Causes of weak labor in women. Weak labor

Childbirth is a regular coordinated contraction of the muscles of the uterus. Due to the fact that these actions are clearly coordinated by the body itself, childbirth takes place in stages - first the cervix opens, and only then the process of giving birth to a child begins. Many people are interested in the question of how long the first and second births last. And this question arose not in vain, because the speed of the first and subsequent births is always different. And if normally the first birth should last a maximum of 12 hours, then the second birth is already 8 hours. If suddenly labor exceeds the normal threshold, doctors talk about weak labor and raise the question of.

The dynamics of labor are assessed by the number of contractions and the speed of cervical dilatation. This is quite easy to calculate. On average, during the first birth, the speed of cervical dilatation is 1.5 cm per hour, and during the second it is much faster - 2.5 (therefore, the second birth should occur more quickly).

Doctors evaluate the speed and strength of contractions using hysterography, when sensors are attached to the mother's stomach to record contractions and their duration.

Weak labor

Why does such a phenomenon as weak labor activity? There can actually be many reasons for this. This may include:

• Obesity;
• Endocrine system disorders;
• Diabetes;
• Gynecological problems;
• Cardiovascular diseases.

It is worth highlighting endocrine system, namely the production of hormones thyroid gland. In the case of hypofunction, childbirth lasts a very long time, and in the case of hyperfunction, on the contrary, it takes place rapidly.

The birth process is also influenced by the weight of the child - the heavier the baby, the harder it will be for him to be born.

Another risk group for weak labor includes women who give birth before 18 and over 35 years of age. Everything is simple here - young girls The nervous system is not yet ready for childbirth, and in adult women, the muscles lose elasticity and hormonal levels change.

There is also such a thing as primary and secondary weakness of labor. The first option is when the uterus initially has low tone, and contractions are very weak and short. But similar condition are treatable, therefore, as a rule, this is prevented even at the stage of pregnancy, when the doctor sees that the tone of the uterus is reduced. The second option is when the uterus is in healthy tone, the process of contractions and cervical dilatation begins as scheduled, but in the process everything suddenly breaks down. This can happen due to so-called “uterine fatigue.”

Induction of labor

It's about stimulation labor is underway not always. For example, if labor is prolonged obstetric reasons(large child, incorrect positioning of the child, entanglement of the umbilical cord, etc.), then it is impossible to stimulate the process, it is only possible.

If the birth process is difficult for other reasons, then doctors first try to stimulate them naturally, i.e. They give the woman in labor medications to relax, after which they cope with the task themselves. If this does not help, then doctors resort to induction of labor, i.e. intensification of contractions. This is achieved by administering a hormone, which in turn stimulates the production of prostaglandins. They are precisely responsible for successful labor.

There is another way to speed up labor - to open the amniotic sac, but this is done in case of polyhydramnios during pregnancy or with a flaccid amniotic sac.

In cases where no stimulation methods have helped, doctors decide to do C-section.

Rapid labor

Too fast childbirth is also not considered the norm. Contractions in this case are very frequent and strong. In just 10 minutes, the uterus contracts up to 5 or more times. As a result, the cervix opens very quickly, due to which labor can be completed in 2-3 attempts. On the one hand, you say, what's wrong with that? The point is that during impetuous kind The baby moves too quickly, resulting in too much pressure on his head. strong pressure. This can lead to cephalohematoma. In addition, the mother herself will suffer, because rapid labor is torn apart. soft fabrics– vagina, perineum. Not to mention the fact that rapid labor They can simply take a woman in labor by surprise, and she will not make it to the maternity hospital in time.

How to help yourself during rapid labor?

First, you need to lie on the side opposite to where the child is located. Secondly, you need the right breathing exercises(superficial quick inhalation and exhalation). If a doctor is observing, he may administer a tocolytic agent.

Sharp pain in the uterus, bleeding indicate that it is necessary to take emergency measures, because fetal hypoxia and soft tissue rupture are possible. If doctors detect a lack of oxygen in the baby (using a heart monitor), an emergency caesarean section is performed, or the baby is delivered with the help of obstetric forceps.

