Normal preliminary period. Preliminary period

– a prolonged prenatal preparatory period, occurring with irregular painful contractions that do not lead to structural changes in the cervix. The pathological preliminary period is characterized by long-term (over 6-8 hours) ongoing ineffective cramping pain, which disrupts the woman’s daily wakefulness and sleep patterns, causes fatigue of the woman in labor and increases the risk of fetal hypoxia. Diagnosis of the preliminary period of labor includes vaginal examination, cardiotocography. In order to relieve the abnormal preliminary period of labor, anesthesia, medicinal sleep, and the administration of beta-agonists are used; sometimes - carrying out caesarean section.

General information

Clinical manifestations of the physiological (uncomplicated) preliminary period of labor, which lasts on average 5-8 hours, are weakly expressed; periodic nagging and cramping pain in the lower abdomen and sacrum do not change the woman’s general well-being. Normal preliminary contractions (false contractions, precursor contractions) can stop and resume after a day, but more often they gradually intensify, become more frequent and turn into regular labor. At the end of the physiological preliminary period, maturation (shortening and softening) of the cervix is ​​observed, and the cervical canal opens by 2-3 cm.

Reasons for the development of the pathological preliminary period of labor

Disturbances in the preliminary period of childbirth are more often observed in cases of pathology of the maternal body: in pregnant women with a labile nervous system, neuroses, and NCD; metabolic and endocrine disorders(obesity, underweight, menstrual dysfunction, sexual infantilism, etc.); accompanying somatic pathology(heart defects, arrhythmia, arterial hypertension, diseases of the kidneys, liver, adrenal glands); inflammatory changes in the uterus (endometritis, cervicitis); gestosis, dystrophic processes after abortions.

In addition, the prolongation of the preliminary period can be facilitated by a woman’s negative attitude towards the birth of a child, fear of childbirth, and the age of first-time mothers under 17 or over 30 years old. TO obstetric reasons complicated preliminary period of labor include multiple, low or high water pregnancy, large fetus, placenta previa, incorrect positions fetus, anatomically narrow pelvis, etc.

Symptoms of the pathological preliminary period of labor

The pathologically occurring preliminary period of labor is characterized by a sharp spastic contraction of the myometrium, leading to the appearance of painful contractions, their protracted course, which does not turn into regular labor. Despite the duration and severity of contractions, the cervix remains firm and long, and the cervical canal does not open. The excitability and tone of the uterus are sharply increased; uterine contractions are monotonous, without a tendency to become more frequent and intensified.

The condition of the pregnant woman is disturbed; the woman gets tired, cannot sleep and rest due to constant pain And emotional stress, becomes irritable and unbalanced. A pregnant woman may notice sweating, pain in the sacrum and lower back, shortness of breath, tachycardia, and intestinal dysfunction.

The pathological preliminary period of labor is often complicated by prenatal rupture of amniotic fluid, labor anomalies, and the appearance and increase of signs of intrauterine fetal hypoxia. In some cases, after the rupture of amniotic fluid, regular contractions appear and labor returns to normal on its own.

Diagnosis of the pathological preliminary period of labor

An external obstetric examination reveals a high location of the presenting part of the fetus, which is located high above the entrance to the pelvis; The tone of the uterus is increased, especially in its lower segment. Carrying out a vaginal examination in pathologies of the preliminary period of labor can be difficult due to the strong tension of the perineal muscles. An internal gynecological examination reveals the presence of spasm of the vaginal muscles and immaturity of the cervix.

Contractions are recorded during cardiotocography of various durations and strength, unequal time intervals between them, predominance of tone lower segment uterus over the tone of the fundus and body. Cytological examination A vaginal smear indicates insufficient estrogen saturation in the body.

Tactics for pathological preliminary period of labor

Tactics in the pathological course of the preliminary period of labor are determined by its duration, the condition of the pregnant woman, the severity of the clinic, the condition of the fetus and the birth canal. In all situations accompanying the pathological preliminary period of labor, the use of estrogens, analgesics, sedatives, and antispasmodics is indicated.

