Pathology of labor

About the pathology of labor of the is spoken in the event of a violation of the normal contractile activity of the uterus during childbirth.

Wrong development of labor clashes and attempts is an anomaly of labor and is considered one of the most common complications in the process of childbirth. The anomalies of labor are all cases of prolonged or excessively rapid birth.

Prolonged delivery is most often associated with hypotension of the uterus. There are primary and secondary weakness of labor. With the primary weakness of contractions, a slight increase in the contractile activity of the uterus is observed in frequency, duration and strength, as well as slowing the opening of the cervix and the forward movement of the fetus along the generic pathways. Less common is the secondary weakness of labor, when the birth act first develops without disturbances and at a normal pace, and then, for a number of reasons, a secondary weakening of the contractile activity of the uterus occurs, and the delivery is significantly delayed. The development of secondary weakness of labor is often noted at the end of the period of disclosure and in the period of exile. Primary weakness of labor is predominant in primiparous women, and secondary weakness is more common in miscreant women.

If the primary weakness of maternity labor is developed at night, it is advisable to provide her with a medical sleep-rest. In the case of delaying the labor process up to 18 hours, it is advisable to provide such a sleep-rest to women in labor not only at night, but also during the day. After awakening from a medical sleep a woman giving birth is required to perform rhythm-stimulating therapy.

Rapid births with signs of hypertension of the uterus and increased its excitability are noted in no more than 2% of parturient women. Rapid or rapid development of the generic process can lead to the development of a number of complications in the mother( trauma of the maternal pathways, discrepancy of the pectoral articulation, bleeding) and in the fetus or newborn child( intrauterine hypoxia or intrauterine asphyxia, intracranial hemorrhage, cephalohematomaperiosteum of the skull bones), fractures of the clavicle, etc.).

In rare cases with hypertension and increased excitability of the uterus, uncoordinated( uncoordinated) birth activity is observed. Dystocia of the cervix is ​​one of the most serious forms of discoordination of labor. With this pathology, there is no active stretching of the cervix during the contraction, but a contraction of it simultaneously with the uterus. With outwardly active, but discordinated labor, dystocia of the cervix does not progress and significantly delay. In such cases, carrying out rhodostimulation is contraindicated, since this will further exacerbate the manifestations of discoordination in the contractile activity of the uterus. In the case of non-coordinated labor, it is advisable to use antispasmodics, sometimes together with drugs that lower the excitability of the central nervous system, or even narcotic drugs. With dystocia of the cervix, it is effective to administer 2 ml of a 1.5% solution of the spasmolytic gangleron drug intramuscularly or 2 ml of a 0.5% solution intravenously.

Development of weakness of labor is most likely in women in the following cases:

• weighed down gynecological obstetrics;

• the age of the pervasive woman is more than 30 years;

• severe obesity;

• large fruit;

• multiple pregnancy;

• pelvic presentation of the fetus;

• malformations of the uterus( bicorne or saddle-shaped uterus), etc.

A set of measures for the artificial inducing of labor in pregnant women for certain indications is called induction.

Before the use of funds that cause or enhance uterine contractions, a woman is administered estrogenic hormones in the amount of 30-40 units. Under the influence of estrogen, the tone and excitability of the uterus increases, the sensitivity of its muscle cells to biologically active substances: pituitrin, oxytocin, acetylcholine, prostaglandins, which can cause a reduction in the musculature of the uterus. To prepare for the induction use spasmolytic drugs( gangleron, no-shpa, dimecoline, etc.), and also the enzyme lidase is prescribed.

The prescribing of medicines and procedures for labor excitement should be carried out in a certain sequence:

• 2 hours prior to the beginning of the application of the mother-raising agents of the pregnant woman, re-administration of estrogen is introduced in a dose of 30-40 U, ​​but in a mixture with 1-2 ml of ether for anesthesia, which almost doubles the absorption of the drug;

• At the same time, toning therapy is performed to increase the tone and excitability of the uterus musculature: 40 ml of 40% glucose solution and 6 ml of 5% solution of ascorbic acid intravenously, as well as 2 ml of a 6% solution of vitamin B1 and 10 ml10% solution of calcium gluconate intramuscularly;

• 2 hours after tonic therapy, the pregnant woman is given 50-60 ml of castor oil inside, and after another 1.5-2 hours, a cleansing enema is placed. Castor oil and cleansing enema intensify intestinal motility and contribute to the production and entry into the blood of acetylcholine, which under usual conditions is rapidly inactivated by the enzyme cholinesterase. To prevent the inactivation of acetylcholine, after an enema, a woman is prescribed one of the anticholinesterase drugs( quinine, proserin or eserine);

• taking one of the anticholinesterase drugs should be combined with the administration of the hormone pituitrin or oxytocin.

The scheme for the sequential application of the means described above is known as the modified Stein-Kurdinovsky scheme. If, after the action of the cleansing enema with vaginal examination, a pronounced "maturity" of the cervix is ​​found, and the fetal bladder is not damaged, then amniotomy should be performed to enhance the pedicle effect. If a woman is diagnosed to be ready for childbirth, determined by the degree of expression of the "maturity" of the cervix, then the administration of anticholinesterase drugs is temporarily delayed, and the child is observed for 1.5-2 hours, and if during this time there is no development of proper labor, then quinine and pituitrin are used. Quinine( hydrochloric acid) is given by mouth at 0.05 g every 30 minutes - in total up to 8-12 powders. For ease of administration, each dose of quinine is wrapped in tissue paper or encapsulated in gelatin capsules. Pituitrin or oxytocin is injected under the skin in 0.25 ml( 1.25 U) at intervals of one hour, up to 4-6 times.