Clinic and treatment of weakness of patrimonial forces. Discoordinated labor activity: symptoms and treatment

There are certain conditions or factors that can contribute to the occurrence of this anomaly:

overwork of a woman due to prolonged childbirth;
neurosis and stress (they impair the connection between the brain and the uterus, which leads to inconsistent activity);
excessive analgesia, overdose of antispasmodics and local anesthesia;
malformations of the structure of the uterus or its underdevelopment;
reduced muscle tone uterus;
unfavorable condition of the cervix (thick, dense and unopened);
the consequences of previous births by cesarean section, namely scarring of the lower uterus (in the area of \u200b\u200bthe scars, the muscles are weak, which can lead to non-rhythmic contraction);
pathological features of a woman (the presence of a narrow pelvis, the presence benign fibroids in the lower part of the uterus);
insufficient blood circulation in the uterus and placenta;
wrong position fetus and placenta attachment;
a sudden drop in the production of various hormones and biologically active substances, due to anxiety and muscle tension of the pregnant woman.

The mechanism of development of discoordinated labor activity

Discoordination in childbirth is characterized by the fact that there is no consistency uterine contractions between its various departments. Normally, uterine contraction occurs from top to bottom and from right to left. With this anomaly, uterine contractions begin, for example, from the lower part of the organ, and not from the corners, as it should be normal. Or the right half of the uterus contracts asymmetrically with respect to the left.

Because of such labor activity the muscles of the uterus are exhausted, making childbirth even more ineffective. Moreover, at this pace of work, the uterus takes almost all the blood circulation from pelvic organs and placenta. As a result, the child lacks oxygen and nutrients. Begins oxygen starvation, which leads to microtraumatization and disruption of work internal organs especially the brain.

When it is damaged during abortion muscle layer, then this section can no longer effectively perform its work. And when a considerable area is damaged during an abortion, then during childbirth it can provoke a discoordinated contraction of the uterus and bring down the rhythm, since it does not participate in the work.

Varieties of discoordinated labor activity

In obstetrics, the following classification of discoordinated labor activity is distinguished:

asymmetric discoordination,
hypertonicity of the lower part of the uterus,
convulsive contractions,
circular dystocia.

Asymmetric discoordination is characterized by uncoordinated activity of the uterus during contraction and is noted with anomalies in the development of the uterus, the presence of myomatous nodes and damage to the walls during abortions.

Hypertonicity of the lower uterus is characterized by the fact that uterine contractions do not occur in normal, but reverse order. That is, impulses are sent not from top to bottom, but from bottom to top, since the lower section is more active than the upper one. In this case, the contractions will be quite painful and active, and the opening of the cervical canal will stop. Hypertonicity of the lower part of the uterus is usually due to the immaturity of the cervix and neurological disorders.

With convulsive contractions, the third type of discoordination in childbirth, uterine contractions occur chaotically, there are different time intervals between contractions. It was also found that only one or a few sections of the muscular apparatus of the uterus can be reduced.

Discoordination in childbirth according to the fourth type - circular dystonia, is characterized by absent contractions of muscle fibers in the area uterine cervix. In this case, childbirth becomes protracted, as a result of which fetal hypoxia may occur.

Clinical picture of discoordinated labor activity

Discoordination in childbirth is also expressed in contractions that are discoordinated in time, for example, when violent activity in childbirth becomes weak, and vice versa. With this anomaly, all the main characteristics of contractions are violated:

the rhythm of activity in childbirth is lost;
there is increased pain;
constantly alternating short and long contractions;
intrauterine pressure becomes uneven.

Clinical picture begins before childbirth in the period of contractions. Discoordination can occur quickly or gradually. You can suspect this anomaly by the following number of signs:

labor activity has not yet begun, and the tone of the uterus has already increased;
the gestational age is already long, childbirth is coming, but there is an unpreparedness of the cervical canal of the uterus;
the cervical canal is not mature enough and not open enough, against the background of the fact that the amniotic fluid has already departed;
the fetal head has not descended into the birth canal from the pelvic cavity.

There are also known signs of discoordination that appear directly during childbirth. The clinic of discoordinated labor activity includes:

sharp painful contractions during childbirth;
inconsistency in the amplitude of uterine contractions - from sharp increase before the decline;
discoordination in opening the cervix of the uterus and expelling the fetus;
the cervix undergoes spasm, which makes it difficult to stretch;
premature birth injury in the form of a hematoma on the head of the fetus or compression of his body due to such uterine contractions.

Diagnosis of discoordinated labor activity

This disorder of labor activity is diagnosed only during childbirth. Doctors, even with a good nine-hour labor activity, must not lose vigilance and pay attention to the accuracy of its increase and the coordination of periods. It is very important to make a timely diagnosis because this anomaly can lead to dangerous complications.

To confirm the diagnosis, a partogram is used in the form of a graphic representation of the rhythm, duration of contractions and pauses between contractions. With its help, you can track the deviations of labor activity.

Also by palpating the uterus, doctors determine the above characteristics of uterine contraction to the touch, which will also help in confirming the diagnosis. Immediately after the diagnosis, a treatment strategy is chosen.

Treatment of discoordinated labor activity

The first thing that is done when a discoordinated labor activity is detected in a pregnant woman is that the woman is given rest. It is carried out with the help of the introduction of sedatives and sedatives, resulting in drug-induced sleep.

As a result, the uterus stops contracting and restores its strength and resources. Oxidized metabolic products are removed and contraction is normalized. It also restores blood circulation in the uterus and placenta.

But sometimes, with not very pronounced discoordination, childbirth can end on its own and naturally. Therefore, a specialist, predicting the outcome of childbirth, takes into account the age of the pregnant woman, the characteristics of pregnancy, the state of health of the mother and fetus.

