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Braxton Hicks Contractions - StatPearls

Deborah A. Raines; Danielle B. Cooper.

Author Information and Affiliations

Last Update: August 8, 2022.

Continuing Education Activity

Braxton-Hicks contractions, also known as prodromal or false labor pains, are contractions of the uterus that typically are not felt until the second or third trimester of the pregnancy. Braxton-Hicks contractions are the body's way of preparing for true labor, but they do not indicate that labor has begun. Because many pregnant patients have not been educated about Braxton-Hicks contractions, they often seek care and undergo unnecessary evaluation for these contractions. This activity reviews the evaluation and management of patients with Braxton-Hicks contractions and highlights the role of the interprofessional team in educating the patient about the condition.

Objectives:

• Describe the etiology of Braxton-Hicks contractions.

• Review the presentation of a patient with Braxton-Hicks contractions.

• Explain how to evaluate a patient with Braxton-Hicks contractions.

• Employ strategies to improve interprofessional communication, which will improve outcomes in patients with Braxton-Hicks contractions.

Access free multiple choice questions on this topic.

Introduction

Braxton Hicks contractions are sporadic contractions and relaxation of the uterine muscle. Sometimes, they are referred to as prodromal or “false labor" pains. It is believed they start around 6 weeks gestation but usually are not felt until the second or third trimester of the pregnancy. Braxton Hicks contractions are the body's way of preparing for true labor, but they do not indicate that labor has begun or is going to start.

Braxton Hicks contractions are a normal part of pregnancy. They may be uncomfortable, but they are not painful. Women describe Braxton Hicks contractions as feeling like mild menstrual cramps or a tightening in a specific area of the abdomen that comes and goes. [1][2][3]

Braxton Hicks contractions can be differentiated from the contractions of true labor. Braxton Hicks contractions are irregular in duration and intensity, occur infrequently, are unpredictable and non-rhythmic, and are more uncomfortable than painful. Unlike true labor contractions, Braxton Hicks contractions do not increase in frequency, duration, or intensity. Also, they lessen and then disappear, only to reappear at some time in the future. Braxton Hicks contractions tend to increase in frequency and intensity near the end of the pregnancy. Women often mistake Braxton Hicks contractions for true labor. However, unlike true labor contractions, Braxton Hicks contractions do not cause dilatation of the cervix and do not culminate in birth.

Etiology

Braxton Hicks contractions are caused when the muscle fibers in the uterus tighten and relax. The exact etiology of Braxton Hicks contractions is unknown. However, there are known circumstances that trigger Braxton Hicks contractions including when the woman is very active, when the bladder is full, following sexual activity, and when the woman is dehydrated. A commonality among all these triggers is the potential for stress to the fetus, and the need for increased blood flow to the placenta to provide fetal oxygenation.[4][5][6]

Epidemiology

Braxton Hicks contractions are present in all pregnancies. However, each woman's experience is different. Most women become aware of Braxton Hicks contractions in the third trimester, and some women are aware of them as early as the second trimester. Sometimes Braxton Hick contractions occurring near the end of the third trimester of pregnancy are mistaken as the onset of true labor. It is not unusual, especially in a first pregnancy, for a woman to think she is in labor only to be told it is Braxton Hicks contractions and not true labor.

Pathophysiology

Braxton Hicks contractions are thought to play a role in toning the uterine muscle in preparation for the birth process. Sometimes Braxton Hicks contractions are referred to as "practice for labor." Braxton Hicks contractions do not result in dilation of the cervix but may have a role in cervical softening.

The intermittent contraction of the uterine muscle may also play a role in promoting blood flow to the placenta. Oxygen-rich blood fills the intervillous spaces of the uterus where the pressure is relatively low. The presence of Braxton Hicks contractions causes the blood to flow up to the chorionic plate on the fetal side of the placenta. From there the oxygen-rich blood enters the fetal circulation.

History and Physical

When assessing a woman for the presence of Braxton Hicks contractions, there are some key questions to ask. Her response to these questions will assist the healthcare provider to differentiate Braxton Hicks contractions and true labor contractions.[7][8][9]

• How often are the contractions? Braxton Hicks contractions are irregular and do not get closer together over time. True labor contractions come at regular intervals, and as time goes on, they get closer together and stronger.