If the preliminary period of labor lasts less than 6 hours, is accompanied by cervical maturity and the fetal head standing at the entrance to the pelvis, treatment begins with electroanalgesia or acupuncture. If the amniotic sac is intact and the birth canal is mature, amniotomy is performed. If the preliminary period of labor lasts up to 6 hours, but the cervix is ​​immature, sedation (administration of diazepam) and medicinal preparation of the cervix (prescription of prostaglandins E2, estradiol dipropionate, estrone, etc.) are indicated.

During the protracted preliminary period of labor (10-12 hours or more), accompanied by fatigue of the woman in labor, medicated sleep is used. After awakening, 85% of women experience active labor phase with normal contractile activity of the uterus. In the remaining 15%, due to the absence or mildness of contractions, careful administration of uterotonics (oxytocin, prostaglandin) is indicated. In addition to all of the above, β-adrenergic agonists (hexoprenaline, terbutaline, fenoterol, etc.) are used to relieve the pathological preliminary period of labor.

If it is impossible to achieve active and regular labor activity, as well as in case of a burdened obstetric history, large fetus, breech presentation, extragenital diseases, signs of fetal hypoxia, it is advisable to perform delivery by cesarean section. Maximum term treatment of the pathological preliminary period of labor should not exceed 3-5 days.

Prevention of the development of pathological preliminary period of labor

To exclude an abnormal course of the preliminary period of labor, competent preparation and management of pregnancy, compliance by the woman with the prescribed regimen, and psychoprophylactic preparation for childbirth are necessary.

Particular attention of the obstetrician-gynecologist should be directed to the contingent of pregnant women who constitute a risk group for the development of a pathological preliminary period of labor - primiparas of young and older age, women with a burdened obstetric-gynecological history, chronic inflammation genitals; neuroendocrine, somatic and neuropsychiatric disorders; anatomical inferiority of the uterus; fetoplacental insufficiency; polyhydramnios, multiple births or large fetuses.

The preliminary period is observed in 33% of pregnant women, with a gestational age of 38-40 weeks.

The normal preliminary period is characterized by rare, weak cramping pain in the lower abdomen and lower back, occurring against the background normal tone uterus. Its duration can reach 6-8 hours. A mature cervix is ​​diagnosed in 87% of women.

The pathological preliminary period is characterized by painful contractions, alternating in strength and sensation, occurring against the background of increased uterine tone. Contractions are regular in 14% of women; the frequency and strength of contractions are similar to true labor, but do not lead to structural changes in the cervix. Contractions tire the pregnant woman and lead to disruption circadian rhythm sleep and wakefulness. The duration of the pathological preliminary period is often more than 8-10 hours.

The pathological preliminary period is characterized by insufficient production of hormones of the fetoplacental complex, a decrease in the activity of the sympathetic part of the sympathetic-adrenal system, and a decrease in the accumulation of serotonin in the blood at the end of pregnancy.

In order to correct the pathological preliminary period, estrogens are prescribed at the rate of 300 IU/kg body weight: promedol 2% - 1.0 subcutaneously and intramuscularly; anticholinergics (aprofen 25 mg, diprofen - 50 mg). In case of restless behavior of a pregnant woman, heated pipolfen (25 mg), diphenhydramine (10 mg), novocaine (0.25%-30.0) is additionally administered rectally (if tolerated).

If labor does not develop within 6-8 hours from the moment the complex of antispasmodic and analgesic drugs is administered, it is recommended to continue the administration of astrogen 20-30 thousand units intramuscularly twice a day and antispasmodics (no-spa 40 mg, typhen - 30 mg x 3 times per day), as well as prostaglandins in the form of vaginal gel and tablets. Mildly diabetic pregnant women should be prescribed seduxen and tazepam.

If the pregnant woman is tired and the preliminary period is long, therapeutic obstetric anesthesia is indicated: GHB 50-60 mg/kg body weight, premedication (promedol 25 mg, pipolfen 25 mg). These therapeutic measures can be repeated after 10-12 hours up to 3 times.

The maximum duration of preparation for childbirth should not exceed 3-5 days.

If there is no effect from the drug therapy, ongoing pain, an “immature” cervix in women with OAA, or extragenital pathology, delivery is carried out by cesarean section.

When the pregnant woman is well prepared for childbirth, a programmed birth is indicated, including ampyotomy after preliminary administration of antispasmodics, followed by observation for 2-4 hours.

Prescribe birth accelerators with caution. If necessary, oxytocin and prostaglandins should be used with antispasmodic drugs (buscopan, halidor, no-sla, baralgin) to avoid the development of secondary discoordinated labor.

