Weak labor activity - how to avoid serious complications? Anomalies of labor activity.

Weakness of labor activity is a pathological condition that is characterized by a decrease and weakening of contractions, as well as a slow opening of the cervix. At the same time, the woman in labor gets very tired and loses strength.

Weak labor activity is primary and secondary.

Primary is a decrease in uterine activity that occurs at the very beginning of childbirth. The frequency of occurrence is 5-7% of the number of all births.

Secondary - this is a decrease in the duration, intensity and frequency of contractions after a favorable onset of the course of labor. At the same time, the rate of opening and smoothing of the cervix also decreases, and the movement of the fetus through the birth canal slows down. It occurs in 2-3% of births.

Causes

The risk group includes pregnant women who have a history of:

• childhood infections (rubella, chickenpox, measles);
• late onset of the first menstruation (menarche), after 15-16 years;
• menstrual irregularities;
• infantilism (small uterus);
• anomalies in the development of the uterus;
• inflammatory diseases of the reproductive system;
• scar on the uterus (after caesarean section, removal of fibroids, ectopic pregnancy, etc.);
• abortions;
• large fruit;
• a large number of births;
• diseases with metabolic disorders.

The reason for the weakness of the birth process can be mechanical obstacles (narrow pelvis, breech presentation of the fetus, inelasticity of the cervix). The age of the pregnant woman also plays a role - women under the age of 17 and over 30 are more prone to anomalies in labor. Obstetric reasons include:

• prenatal outpouring of water;
• multiple pregnancy;
• post-term pregnancy or, conversely, premature birth;
• large size of the fetus;
• transverse or oblique position of the fetus;
• pelvic presentation of the fetus;
• fear of childbirth, great loss of strength.

The reasons may be from the side of the fetus:

• intrauterine infection;
• malformations and anomalies of development;
• Rhesus conflict;

Most often, for the development of weak labor activity, several reasons or a combination of them are needed.

Signs of weak labor activity

Primary weakness of labor can be manifested by such symptoms:

• contractions become less sensitive, rare or short;
• the smoothing of the cervix and the opening of the uterine pharynx slow down or stop (the doctor determines during a vaginal examination);
• the presenting part of the fetus (head or pelvic end) remains permanently movable or pressed against the entrance to the small pelvis;
• the long course of the first stage of labor (for primiparous more than 12 hours, for multiparous more than 10 hours) and, as a result, the fatigue of the woman in labor;
• possible untimely discharge of amniotic fluid.

Norms of disclosure and contractions in the first stage of labor

Normally, in a primiparous woman, the cervix of the uterus opens by 1-1.2 cm per hour, in a multiparous woman - 1.5-2 cm per hour. If the cervix opens more slowly, then this may indicate the development of primary weakness of labor activity.

In the first period, the normal duration of contractions is 20-30 seconds, and the interval between them is 7-10 minutes. With the pathology of labor activity, their duration decreases, and the interval between them increases.

Secondary generic weakness is characterized by a longer period of expulsion of the fetus (more than 1-1.5 hours). This is due to the weakening or cessation of contractions, which at the beginning were intense, rhythmic and prolonged. At this point, the progress of the fetus along the birth canal slows down or stops altogether.

Diagnostics

Primary weakness of labor activity is diagnosed on the basis of:

• decrease in uterine activity (contractions weaken, become rare);
• reducing the speed of smoothing the neck and opening the uterine pharynx;
• prolonged standing of the presenting part of the fetus at the entrance to the small pelvis;
• increase in delivery time.

The diagnosis is also made on the basis of partogram data, if there is no dynamics of cervical dilatation within two hours.

Partogram - a description of childbirth in a graphical way, which displays data on cervical dilatation, fetal progress, pulse, blood pressure, fetal heartbeat, amniotic fluid, contractions, etc.

Secondary birth weakness is diagnosed on the basis of the clinical picture and partogram data. In addition, it is necessary to monitor the condition of the fetus (listen to the heartbeat, install a CTG sensor), as there is a risk of developing hypoxia. After establishing the diagnosis, obstetricians need to decide on the tactics of childbirth.

