Birth abnormalities

– their main types include weak labor activity, excessively strong and discoordinated labor activity .

Weakness of labor activity . It is characterized by insufficient strength and duration of contractions of the myometrium, an increase in pauses between contractions.

Types Of weakness of labor activity

Distinguish primary and secondary generic weakness. Primary weakness occurs at the beginning of the labor act and can continue both in the II and III period of labor. Secondary weakness develops against the background of normal contractions in the I or II period of labor.

Causes Of weakness of labor activity

Causes of primary weakness of labor activity: overstrain of the Central nervous system, endocrinopathy, previous disorders of the menstrual cycle, infantilism, metabolic disorders, uterine malformations, inflammatory processes in the genitals, overgrowth of the uterus (polyhydramnios, multiple births, large fetuses), old age of the first-born, perenashivanie, etc. The development of primary weakness of contractions contributes to the prenatal outpouring of amniotic fluid.

Causes of secondary generic weakness, in addition to the above, – fatigue mothers during labor, clinically narrow pelvis, cross fetal position, breech presentation, rigidity cervix, haphazard appointment of drugs that stimulate labor. Weakness of labor activity is expressed in shortening the contractions (or attempts) and increasing the pauses between them. This leads to a prolonged course of labor, fetal hypoxia, the development of ascending infection (chorioamnionitis), bleeding in the postpartum and early postpartum periods, and an increase in the frequency of postpartum diseases.

Diagnosis of labor Weakness

Put on the basis of dynamic observation of the nature of labor – weak, short contractions, long pauses between them, slow opening of the cervix (determine when. vaginal examination), slow progressive advance of the pre-lying part of the fetus. Additional research methods include cardiotocography and external hysterography.

Excessive labor activity. It is caused by hypertonus of the uterus and is clinically expressed by very frequent contractions with shortened intervals between them. Childbirth ends quickly( rapidly), while there is a disorder of utero-placental blood circulation and fetal hypoxia. A child is often born with intracranial birth trauma.

Discoordinated labor is characterized by a haphazard reduction of the uterus (bottom and lower segment). Contractions are regular, but very painful and ineffective; the opening of the throat is slow, despite the absence of signs of rigidity. There is no advance of the pre-lying part of the fetus, spontaneous urination is disturbed, although there are no signs of pressing the bladder.

Causes of Discoordinated labor activity

Intrauterine hypoxia of the fetus often occurs due to disorders of the utero-placental blood circulation.

Treatment of birth Abnormalities

Treatment of birth abnormalities is determined by the woman's condition. If the mother is very tired, she should be given rest for 2-4 hours (obstetric anesthesia). To do this, premedication is performed: 0.5-1 ml of 0.1% solution of atropine sulfate p/K, then 500-1000 mg of predion (viadryl) in/in or 20 ml of 20% solution of sodium oxybutyrate. After the end of narcotic sleep, labor activity usually increases and additional prescribing of drugs that stimulate labor is not required. If contractions remain weak, apply one of the medical schemes rodostimulyatsii.

When Mature the cervix it is advisable/drip oxytocin (5 IU of oxytocin, diluted in 500 ml 5% glucose solution) at a rate of from 8 to 40 drops in 1 min; if unripe cervix before oxytocin create hormonal balance, prescribing estrogens to 20 000 IU of estradiol dipropionate (estradiol propionate) together with 0.5 ml of anesthetic ether in the thickness of the cervix.

Effective intravenous administration of 5 mg of prostaglandin E2A in 500 ml of isotonic sodium chloride solution or 2.5 mg of prostaglandin 2A together with 2.5 UNITS of oxytocin diluted in 500 ml of isotonic sodium chloride solution. The rate of administration is from 6 to 20-30 drops per 1 min.

Caesarean section uterine inertia should be used only in cases when conservative therapy is unsuccessful and the forecast of labor for the mother and adverse plaid, especially when combined with the weakness of labor with other disorders (pelvic fetal presentation, obstetric history, older age of mothers, etc.).

In case of secondary weakness of labor that is not amenable to medication, depending on the obstetric situation, obstetric forceps are applied, fetal vacuum extraction, fetal extraction by the pelvic end, etc.

When the attempts are weak due to the failure of the abdominal muscles, sometimes a verbov bandage is used – a special device made of fabric for tightening the abdomen of a woman in labor during the attempt. Verbov's bandage can be replaced with a sheet. In cases of rigidity of the uterine pharynx and failure to use spasmolytic agents, sometimes resort to its finger expansion. If there are signs of developing infection, as well as with an anhydrous interval of more than 10 hours, if the end of labor is not expected in the next 1-2 hours, antibiotics are prescribed.

In case of excessively strong labor activity, labor management is aimed at reducing labor activity. The woman in labor is placed on the side opposite to the position of the fetus, and given anesthesia (for example, fluorotane). The use of nitrous oxide, nitrogen is impractical, because it does not reduce the tone of the uterus. For the regulation and the weakening of labor effective is the use of (B-agonists – effects or ritodrine. The drugs are administered intravenously (0.5 mg of partusisten or 10 mg of ritodrin is dissolved in 250-400 ml of isotonic sodium chloride solution), gradually increasing the speed of administration until the effect occurs, which usually occurs after 5-10 minutes. Childbirth takes place in the position of the woman on the side, opposite to the position of the fetus.

When discoordinated labor is used psychotherapy, analgesic, Sedative, antispasmodic, P-adrenomimetic agents, obstetric anesthesia (predion or sodium oxybutyrate). Electroanalgesia is effective. In the case of convulsive contractions, or uterine tetany, treatment depends on the cause of this complication. So, in case of an overdose of oxytocin, its administration is immediately stopped and, if necessary, the woman in labor is given deep anesthesia. Effective intravenous administration (Z-adrenomimetikov: partusistena, terbutalin.

If the birth canal is prepared, then under anesthesia, the fetus is extracted using obstetric forceps (for head presentation) or by the leg (for pelvic presentation). With a dead fetus, a fruit-destroying operation is performed. After fetal extraction, the placenta is manually separated, the afterbirth is isolated, and the uterine cavity is examined to exclude ruptures.