Obstetrics and gynecology. Abnormalities of labor (turbulent labor, tetanus of the uterus) (most important)

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Obstetrics and gynecology. Abnormalities of labor (turbulent labor, tetanus of the uterus) (most important)

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23. Anomalies of labor activity (violent labor activity, uterine tetanus)

Strong and frequent contractions and attempts (after 1-2 minutes), which lead to rapid (1-3 hours) and rapid (up to 5 hours) childbirth, are characterized as excessively strong, violent labor activity. The expulsion of the fetus sometimes occurs in 1-2 attempts. Violent labor activity is dangerous for the mother and fetus, causing deep ruptures of the cervix, vagina, clitoris, and perineum in parturient women. With violent labor activity, premature detachment of a normally located placenta or the development of bleeding is possible. To reduce violent labor activity, 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 childbirth. To normalize the process of childbirth and reduce too violent labor activity, magnesium sulfate is used intravenously and tocolytics (partusisten, ginipral). It is necessary to reduce the number of contractions to 3-5 within 10 minutes.

Tetany uterus is rare. It is characterized by constant tonic tension of the uterus, which does not relax at all. The reason is the simultaneous occurrence of several pacemakers in different parts of the uterus.

The causes of this pathological condition can be significant obstacles to the passage of the fetus, a narrow pelvis, neoplasms, and inadequate use of labor-stimulating drugs.

In the treatment of uterine tetany, anesthesia is used, after which labor activity is restored, and childbirth ends naturally. With tetany of the uterus, a caesarean section is performed in case of symptoms of uterine rupture, premature detachment of a normally located placenta, mechanical obstruction to the passage of the fetus.

Discoordination of labor activity consists in chaotic contractions of various parts of the uterus due to the displacement of the pacemaker zone. Several such zones may occur simultaneously. The left and right halves of the uterus can contract in an uncoordinated way, but this mainly happens with its lower section. The nature of the contractions changes: they become more frequent (6-7 in 10 minutes), become irregular, prolonged. In the moment between contractions, the uterus cannot relax completely. The behavior of the mother in labor is restless. There is difficulty urinating. The opening of the uterine os, despite frequent, strong and painful contractions, occurs very slowly or does not occur at all, as a result of which the fetus almost does not move along the birth canal. Due to violations of the contractile activity of the uterus and its incomplete relaxation, the occurrence of complications is often observed: significant hypoxia of the fetus and its intracranial injury. Violation of the contractile activity of the uterus can lead to untimely discharge of amniotic fluid.

Therapy of discoordination of labor activity is aimed at eliminating excessive uterine tone. Use sedatives, antispasmodics, painkillers and tocolytic drugs.

Author: Ivanov A.I.

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