Preventive measures

There are some folk remedies, which, along with medications, can affect the production of the aforementioned prostaglandins and prepare the uterus for childbirth. This includes vegetable oils, nuts – a spoon is enough olive oil and a couple of nuts. Very stimulating sex life a few days before the expected due date. Honey and raisins will support blood glucose levels.

This article will discuss the issue of weakness of labor. We will tell you in detail about the causes, symptoms, consequences and resolution of labor.

For let's denote what it is. Weakness of labor is insufficient activity of the uterus. That is, childbirth is difficult and lengthy, since the uterus contracts poorly, the cervix opens with difficulty and the fetus comes out very slowly and with difficulty. Childbirth does not always go well, as it should, and labor anomalies occur. You will learn about one of them in great detail from this article.

Weakness of labor

As sad as it may sound, labor anomalies are quite common. The reasons for this phenomenon are quite numerous. Now we will talk about the weakness of the birth process.

This is one of possible violations labor activity. With this diagnosis, the contractile function of the uterus, which is necessary for expulsion of the fetus, is weakened. This is due to:

• low ;
• rare contractions;
• weak amplitude of contractions;
• predominance of diastole;
• the period of contractions significantly lags behind the period of relaxation;
• slow dilatation of the cervix;
• slow progress of the fetus.

The symptoms will be presented in more detail in another section. Now let's give some statistics. This diagnosis in obstetrics and gynecology is the most popular, since it is a very common complication of childbirth and the cause various pathologies both mother and child. Statistics say that more than seven percent of births are complicated precisely by the weakness of labor. And one more fact: this diagnosis is made more often to women who give birth to their first child. As a rule, subsequent births occur without any difficulties, however, there are cases of diagnosing weakness of labor during subsequent births.

Causes

We explained what weakness of labor is. The reasons may be many factors. We suggest listing them. The reasons for the weakness of labor can be:

• morphological inferiority of the uterus;
• insufficiency of hormonal regulation of the birth process;
• functional inertia of nerve structures;
• extragenital diseases;
• hypoplasia;
• myoma;
• chronic endometritis;
• adenomyosis;
• bicornuate uterus;
• saddle uterus;
• medical abortion;
• scraping;
• conservative myomectomy;
• scars after treatment of cervical erosion (if the woman has not previously given birth).

Some other reasons can be noted. Weakness ancestral forces may arise due to an imbalance of factors that influence labor. TO positive factors The following can be included:

• prostaglandins;
• estrogens;
• oxytocin;
• calcium;
• mediators and so on.

Negatively affect:

• progesterone;
• magnesium;
• enzymes that destroy mediators and others.

It is very important to note that women suffering from certain disorders (vegetative-metabolic) often encounter this problem during childbirth. Such violations include:

• obesity;
• hypothyroidism;
• hypofunction of the adrenal cortex;
• hypothalamic syndrome.

The age of the primigravida also has a great influence. If the girl is very young or her age exceeds 35 years, then labor may be difficult. The date at which labor began is also important. Weakness of the uterus can cause post-term pregnancy or premature pregnancy.

If the pregnancy is multiple, it is possible this pathology during childbirth. At multiple pregnancy overstretching of the uterus occurs. Overdistension can also occur with a large fetus or polyhydramnios.

Miniature girls often face difficulties in labor, since a narrow pelvis is also the cause of weak functioning of the uterus. The reason is the disproportion between the size of the child and the woman’s pelvis.

The reasons are still very numerous; unfortunately, it will not be possible to list them all. Now let's highlight some of the most popular ones:

• overwork;
• mental stress;
• physical exercise;
• poor nutrition;
• lack of sleep;
• fear of childbirth;
• discomfort;
• poor care for the mother in labor and so on.

Thus, all reasons can be classified as follows:

• on the mother's side;
• pregnancy complications;
• from the child's side.

Kinds

Weakness of labor can occur at absolutely any stage of labor. In this regard, it is customary to distinguish some types of weakness:

• primary;
• secondary;
• weak attempts.

We propose to consider each type separately in a little detail.

