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Lower uterine hypertonicity (reverse gradient)
Last reviewed: 08.07.2025
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Hypertonicity of the lower uterine segment, or reverse gradient, is a pathological condition in which the contraction wave begins in the lower uterine segment and spreads upward with decreasing strength and duration, with the lower segment contracting more strongly than the body and fundus of the uterus. Such contractions of the uterus are not effective in ensuring the opening of the cervix, despite the fact that they can be as strong as during normal labor. In fact, these contractions are aimed at closing the cervix, especially in the early stages of labor, when mainly the lower segment of the uterus actively contracts.
The etiology of this anomaly is not fully understood, but most researchers are inclined to believe that the main cause of hypertonicity of the lower uterine segment is a violation of the mechanism of reciprocal (conjugated) relations between the body and the cervix, which is due to their different innervation. As has now been established, such an anomaly of labor is often observed with an "immature" and rigid cervix.
The clinical picture of hypertonicity of the lower segment is characterized by quite pronounced labor activity, but contractions are more painful than normal, there is no dilation of the cervix or its dynamics are poorly expressed, the presenting part of the fetus does not advance. Pain is usually expressed in the lower parts of the uterus and in the lumbar region. High tone of the uterus is determined in its lower parts. Premature rupture of amniotic fluid is often observed. Subsequently, secondary weakness of labor may develop. Intrauterine suffering of the fetus is often noted. Hypertonicity of the lower segment of the uterus is observed in the first period of labor and especially in the early stages of dilation of the cervix.
The diagnosis is easily made based on clinical data. Multichannel hysterography is of great help in diagnosis, where in this anomaly, contractions in the lower uterine segment are dominant compared to contractions in the body and fundus of the uterus.
Differential diagnosis should be made primarily with clinical inconsistency.
To restore the triple descending gradient with the dominant fundus, it is recommended to conduct psychotherapy, use analgesics, sedatives, antispasmodics, obstetric anesthesia. Therapeutic electroanalgesia and opening of the amniotic sac have a good effect. It is a mistake to prescribe oxintotic agents and attempt digital dilation of the cervix (!).
First of all, it is necessary to find out the cause of this pathology. Thus, if immaturity of the cervix is established, it is necessary to carry out treatment aimed at its maturation.
During labor, careful monitoring of the nature of labor, the dynamics of cervical dilation (maintaining a partogram), and fetal heartbeat is important; prevention of fetal hypoxia is mandatory.
If there is no effect from the therapy, taking into account the condition of the mother and the fetus, the question of delivery by cesarean section should be raised in a timely manner.
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