With discoordination of types 2 and 4, that is, with hypertonicity of the lower part of the uterus and dystocia of the cervical canal, antispasmodics are administered. They relieve spasm, relax muscles, which will normalize contractions. But if the condition of the woman in labor becomes worse or the above-mentioned remedies are not effective, they urgently resort to surgical intervention.

If the woman in labor has previous miscarriages or cases of stillbirth, C-section. This treatment tactic is used if there is:

malposition;
large uterine fibroids;
prolonged infertility;
late toxicosis;
chronic diseases and serious disorders functions endocrine glands, of cardio-vascular system, liver and kidneys;

Complications of discoordinated labor activity

Timely therapy and the prevention of anomalies with the help of preventive measures are very important, since serious complications can occur due to incoordination during childbirth:

Intrauterine oxygen starvation (discussed above).

Fetal trauma. Because of this reduction, intrauterine pressure is not uniform. Therefore, some parts of the child may be affected high pressure and damage them.

Postpartum bleeding. Due to discoordinated labor activity, the uterus may run out of steam. She subsequently relaxes. There are always injuries during childbirth. During normal contraction, the vessels contract during contractions. And with such a reduction, this will not happen. This means bleeding can occur.

Preventive measures of discoordinated labor activity

To prevent incoordination during childbirth, you should:

constantly, throughout pregnancy, be observed by a gynecologist, especially for women over 30 years old, and follow all his recommendations;
at the appointed time to come for an ultrasound examination to detect possible deviations in the early stages;
take courses on psychoprophylactic preparation for childbirth, in the event that there is an uncontrollable fear of giving birth;
lead healthy lifestyle life, as the smooth functioning of the internal organs, the brain and a favorable hormonal background will allow you to cope with this pathology on your own or with treatment without complications.

Forecast

In most cases (85%), labor activity returns to normal after medical sleep. But in 5%, labor activity may stop altogether, and in 10%, only weak, irregular and painful contractions will remain, which requires medical stimulation.

Discoordinated labor activity refers to hyperdynamic dysfunction of the contractile activity of the uterus. This serious, dangerous for mother and fetus pathology occurs infrequently (only in 1-3% of total number childbirth). Discoordination of labor activity is understood as the lack of coordination

contractions between different sections of the uterus: its right and left half, upper (bottom, body) and lower sections. Violation of the coordination of contractions, possibly due to a change in the localization of the so-called pacemaker, which begins to function in the area of the bottom, body and even lower segment. It is believed that contractions in the bottom area are stronger than in the area of the body and lower segment, which is explained by the thickness of the myometrium and the accumulation of the contractile protein actomyosin. "Pacemaker" is a physiological, not anatomical concept, since its histological confirmation has not yet been identified. Forms of discoordination of labor activity are diverse:

Distribution of the wave of contraction of the uterus from the lower segment upwards (dominant of the lower segment; spastic segmental dystocia of the body of the uterus);

Lack of relaxation of the cervix at the time of contraction of the muscles of the body of the uterus (dystocia of the cervix);

Spasm of the muscles of all parts of the uterus (tetany of the uterus).

Currently, the first 2 options are often and quite reasonably combined into one concept - a spastic contraction ring. With this pathology, the "pacemaker" is shifted to the border of the lower segment and the body of the uterus, so the contraction wave does not begin with upper divisions uterus, but from the lower segment. As a result, there is a spasm of the circular muscles of the lower segment. Spasmodic contraction of the lower segment can be formed at different levels: from its border with the body of the uterus to the internal os, inclusive.

Tetany of the uterus refers to the most severe form of hypertensive uterine dysfunction, in which there are several centers of excitation. different plots The uterus has its own strength, frequency and duration of contractions. A single wave of contraction is not formed. There is no total effect of the contraction - relaxation and opening of the uterine os.

The causes of discoordinated labor activity have not been studied enough. Predisposing factors are malformations of the uterus, cicatricial changes in the cervix, flat fetal bladder, degenerative changes uterus due to inflammatory process or the presence of uterine neoplasms. Discoordination of the contractile activity of the uterus often develops when the woman's body is not ready for childbirth, including with an immature cervix.

clinical picture. Discoordinated labor activity is accompanied by the restless behavior of the woman in labor, which

toraya complains of sharp painful contractions. Pain sensations are localized mainly in the region of the sacrum, and not in lower sections abdomen, as in uncomplicated childbirth. With tetany of the uterus, the pain becomes dull and constant. With discoordination of contractions, the woman in labor behaves restlessly, rushes about, screams, and often becomes indifferent during the transition to tetany of the uterus. Disco-ordination of contractile activity may be accompanied by vomiting, sweating, hyperthermia, tachycardia, and increased blood pressure. Impaired spontaneous urination.

typical feature clinical course childbirth, complicated by discoordination of contractions, is the lack of dynamics of the opening of the cervix and the movement of the fetus through the birth canal. The presenting part remains mobile for a long time above the entrance to the small pelvis. Significantly more often than in the physiological course of childbirth, incorrect insertion of the head is observed: extensor, high straight standing of the sagittal suture, posterior parietal asynclitic insertion. These facts indicate that, along with the shape and size of the entrance to the small pelvis and the head of the fetus, the lower segment of the uterus determines the features of the biomechanism of childbirth.

The discoordination of labor activity sharply disrupts the utero-placental circulation, as a result of which severe hypoxia develops rapidly. A negative mechanical effect on the condition of the fetus can be exerted by circulatory spasmodic contractions in the region of the lower segment of the uterus, leading to hemorrhages.

All types of discoordination of labor activity are accompanied not only by uterine hypertonicity, but also by an imbalance between intra-amniotic and intra-myometrial pressure. The prevalence of intramyometrial pressure can lead to premature detachment of the placenta. Excess intra-amniotic pressure threatens with the most severe complication - amniotic fluid embolism.