Primary weakness of labor is characterized by inactive contractions in the first stage of labor. They are very weak, short and not rhythmic at all. It is important to note that with primary weakness, decreased uterine tone is noticed (less than 100 mm Hg). At this stage, the woman is able to diagnose the problem herself. How to do this? Time ten minutes and count the number of contractions during this period. If the number does not exceed two and you practically do not feel them, then the diagnosis has been confirmed. You can also measure the time of one contraction; it should be more than 20 seconds in the absence of weakness of labor. Diastole, or the rest period, is almost doubled. How can the sensation of contractions indicate a problem? It's simple, if they are painless or slightly painful, then the pressure from the uterus is not enough to open the cervix.

Secondary weakness of labor is characterized by a weakening of the intensity of the uterus. Before this, contractions could have been normal. The reasons for the development are the same as for the primary weakness of the generic forces. Another indicator is the progression of the opening of the uterine pharynx. If progress is not visible after five to six centimeters of dilation, then we can confidently speak of secondary hypotonic dysfunction of the uterus.

If primary and secondary weakness is observed in ten percent of cases of unfavorable labor and is characteristic of primiparous women, then weakness of the pushing period is extremely rare (two percent of all cases of difficult labor), and it is characteristic of multiparous women or obesity.

Symptoms

Symptoms of primary weakness of labor include:

• decreased excitability of the uterus;
• decreased uterine tone;
• reduced frequency of contractions (up to two in ten minutes);
• short duration of contractions (up to twenty seconds);
• the contraction force does not exceed 25 mm Hg. Art.;
• short period of contraction;
• extended rest period;
• there is no increase in intensity and frequency;
• painlessness or low pain of contractions;
• slow changes in the structure of the cervix (this includes shortening, smoothing and dilation).

All this can significantly increase total time childbirth This, in turn, has a bad effect on the mother and the child. The woman in labor becomes very tired, early expulsion of water is possible.

Symptoms of secondary weakness:

• weakening of the intensity of contractions (possibly even their complete cessation);
• weakening of tone;
• decreased excitability;
• there is no progression of opening of the uterine pharynx;
• stopping the advancement of the fetus through the birth canal.

This is no less dangerous than primary weakness. The baby may develop asphyxia or die. For the mother, this is dangerous due to the possibility of infection of the uterus and birth injuries. Prolonged standing of the baby's head in the birth canal can lead to the formation of hematomas or fistulas.

Diagnostics

In this section we will talk about diagnosing the problem of weakness (primary and secondary) of labor. The diagnosis of primary weakness is made on the following basis:

• decreased uterine activity;
• reduced rate of cervical effacement;
• delayed opening of the uterine pharynx;
• long standing of the fetus;
• increased labor time.

It's important to note that big influence The partogram (or graphic description of childbirth) influences the diagnosis. This diagram shows everything:

• cervical dilatation;
• fetal advancement;
• pulse;
• pressure;
• baby's heartbeat;
• contractions and so on.

If there is no progress in dilation of the cervix within two hours, which is clearly presented in the partogram, then this diagnosis is made.

Diagnosis of secondary weakness is based on these indicators:

• partograph;
• listening to the heartbeat.

This is necessary to prevent the fetus from developing hypoxia. There are some difficulties in the labor process that are symptomatically similar to weakened labor. These include:

• pathology;
• discoordination of labor;
• clinically narrow pelvis.

Treatment

It is important to note that treatment is selected individually for each woman in labor. When treating, the doctor must take into account all the data he has (the condition of the woman and baby).

A good remedy for weak labor activity is a technique. For this purpose, special drugs are administered so that the woman can rest, then labor activity can intensify.

If this does not help, then they resort to puncturing the amniotic sac. After this procedure, labor becomes much more intense. It is worth noting that the puncture is carried out only if the cervix is ​​ready.

Sometimes doctors resort to drug stimulation. Now we will briefly look at the drug “Miropriston” for inducing labor. This drug should be taken strictly under the supervision of doctors. It suppresses progesterone, which has beneficial influence on contractile activity of the uterus.

Delivery

If no methods help, including Miropriston to induce labor, then the doctor may perform an emergency cesarean section. What techniques are performed before surgery:

• medicated sleep;
• amniotomy;
• drug stimulation.

Among other things, there may be additional indications for surgery. There is a certain list of contraindications to stimulation of labor (narrow pelvis, threat to life, and so on).

