Inefficient uterine activity

1. Big picture

Inefficient uterine activity means uterine contractions are present but do not produce effective cervical dilatation, fetal descent, or fetal rotation.

The examiner wants one key clinical principle:

Before treating weak or abnormal contractions with oxytocin, exclude obstruction.

If the uterus is weak and the pelvis/fetus are suitable → augmentation may help. If the uterus is contracting against obstruction → oxytocin can cause uterine rupture, fetal distress, and maternal collapse.

Inefficient labour progress
        ↓
Assess contractions + cervix + fetal descent
        ↓
Exclude malpresentation, malposition, CPD, obstruction, fetal compromise
        ↓
If hypotonic and safe → amniotomy/oxytocin
        ↓
If hypertonic/incoordinate or obstructed → do NOT blindly augment

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