Ed. K.V. Voronina

In light of the imminent second birth, I still can’t calm down about my first, I’m endlessly looking for some information about why my labor lasted so long the first time, whether it was normal or not, whether the doctors behaved correctly and what could be done to avoid neurology in my son. Today for the first time I came across information about pathological preliminary period of labor. Maybe it will be useful for someone to read.

Pathological preliminary period of labor – a prolonged prenatal preparatory period, occurring with irregular painful contractions that do not lead to structural changes in the cervix.

There are physiological (uncomplicated) and pathological preliminary periods of labor.

Clinical manifestations physiological preliminary period of labor, lasting on average 5–8 hours, are weakly expressed; periodic nagging and cramping pain in the lower abdomen and sacrum do not change the woman’s general well-being. Normal preliminary contractions (false contractions, precursor contractions) can stop and resume after a day, but more often they gradually intensify, become more frequent and turn into regular labor.

The incidence of pathology in the preliminary period of labor is 10–17%. During development pathological preliminary period The latent phase of labor is prolonged and can last from 6–8 hours to 24–48 hours or longer. Spastic contractions in this case occur against the background of increased myometrial tone; in strength, frequency and pain they are comparable to true labor, but do not lead to ripening of the cervix. In obstetrics and gynecology, the pathological preliminary period of labor is regarded as hypertensive uterine dysfunction. The pathological preliminary period of labor can turn into weak or discoordinated labor.

Reasons for the development of the pathological preliminary period of labor

Disturbances in the preliminary period of labor are more often observed in cases of pathology of the maternal body: in pregnant women with a labile nervous system, neuroses, and NCD; metabolic and endocrine disorders(obesity, underweight, menstrual dysfunction, sexual infantilism, etc.); concomitant somatic pathology (heart defects, arrhythmia, arterial hypertension, diseases of the kidneys, liver, adrenal glands); inflammatory changes in the uterus (endometritis, cervicitis); gestosis, dystrophic processes after abortions.

In addition, the prolongation of the preliminary period can be facilitated by a woman’s negative attitude towards the birth of a child, fear of childbirth, and the age of first-time mothers under 17 or over 30 years old.

Obstetric causes of a complicated preliminary period of labor include multiple pregnancy, low or high water pregnancy, large fetus, placenta previa, abnormal fetal position, anatomically narrow pelvis, etc.

Symptoms of the pathological preliminary period of labor

• preparatory prenatal contractions of the uterus are painful, occur not only at night, but also during the day, are irregular and for a long time do not pass into labor. The duration of the pathological preliminary period can range from 24 to 240 hours, depriving the woman of sleep and rest;
• There are no structural changes in the cervix (“ripening”). The cervix remains long, eccentrically located, dense, the external and internal os are closed. Sometimes the internal pharynx is defined as a dense ridge.
• there is no proper deployment of the lower segment, which (with a “mature” cervix) should also involve the supravaginal portion of the cervix. The excitability and tone of the uterus are increased.
• the presenting part of the fetus is not pressed against the pelvic inlet (in the absence of any disproportion between the size of the fetus and the woman’s pelvis).
• due to hypertonicity of the uterus, palpation of the presenting part and small parts of the fetus is difficult.
• uterine contractions have been monotonous for a long time: their frequency does not increase, their strength does not increase. A woman’s behavior (active or passive) does not have any influence on them (it does not strengthen or weaken).
• violated psycho-emotional state pregnant: unbalanced, irritable, tearful, afraid of childbirth, not sure of its successful outcome.

In the absence of treatment for the pathological preliminary period often arise signs of hypoxia, decrease in the biophysical profile of the fetus.

Tactics for pathological preliminary period of labor

Tactics in the pathological course of the preliminary period of labor are determined by its duration, the condition of the pregnant woman, the severity of the clinic, the condition of the fetus and the birth canal.

If the preliminary period of labor lasts less than 6 hours, accompanied maturity of the cervix and position of the fetal head at the entrance to the pelvis, treatment begins with electroanalgesia or acupuncture. With a “mature” cervix, taking into account the favorable obstetric situation (proportionality of the fetal head and maternal pelvis, etc.), early amniotomy is indicated.