Prevention

We examined in detail the issue of weakness of labor. The obstetrician-gynecologist who is caring for your pregnancy can give advice on prevention. He should talk about possible complications during childbirth and carry out physical and psychological preparation women in labor. In addition to labor stimulation, prophylaxis is mandatory possible complications in the fetus.

Consequences

What are the complications of weak labor? For mom this could be:

• formation of hematomas;
• fistula formation;
• possible infection.

The following complications are possible for the child:

• hypoxia;
• acidosis;
• cerebral edema;
• death.

It all depends on the professionalism of the doctor. At proper stimulation and strict monitoring of the condition of the child and mother there should be no consequences.

Forecast

Now briefly about predicting the weakness of labor. As mentioned earlier, everything depends on the professionalism of the doctor and psychological state women. Don't panic, but listen to the recommendations of a specialist. Complications after obstructed labor are quite rare.

The course of subsequent births

The weakness of labor during the first birth does not mean that all subsequent ones will proceed similarly. Primary and secondary weakness often occurs in women who give birth to their first child. A small percentage of multiparous women may experience weakness during the pushing period.

Both pregnant women and doctors want all births to take place without complications. But, despite this, complications still occur, and one of them is weakness of labor. It is characterized by weakening and shortening of contractions, slowing down the opening of the cervix and the advancement of the fetal head along birth canal. In primiparous women, labor weakness is twice as common as in multiparous women.

Classification of weakness of labor

Weakness of labor can occur both in the first and second stages of labor, and in connection with this they distinguish:

• primary weakness of labor;
• secondary weakness of labor;
• weakness pushing.

Causes of weakness of labor

The causes of weak labor can be divided into three groups: maternal, fetal and pregnancy complications.

From the mother's side:

• diseases of the uterus (uterine fibroids, endometriosis, chronic endometritis);
• extragenital diseases ( diabetes, hypothyroidism, obesity);
• infantilism of the genital organs (hypoplasia of the uterus);
• anatomically narrow pelvis;
• nervous overstrain of a woman, lack of psychoprophylactic preparation for childbirth;
• surgeries on the uterus (caesarean section, myomectomy);
• age of the woman in labor (over 30 years and under 18);
• rigidity (reduced elasticity) of the genital tract.

From the fetus:

• large size of the fruit;
• multiple births;
• incorrect presentation or insertion of the fetal head;
• discrepancy between the sizes of the fetal head and pelvis.

Complications of pregnancy:

• polyhydramnios (overstretching of the uterus and decreased contractility);
• oligohydramnios and flaccid amniotic sac (flat); gestosis, anemia of the pregnant woman.

Primary weakness of the generic forces

Primary weakness of labor occurs with the onset of labor and is characterized by weak, painless contractions, their frequency is no more than 1-2 per 10 minutes, and their duration is no more than 15-20 seconds. The opening of the uterine pharynx is very slow or does not occur at all. In primiparous women, the opening of the cervix to 2-3 cm from the beginning of contractions takes more than 6 hours, and in multiparous women it takes more than 3 hours.

Such ineffective labor activity leads to fatigue of the woman in labor, depletion of the energy reserves of the uterus and intrauterine hypoxia of the fetus. The fetal head does not advance, the amniotic sac does not function, it is weak. Childbirth threatens to become protracted and lead to the death of the child.

Secondary weakness of the generic forces

Secondary weakness of labor usually occurs at the end of the first or at the beginning of the second stage of labor and is characterized by a weakening of labor after a fairly intense onset and course. Contractions slow down and may stop altogether. The opening of the cervix and the advancement of the fetal head are suspended, signs of intrauterine suffering of the child appear, prolonged standing of the fetal head in one plane of the small pelvis can lead to swelling of the cervix and the occurrence of urinary or rectovaginal fistulas.

Weakness of pushing

Weakness of pushing usually occurs in multiparous women (muscle weakness abdominals), in women giving birth with divergence of the anterior muscles abdominal wall(hernia of the white line of the abdomen), in obese women. Characterized by weakness of pushing, ineffective and short-lived pushing (pushing is carried out using the abdominal muscles), physical and nervous exhaustion mothers, the appearance of signs of fetal hypoxia and stopping its movement along the birth canal.