Opening of the uterine os with cervical dystocia occurs only after deep ruptures, in some cases passing to the lower segment. With other variants of discoordination of contractions, the opening of the cervix is impossible without adequate treatment. If the birth of the fetus still occurs through the natural birth canal, then the violation of contractile activity leads to a complicated course of the afterbirth and postpartum periods, which is accompanied by increased blood loss, in the pathogenesis of which, in addition to the hypotonic state of the myometrium, disturbances in the hemostasis system can also play a role.

Diagnostics. The diagnosis of discoordinated labor activity is established on the basis of an assessment of the nature of labor activity and its effectiveness. To recognize the form of anomaly of contractile activity of the uterus, the following are used:

Complaints of the woman in labor;

Assessment of the general condition of the woman;

Data of external and internal obstetric examination;

The results of hardware methods of examination. The clinical picture is accompanied by a pronounced set

complaints: sharp pains(more often - in the sacrum, less often - in the lower abdomen), appearing during a fight; nausea, vomiting, feeling of fear. With tetany of the uterus, the nature of complaints may change: the pain becomes constant, but mostly dull; instead of fear, apathy appears.

The general condition of a woman largely depends on the severity pain symptom, as well as from vegetative disorders ( profuse sweating, hyperthermia, tachycardia, hypertension, etc.), which are poorly expressed with cervical dystocia and increase with tetany of the uterus.

A careful obstetric examination gives a fairly accurate idea of the nature of violations of labor activity. With cervical dystocia, external methods can detect an increased tone of the uterus, which makes it somewhat difficult to determine the small parts of the fetus, its position and appearance. With segmental contraction of the circular muscles of the lower segment, it is possible to palpate the "spastic ring". In both cases, the head remains movable above the entrance to the pelvis. In the case of tetany, the fetus is tightly covered by the uterus. Not only the body is in a tense state, but also the lower segment of the uterus, therefore, as a rule, it is not possible to determine the position, position, presenting part of the fetus. Contractions are uneven in strength, frequency, duration; with tetany against the background of uterine hypertonicity, contractions seem weak.

A vaginal examination indicates the absence of the dynamics of the birth act: the neck is thick, often edematous, in the area of \u200b\u200bthe internal pharynx or the lower segment adjacent to it, a spastic ring - “pulp” is palpated. A flat fetal bladder is often tightly connected with the tissues of the lower segment. fetal head long time remains mobile over the entrance to the pelvis, often tends to form incorrect insertions. With tetany of the uterus, a vaginal examination may reveal muscle tension pelvic floor and spasmodic constriction of the vagina.

The diagnosis of discoordinated contractile activity of the uterus is confirmed by cardiotocography, external

multichannel hysterography and internal tocography. Hardware studies reveal irregular in frequency, duration and strength of contraction against the background of increased basal tone of the myometrium. At times a few uterine cycles combine into convulsive contractions. With tetany of the uterus against the background of hypertonicity, contractions can be rare, with a low amplitude of contraction. With the help of multichannel hysterography, asynchrony and arrhythmia of contractions of various parts of the uterus are determined. Accurate data on the state of the basal tone of the uterus is obtained using internal tocography, they significantly exceed the normal figures of 8-12 mm Hg. Art.

Cardiotocography, carried out before delivery in dynamics, helps not only to monitor labor activity, but also provides early diagnosis fetal hypoxia.

Treatment. Childbirth, complicated by discoordination of the contractile activity of the myometrium, can be carried out through the natural birth canal or completed with a caesarean section.

Indications for operative delivery are:

Aggravated obstetric and gynecological history (prolonged infertility, miscarriage, poor outcome of previous births, etc.);

Concomitant somatic (cardiovascular, endocrine, bronchopulmonary and other diseases) and obstetric (fetal hypoxia, postmaturity, breech presentation and incorrect insertion of the head, large fetus, narrowing of the pelvis, preeclampsia, uterine fibroids, etc.) pathology;

Primiparous older than 30 years;

Lack of effect from conservative therapy.
Conservative management of childbirth requires an emergency physician

vigilance and careful monitoring of the dynamics of contractions and the condition of the fetus. Discoordinated contractions of the myometrium against the background of uterine hypertonicity often and rather quickly contribute to the development of acute fetal hypoxia, so you should always be ready to change the tactics of the treatment from conservative to surgical. Conservative treatment lower segment hypertonicity and cervical dystocia have much in common. It begins with the appointment of antispasmodics and tocolytics. Antispasmodics (2 ml of no-shpy, 4 ml of papaverine, 4 ml of gangleron or 5 ml of baralgin) are administered intravenously. Tocolytics (β-agonists) are used in dosages sufficient to completely eliminate convulsive contractions. For this, 0.5 mg of partusisten, alupent, bricanil or 10 μg of ginipral are diluted in 300 ml of isotonic

sodium chloride solution or 5% glucose. Infusion starts at a rate of 10 caps/min and increases by 10 caps. every 10 minutes up to 40 drops / min. In the presence of contraindications to β-adrenergic agonists, calcium antagonists (isoptin, verapamil) are used to regulate labor activity. One of the calcium antagonists is diluted in 300 ml physiological saline immediately before administration and begin intravenous infusion with an initial rate of 0.8 µg/min (10 drops/min). The duration of administration should not exceed 1 hour. To enhance the tocolytic effect, a combined infusion of β-agonists and calcium antagonists is used, since they potentiate each other's action.

When opening the uterine pharynx more than 3-4 cm, you can enter 1-2 ml of a 2% solution of promedol. To relieve mental tension, it is useful to use tranquilizers (for example, 2 ml of 0.5% seduxen) with antihistamines (1-2 ml of 2.5% pipolfen).