Before amniotomy, it is necessary to administer antispasmodics intravenously, since a rapid decrease in volume can cause hyperdynamic contractions of the uterus (discoordinated contractions).

When the duration of the preliminary period of labor is up to 6 hours, but the immaturity of the cervix, sedation (administration of seduxen) and drug preparation of the cervix are indicated.

At protracted preliminary period of labor (10–12 hours or more), accompanied by fatigue of the woman in labor, medicated sleep is used. After awakening, 85% of women enter the active labor phase with normal contractile activity of the uterus. In the remaining 15%, due to the absence or mildness of contractions, careful administration of uterotonics (oxytocin, prostaglandin) is indicated.

In case of an untreated pathological preliminary period, drugs with a strong oxytocic effect (prostin F2a) cannot be used due to the danger of increasing spastic contraction of the obturator, circulatory muscles of the internal os of the uterus. Spiral-shaped fibers of the body of the uterus, tubal angles, and vagina are involved in the spastic process. The severity of the violations gradually increases.

It is impossible to open the amniotic sac if the cervix is ​​“immature”!

If there is no effect from the therapy, the structural “immaturity” of the cervix persists, the indications for delivery by cesarean section should be expanded.

At inability to achieve active and regular labor, as well as with a burdened obstetric history, large fetus, breech, extragenital diseases, signs of fetal hypoxia, it is advisable to carry out delivery by cesarean section.

Briefly about my situation with my first birth. After reading these articles (here I tried to collect information from several), I got the impression that my birth was delivered by a gang of self-taught idiots, and not by the best doctors in Krasnodar maternity hospital. They did the opposite! I was faced with a situation where labor was not improving in any way and ineffective frantic contractions were occurring exactly every 5 minutes for as many as 30 hours (until the moment of hospitalization in the maternity hospital), but at the same time leading to absolutely nothing.

At the maternity hospital I was told that these were sweatpants, and I was sent home. They say that real contractions cause dilatation and the cervix smoothes out, but everything is deaf for me. My abdominal and pelvic muscles were in such a rocky state that I didn’t feel the urge to go to the toilet at all. I couldn’t give urine upon admission; I just didn’t feel any urine. In the delivery room, they pushed a catheter into me and took tests, and my urinary tract was removed to such an extent (these are the words of the midwife who inserted the catheter) that I don’t know how it remained intact, and I didn’t feel it at all. At the same time, I had quite severe gestosis (30 kg of edema) and 14 years of hypothyroidism ( endocrine pathology) behind your shoulders. Well, are they really in medical university weren’t they taught that there is a pathological preliminary period?

Doctors admitted acute hypoxia in my son. But even then they did not calm down and continued to mess up. Instead of immediately anesthetizing me, they pierced my amniotic sac and gave me oxytocin, so that dilation would begin and the contractions would become even stronger (and in the article, let me remind you, it is written that with an immature cervix and an untreated preliminary period of labor, you can neither pierce the sac nor give oxytocin until labor stabilizes). And only then they gave me an epidural. And only on it did the opening move from a dead point.

But the doctors did not calm down even then. When I started to feel like hell at 6 cm, they didn’t decide on a caesarean section, but simply injected me with an epidural! ON THE PUSH! And after 3 hours they ticked off a box in their shift that another girl was safely delivered that day.

And they didn’t care what would happen next to me and my son, how such childbirth would affect us. However, they did not write on my chart how long the contractions actually lasted. According to their writings, I happily arrived at the maternity hospital in the morning with 3 cm of dilation and happily gave birth to a healthy son 6 hours after admission.

Physiological course of childbirth possible only if there is formed generic dominant, i.e. when the body is biologically ready for childbirth. The formation of the generic dominant is completed during the last 2-3 weeks. pregnancy, which gives grounds to distinguish the so-called preparatory period (harbingers of childbirth). The preparatory period, in turn, passes into the preliminary period, and the preliminary period into childbirth.

Harbingers of childbirth characterized by many features. Thus, before the onset of labor, the presenting part of the fetus and the fundus of the uterus descend, which is due to the formation of the lower segment of the uterus.

