Features of management of labor with uterus overextension
Jun 12, 2018
The overgrowth of the uterus can be caused by multiplicity, polyhydramnios, large or giant fetuses. When the uterine wall is overextended, a weakness of labor is often observed in labor, which is associated with uterine hypotension, excessive stretching of the anterior abdominal wall, and a pronounced divergence of the rectus abdominis muscles. Hypotension of the uterus often leads to complications of postpartum or early postpartum periods: hypotonic or atonic uterine bleeding.
Often with uterine overgrowth, late toxicosis of pregnant women develops, the manifestations of which grow during the birth act. As a result of overstretch of the uterus of any origin, there is a violation of uteroplacental blood circulation and fetal hypoxia.
Women with uterine overgrowth symptoms to prevent the development of weakness of labor from the end of pregnancy and in the process of childbirth should appoint estrogens( 30 000-40 000 ED intramuscularly).This will increase the sensitivity of the neuromuscular apparatus of the uterus to biologically active substances, causing its reduction. For the same purpose, drugs that enhance the excitability and contractility of the uterus and replenish its energy resources are used: solutions of glucose and ascorbic acid intravenously, vitamin B1, ATP or cocarboxylase, as well as calcium gluconate intramuscularly).
To prevent and treat fetal hypoxia, drugs that improve uteroplacental circulation and oxygen supply of the fetus are used:
• sygetin against the background of vasodilator application;
• new generation tocolytics( adrenomimetics) - briikanil, ginipral - to activate metabolism in the placenta;
• disaggregants( trental, low molecular weight dextrans) and anticoagulants( heparin) to improve the reocoagulation properties of the blood;
• ATP, cocarboxylase, folic acid, concentrated solutions of glucose, methionine, shock doses of vitamin B12, galascorbine.
With , the uterine overgrowth of to prevent hypotension or atony of the uterus should not be allowed to be rapidly emptied. For example, the birth of the second of the fetus's twin should not be allowed immediately after the birth of the first, except for cases when there are indications for urgent delivery of a woman( eclampsia, acute cardiovascular insufficiency, pulmonary edema, etc.).Also, the release of amniotic fluid is gradually carried out after the opening of the fetal bladder during the phenomenon of polyhydramnios. In the presence of a large or giant fruit( the mass of the fruit is 5000 g or more), one should not allow its birth too quickly. Such a gradual release of the uterus from its contents and the adoption of other preventive measures( emptying the bladder, the introduction of uterine contracting agents, etc.) can prevent the onset of hypotonic and atonic uterine bleeding.
In case of multiple pregnancy, late toxicoses of pregnant women develop more often than under normal conditions, the manifestations of which are intensified during the delivery process. Unusually, often in multiple pregnancies, there is an onset of premature birth. In addition, with multiple pregnancies, the pelvic presentation or the incorrect position of one or both fetuses is more common( in the case of twins), and premature detachment of the normally located placenta occurs, especially after the birth of one of the twins and in the presence of identical twins, when there is a child's place common to both fruits. These features should be remembered in the management of labor in women with multiple pregnancies.
The delivery of a woman with the second of twin fetus( in the absence of signs of its hypoxia) is carried out 20-30 minutes after the birth of the first child. The birth of the second of the twins of the fetus occurs usually quickly, after the spontaneous or artificial opening of its fetal bladder and provided it is in the longitudinal position. In the case of a transverse or oblique fetal position, immediately after opening the fetal bladder, it is necessary to perform a classical( external-internal) turn on the stem and extract it beyond the pelvic end. The fetal bladder of the second fetus should be opened with caution, especially with the high standing of the fetus present above the entrance to the pelvis. After the birth of the first fetus and the crossing of the umbilical cord, the mother's end of the umbilical cord should be carefully bandaged or clamped tightly. This is due to the fact that in single-egg double, due to the common placental circulation for both fruits from the poorly clamped vessels of the umbilical cord of the first fetus, the second fetus loses blood, and if it goes unnoticed, it may die.
When a large and, especially, a giant fetus is born, injuries to the birth canal and child often occur. To prevent possible injury at the final stage of the expulsion period( during the embryo of the fetal head), it is advisable to cut the perineum. Large and gigantic children are often born in women with diabetes. Therefore, a newborn child, despite the great weight at birth, differs in functional immaturity and often suffers from hypoxia, and on the Apgar scale gets a low score. A diabetic mother and a child born to her should be under special supervision of doctors( obstetrician, neonatologist and endocrinologist) and receive appropriate treatment.