If therapy is not effective enough, in the complex medical measures epidural anesthesia is added, which is carried out by puncture and catheterization of the epidural space at the level of II-III or III-IV lumbar vertebrae. The most commonly used anesthetics are trimecaine, lidocaine, or bupivacaine. After the elimination of convulsive contractions of the uterus, normal labor activity can recover on its own. If this does not happen, then under ongoing epidural anesthesia, careful rhodostimulation of PG E 2 (with opening of the uterine os up to 4 cm) or F 2 a (with a larger opening - 4-5 cm) is started.

In the period of exile after the birth of the fetal head, a spasm of the internal os or lower segment may occur, making it difficult to remove the shoulders. To prevent this complication, the second stage of labor should be carried out under the cover of antispasmodics. Prevention of bleeding in the afterbirth and postpartum periods is required.

Total spasm of the muscles of the uterus most often requires operative delivery, mainly in the interests of the fetus. Conservative management of childbirth in such cases is an exception, usually associated with the presence of contraindications or the woman's refusal to operate. Treatment of uterine tetany largely coincides with the treatment of other forms of discoordinated labor activity. The complex of therapeutic measures may include: therapeutic obstetric anesthesia, tocolytics, antispasmodics, epidural anesthesia, tranquilizers and antihistamines, means of preventing fetal hypoxia.

In modern obstetric practice for fast withdrawal total uterine spasm more often use tocolysis of the bolus form of ginipral (25 mcg IV slowly in 20 ml of saline). The mode of introduction of a tocolytic agent should be sufficient to completely remove contractile activity and reduce uterine tone to 10-12 mm Hg. Art. Then tocolysis (10 μg of ginipral in 400 ml of saline) continues for 40-60 minutes. If, within the next hour after the cessation of the administration of p-agonists, the normal nature of labor activity is not restored, then careful drip administration of prostaglandins begins. For the greatest efficiency, infusion can be combined (3-agonists and PG E 2 in the latent phase or F 2 a in active phase disclosure period. The combined use of these drugs leads to an increase in the amplitude of contraction while maintaining the normal basal tone of the myometrium, which contributes to the acceleration of the opening of the uterine os. If epidural anesthesia is not possible for any reason, tocolysis and subsequent labor stimulation is carried out against the background of antispasmodics, analgesics, tranquilizers with antihistamines, as in the treatment of other forms of discoordination of contractile activity. According to the same rules, the subsequent and early postpartum periods are carried out.

Prevention of intrauterine fetal hypoxia is mandatory for all violations of contractile activity. Adequate assistance to a woman in labor has a positive effect on the condition of the fetus: all means and methods used to eliminate convulsive contractions help to improve uteroplacental blood flow, eliminate overflow of intervillous spaces venous blood and increase inflow arterial blood. We should not forget about the use of generally accepted means of prevention: glucose, vitamins B In 6 and C, cocarboxylase, mildronate, oxygen inhalations, etc. However, it must be remembered that all these drugs are effective only after the elimination of total uterine spasm.

Discoordination of labor activity - a violation of contractions, characterized by increased tone and lack of coordination between the departments of the uterus.

Pathology is rare, the main reason for its occurrence is the unpreparedness of the woman's body for childbirth.

The reasons

The main factors in the development of discoordination of labor activity:

Vegetative disorders nervous system. Their occurrence is facilitated by stress, attempts to give birth to a child when the body is not yet ready.
Anomalies in the development of the uterus.
Narrow pelvis.
Malposition.
Incorrect insertion of the fetal head into the pelvis.
Myomatous node located in the lower part of the uterus or cervix.
Psychological unpreparedness of the mother for childbirth, fear, increased threshold of pain sensitivity.
Labor induction strong drugs in the absence of indications or without taking into account contraindications (medical error).

Symptoms of discoordination of labor activity

Signs preceding discoordinated labor activity:

An immature cervix during a full-term pregnancy or at the time of the onset of labor (determined by a doctor or midwife by the vaginal route).
Pathological preliminary period(prenatal condition, characterized by irregular contractions and does not lead to the opening of the cervix).
Prenatal discharge of amniotic fluid with a small opening of the cervix.
Hypertonicity of the uterus (tension, increased contractions).
The presenting part of the fetus at the beginning of labor is not pressed against the entrance to the small pelvis (determined by a doctor or midwife using external studies).
On palpation, the uterus resembles the shape of an "elongated egg" and tightly covers the child (determined by the doctor).
Often accompanied by oligohydramnios and fetoplacental insufficiency (morphological and / or functional disorders in the placenta).

The main symptoms of discoordination of labor activity:

contractions are sharply painful, frequent, different in strength and duration;
pain is more often in the sacrum, less often in the lower abdomen;
restless behavior of a woman, a feeling of fear;
nausea, vomiting;
there is no cervical dilatation;
uterine hypertonicity.

Severity and possible complications:

1 degree: contractions are frequent, long, painful. The relaxation period is shortened. The opening of the cervix is very slow, tears or tears may form. At vaginal examination it is found that the fetal bladder has a flat shape, there are few anterior waters.

If an amniotomy is performed or an independent outflow of water occurs, then contractions can normalize, become less painful and regular.

If the fetal bladder remains intact and the uterine contractions are not corrected in time with antispasmodic and painkillers, then the condition will worsen. Childbirth will become protracted, and hypertonicity will increase. Discoordination can turn into weakness of labor activity (this, on the contrary, is a reduced activity of the uterus, leading to a weakening of contractions).

At this stage, early diagnosis of pathology and the beginning of treatment are important. 2 and 3 degree develop very rarely, as there are modern methods diagnostics, which allow to identify the pathology at the stage of the beginning of development. Not less than an important factor is timely appeal women in labor to the maternity hospital for medical care. With the onset of labor activity (contractions), you should immediately call an obstetric ambulance team.

2 degree develops more often with a clinical narrow pelvis or the use of unindicated rhodostimulation (medical error). And it can also be a consequence of aggravation of the 1st degree.