Treatment of weakness of labor

Treatment of weakness of labor forces should be carried out individually in each case, taking into account the history of the woman in labor and clinical picture. Medicinal sleep-rest helps a lot, especially when the woman in labor is very tired.

For this purpose, antispasmodics, painkillers and sleeping pills. Sleep on average lasts no more than 2 hours, after which labor usually resumes and becomes intense.

In case of flat membranes, polyhydramnios or long term During childbirth, the amniotic sac is opened (amniotomy). Also, the woman in labor is advised to lie on the side where the back of the fetus lies (additional stimulation of the uterus).

If all measures are ineffective, they begin intravenous administration uterotonics (drugs that increase uterine contractions). They are dripped very slowly, with mandatory monitoring of the fetal heartbeat. Uterotonics include oxytocin and prostaglandin preparations (they, unlike oxytocin, promote dilation of the cervix).

It is impossible to stop the infusion of contractiles, even with established good labor. Additionally, fetal hypoxia is prevented (sigetin, actovegin, glucose, cocarboxylase). If there is no effect of treatment, an emergency caesarean section is indicated.

At normal course During pregnancy, towards the end of pregnancy, prenatal contractions of the uterus are observed, which are most often painless, mainly occur at night and lead to shortening and softening of the cervix, and a slight opening of the cervical canal.

The main types of labor anomalies include a pathological preliminary period, primary and secondary weakness of labor, excessively strong labor, incoordination of labor and uterine tetanus.

Pathological preliminary period

In contrast to normal prenatal contractions of the uterus, the pathological preliminary period is characterized by spastic, painful and erratic contractions of the uterus and the absence of structural changes from the cervix, which is a sign prenatal disorder its contractile function. The pathological preliminary period can last up to several days. A common complication pathological preliminary period is untimely rupture of amniotic fluid. The main reasons that lead to the development of this complication are: nervous stress; endocrine and metabolic disorders; inflammatory changes in the uterus, age of primigravida over 30 years and under 17 years.

Treatment of the pathological preliminary period should be aimed at accelerating the “ripening” of the cervix and relieving uncoordinated painful contractions of the uterus. In case of fatigue and increased irritability, the patient is prescribed medicated sleep-rest, sedatives (leonwort tincture, soothing herbs, valerian root); antispasmodics; painkillers; β-mimetics (ginipral, partusisten). To urgently prepare the cervix for childbirth, drugs based on prostaglandin E2 are used, which are injected into cervical canal or posterior arch vagina. The duration of treatment for the pathological preliminary period should not exceed 3-5 days. With a “mature” cervix, taking into account a favorable obstetric situation, early opening of the amniotic sac and delivery through the natural birth canal are possible. If there is no effect from the therapy, the “immaturity” of the cervix persists, it is advisable to perform a cesarean section.

Weak labor

Weakness of labor is characterized by insufficient strength and duration of uterine contractions, increased intervals between contractions, disruption of their rhythm, slower dilation of the cervix, and delayed fetal advancement. There are primary and secondary weakness of labor. With primary weakness, contractions from the very beginning of labor are weak and ineffective. Secondary weakness occurs against the background of normal labor. Weakness of labor leads to a protracted course of labor, fetal hypoxia, fatigue of the woman in labor, prolongation of the anhydrous interval, infection of the birth canal, the development of inflammatory complications, bleeding during childbirth and postpartum periods. The causes of generic weakness are very numerous. The main ones among them are violations of the mechanisms regulating the birth process, which include: changes in function nervous system as a result of stress, frustration endocrine functions, violations menstrual cycle, metabolic diseases. In a number of cases, the weakness of the generic forces is due to such pathological changes uterus, such as developmental defects, inflammation, overdistension. Insufficiency of contractile activity during childbirth is also possible in the presence of a large fetus, multiple pregnancy, polyhydramnios, uterine fibroids, post-term pregnancy, and in women with severe obesity. Among the reasons for secondary weakness of labor, in addition to those already listed, we should note the fatigue of the woman in labor as a result of long and painful contractions, an obstacle to the birth of the fetus due to a discrepancy in the size of the head and pelvis, with incorrect position of the fetus, with the presence of a tumor in the pelvis.