• How long are the contractions? Braxton Hicks contractions are unpredictable. They may last less than 30 seconds or up to 2 minutes. True labor contractions last between 30 to less than 90 seconds and become longer over time.

• How strong are the contractions? Braxton Hicks contractions are usually weak and either stay the same or become weaker and then disappear. True labor contractions get stronger over time.

• Where are the contractions felt? Braxton Hicks contractions are often only felt in the front of the abdomen or one specific area. True labor contractions start in the midback and wrap around the abdomen towards the midline.

• Do the contractions change with movement? Braxton Hicks contractions may stop with a change in activity level or as the woman changes position. If she can sleep through the contraction, it is a Braxton Hicks contraction. True labor contractions continue and may even become stronger with movement or position change.

During the physical assessment, the provider may palpate an area of tightening or a "spasm" of the uterine muscle, but the presence of a uterine contraction in the uterine fundus is not palpable. The woman will be assessed for the presence of uterine bleeding or rupture of the amniotic membrane. An examination of the cervix reveals no change in effacement or dilatation as a result of the Braxton Hicks contractions.

Evaluation

There are no laboratory or radiographic tests to diagnose Braxton Hicks contractions. Evaluation of the presence of Braxton Hicks contractions is based on an assessment of the pregnant woman's abdomen, specifically palpating the contractions.

Treatment / Management

By the midpoint of pregnancy, the woman and provider should discuss what the woman may experience during the remainder of the pregnancy. Braxton Hicks contractions are one of the normal events a woman may experience. Teaching her about Braxton Hicks contractions will help her to be informed and to decrease her anxiety if they occur.[10][11][12]

There is no medical treatment for Braxton Hicks contractions. However, taking action to change the situation that triggered the Braxton Hicks contractions is warranted. Some actions to ease Braxton Hicks contractions include:

• Changing position or activity level: if the woman has been very active, lie down; if the woman has been sitting for an extended time, go for a walk.

• Relaxing: take a warm bath, get a massage, read a book, listen to music, or take a nap.

• Drinking water to rehydrate.

If these actions do not lessen the Braxton Hicks contractions or if the contractions continue and are becoming more frequent or more intense, the patient's healthcare provider should be contacted.

Also, if any of the following are present the healthcare provider should be contacted immediately:

• Vaginal bleeding

• Leaking of fluid from the vagina

• Strong contractions every 5-minutes for an hour

• Contractions that the woman is unable to "walk through"

• A noticeable change in fetal movement, or if there are less than ten movements every 2 hours.

Differential Diagnosis

• Amenorrhea

• Ascites

• Full bladder

• Hematometra

• Nausea

• Ovarian cysts

• Pseudocyesis

• Uterine fibroids

• Vomiting

Pearls and Other Issues

In addition to Braxton Hicks contractions, there are other causes of abdominal pain during pregnancy. Some normal reasons for abdominal pain during pregnancy, in addition to Braxton Hicks contractions and true labor contractions, include:

• Round ligament pain or a sharp, jabbing feeling felt in the lower abdomen or groin area on one or both sides.

• Higher levels of progesterone can cause excess gas during pregnancy.

• Constipation may be a source of abdominal pain.

Circumstances in which abdominal pain is a sign of a serious condition that requires immediate medical attention include:

• Ectopic pregnancy.

• Placental abruption. A key symptom of placental abruption is intense and constant pain that causes the uterus to become hard for an extended period without relief.

• Urinary tract infection symptoms include pain and discomfort in the lower abdomen as well as burning with urination.

• Preeclampsia is a condition of pregnancy occurring after 20-weeks gestation and characterized by high blood pressure and protein in the urine. Upper abdominal pain, usually under the ribs on the right side, can be present in preeclampsia.

If a woman is unsure if she is experiencing Braxton Hicks contractions or another condition, a discussion with a healthcare provider is needed. The healthcare provider may recommend a visit to the office setting or labor and delivery for an examination by a healthcare professional to determine the cause of the abdominal pain.

Enhancing Healthcare Team Outcomes

Braxton hicks contractions are fairly common and it is important for the emergency department physician labor & delivery nurse and nurse practitioner to be aware that this is not true labor. If there is any doubt, the obstetrician should be consulted. However, at the same time, the onus is on the healthcare workers to rule out true labor. Other organic disorders like appendicitis, urinary tract infection or cholecystitis must also be ruled out. With the right education, patients with braxton hicks contraction will not needlessly rush to the ED every time they sense a contraction.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Hanghøj S. When it hurts I think: Now the baby dies. Risk perceptions of physical activity during pregnancy. Women Birth. 2013 Sep;26(3):190-4. [PubMed: 23711581]

2.