Weakness of labor must be distinguished from the following pathologies:

• pathological preliminary period (chaotic false contractions with an immature cervix);
• discoordinated labor activity (violation of the contractile activity of the uterus, it is extremely painful; it is very rare);
• clinically narrow pelvis (mismatch between the size of the pelvis and the head of the fetus).

Treatment and delivery in case of weak labor activity

There are several methods of medical care. The doctor makes a decision depending on the causes of the pathology and the condition of the woman in labor and the fetus. If labor is prolonged and life-threatening, labor is induced or an emergency caesarean section is performed. Methods of medical care:

1. Stimulation of childbirth without medication. Labor activity can be strengthened by the procedure of amniotomy (opening of the fetal bladder), which allows you not to use drugs. Do not be afraid, amniotomy is completely painless.

2. Medicinal stimulation. It is carried out in case of ineffectiveness of the amniotomy. It can be carried out with the help of strong analgesics, which induce drug-induced sleep to relax and rest the woman in labor. Stimulation with oxytocin and prostaglandins is performed intravenously.

3. Cesarean section. An emergency operation is performed in case of ineffective stimulation and in case of a threat to life for the woman in labor or the fetus.

drug sleep

For therapeutic sleep, sodium oxybutyrate and glucose are administered, performed by an anesthesiologist. In his absence, the obstetrician introduces promedol, relanium, atropine and diphenhydramine. Medication sleep allows a woman in labor to rest for 2-3 hours and gain strength, and also helps to intensify contractions. If there is an indication for an emergency caesarean section, then there is no need for therapeutic sleep.

After the woman has a rest, the doctor needs to assess her condition and the fetus, as well as the degree of opening of the uterine pharynx. After that, a hormonal-energy background is created with the help of:

• ATP, riboxin, cocarboxylase;
• 40% glucose solution;
• calcium preparations (to enhance uterine contraction);
• vitamins: B1, B6, E, ascorbic acid;
• piracetam (to improve uterine circulation).

Amniotomy

Opening the fetal bladder promotes the production of prostaglandins, which stimulate contractions. It is performed when the cervix is ​​dilated by 3-4 cm. 2-3 hours after the procedure, the doctor needs to assess the state of the dynamics of cervical dilatation, and also decide on the use of reducing drugs.

Medical stimulation

When stimulated with drugs, oxytocin and prostaglandins are used.

Oxytocin is administered intravenously through a drip. It provokes increased contractions and the production of prostaglandins. Oxytocin is administered when the uterine os opens by 5-6 cm or more, only after amniotomy or spontaneous discharge of amniotic fluid.

Prostaglandin E2 contributes to the development of normal contractions. The drug also accelerates the maturation of the cervix and its opening, while not disturbing the uteroplacental circulation. The drug is administered similarly to oxytocin. It is used until the opening of the uterine os by 2-3 cm with an insufficiently mature cervix.

Prostaglandin F2a (enzaprost or dinoprost) is used when opening the uterine os by 5 cm or more. Effects of the drug: stimulation of contractions, narrowing of blood vessels, increased blood clotting. Therefore, it is contraindicated in preeclampsia and blood diseases. Prostaglandin F2a is administered intravenously using a drip system.

With drug stimulation, it is mandatory to prevent fetal hypoxia every 3 hours. For this, a 40% glucose solution + ascorbic acid + eufillin, sigetin or cocarboxylase is injected intravenously. It also shows the inhalation of humidified air.

C-section

If all of the above methods were ineffective or there are additional indications, then a caesarean section is performed.

Contraindications for labor stimulation

• narrow pelvis (anatomical and clinical);
• the presence of a scar on the uterus;
• women with a history of more than 5-6 births;
• incorrect position and presentation of the fetus;
• life threatening for the mother and fetus.

