Obstetrics and gynecology. Anomalies of labor (pathological preliminary period, weakness of labor) (most important)

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Obstetrics and gynecology. Anomalies of labor (pathological preliminary period, weakness of labor) (most important)

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22. Anomalies of labor activity (pathological preliminary period, weakness of labor activity)

Pathological preliminary period, primary and secondary weakness of labor activity, excessively strong labor activity, discoordination of labor activity, tetanus of the uterus are the main types of anomalies of labor activity.

The pathological preliminary period is characterized by spastic, painful and erratic uterine contractions and the absence of structural changes in the cervix. The duration of the pathological preliminary period can be several days. Untimely discharge of amniotic fluid is the most common complication of the pathological preliminary period.

The main thing in the treatment of the pathological preliminary period is: accelerated preparation of the cervix for the onset of labor and the elimination of painful erratic contractions. With fatigue and increased irritability, the patient is prescribed sedatives, antispasmodics, painkillers, b-mimetics (ginipral, partusisten). With the ineffectiveness of the therapeutic effect, operative delivery by caesarean section is performed.

Weak labor activity is manifested by a slowdown in the opening of the cervix, an increase in the intervals between contractions, a violation of their rhythm, insufficient strength and duration of uterine contractions, and a delay in the advancement of the fetus. There are primary and secondary weakness of labor activity. With primary weakness from the very beginning, labor activity is ineffective, sluggish, contractions are weak. Secondary weakness occurs during the normal course of childbirth. Insufficiency of contractile activity during childbirth is possible in the presence of a large fetus, with polyhydramnios, multiple pregnancy, uterine myoma, post-term pregnancy. The reasons for the secondary weakness of labor can be the fatigue of the woman in labor as a result of prolonged and painful contractions, an obstacle to the fetus being born, the incorrect position of the fetus, the presence of a tumor in the small pelvis.

Treatment of weak labor activity consists in rhodostimulation with an open fetal bladder. Rhodostimulation is carried out by intravenous drip of oxytocyne drugs, prostaglandin F2a. If the woman in labor is tired and there is weakness and insufficiency of contractions at night, as well as with a slight opening or unavailability of the cervix for labor, the woman should rest for several hours with the help of obstetric anesthesia. Stimulation of labor activity has contraindications: discrepancy between the size of the mother's pelvis and the size of the fetus, existing scars on the uterus of various origins (after gynecological operations to remove myomatous nodes or after previous births performed surgically using a caesarean section), the presence of symptoms of a threatening uterine rupture, which are present in the anamnesis recent septic diseases of the genital organs of severe course.

Author: Ivanov A.I.

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