The main method of treating weakness of labor is labor stimulation when the amniotic sac is opened, which consists of intravenous drip administration medicines, increasing the contractile activity of the uterus (oxytocin, prostaglandin F2a). A significant effect in the treatment of weakness of labor can be obtained by combining prostaglandin F2a with oxytocin. If the woman in labor is tired, weak labor forces are detected at night, if the cervix is ​​poorly prepared for childbirth or is not open enough, treatment should begin by allowing the woman to rest for 2 to 3 hours (obstetric anesthesia). Otherwise, labor stimulation may further complicate the course of labor. After rest, a vaginal examination is performed to determine the obstetric situation and the condition of the fetus is assessed. After sleep, labor may intensify, and further treatment not required. If labor remains insufficient, uterine stimulating agents are prescribed. Contraindications to stimulation of labor are: discrepancy between the size of the fetus and the mother's pelvis, the presence of a scar on the uterus after a cesarean section or after removal of uterine fibroid nodes, symptoms of impending uterine rupture, previous severe septic diseases of the genital organs. If, with the introduction of drugs that enhance uterine contractions, no dynamics of cervical dilatation are observed within 2 hours or the condition of the fetus worsens, then further administration of drugs is not advisable. In this situation, the issue should be resolved in favor of operative delivery. The choice of method depends on the specific obstetric situation. If labor is weak in the first stage of labor, a caesarean section should be performed. In the second stage of labor, it is advisable to apply exit forceps or perform vacuum extraction.

Violent labor activity

Excessively strong, violent labor is characterized by very strong and/or frequent contractions and pushing (every 1-2 minutes), which can lead to rapid (1-3 hours) or rapid (up to 5 hours) labor. Expulsion of the fetus sometimes occurs in 1-2 attempts. Violent labor poses a danger to the mother and fetus. Women in labor often experience deep ruptures of the cervix, vagina, clitoris, and perineum; premature detachment of a normally located one or the development of bleeding is possible. Frequent, very strong contractions and rapid expulsion of the fetus often lead to hypoxia and birth injury to the fetus.

When correcting rapid labor, the woman in labor is given a position on her side, opposite to the position of the fetus, which she maintains until the end of labor. The woman in labor is not allowed to get up. To regulate and relieve excessive labor, intravenous administration of magnesium sulfate and tocolytic drugs (partusisten, ginipral, etc.) is used, achieving a reduction in the number of contractions to 3-5 in 10 minutes.

Tetanus of the uterus

Uterine tetany is rare. In this case, the uterus does not relax at all, but remains in a state of tonic tension all the time, which is due to the simultaneous appearance of several pacemakers in various areas uterus. At the same time, the reductions various departments the uteruses do not coincide with each other. There is no overall effect of the contraction of the uterus, which leads to a slowdown and stop of labor. Because of significant violation In the uteroplacental circulation, severe fetal hypoxia develops, which manifests itself in disturbances in its cardiac activity. The degree of opening of the uterine pharynx decreases compared to the previous data vaginal examination. A woman in labor may experience an increase in body temperature and develop chorioamnionitis, which worsens the prognosis for the mother and fetus. Uterine tetany can be one of the symptoms of such serious complications as threatening or incipient uterine rupture, premature detachment of a normally located uterus. The reasons for this anomaly are the presence of significant obstacles to the advancement of the fetus, a narrow pelvis, tumor, and unreasonable, erroneous prescription of birth-stimulating drugs.

When treating uterine tetany, anesthesia is used. Often, after anesthesia, labor activity returns to normal, and labor ends spontaneously. In case of uterine tetany, which is a symptom of its rupture, in case of premature detachment of a normally located placenta, or mechanical obstruction to the passage of the fetus, a cesarean section is performed. If there is a complete opening of the cervix, then under anesthesia the fetus is removed using obstetric forceps or by the pedicle (in case of breech presentation).