Possible Complications

In the case of an incorrect choice of a delivery strategy with weak labor activity, the following complications are possible:

• abuse of stimulant drugs can lead to discoordinated labor and fetal hypoxia.
• prolonged standing of the presenting part of the fetus in one plane of the small pelvis can lead to compression of the soft tissues, in which there is a risk of urogenital fistulas. On the part of the fetus, this can lead to impaired cerebral circulation and cerebral hemorrhage.
• in women with weakness of labor in the postpartum period, there is a risk of hypo- and atonic bleeding, infectious diseases.

Forecast

With adequate medical care, the prognosis for the woman and the fetus is favorable. Much depends on the psychological state of the woman, there is no need to panic and be afraid, it is better to listen to the recommendations of the obstetrician. Serious complications are rare.

Some research on pregnancy

Both pregnant women and doctors want childbirth to take place without any complications. However, despite this, anomalies of labor activity still happen, and one of them is the weakness of labor activity. This complication is characterized by weakening and shortening of contractions, slowing down the opening of the cervix and, accordingly, the advancement of the baby's head through the birth canal. If a woman has a second birth, weak labor activity is unlikely, more precisely, in multiparous women, it occurs twice as rarely as in primiparas. Why is this happening and how to correct the weakness of tribal forces?

· Anomalies of labor activity: classification of weakness of labor forces

Weakness of labor can occur both in the first stage of labor and in the second, so it happens:

1. primary weakness of tribal forces;

2. secondary weakness of labor activity;

3. as well as weakness of attempts.

· Weak labor activity: causes

The causes of weakness in childbirth can be divided into three conditional groups: on the part of the woman in labor, on the part of the child, and complications of pregnancy.

Causes of weakness of labor activity on the part of the mother:

1. infantilism of the genital organs (uterine hypoplasia);
2. diseases of the uterus (endometriosis, chronic endometritis, uterine fibroids);
3. extragenital diseases (obesity, diabetes, hypothyroidism);
4. anatomically narrow pelvis;
5. operations on the uterus (myomectomy, caesarean section);
6. lack of mental preparation for childbirth, nervous strain of the woman in labor;
7. the age of the woman (under 18 and over 30);
8. rigidity of the genital tract (reduced elasticity).

Causes of weakness of labor activity on the part of the fetus:

1. incorrect insertion or presentation of the fetal head;
2. multiple pregnancy;
3. large size of the fetus;
4. discrepancy between the size of the pelvis and the head of the fetus.

Complications of pregnancy:

1. anemia, preeclampsia in a pregnant woman;
2. polyhydramnios (overdistension of the uterus can reduce its contractility);
3. oligohydramnios and flaccid, flat fetal bladder.

• Primary weakness of labor activity

There is a primary weakness of labor activity with the onset of labor, it is characterized by weak, painless contractions, their low frequency (no more than 1-2 contractions within 10 minutes), and duration (no more than 15-20 seconds). If labor activity is weak, the opening of the uterine os occurs very slowly or does not occur at all. In nulliparous women, the opening of the cervix to a size of 2-3 cm in diameter (or 2-3 fingers, as obstetricians often “measure”) takes longer than 6 hours from the onset of contractions, and in multiparous women - longer than 3 hours.

Such a weak, ineffective labor activity greatly tires the woman in labor, depletes the energy reserves of the uterus and leads to intrauterine fetal hypoxia. Due to weakness, the fetal bladder does not function properly, the baby's head does not move along the birth canal. Childbirth threatens to be seriously delayed and end in the death of the fetus.

· Secondary weakness of labor activity

Usually, the secondary weakness of labor activity occurs at the beginning of the second or at the end of the first period of labor, it manifests itself in the form of a weakening of labor activity after an intensive onset and course of labor. The contractions slow down and may eventually stop altogether. The opening of the cervix is ​​suspended, as is the advancement of the fetal head, all this is accompanied by signs of intrauterine suffering of the child, if the fetal head stands in one place of the small pelvis for a long time, this can result in cervical edema and the appearance of rectovaginal or urinary fistulas in a woman in labor.