This degree is characterized by a long painful course of childbirth, the cervix may remain immature after 8-10 hours of the onset of labor. The presenting part of the fetus remains mobile for a long time and is not pressed against the entrance to the small pelvis.

The pressure in the uterus can rise and exceed the norm, and this carries the risk of developing amniotic fluid embolism (amniotic fluid entering the mother's bloodstream). Also, intrauterine pressure may, on the contrary, decrease, as a result of which there is a possibility of premature placental abruption.

At this stage, the outpouring of amniotic fluid will not change the situation, since by this time the anterior waters may not remain. The uterus very tightly covers the fetus and takes the form of an "elongated egg" or "hourglass". This condition is dangerous and threatens to rupture the uterus, as well as mechanical compression and trauma to the organs of the fetus.

The woman in labor behaves very restlessly, screams, becomes uncontrollable. There is vomiting excessive sweating body temperature can reach 39 degrees. It also increases blood pressure.

3 degree the heaviest. In this case, the uterus is divided into several zones, where each takes on the function of a trigger center (normally, there is only one pacemaker, usually in the area of the uterine fundus). Each segment is reduced in its own rhythm and frequency, so they do not coincide with each other. Childbirth in this case can stop.

Contractions become rare, weak and short, but the tone is preserved (this is the only difference from the weakness of labor activity). Hypertonicity is permanent, so there is no relaxation phase. The woman in labor stops screaming, rushing about, but behaves indifferently. This is dangerous because doctors can make mistakes, diagnose secondary weakness and prescribe labor stimulation, which is absolutely contraindicated in discoordinated labor.

The uterus covers the fetus very strongly, which causes it to suffer. Sometimes, at grade 3, a birth tumor is diagnosed in a child through the vaginal route.

With the third degree of discoordination of labor, delivery must be carried out by caesarean section (if there are no contraindications).

Diagnostics

When a woman in labor enters the maternity hospital, the doctor examines medical card(history, course of pregnancy, etc.) to identify risk factors and threatening conditions. Estimated general state patients, somatic health and obstetric situation. It is necessary to exclude a narrow pelvis, incorrect position of the fetus, pathological preliminary period and others. possible reasons incoordination of uterine contraction.

The doctor evaluates the nature of labor and its effectiveness every 1-2 hours based on:

complaints of a woman;
the general condition of the woman in labor (pain sensitivity, fear, anxiety, etc.);
cervical dilatation dynamics;
condition of the fetal bladder;
external obstetric studies (determination of the position of the fetus, presenting part, etc.);
frequency, intensity, rhythm of contractions and a period of relaxation;
hardware studies (CTG, external hysterography and internal tocography).

With CTG and external hysterography, a special sensor is attached to the abdomen, and with tocography - in the uterus. These studies reveal the irregularity of contractions, determine the duration, frequency and strength of uterine contractions, as well as intrauterine pressure. With the help of CTG, it is also possible to diagnose fetal hypoxia.

Delivery with discoordination of labor

Childbirth with this pathology can be carried out through natural ways or end with a caesarean section, it depends on the severity and the complications that have arisen.

In the absence of indications for operative delivery, drug therapy. Administered intravenously or intramuscular injection antispasmodics (No-shpa, Baralgin) and painkillers (Promedol).

To eliminate uterine hypertonicity, beta-agonists are used (Partusisten, Brikanil, Alupent). Normally, after 30-40 minutes, contractions resume and are regular.

With discoordinated labor activity, it is necessary to eliminate the defective fetal bladder. Amniotomy (artificial opening of the bladder) is performed only after the introduction of antispasmodics.

It is mandatory to carry out the prevention of fetal hypoxia and placental insufficiency (Eufillin, Reopoliglyukin, Actovegin, Cocarboxylase, Seduxen).

When opening the cervix by 4 cm, epidural anesthesia is performed (done into the spine).

During the period of attempts, an episiotomy (a small dissection of the perineum) is shown, which is done in order to reduce the mechanical effect on the fetal head.

Indications for caesarean section:

burdened obstetric history (adverse outcome of past births, miscarriage, etc.);
somatic diseases (cardiovascular, endocrine, etc.);
fetal hypoxia;
large fruit;
prolongation of pregnancy;
narrow pelvis;
incorrect position of the fetus or breech presentation;
first birth after 30 years;
discoordination of labor activity of 2 and 3 degrees of severity;
ineffectiveness of drug therapy.

At birth, there must be: experienced doctor obstetrician-gynecologist, anesthesiologist-resuscitator and neonatologist.

Forecast

The prognosis is based on the age of the woman in labor, the state of health of the woman and the fetus, anamnesis, the course of pregnancy, and the obstetric situation.

In most cases, childbirth ends favorably.

Some research on pregnancy

Violations of the birth process often pose a danger to the health and life of mother and baby. Of course, these complications require the intervention of doctors and medical correction. One of these complications is the discoordination of labor.

Complications in childbirth: causes

In order to understand the signs and causes of any complications of childbirth, you need to understand how this process should proceed normally. It is important not only for physicians, but also for future parents themselves to know what labor activity is, what changes in a woman’s body causes the onset of labor, and what determines the intensity of the labor process.

Childbirth is essentially contractions of the muscular wall of the uterus (contractions), alternating with periods of relaxation. Contractions continue throughout all periods of childbirth. In the body future mother contractions consistently cause the following changes:

shortening and smoothing of the cervix;
gradual opening of the cervix;
progression of the fetus from the uterine cavity down the birth canal;
the birth of a baby;
separation of the placenta from the wall of the uterus;
the birth of the placenta - the placenta with the remains of the membranes and umbilical cord.