Discoordination of labor

Discoordination of labor is characterized by erratic contractions of various parts of the uterus due to a displacement of the pacemaker zone. Several such zones can appear at the same time. In this case, the synchronism of contraction and relaxation of individual parts of the uterus is not observed. The left and right halves of the uterus can contract asynchronously, but more often this refers to a disruption of the contraction processes in its lower section. Contractions become painful, spastic, uneven, very frequent (6-7 in 10 minutes) and prolonged. The uterus does not relax completely between contractions. The behavior of the woman in labor is restless. Nausea and vomiting may occur. There is difficulty urinating. Despite frequent, strong and painful contractions, the opening of the uterine pharynx occurs very slowly or does not progress at all. In this case, the fetus almost does not move along the birth canal. Due to disturbances in uterine contraction, as well as due to incomplete relaxation of the uterus between contractions, severe fetal hypoxia often develops, and intracranial injury to the fetus is also possible. Discoordination uterine contractions often causes untimely rupture of amniotic fluid. The cervix becomes dense, the edges of the uterine pharynx remain thick, tight and cannot be stretched. The development of discoordinated labor is facilitated by the mother's negative attitude towards childbirth, the age of the first-time mother over 30 years, untimely rupture of amniotic fluid, rough manipulations during childbirth, developmental anomalies and tumors of the uterus.

When treating incoordination of labor, which is aimed at eliminating excessive uterine tone, sedatives, anti-spasm drugs, painkillers and tocolytic drugs are used. The most optimal method of pain relief is epidural anesthesia. Childbirth is carried out with constant medical supervision and monitoring of fetal cardiac activity and uterine contractions. In case of ineffective treatment, as well as in the presence of additional complications it is advisable to perform a cesarean section without attempting corrective therapy.

Prevention of labor anomalies

In order to prevent labor anomalies, careful adherence to the medical and protective regime, careful and painless management of childbirth are necessary. Drug prevention carried out in the presence of risk factors for the development of abnormalities of contractile activity of the uterus: young and elderly age primiparous; complicated obstetric and gynecological history; indication of chronic infection; the presence of somatic, neuroendocrine and neuropsychiatric diseases, vegetative-vascular disorders, structural inferiority of the uterus; ; overdistension of the uterus due to polyhydramnios, multiple pregnancies or a large fetus.

Poor labor is a common reproductive problem that occurs more often during the first birth. The disease is considered directly generic and manifests itself when contractions occur. Despite the seemingly obvious and in no way frightening name, the problem can result in a series of unpleasant consequences, the worst of which is the death of a newborn.

What is weakness of labor?

This concept hides an anomaly of labor, characterized by weak motility of the uterus, as a result of which the force of contractions is not enough to move the fetus to the exit. As a result of weak or rare contractions of the uterus, the duration of labor increases to a critical level. At the same time, the woman becomes very exhausted during contractions, she does not have the strength to push and push the baby to the exit. The danger also lies in the fact that the water may have receded a long time ago, so the fetus is susceptible to various infections, as well as death as a result of suffocation or lack of oxygen.

Violation is assigned to 10% of cases from total number all birth problems.

The essence of the violation is that due to physiological characteristics the female body, the characteristics of pregnancy or obstetric errors, the uterus does not contract to such a level at which normal intensity contractions are possible. As a result, they become weak, short and sparse.

How can you recognize weak labor?

This feature of the female body is diagnosed if childbirth lasts longer than usual. For example, the firstborn is born, on average, in 11-12 hours, and the second and subsequent babies - in 8. If the birth process is delayed for a longer period, we can conclude that labor is weak. Based on some parameters of the birth process, pathology can be assumed earlier.

The signs are:

• Barely noticeable contractions;
• The dynamics of the uterus are disturbed (contractions and dilations occur chaotically, with different intensity and frequency);
• Long-term presence of the child at the base of the pelvis;
• Untimely release of amniotic fluid;
• Increasing the duration of labor;
• Lack of progress in uterine dilatation for more than 120 minutes (according to the partogram).

Analyzing the external state expectant mother, the main indicators of labor, specialists draw a conclusion about the presence or absence of pathology and, if necessary, prepare to induce labor.

What is the reason for the weakness of labor?

Since this problem most often affects primiparous women, its main cause is the peculiarity of a young body that has not known childbirth. When the baby is born female body is under enormous pressure, resulting in the immune system trying to stop this process. To protect against excessive stress, special mechanisms are put into operation that try to relieve a woman from pain and restore normal functioning of all organ systems.