· Weakness of attempts

As a rule, weakness of attempts occurs in women who have repeatedly or multiparous (due to weakening of the abdominal muscles), with a divergence of the muscles of the anterior abdominal wall (in the case of a hernia of the white line of the abdomen), with obesity of the woman in labor. The weakness of the attempts is manifested by their inefficiency and short duration (the implementation of the attempts occurs due to the abdominal muscles), nervous and physical exhaustion of the woman in labor. As a result, there may be signs of fetal hypoxia and stop the movement of the child through the birth canal.

· Weak labor activity: treatment

Treatment of weakness in childbirth should be carried out individually in each individual case, taking into account the anamnesis of the woman giving birth and the clinical picture, that is, the condition of the woman in labor and the child and the current situation.

Provides good help medical sleep-rest, especially with severe fatigue of a woman. For this, painkillers, antispasmodics and hypnotics are used. On average, the duration of medical sleep is no more than 2 hours, and labor activity usually recovers after that and becomes intense.

If weak labor activity occurs due to a flat fetal bladder, a long course of labor or polyhydramnios, then they can resort to help- open the fetal bladder, pierce it. It is also recommended for a woman in labor to lie exactly on the side where she is, i.e. the back of the fetus is present - thus, additional stimulation of the uterus occurs.

In case of ineffectiveness of all measures, the treatment of weakness of labor activity is carried out intravenous administration of uterotonics(means that enhance uterine contraction). Uterotonics are dripped very slowly, in parallel, a diagnosis of the condition of the fetus is necessarily carried out - the heartbeat of the child is constantly monitored. These drugs include. Prostogladins, in addition to their contractile properties, also stimulate cervical dilatation. Moreover, it is impossible to stop intravenous infusion of reducing agents, even when a good labor activity has been established. In addition to the treatment of weakness of labor, the prevention of fetal hypoxia is carried out with the help of such medicines as Actovegin, Sigetin, glucose preparations, cocarboxylases. If the effect of treatment, in the form of activation of labor activity, intensification of contractions, promotion of the child through the birth canal, is absent, it is necessary to carry out an emergency.

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

Let's define what it is. The weakness of labor is the lack of activity of the uterus. That is, childbirth is difficult and lengthy, since the uterus does not contract well, the cervix opens with difficulty, and the fetus comes out very slowly and difficultly. Childbirth does not always go well, as expected, there are anomalies in labor activity. You will learn about one of them in great detail from this article.

Weak labor activity

No matter how sad it may sound, but anomalies of labor activity 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 the possible violations of labor activity. With this diagnosis, the contractile function of the uterus, which is necessary for the expulsion of the fetus, is weakened. This is due to:

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

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

Causes

We explained what the weakness of labor activity is. The reasons can be many factors. We propose to list them. The reasons for the weakness of labor activity can be:

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

There are some other reasons that can be noted. Weakness of tribal forces may arise due to an imbalance of factors that affect labor activity. Positive factors include the following:

• 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 some disorders (vegetative-metabolic) often face this problem during childbirth. Such violations include:

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

The age of the primiparous also has a great influence. If the girl is very young or her age exceeds 35 years, then labor can be difficult. The period at which labor activity began is also important. Weakness of the uterus can be the cause of a delayed pregnancy or premature.

If the pregnancy is multiple, then this pathology is possible during childbirth. With multiple pregnancy, the uterus is overstretched. Overstretching can also occur with a large fetus or polyhydramnios.

Often, miniature girls face difficulty in labor activity, since a narrow pelvis is also the cause of weak work 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;
• the discomfort;
• poor care of the woman in labor and so on.

Thus, it is possible to classify all causes as follows:

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

Kinds

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

• primary;
• secondary;
• weak pushes.

Let's take a closer look at each type separately.

The primary weakness of labor activity is characterized by inactive contractions in the first stage of labor. They are very weak, short and not at all rhythmic. It is important to note that with primary weakness, an underestimated uterine tone (less than 100 mm Hg) is noticed. At this stage, the woman is able to diagnose the problem herself. How to do it? Record 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 was confirmed. You can also measure the time of one contraction, it should be more than 20 seconds in the absence of weakness in labor. Diastole, or rest period, is almost twice as long. How can the palpability 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 activity is characterized by a weakening of the intensity of the work of the uterus. Prior to this, contractions may have been normal. The causes of development are the same as with the primary weakness of the ancestral forces. Another indicator is the progression of the opening of the uterine os. If progress is not visible after five or six centimeters of dilatation, 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 births and is characteristic of primiparas, then weakness of the straining period is extremely rare (two percent of all cases of difficult births), and it is characteristic of multiparous women or with obesity.