Normal labor activity has two clear characteristics: regularity and dynamism. Regularity is understood as contractions of the same strength and duration, alternating at equal intervals(for example: 10 second bout - 15 minute gap - 10 second bout - 15 minute gap, etc.). The dynamic development of labor activity involves a gradual increase in strength and an increase in the duration of uterine contractions, accompanied by a gradual decrease in the intervals between them. So, at the beginning of the first stage of labor, when the process of shortening the cervix begins, the contractions are barely noticeable, last 5-7 seconds, and the interval between them is 20 or more minutes. And by the end of the first stage of labor, at the moment of full disclosure of the cervix, the contractions are very noticeable, they can last from 40 to 60 seconds, and the interval between them is no more than 2 minutes.

Contractions are necessary to open the cervix, as well as to advance the fetus - when the uterus contracts during contraction, it becomes very dense and decreases in volume, as if pushing the baby out of itself. Normally, while the contractions are short and weak, the opening is slow, and as the contractions of the uterus become more intense, the opening in the neck under the pressure of the baby's head stretches faster and faster, and he begins to descend through the birth canal.

Complications of childbirth: signs of discoordination

With discoordination of labor, contractions develop rapidly, painfully and ineffectively: the cervix does not open and the baby does not move through the birth canal. Discoordination, unlike other complications of labor, always occurs from the very beginning of labor and has characteristic signs by which it can be easily recognized.

Unlike the normal onset of labor, in which the first contractions are almost painless, with discoordination, the very first sensations of the expectant mother become very intense and sharply painful.

Normally, labor activity develops very smoothly and gradually: the first contractions that a woman feels usually last no more than 10-15 seconds, and the intervals between them are at least 20 minutes. With the development of discoordination, contractions from the very beginning become long and frequent: they last for a minute or even more, and the intervals between them may not exceed 7 minutes.

With discoordination, contractions are irregular, chaotic - they can be different in strength, duration and breaks, as is the case with "training" contractions. However, unlike the latter, such irregular uterine contractions are very painful.

Absent in the discoordination of labor and another important sign of the normal course of childbirth - positive dynamics, or a gradual increase in contractions. Normally, as the process develops, contractions gradually become longer, stronger and more frequent, and this never happens with discoordinated labor.

Another characteristic sign of the development of this complication are special pain during fights. Normally, they appear gradually, closer to the middle of the birth process, and have a wave-like character: they increase towards the middle of the contraction and decrease towards its end. In the meantime, pain passes between them. Discoordination is characterized by sharp, spastic pain, which does not change in intensity during the contraction and does not disappear completely in the intervals.

For a doctor, the main sign that allows one to suspect the development of discoordination of labor activity is the lack of cervical dilatation against the background of frequent, erratic contractions, complaints about severe pain and excited emotional state women in labor.

Complications of childbirth: what is the reason for the discoordination of labor?

Discoordination of contractions is an unusual complication of childbirth. Unlike other violations of labor activity, its causes are most often associated not with the peculiarities of health or the course of pregnancy, but with the state of the nervous system of the expectant mother at the time of the onset of childbirth.

Contractions occur due to nerve impulses, "signals" sent by the cerebral cortex to the uterus. If they act too often and haphazardly, then the discoordination of the birth process develops. As a rule, the main cause of such an excited state of the nervous system and dysregulation of childbirth becomes ... intense fear expectant mother before childbirth.

Naturally, on the eve of childbirth and during them, every woman experiences strong excitement, fear for herself and the child. However, if at the same time the expectant mother does not imagine what exactly will happen to her during childbirth, how long they can last, how her feelings will change, where she will be, what doctors can do and why, a new fear joins the listed unrest. This fear of the unknown is dangerous psychological condition, which during childbirth can lead to disruption of the nervous system. As a result of "nervous failures", the signals that coordinate labor activity come unevenly, may weaken or, on the contrary, sharply increase. Because of these violations, contractions become painful and unproductive. Unfortunately, often such contractions negatively affect not only the well-being of the expectant mother, but also the health of the baby: frequent intense contractions of the uterus interfere with the normal blood flow in the placenta, which is necessary for the baby to breathe, and he begins to suffer from a lack of oxygen.

Diagnosis of discoordination of labor activity

To diagnose discoordination of contractions, cardiotocography (CTG) is used.

Two sensors are attached to the belly of the expectant mother with the help of elastic bands. One catches the baby's heartbeat, by which doctors can judge his health and how he tolerates contractions. Another sensor registers contractions. The results are recorded in the form of two graphs. Analyzing such a record, the doctor can get an objective and very accurate idea of the nuances of the development of labor and the well-being of the baby.

Complications in childbirth: life-saving measures

In order to normalize the development of contractions, it is necessary to cope with emotional arousal expectant mother, because this is the main reason improper development tribal activity. In this situation, it is very important to try to create for the woman as much as possible comfortable conditions: allocate a separate ward, allow the presence of a psychologist or one of the relatives at the birth. Doctors and midwives maternity ward they try to calm the woman in labor, explain how best to behave during labor, show techniques for pain relief and relaxing breathing. A warm shower, massage, and movement during contractions can help you relax and deal with emotions.

If these methods are not enough, you have to use medicines. To date, the most effective and most commonly used method of treating discoordinated contractions is epidural anesthesia. The effect of anesthesia in this case is explained simply: as soon as the woman in labor ceases to feel contractions, she calms down, the excitation of the cerebral cortex decreases, and the signals that cause the uterus to contract begin to go evenly. In addition, in the presence of strong contractions, the "epidural" works as a powerful antispasmodic, contributing to the rapid softening and atraumatic opening of the cervix.

Complications in childbirth: prepare in advance

Unfortunately, in real life the staff of the maternity ward may not have enough time to spend many hours in the ward of the expectant mother, provide her with special psycho-emotional support, teach her to relax, control emotions and behave correctly during labor. Most reliable way to avoid the development of discoordination of labor activity lies in the early psychological and practical training to childbirth.