MacKinnon K, McIntyre M. From Braxton Hicks to preterm labour: the constitution of risk in pregnancy. Can J Nurs Res. 2006 Jun;38(2):56-72. [PubMed: 16871850]

3.

Dunn PM. John Braxton Hicks (1823-97) and painless uterine contractions. Arch Dis Child Fetal Neonatal Ed. 1999 Sep;81(2):F157-8. [PMC free article: PMC1720982] [PubMed: 10448189]

4.

Lockwood CJ. The diagnosis of preterm labor and the prediction of preterm delivery. Clin Obstet Gynecol. 1995 Dec;38(4):675-87. [PubMed: 8616965]

5.

Arduini D, Rizzo G, Rinaldo D, Capponi A, Fittipaldi G, Giannini F, Romanini C. Effects of Braxton-Hicks contractions on fetal heart rate variations in normal and growth-retarded fetuses. Gynecol Obstet Invest. 1994;38(3):177-82. [PubMed: 8001871]

6.

Kofinas AD, Simon NV, Clay D, King K. Functional asymmetry of the human myometrium documented by color and pulsed-wave Doppler ultrasonographic evaluation of uterine arcuate arteries during Braxton Hicks contractions. Am J Obstet Gynecol. 1993 Jan;168(1 Pt 1):184-8. [PubMed: 8420324]

7.

Lockwood CJ, Dudenhausen JW. New approaches to the prediction of preterm delivery. J Perinat Med. 1993;21(6):441-52. [PubMed: 8006770]

8.

Rhoads GG, McNellis DC, Kessel SS. Home monitoring of uterine contractility. Summary of a workshop sponsored by the National Institute of Child Health and Human Development and the Bureau of Maternal and Child Health and Resources Development, Bethesda, Maryland, March 29 and 30, 1989. Am J Obstet Gynecol. 1991 Jul;165(1):2-6. [PubMed: 1677235]

9.

Oosterhof H, Dijkstra K, Aarnoudse JG. Fetal Doppler velocimetry in the internal carotid and umbilical artery during Braxton Hicks' contractions. Early Hum Dev. 1992 Aug;30(1):33-40. [PubMed: 1396288]

10.

Oosterhof H, Dijkstra K, Aarnoudse JG. Uteroplacental Doppler velocimetry during Braxton Hicks' contractions. Gynecol Obstet Invest. 1992;34(3):155-8. [PubMed: 1427416]

11.

Bower S, Campbell S, Vyas S, McGirr C. Braxton-Hicks contractions can alter uteroplacental perfusion. Ultrasound Obstet Gynecol. 1991 Jan 01;1(1):46-9. [PubMed: 12797102]

12.

Hill WC, Lambertz EL. Let's get rid of the term "Braxton Hicks contractions". Obstet Gynecol. 1990 Apr;75(4):709-10. [PubMed: 2314790]

Braxton-Hicks contractions or false labor contractions are irregular contractions and relaxation of the muscles of the uterus as a way of preparing for true labor. They are thought to start around 6 weeks of gestation but are not usually felt until the 2nd or 3rd trimester.

False contractions are a normal part of pregnancy. They may be uncomfortable, but not painful. Women describe them as a feeling that feels like mild menstrual cramps or tightness in a specific area of ​​the abdomen that quickly resolves.

They are also irregular in duration and intensity, occur infrequently, are unpredictable and not rhythmic, and are more uncomfortable than painful.

Braxton Hicks contractions tend to increase in frequency and intensity towards the end of pregnancy. Women often mistake Braxton Hicks contractions for real labor. However, unlike real contractions, they do not dilate the cervix and result in the birth of a baby.

Braxton Hicks contractions occur when the muscle fibers of the uterus contract and relax. The exact etiology of Braxton Hicks contractions is unknown. However, there are circumstances that can cause them:

• when the woman is very active,
• when the bladder is full,
• after sexual activity,
• when the woman is dehydrated.

Common among all these circumstances is the potential stress on the fetus and the need for increased blood flow to the placenta to provide oxygen to the fetus.

