is kind of a good sign so far. I will take her to OBGN tomorrow early morning and will update you with a follow-up.
I'm in the middle east so our timing is GMT+4 (thus the timing I gave above)
I'm a medical student, perhaps that helped me give you a good history of my wife condition.
few more questions
1.Can we say these contractions could be one of the reasons as to why my wife can't feel the fetal movements?
2.Do these contractions my wife feels (Irritable uterus or XXXXXXX hicks) affect the well-being of the baby? I can imagine it as squeezing the fetus up and not giving it chance to play around or even move, wrong imagination??
I hope everything turns out well tomorrow
I told my wife to drink Vimto or something sugary and lie on her left for at least 45 minutes, the fetus moved 1 time which I think is kind of a good sign so far. I will take her to OBGN tomorrow early morning and will update you with a follow-up.
I'm in the middle east so our timing is GMT+4 (thus the timing I gave above)
I'm a medical student, perhaps that helped me give you a good history of my wife condition.
few more questions
1.Can we say these contractions could be one of the reasons as to why my wife can't feel the fetal movements?
2.Do these contractions my wife feels (Irritable uterus or XXXXXXX hicks) affect the well-being of the baby? I can imagine it as squeezing the fetus up and not giving it chance to play around or even move, wrong imagination??
I hope everything turns out well tomorrow
Brief Answer:
Please insist on AFI
Detailed Answer:
Dear XXXX,
Let me clarify your queries before I give further advice.
1. The painful prelabour contractions are not so strong to interfere the foetal movements; and any way the foetal movements are perceived best during relaxation phase of the uterus.
2. During painful prelabour, the uterine contractions are of very low intensity (<8 mm). When actual labour contractions, even in second stage do not endanger the foetus, how painful prelabour will do that? Moreover, there is a sufficient phase of relaxation between two contractions which takes care of foeto-placental perfusion.
Please insist on Manning's score, at least Amniotic Fluid Index. Considering the extent of placental calcification, this would be a critical parameter to monitor Foetal safety. Manning's score 4 and below demands for immediate termination of pregnancy while 8 and above indicate foetal safety.
AFI above 10 is safe while if it is under 5 it demands immediate termination of pregnancy to save foetal life. Such foeti cannot sustain the stress of labour contractions and hence Caesarean section is the choice of delivery.
Please upload all the images and reports and also the images and reports of the investigations I have suggested.
Please feel free to ask for any more information or advice.
Dr. Nishikant Shrotri
Please insist on AFI
Detailed Answer:
Dear XXXX,
Let me clarify your queries before I give further advice.
1. The painful prelabour contractions are not so strong to interfere the foetal movements; and any way the foetal movements are perceived best during relaxation phase of the uterus.
2. During painful prelabour, the uterine contractions are of very low intensity (<8 mm). When actual labour contractions, even in second stage do not endanger the foetus, how painful prelabour will do that? Moreover, there is a sufficient phase of relaxation between two contractions which takes care of foeto-placental perfusion.
Please insist on Manning's score, at least Amniotic Fluid Index. Considering the extent of placental calcification, this would be a critical parameter to monitor Foetal safety. Manning's score 4 and below demands for immediate termination of pregnancy while 8 and above indicate foetal safety.
AFI above 10 is safe while if it is under 5 it demands immediate termination of pregnancy to save foetal life. Such foeti cannot sustain the stress of labour contractions and hence Caesarean section is the choice of delivery.
Please upload all the images and reports and also the images and reports of the investigations I have suggested.
Please feel free to ask for any more information or advice.
Dr. Nishikant Shrotri
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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