In order to get rid of fear, learn to relax, control emotions and be able to behave correctly during childbirth, you can read popular literature on preparing for childbirth (books, magazines for pregnant women) and sign up for special courses for expectant mothers, which are organized during childbirth. women's consultations, maternity hospitals or family clubs for parents and kids. Communication with specialists and other mothers, the opportunity to ask all your questions and master the technique of self-anaesthesia of childbirth will help to cope with unconscious fear and insure against childbirth complications associated with impaired coordination of the process by the nervous system.

coordinated work

Two powerful regulatory systems are responsible for the emergence and development of labor activity - nervous and hormonal. It is on their condition and interaction that the normal course of childbirth depends. By the end of pregnancy, on the one hand, there is an increase in the excitability of the uterus (area nervous regulation), and on the other hand, an increase in the amount of hormones that act on the nervous elements of the uterus. When the excitability of the uterus and the strength of stimuli reach a certain limit, regular labor activity occurs.

The more terrible, the more painful

The level of discomfort and pain during contractions directly depends on fear and tension. If a woman in labor is not mentally ready for childbirth and is very afraid, then even in cases where childbirth proceeds without complications, contractions are felt much more painful than usual. This is easily explained: the sensation of pain directly depends on the ratio of various hormones in the blood of the woman in labor. The most important of these are endorphins and adrenaline. Endorphins have an analgesic effect, an increase in adrenaline in the blood, on the contrary, leads to a decrease in the pain threshold. Fear and excitement cause a decrease in the production of endorphins and stimulate the release of adrenaline. As a result, the pain during the contraction is felt much stronger.

In the normal course of pregnancy, closer to the time of delivery, prenatal contractions of the uterine walls are observed, which are often painless, but mostly they occur at night and provoke softening of the cervix.

The main types of anomalies include discoordination of labor, which provokes a violation of the normal course of pregnancy. Such violations pose a serious threat to the health of the woman and the fetus, which is why they require timely medical intervention and medical correction.

How is the birth process going?

In order to understand what complications of labor activity are, it is important to clearly understand how the birth proceeds in normal condition. A pregnant woman should clearly understand what natural labor activity is, how the onset of labor can be recognized, and what exactly determines the intensity of this process.

Labor activity is essentially a contraction of the walls of the uterus, alternating with relaxation. Contractions continue throughout the entire period of the course of childbirth. In the body of a pregnant woman, they provoke various kinds of changes, in particular, such as:

softening of the cervix;
dilatation of the cervix;
promotion of the child through the birth canal;
birth of a child;
separation of the placenta from the walls of the uterus;
exit of the placenta.

The normal course of labor activity is characterized by dynamism and regularity. Regularity means contractions of the same duration and intensity, having equal intervals of time. Dynamism implies a gradual increase in intensity and an increase in the duration of uterine contractions.

Contractions are required for as well as the subsequent advancement of the fetus through the birth canal. The uterus contracts somewhat during contractions, it becomes much denser and decreases somewhat in volume, thereby pushing the baby out. Normally, while the contractions are weak and short, the opening of the cervix occurs quite slowly, and when the contractions become more intense, the opening in the cervix is more and more stretched, and the child begins to gradually move along the birth canal.

What provokes the occurrence of discoordination of contractions

Discoordination of labor activity is characterized by the fact that contractions are very violent, painful and often not effective enough. In this case, the opening of the cervix and the subsequent promotion of the child does not occur. Unlike many other complications of childbirth, the symptoms of discoordination of labor activity from the very beginning are quite pronounced, making it quite possible to recognize its course in the body. Unlike the natural course of childbirth (in which the first contractions are almost painless), with violations, the first sensations will be very sharp and painful.

In a normal state, labor activity proceeds quite slowly and gradually, since the very first contractions that a pregnant woman feels usually last for several seconds, and the duration between them is no more than 20 minutes. Discoordination of labor activity is characterized by the fact that from the very beginning the contractions become long and frequent, since they last more than 1 minute, and the intervals between them do not exceed several minutes. In addition, the contractions are quite irregular and they are felt quite painfully. At the same time, there is no positive dynamics of the course of labor and a gradual increase in contractions.

Causes of pathology

Unlike the natural course of childbirth, the pathological process is characterized by painful, spastic and irregular contractions of the uterus, as well as the absence of changes in its structure. In case of violations of the normal course of childbirth, the cervix does not soften, it becomes dense and practically does not open. The pathological process can continue for several days.

If there is a discoordination of labor activity, the reasons for this can be very different, in particular, this condition leads to:

nervous strain;
inflammatory processes occurring in the uterus;
metabolic and endocrine disorders.

In addition, the discoordination of labor activity may have other reasons, since age-related changes lead to such a violation. In particular, pathology can occur if the age of the primipara is more than 30 or less than 17 years.

Features of the pathology

Many pregnant women are interested in: discoordination of labor activity - what is it and how does the pathology develop? Such a violation is characterized by erratic intense contractions of various parts of the uterus, which occur as a result of a shift in the rhythm area. At the same time, a similar condition can be observed in several separate areas of the uterus. In this case, there is no synchrony of contraction and relaxation.

Discoordination of labor activity is enough dangerous pathology, which provokes a violation of uterine contractions, as well as untimely discharge of amniotic fluid. The cervix becomes much tighter, and the edges of the cervix become tight and cannot be stretched.

Thus, the discoordination of labor activity (what it is and how such a pathology manifests itself, we discussed above) requires the intervention of specialists who can quickly recognize the ongoing disorders in the body and select the most suitable techniques conducting therapy.

Symptoms of pathology

Discoordination of contractions is considered the most unusual and rather dangerous complication of labor. Unlike many other complications, the causes of the pathology that have arisen are not associated with the state of health of the pregnant woman or with the peculiarities of the course of the process of bearing a child. The main cause of the violation is associated with the state of the nervous system of a woman at the time of the onset of labor.