• Change position or activity level: if you were very active, lie down; if you have been sitting for a long time, go for a walk.
• Relax: take a warm bath, massage, read a book, listen to music or take a nap.

If you have Braxton Hicks contractions or if they continue and become more frequent and intense, you should see your doctor.

When assessing for Braxton Hicks contractions, there are a few key questions to ask yourself. We have prepared for you a table with questions, the answers to which will help you understand what kind of contractions you have:

	Braxton Higgs contractions	Real labor pains
How often do contractions occur?	Irregular and do not increase over time.	Occurs at regular intervals and gets stronger over time.
How long do contractions last?	Unpredictable. They can last less than 30 seconds or up to 2 minutes.	Lasts 30 to 90 seconds and gets longer over time.
How strong are the contractions?	Usually weak and either stay the same or get weaker and then disappear.	Increase over time.
Where do contractions feel?	Often only felt in the front of the abdomen or in one specific area.	Begin in the middle of the back and wrap around the belly towards the midline.
Do abbreviations change with movement?	May stop if activity level changes or if woman's position changes.	Continue and may even get worse with movement or change of position.

Back to article list

False contractions. What are false contractions?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

False contractions are irregular uterine contractions that cause pain but no cervical dilatation. Occur in late pregnancy, more often after the 20th week. The main manifestations: cramping pains in the lower abdomen or in the lumbar region without a clear periodicity. Methods for diagnosing this condition are cardiotocography, examination of the cervix in mirrors with the determination of its degree of maturity, ultrasound of the genitals with an assessment of uterine blood flow. Specific treatment depends on the duration of pregnancy and the causes of this condition.

ICD-10

O47 False contractions

• Causes
• Pathogenesis
• Symptoms of false contractions
• Diagnostics
• Treatment of false contractions
• Prognosis and prevention
• Prices for treatment

General

False contractions are otherwise called "training" or "Braxton-Hicks contractions" after the English doctor who first described this phenomenon. Back in 1872, he noted that many women feel such contractions long before the expected birth. This caused fear and confusion among women in connection with the timing of real childbirth, so J. Braxton Hicks began to warn pregnant women in advance about the possibility of such a phenomenon. False contractions normally occur in 33% of pregnant women. Multiparous women feel false contractions at an earlier date compared to primiparas.

false contractions

Causes

The contractile activity of the uterus depends on the work of the pituitary gland. In the later stages (from 37 weeks), the preparation of the body for future childbirth gradually begins, hormones that have contractile ability (oxytocin, cortisone-like substances) are released. Under their influence, contractions periodically occur in the myometrium. In early gestation, the causes of false contractions can be:

• Pathology of the pituitary and endocrine glands. An increased content of thyroid, adrenal, and posterior pituitary hormones in the blood can increase the readiness of muscle cells to contract. An increase in the level of prolactin provokes excessive formation of male steroid hormones in the female body, which can also lead to false contractions.
• Uterine hypertonicity. The increased readiness of the myometrium for premature contractions can be caused by various factors. Both hormonal causes (reduced progesterone levels) and changes in the fetal-uterine blood flow (like hypoxia of the uterine muscles) play a role here.
• Underdevelopment of the neuro-receptor apparatus of the uterus. The ratio of the number of receptors for estrogen and progesterone is not constant and normally changes at different stages of pregnancy. A pathological increase in the number of estrogen receptors contributes to the occurrence of premature uterine contractions.

The risk group for the occurrence of false contractions in early pregnancy includes patients with preeclampsia, congenital anomalies of the reproductive apparatus and immune diseases. The development of false contractions is facilitated by overstretching of the uterus during multiple pregnancy or the presence of a postoperative scar. Very often, pathological contractile activity of the muscular layer of the uterus is observed with intrauterine infection and isthmic-cervical insufficiency.

Pathogenesis

In the last month of pregnancy, the contractile activity of the myometrium increases. The synthesis of biologically active substances and hormones that stimulate the tension of muscle fibers increases. The number of excitatory uterine contractions of nerve impulses increases. In the brain, a focus coordinating labor activity is formed - the “dominant of childbirth”.