Precursors of childbirth include also: a decrease in the pregnant woman’s body weight (by 400-1000 g), increased urination, an increase in transudate in the vagina and the appearance of mucous discharge, moderate pain in the lower abdomen, lower back and sacroiliac joints. An important harbinger of labor is painless, irregular in frequency, duration and intensity of uterine contractions, described by Braxton-Gix. During the first pregnancy, Braxton-Hicks contractions are usually painless until labor begins, but with each subsequent pregnancy, the contractions become increasingly painful long before labor begins. Contractions of the uterus during pregnancy improve its blood circulation and, along with the processes of hypertrophy and hyperplasia of the myometrium, contribute to the formation of the lower segment of the uterus (fetal receptacle), shortening and softening of the cervix, and its “maturation”.

According to M.P. Nageotte et al (1988), frequency uterine contractions increases with increasing gestational age from 0.65 in 10 minutes at 30 weeks. up to 1.0 in 10 minutes - at 40 weeks.

Multichannel hysterography revealed that pacemaker at Braxton-Hicks contractions is in various departments uterus and the wave of contraction spreads over various distances. These contractions are sometimes mistaken for the onset of labor ("false labor").

When f physiological course of pregnancy preliminary period not clinically manifested. Contractions of the uterine muscles in the preliminary period are not accompanied by pain and do not cause prenatal discomfort. Often a pregnant woman wakes up at night due to the sudden spontaneous onset of labor. Moderate painful sensations in this contingent of pregnant women, making up about 70%, appear with the development of regular labor. Their labor proceeds without pathological abnormalities, its duration is within optimal timing, contractions are mildly painful, the outcome of the birth is favorable.

Anomalies of labor are often preceded by a change in the nature of the prenatal preparatory period. In Anglo-American literature pathological preliminary period called “false labour”.

Pathogenesis (what happens?) During the Pathological preliminary period:

The frequency of this pathology ranges from 10 to 17%, coinciding with the frequency of abnormal labor. If normal prenatal contractions of the uterus are clinically invisible, painless, often occur at night and lead to shortening, softening of the cervix and opening of the cervical canal by 2-3 cm, then the pathological preparatory (preliminary) period is characterized by spastic contraction of the circular muscle fibers in the isthmus and reflects prenatal hypertensive uterine dysfunction.

Symptoms of the Pathological preliminary period:

Pathological preliminary period characterized by the following clinical signs.

• Preparatory prenatal contractions of the uterus are painful, occur not only at night, but also during the day, are irregular and do not progress into labor for a long time. The duration of the pathological preliminary period can range from 24 to 240 hours, depriving a woman of sleep and rest.
• Structural changes the cervix ("ripening") does not occur. The cervix remains long, eccentrically located, dense, the external and internal os are closed. Sometimes the internal pharynx is defined as a dense ridge.
• There is no proper deployment of the lower segment, which (with a “mature” cervix) should also involve the supravaginal portion of the cervix. The excitability and tone of the uterus are increased.
• The presenting part of the fetus is not pressed against the pelvic inlet (in the absence of any disproportion between the size of the fetus and the woman’s pelvis).
• Due to the hypertonicity of the uterus, palpation of the presenting part and small parts of the fetus is difficult.
• Contractions of the uterus for a long time are monotonous: their frequency does not increase, their strength does not increase. A woman’s behavior (active or passive) does not have any influence on them (it does not strengthen or weaken).
• The psycho-emotional state of the pregnant woman is disturbed: she is unbalanced, irritable, tearful, afraid of childbirth, and unsure of its successful outcome.

The essence of the pathological preliminary period lies in increased tone myometrium, spastic contraction of the internal uterine os and lower uterine segment, where muscle fibers have circular, transverse and spiral directions.

The presence of a pathological preliminary period indicates a pathology of uterine contraction preceding childbirth, insufficient, asynchronous readiness of the mother and fetus to initiate labor.

The pathological preliminary period turns into either discoordination of labor or primary weakness of contractions; often accompanied by severe autonomic disorders (sweating, sleep disturbances, vegetative-vascular dystonia). A pregnant woman complains of pain in the sacrum and lower back, bad dream, palpitations, shortness of breath, impaired bowel function, increased and painful fetal movements.

In the absence of treatment for the pathological preliminary period, signs of hypoxia and a decrease in the biophysical profile of the fetus often appear.