Symptoms

Symptoms of primary weakness of labor activity 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 force of contractions does not exceed 25 mm Hg. Art.;
• short period of reduction;
• extended rest period;
• there is no increase in intensity and frequency;
• painless or painless contractions;
• slow change in the structure of the cervix (this includes shortening, smoothing and opening).

All this can significantly increase the overall time of delivery. This, in turn, affects the mother and the child badly. The woman in labor is very overworked, early expulsion of waters is possible.

Symptoms of secondary weakness:

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

This is no less dangerous than the primary weakness. The child may develop asphyxia or may die. For the mother, this is dangerous due to the possibility of infection of the uterus, 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 focus on diagnosing the problem of weakness (primary and secondary) of labor activity. The diagnosis of primary weakness is based on the following:

• decreased activity of the uterus;
• reduced rate of neck smoothing;
• delayed opening of the uterine pharynx;
• long standing fetus;
• extended delivery time.

It is important to note that the partogram (or graphic description of childbirth) has a great influence on the diagnosis. This chart shows it all:

• neck opening;
• promotion of the fetus;
• pulse;
• pressure;
• baby's heartbeat
• fights and so on.

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

Diagnosis of secondary weakness is based on these indicators:

• partogram;
• listening to the heartbeat.

This is necessary so that the fetus does not develop hypoxia. There are some complexities of the birth process that are symptomatically similar to weakened labor. These include:

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

Treatment

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

A good remedy for weak labor activity is a technique. For this, special preparations are introduced so that the woman has a rest, then labor activity may intensify.

If this does not help, then they resort to a puncture of the fetal bladder. After this procedure, labor activity becomes much more intense. It should be noted that the puncture is carried out only if the neck is ready.

Sometimes doctors resort to drug stimulation. Now we will briefly consider the drug "Miropriston" to stimulate labor. This drug should be taken strictly under the supervision of doctors. It suppresses progesterone, which has a beneficial effect on the contractile activity of the uterus.

delivery

If no methods have helped, including Miropriston to stimulate labor, then the doctor may perform an emergency caesarean section. What techniques are performed before the operation:

• medical sleep;
• amniotomy;
• medical stimulation.

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

Prevention

We examined in detail the issue of weakness of labor activity. prevention can be given by an obstetrician-gynecologist who is managing your pregnancy. He should talk about possible complications during childbirth and conduct physical and psychological preparation of the woman in labor. In addition to rhodostimulation, prevention of possible complications in the fetus is mandatory.

Consequences

What are the complications of labor weakness? For a mother, this could be:

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

For a child, the following complications are possible:

• hypoxia;
• acidosis;
• swelling of the brain;
• death.

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

Forecast

Now briefly about predicting the weakness of labor activity. As mentioned earlier, it all depends on the professionalism of the doctor and the psychological state of the woman. Do not panic, but listen to the recommendations of a specialist. Complications after obstructed childbirth are quite rare.

The course of subsequent births

The weakness of labor activity during the first birth does not mean that all subsequent ones will proceed in the same way. Primary and secondary weakness is common in women who give birth to their first child. A small percentage of multiparous women may experience weakness in the labor period.

In the normal course of pregnancy, closer to its end, prenatal uterine contractions are noted, which are most often painless, mainly occur at night and lead to shortening and softening of the cervix, and opening of the cervical canal.

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

Pathological preliminary period

Unlike 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 in the cervix, which is a sign of a prenatal violation of its contractile function. The pathological preliminary period can last up to several days. A frequent complication of the pathological preliminary period is the untimely discharge 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, the age of the primipara is over 30 years and under 17 years of age.