Periodically occurring during this period, false contractions help maintain normal uterine tone and stimulate fetoplacental blood flow. The vessels of the placenta do not have their own muscle layer, periodic uterine contractions displace venous blood from them, which is replaced by arterial blood. Thus, the fetus receives more oxygen and nutrients.

false contractions

Symptoms of false contractions

False contractions are felt by a pregnant woman as an irregular tension in the lower abdomen. The sensations may resemble discomfort during menstruation. Pains of a pulling, aching nature can spread to the lumbar region, sometimes they are accompanied by a feeling of fullness in the genital area. The abdomen during the period of the fight becomes dense, rounded, "hardens". With a high pain threshold, Braxton-Hicks contractions may not be felt at all and may be detected by chance, for example, during a doctor's appointment.

False contractions begin and end suddenly, they have no clear rhythm. Attacks often develop at night, when the pituitary gland increases the production of oxytocin. They are distinguished from true contractions by the fact that the force of contractions does not increase over time, and the intervals between contractions do not decrease. False contractions disappear with a change in position or cessation of physical activity. They may appear and end several times a day.

Diagnostics

The presence of Braxton-Hicks training contractions can be suspected already on the basis of the patient's complaints. During the examination, the tone of the uterus is assessed, which often tenses in response to palpation. Be sure to conduct an examination in the mirrors to determine the degree of maturity of the cervix and its length. If it is shorter than 25 mm, then this is considered a risk of preterm labor and requires appropriate therapy (installation of a pessary, circling).

From the genital tract of a pregnant woman, a smear is taken for the flora, a nitrazine test is performed to exclude spotting, infection, or leakage of amniotic fluid. To assess the general condition of the expectant mother, laboratory tests are carried out, such as a general analysis of urine and blood, a biochemical study, an assessment of the excretory function of the kidneys (Zimnitsky's test). The patient consults a general practitioner, if necessary, a nephrologist and endocrinologist.

As special studies, methods for assessing the condition of the uterus and fetus are used. It is very important to examine the placenta for functional consistency, location and intensity of blood flow. For this, the following is carried out:

• Cardiotocography. At the same time, it allows you to track the contractile activity of the uterus, the presence of contractions and the state of the fetal heart activity. Based on the results, it can be decided whether the fetus suffers from a lack of oxygen during contractions.
• Ultrasound of fetal and uterine blood flow. During the study, anomalies of the vascular bed of the placenta, uterus, and fetus are revealed. Sometimes there is a premature "aging" of the placenta, because of this, the level of blood circulation decreases, hypoxic conditions may develop in the fetus or in the myometrium, which cause abnormal contractions.

Cardiotocography

Treatment of false contractions

Treatment tactics are selected depending on the gestational age at which false contractions occurred. Starting from 37 weeks of gestation, with normal tests, the treatment of false contractions is not carried out. From 22 to 37 weeks, therapy is primarily aimed at eliminating the cause that caused uterine contractions. With endocrine pathology, hormonal correction is prescribed, maintaining an adequate level of progesterone, as the main prolonging pregnancy hormone.

With an increased tendency of the uterus to contractions, tocolytic (relaxing myometrium) therapy is performed. A proven remedy is magnesium sulfate (magnesia). When administered intravenously and intramuscularly, it has an anticonvulsant effect. In addition, the drug prevents fluid retention in the body of a pregnant woman and activates the fetal-uterine blood flow. Sometimes the introduction of a drug is used as a diagnostic test: false contractions stop at the same time, but it does not affect true contractions.

Selective beta-agonists (hexoprenaline), inhibitors of prostaglandin synthesis (indomethacin) and antispasmodics (drotaverine) are also used from tocolytics according to indications. For the prevention of intrauterine fetal hypoxia and circulatory disorders in the uterus and placenta, cytoprotectors and antiplatelet agents (pentoxifylline) are prescribed.

Prognosis and prevention

False contractions do not lead to the onset of labor, so the prognosis for pregnancy is favorable. In most cases, false contractions are part of the normal process of preparing for childbirth. If they are caused by a complicated course of pregnancy, it is important to be examined in time and carry out adequate treatment. To prevent false contractions, a pregnant woman is advised to avoid excessive physical exertion and stressful situations. Also, for the coordinated work of the pituitary gland and endocrine glands, it is necessary to observe the daily regimen and good sleep.

You can share your medical history, what helped you in the treatment of false contractions.

Sources

1. Problems of false contractions in modern obstetrics / Buzumova Zh.

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