Diagnosis of the Pathological preliminary period:

Clinical and laboratory research made it possible to identify a violation of autonomic balance in these patients: an increase in the level of adrenaline and norepinephrine in the blood, a decrease in acetylcholinesterase activity of erythrocytes. There is also an increase in the content of prekallikrein, a decrease in the ATPase activity of myosin, antioxidant protection, intensity metabolic processes in the uterus ( low level activity of glucose-6-phosphate dehydrogenase - G-6-FDG, decrease in the content of protein and non-protein SH groups), the predominance of the glycolytic pathway of glucose metabolism.

An increase in the level of norepinephrine (in the absence of changes in the content of adrenaline and a decrease in acetylcholinesterase activity of erythrocytes) in pregnant women with a pathological preliminary period indicates intensive synthesis and release of norepinephrine from presynaptic membranes, i.e. simultaneous hyperactivity of the adrenergic and cholinergic systems. When comparing the amount of adrenaline, norepinephrine and acetylcholinesterase activity of erythrocytes with the results of determining the contractile activity of the uterus during the pathological preliminary period, it was revealed sharp increase excitability and tone of the uterus.

Analysis of the results of determining the activity of the kinin system showed that in women with an “immature” cervix and a pathological preparatory period, high content in the blood plasma of prekallikrein, which under certain conditions easily turns into kallikrein.

The contractile activity of the uterus depends on the level of substances involved in metabolic processes in the myometrium and the activity of redox processes, which are indirectly judged by the concentration of sulfhydryl (SH) groups, the activity of transketalase and enzymes of the pentose phosphate pathway of glucose oxidation.

We have obtained data on an increase in the content of protein and non-protein SH groups in healthy women at the end of pregnancy compared to patients who had a pathological preliminary period of at least 2-3 days. This can be regarded as a compensatory increase in the power of the antioxidant system in the redox reactions of the body in response to prolonged non-productive contractions of the uterus. A decrease in the number of non-protein SH groups during the pathological preliminary period confirms the tension of the mediator system of myometrial contractile proteins, which determine the force of contraction.

A study of enzymes characterizing the pentose phosphate pathway of glucose oxidation revealed a significantly lower (more than 1/3) level of G-6-FDG activity in the blood of women with a pathological preliminary period compared to healthy pregnant women, which indicates a decrease in the intensity of metabolic processes and biosynthesis of estrogen, as well as insufficient endocrine stimulation of the uterus with a predominance of the glycolytic pathway of glucose metabolism. It has been established that G-6-FDG and transketalase are a regulatory link in the synthesis of estrogens and provide pathways for the metabolism of carbohydrates necessary for the synthesis of ribonucleic acid molecules.

Results of studying indicators characterizing functional activity adrenergic and cholinergic systems, in full-term pregnancy and a protracted pathological preliminary period (from 1-3 days), confirm the predominance of parasympathetic tone nervous system. These women were found to have increased activity cholinergic nervous system, higher levels of serotonin, histamine and prekallikrein in the blood, which is accompanied by increased excitability and hypertonicity of the uterus. A decrease in the number of SH groups, a decrease in the content of transketalase and the activity of pentose phosphate oxidation enzymes indicate a low level of reserve capacity for contractile activity of the uterus.

A characteristic complication of the pathological preliminary period is prenatal rupture of amniotic fluid, which reduces the volume of the uterus and reduces the tone of the myometrium. If at the same time the cervix has sufficient “maturity”, the contractile activity of the uterus can itself normalize and go into normal labor activity.

Treatment of the Pathological preliminary period:

If the cervix remains “immature,” labor, as a rule, does not develop independently. Either a true post-term pregnancy begins, or the onset of labor takes on a pathological character.

Prenatal discharge of amniotic fluid in combination with a pathological preliminary period, an “immature” cervix indicates disturbances in the neuroendocrine and myogenic regulation of contractile activity of the uterus.

Violation of the integrity of the membranes may be a consequence of inflammatory changes in the membranes with chorioamnionitis, endocervicitis, isthmic-cervical insufficiency, and colpitis.

But the main reason for this complication (as our studies have shown) is an uneven, abrupt increase and decrease in intra-amniotic pressure in uterine cycle(contraction-relaxation) against the background of increased (up to 13-15 mm Hg) basal tone.

The pathological preliminary period must be included in the diagnosis as a nosological form of prenatal pathology of uterine contractile activity that requires treatment.

