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Uterine hyperstimulation is often unrecognised and is a common result of current oxytocin use. In the West Midlands, 58% of units have a 15 minute incremental interval for Syntocinon infusion, whereas according to RCOG recommendations, there is no benefit of using intervals less than 30 minutes. Less than 40% of units in this region have a protocol for dealing with uterine hyperstimulation.  

Suggested Management of Uterine Hyperstimulation:


  • Syntocinon off!
  • Turn mother on her side
  • Oxygen by mask
  • Prepare for possible delivery
  • Consider Tocolytics if no response

Indications for tocolytics during labour at term include fetal distress associated with uterine hypertonus, cord prolapse and trapped breech. Currently licensed tocolytics are Beta-sympathomimetics: Salbutamol Ritodrine (Reference 1), and Terbutaline (Reference2). Magnesium Sulphate and Nitroglycerin (Reference 03) have also been trialed. Magnesium Sulphate (Reference 4) is not as effective as Terbutaline, but may be a good second line drug when ß-sympathomimetics can not be used. A possible consequence of any tocolytic therapy is uterine atony post delivery resulting in postpartum haemorrhage.


1. Mendez-Bauer C, Shekarloo A, Cook V, Freese U, (1987), "Treatment of acute intrapartum fetal distress by beta 2-sympathomimetics." Am J Obstet Gynecol 1987 Mar;156(3):638-42, Abstract


  • Smith C. "Reversing acute intrapartum fetal distress using tocolytic drugs." Clinical Obstetrics and Gynecology 1991;34(2):352-9
  • Shekarloo A. "Terbutaline (intravenous bolus) for the treatment of acute intrapartum fetal distress." Am J Obstet Gynecol 1989;615-8
  • Patriarco M. "A study on intrauterine fetal resuscitation with terbutaline." Am J Obstet Gynecol 1987;157:384-7

3. Mercier F. "Intravenous nitroglycerin to relieve intrapartum fetal distress related to uterine hyperactivity: a prospective." Anestesea and Analgesia 1997;84(5):1117-20

4. Magann EF, Cleveland RS, Dockery JR, Chauhan SP, Martin JN Jr, Morrison JC , (1993), "Acute tocolysis for fetal distress: terbutaline versus magnesium sulphate." Aust N Z J Obstet Gynaecol 1993 Nov;33(4):362-4, Abstract

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