Contractions appear due to the passage of nerve impulses sent by the brain to the uterus. If these impulses pass often enough and haphazardly, then there is a discoordination of labor activity. The main reason for this condition and disruption of the natural course of childbirth is the fear of the pregnant woman before childbirth.

As a result of failures of the nervous system, the signals responsible for the course of labor activity arrive rather unevenly and can weaken after a certain time or, on the contrary, increase. Due to the ongoing violations, contractions become much more painful and not productive enough. Often, such contractions have a bad effect on the well-being of the pregnant woman and the child.

The main signs of discoordination of childbirth are considered to be an increase in pain during childbirth, since a woman has panic tension, fear of childbirth and the presence negative emotions. At the same time, spastic contraction of the uterus during a contraction can occur not only in the region of longitudinal nerve fibers, but also in the region of transverse ones.

In some cases, there may be discoordination of labor activity by the type of cervical dystocia, which occurs as a result of the presence of abnormalities in the fetus or pregnant woman. Similar state can be observed due to the presence of a rather narrow pelvis in a woman, which provokes a complex course of labor.

In case of violation of normal labor activity, multiple ruptures of the cervix, vagina, as well as tears of the walls of the uterus can occur. In addition, a protracted course of childbirth can be observed, and in some cases it also occurs in a child.

The severity of the pathology

In the process of childbirth, discoordination of labor activity can often be observed. The classification of such a pathology is based on the severity and possible complications illness.

The first stage of the disease is characterized by the occurrence of prolonged, frequent and painful contractions. The relaxation period is significantly reduced. The opening of the cervix is very slow, and as a result, significant tears can occur. During the examination, it is found that there is very little fetal water. If an opening of the fetal bladder occurs, then contractions can immediately normalize.

The second degree of pathology often manifests itself in the presence of a narrow pelvis in a woman or as a result of the use of a certain rhodostimulation, which is prohibited for a pregnant woman. In addition, the 2nd degree occurs as a result of the aggravation of the course of the 1st stage of the pathology. This stage is characterized by a rather long and painful course of labor. The cervix can remain immature for up to 10 hours after the onset of labor. The fetus remains motionless throughout the entire time and does not move towards the entrance to the small pelvis. Such a condition threatens to rupture the walls of the uterus, as well as injuring some organs of the fetus.

The third stage of the pathology is the most difficult, since the uterus in this case is divided into several separate zones, where each takes over the function of a kind of trigger center. Each section of the uterus contracts according to its own rhythm, which do not coincide at all with one another. In this case, labor activity can completely stop.

The uterus compresses the fetus very strongly, as a result of which it suffers very much and sometimes natural childbirth tumor can be diagnosed. With the course of this degree of pathology, a caesarean section is indicated, if there are no contraindications for such an operation.

Diagnosis of discoordination of labor

We already know what discoordination of labor is. Diagnosis and treatment require competent, integrated approach. It is very important to recognize the existing violations in a timely manner, as this will allow you to choose the required method of therapy.

Diagnosis involves cardiotocography. When it is performed, sensors are attached to the belly of the pregnant woman, fixed with elastic bands. One of these sensors captures the baby's heartbeat.

Another sensor helps to control the process of contractions. All results obtained are recorded in the form of graphs. By analyzing the results, the doctor can get a complete picture of the course of labor and its possible violations.

Treatment of violation of labor activity

Treatment of incoordination of labor activity should be primarily aimed at eliminating pathological process. If there is a strong spasm of the uterus, then the pregnant woman is prescribed tranquilizers and antispasmodics. After the termination of the action of the substances used, labor activity returns to normal.

Therapy should be aimed at eliminating painful uterine contractions, as well as accelerating the opening of the cervix of the organ. Painkillers, antispasmodics, as well as sedatives. For the rapid preparation of the cervix for disclosure and the onset of labor, drugs based on prostaglandin are used. The duration of the course of therapy largely depends on the characteristics of the course of the pathological process, but it should not last more than 3-5 days. In the absence of the desired effect from the therapy, a caesarean section is indicated.

What to do if the expectant mother suspects that she has labor incoordination? The pregnancy pathology clinic has all the necessary means for conducting high-quality complex therapy, so it is important to consult a doctor in a timely manner.

Prevention

In order to prevent discoordination of childbirth, careful observance of the regimen prescribed by the doctor is shown, as well as painless and careful management of the entire process and full control by specialists. Drug therapy is carried out without fail as a preventive measure in the presence of risk factors for the occurrence of abnormalities of uterine contraction.

Women at risk, be sure to carry out physiological and psychological preparation to childbirth, and it is also important to teach pregnant women how to muscle relaxation. It is imperative to control muscle tone and prevent stressful situations. The duration of night sleep should be at least 8-10 hours, and it is also important to correctly organize daytime rest. Long walks in the fresh air and properly selected food are provided.

The course of childbirth with discoordination

Childbirth with discoordination takes place naturally or a caesarean section is prescribed - it all depends on the severity of the pathology and the complications that have arisen.

In the absence of indications for surgery, drug therapy is performed. For this, the introduction of antispasmodics is prescribed, in particular, such as "Baralgin" or "No-Shpa". In addition, painkillers are used. To eliminate the hypertonicity of the uterus, "Brikanil", "Partusisten", "Alupent" are used, after which literally half an hour later the contractions resume and proceed normally.

Prevention of fetal hypoxia is necessarily shown, and when the cervix is opened by 4 cm, obligatory epidural anesthesia is performed (the drug is injected into the spine).

If drug therapy does not help, then a caesarean section is performed. The main indications for surgery are:

unfavorable outcome of previous births;
the presence of concomitant diseases;
large fruit;
narrow pelvis;
prolongation of pregnancy;
malposition.

In the presence of the pathology we are considering, an experienced gynecologist, anesthesiologist-resuscitator and neonatologist must be present during childbirth.