With timely and adequate treatment You can speed up the “ripening” of the cervix, relieve uncoordinated painful contractions of the uterus, and achieve spontaneous development of labor. Therapy is selected depending on the pathogenesis of this pathology.

Apply: electroanalgesia, electrorelaxation of the uterus, drug therapy(antispasmodics, tocolytics, analgesics, prostaglandin E2 preparations).

In case of fatigue and increased irritability, the patient is prescribed medicated sleep-rest, sedatives(seduxen, droperidol). Tranquilizers during pregnancy are contraindicated due to the risk of impact on the limbic system of the fetal brain, where the centers are formed emotional sphere person.

Depending on the degree of “immaturity” of the cervix, the following is administered:

• antispasmodics of your choice (no-spa 4 ml, baralgin 5 ml) intravenously or intramuscularly 2 times a day;
• analgesics (promedol 20-40 mg, tramal 15-20 mg) at night;
• For urgent preparation cervix for childbirth using prostaglandin E2 preparations (Prostin E2, Prepedil in the form of a gel), which are injected into the cervical canal or posterior arch vagina.

Drugs with a strong oxytocic effect (oxytocin, prostin F2a) cannot be used during the pathological preliminary period due to the risk of increasing spastic contraction of the obturator, circulatory located muscles of the internal os of the uterus. Spiral-shaped fibers of the body of the uterus, tubal angles, and vagina are involved in the spastic process. The severity of the violations gradually increases.

Before appointment medications To correct the preliminary period, it is necessary to have a clear understanding of the risk factors that allow you to draw up a concept for managing labor, assess age, parity of pregnancy and childbirth, anamnesis, the state of health of the woman and her fetus, and the proportional relationship between the sizes of the pelvis and head.

If all data from an objective examination and laboratory parameters allow upcoming birth lead through natural birth canal, therapeutic measures are repeated at least 2-3 times with an interval of 6 hours. Then the obstetric situation is re-evaluated, turning Special attention to change the condition of the cervix (“mature”, “not mature enough”, “ complete absence maturation").

The maximum duration of treatment should not exceed 3-5 days.

It is necessary to distinguish between two main options for the obstetric situation in the pathological preliminary period: a combination with a “mature” cervix and a combination with an “immature” or “insufficiently mature” cervix.

The condition of the cervix is ​​the main indicator of the synchronous biological readiness of the mother and fetus for childbirth.

With a “mature” cervix, taking into account the favorable obstetric situation (proportionality of the fetal head and maternal pelvis, etc.), early amniotomy is indicated.

Before amniotomy, it is necessary to administer antispasmodics intravenously, since a rapid decrease in volume can cause hyperdynamic contractions of the uterus (discoordinated contractions). It is impossible to open the amniotic sac if the cervix is ​​“immature”!

If there is no effect from the therapy, the structural “immaturity” of the cervix persists, the indications for delivery by cesarean section should be expanded.

During prenatal rupture of amniotic fluid, the main determining indicator for choosing delivery tactics is the condition of the cervix and fetus.

It should be taken into account that discoordination of contractile activity of the uterus is often accompanied by an increase in body temperature to 37.8-38 °C, at which point surgical delivery is contraindicated.

With prenatal rupture of amniotic fluid, satisfactory condition the fetus and the cervix is ​​completely ready for childbirth, you can wait 3-4 hours until labor develops on its own, or carry out careful labor stimulation with prostaglandin E2 preparations (together with the administration of antispasmodics).

To treat the pathological preliminary period in the absence of effect from the above therapy, “acute” tocolysis is used, which effectively relieves spastic contractions of the uterine isthmus, reduces basal tone and normalizes uterine excitability.

Tocolytic (β-adrenomimetic) drugs used for this purpose include: ginipral, fenoterol, partusisten. The method of “acute” tocolysis is as follows: 5 ml of ginipral, containing 5 μg of hexoprenaline sulfate in 1 ml, is dissolved in 200 ml isotonic solution sodium chloride or 5% glucose solution and administered intravenously slowly (6-12 drops/min). Tocolysis is used taking into account contraindications and side effects.

Adequate treatment, as a rule, promotes the development of labor. The presence of a pathological preliminary period indicates that the pregnant woman has an initial pathology of contractile activity of the uterus even before the development of labor.