Age plays a big role: weakness of labor is inherent in girls under 17 years of age and women after 30 years of age.

There are also several other groups of reasons.

1. Physiological - related to the characteristics of women's health.

• Infectious childhood diseases (rubella, measles, chickenpox);
• Inflammation of the uterus, ovaries, appendages, fallopian tubes etc.;
• Neoplasms of the pelvic organs;
• Multiple previous births;
• Late first menstruation;
• Irregular menstrual cycle;
• Small uterus;
• Endocrine diseases, metabolic disorders;
• Abortion;
• Scar on the uterus;
• Anomalies of the uterus;
• Narrow pelvis;
• Low elasticity of the uterus.

2. Obstetric reasons:

• Excessive proportion of amniotic fluid;
• Expecting two or more children;
• Abnormal location of the placenta;
• Large fruit size;
• The release of water before contractions begin;
• Premature birth or post-term pregnancy;
• Malposition;
• Psycho-emotional problems, physical impotence (lack of strength).

3. Causes from the fetus:

• Rh discrepancy between mother and child;
• Infectious processes;
• Fetoplacental insufficiency;
• Congenital developmental anomalies.

Usually, several causes are discovered at the same time.

Classification

In medicine, two types of weak labor are defined - primary and secondary. The significant difference is that with secondary weakness, no signs are initially observed, but the rhythm, intensity and duration of contractions gradually decrease.

Primary weakness appears immediately:

Contractions become increasingly rare, shorter and less sensitive;

The rate of smoothing of the cervix and opening of the uterine pharynx slows down, or these processes stop altogether;
The head or pelvis of the fetus remains mobile or pressed against the entrance to the pelvis for too long;
Woman's impotence due to long first period of childbirth (from 12 hours in a primiparous woman and from 10 in a multiparous woman).

During the first birth, the rate of dilatation of the cervix is ​​1-1.2 cm per hour for women giving birth to their first child, and 1.5-2 cm per hour if the child is at least the second for the woman in labor. Primary weakness of labor is determined if the speed is less. During the same period, matchmaking should last 20-30 seconds with a break of about 8 minutes. Pathologies of labor reduce the duration of contractions, but increase the interval between them.

For secondary weakness Labor is characterized by a long period of expulsion of the fetus - more than 1.5 hours. This is due to the fact that contractions weaken sharply and their rhythm slows down.

What does a doctor do if labor is weak?

Analyzing the condition of the mother, child and the intensity of labor, the doctor makes a decision regarding future actions. If there is a high probability of risk, an emergency caesarean section is performed and labor is induced. Methods medical care are:

• Amniotomy— opening of the amniotic sac, in which drug induction of labor may not be used. The procedure is completely painless.
• Taking or injecting medications. This method is used if amniotomy is ineffective. Strong painkillers may be recommended, which lead to medicated sleep, during which the woman in labor can rest and recuperate. Oxytocin and prostaglandins are also administered intravenously.
• C-section— emergency surgery carried out as a last resort if there is a threat to the life of the mother or child. In this case, an incision is made in abdominal area and the uterus (with anesthesia) and the fetus is removed.

There are also special contraindications to induce labor. These include a narrow pelvis, incorrect position and fetal presentation, 3 or more births in the woman’s history, scars on the uterus, risk fatal outcome for a woman or fetus.

How can weak contractions be dangerous?

If a woman is in the hands of professionals who can provide timely assistance, her life and the life of the baby are not in danger. Only favorable conditions depend on the woman in labor. psychological attitude, calmness and focus on a good result.

What complications can there be and why?

• Excessive stimulation with medical supplies can lead to abnormal contractions of the uterus, and ultimately to the death of the fetus from suffocation;
• When a child occupies the same position in the womb for a long time, the soft tissues begin to be compressed, which often causes circulatory problems or cerebral hemorrhage;
• Risk of occurrence various kinds bleeding and infectious diseases in a woman in labor.

Weak labor is one of those ailments that cannot be diagnosed in advance and any measures cannot be taken to avoid it. Therefore, pregnancy planning, constant monitoring by the same doctor and a positive psychological attitude are important. If a woman listens to the doctor and follows all recommendations, childbirth will be easy and without harm to her and the child.

Especially for- Elena Kichak