Hoehne’s sign refers to the absence of uterine contractions during labor and delivery despite repeated doses of oxytocic drugs. It is considered a serious clinical indicator of uterine rupture, a life-threatening obstetric emergency.

Pathophysiology

• In normal labor, oxytocic drugs (e.g., oxytocin) stimulate the uterine myometrium to contract, facilitating cervical dilation and fetal descent.

• In uterine rupture, the integrity of the uterine wall is lost, leading to:

  • Loss of contractile function in the myometrium.

  • Hemorrhage into the peritoneal cavity.

  • Disruption of effective labor despite pharmacologic stimulation.

• Hence, failure of uterine contractions despite oxytocics is strongly suggestive of rupture.

Examination Technique

1. Patient observation: Monitor uterine contractions during active labor.

2. Oxytocic administration: Administer oxytocin or other uterotonics as clinically indicated.

3. Assessment:

   • If contractions fail to occur despite escalating doses, suspect Hoehne’s sign.

   • Correlate with other signs of uterine rupture (e.g., maternal shock, abdominal tenderness, loss of fetal station).

Clinical Features

Differential Diagnosis

Maternal & Neonatal considerations

• Maternal: Rapid deterioration due to internal hemorrhage and hypovolemic shock.

• Neonatal: Severe hypoxia, high risk of stillbirth if rupture not recognized promptly.

• Timing: Uterine rupture usually occurs in active labor, often in women with a scarred uterus.

Limitations

• Hoehne’s sign is not an early sign — rupture may already have occurred when contractions are absent.

• Requires exclusion of drug error (e.g., inadequate oxytocin infusion).

• Should always be interpreted with other clinical and fetal monitoring findings.

Patient counseling

• Explain that absent contractions despite oxytocics may indicate a serious uterine complication.

• Stress the need for emergency surgical intervention (usually laparotomy and cesarean delivery).

• Reassure that future pregnancies can be managed with close monitoring and individualized delivery planning.

Conclusion

Hoehne’s sign — absent uterine contractions despite oxytocic administration — is a critical bedside clue to uterine rupture during labor. Prompt recognition, immediate surgical management, and maternal resuscitation are essential to reduce maternal and neonatal morbidity and mortality.

References

1. Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics. 26th ed. New York: McGraw-Hill; 2022.

2. Hofmeyr GJ, Say L, Gülmezoglu AM. WHO systematic review of maternal mortality and morbidity: Uterine rupture. BJOG. 2005;112(9):1221–1228.

3. Arulkumaran S, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics and Gynaecology. 3rd ed. Oxford: Oxford University Press; 2011.

4. American College of Obstetricians and Gynecologists (ACOG). Uterine rupture: Clinical management guidelines. Obstet Gynecol. 2019;133(2):e110–e118.