Treatment of the pathological preliminary period should be aimed at accelerating the "ripening" of the cervix, removing uncoordinated painful uterine contractions. With fatigue and increased irritability, the patient is prescribed medical sleep-rest, sedatives (motherwort tincture, collection of sedative herbs, valerian root); antispasmodics; painkillers; β-mimetics (ginipral, partusisten). For urgent preparation of the cervix for childbirth, drugs based on prostaglandin E2 are used, which are injected into the cervical canal or the posterior vaginal fornix. The duration of treatment of the pathological preliminary period should not exceed 3-5 days. With a "mature" cervix, taking into account a favorable obstetric situation, it is possible to open the fetal bladder early and conduct labor through the natural birth canal. In the absence of the effect of the therapy, the preservation of the "immaturity" of the cervix, it is advisable to perform a caesarean section.

Weak labor activity

The weakness of labor is characterized by insufficient strength and duration of uterine contractions, an increase in the intervals between contractions, a violation of their rhythm, a slowdown in the opening of the cervix, and a delay in the advancement of the fetus. There are primary and secondary weakness of labor activity. With primary weakness, contractions from the very beginning of labor are weak and ineffective. Secondary weakness occurs against the background of normally begun labor activity. The weakness of labor activity leads to a protracted course of labor, fetal hypoxia, fatigue of the woman in labor, lengthening of the anhydrous period, infection of the birth canal, the development of inflammatory complications, bleeding during childbirth and the postpartum period. The reasons for the weakness of generic are very numerous. The main among them are violations of the mechanisms regulating the birth process, which include: changes in the function of the nervous system as a result of stress, disorders of endocrine functions, menstrual disorders, metabolic diseases. In a number of cases, the weakness of the birth forces is due to such pathological changes in the uterus as malformations, inflammation, overstretching. Insufficiency of contractile activity during childbirth is also possible in the presence of a large fetus, with multiple pregnancy, polyhydramnios, uterine myoma, post-term pregnancy, in women with severe obesity. Among the reasons for the secondary weakness of labor activity, in addition to those already listed, it should be noted the fatigue of the woman in labor as a result of prolonged and painful contractions, an obstacle to the fetus being born due to a mismatch in the size of the head and pelvis, with an incorrect position of the fetus, with the presence of a tumor in the small pelvis.

The main method of treating weakness of labor activity is labor stimulation with an open fetal bladder, which consists in intravenous drip administration of drugs that enhance the contractile activity of the uterus (oxytocin, prostaglandin F2a). A significant effect in the treatment of weakness of labor forces can be obtained by combining prostaglandin F2a with oxytocin. If the woman in labor is tired, the weakness of the labor forces is revealed at night, if the cervix is ​​not ready for childbirth or it is not open enough, treatment should begin with giving the woman rest for 2-3 hours (obstetric anesthesia). Otherwise, rhodostimulation can further complicate the course of childbirth. After rest, a vaginal examination is performed to determine the obstetric situation and assess the condition of the fetus. After sleep, labor activity may increase, and further treatment is not required. If labor activity remains insufficient, uterine stimulants are prescribed. Contraindications to induction of labor are: a 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 fibroids, symptoms of threatening uterine rupture, previous severe septic diseases of the genital organs. If with the introduction of drugs that enhance uterine contractions for 2 hours there is no dynamics of cervical dilatation 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. With weakness of labor activity in the first stage of labor, a caesarean section should be performed. In the second stage of labor, it is advisable to apply exit obstetric forceps or perform vacuum extraction.

Violent labor activity

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

When correcting violent 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 mother is not allowed to get up. To regulate and relieve excessive labor activity, intravenous administration of magnesium sulfate, tocolytic drugs (partusisten, ginipral, etc.) is used, achieving a decrease in the number of contractions to 3-5 in 10 minutes.

Uterine tetanus

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 occurrence of several pacemakers in different parts of the uterus. At the same time, the contractions of various parts of the uterus do not coincide with each other. There is no cumulative effect of the action of uterine contraction, which leads to slowing down and stopping labor. Due to a significant violation of the uteroplacental circulation, severe fetal hypoxia develops, which manifests itself in a violation of its cardiac activity. The degree of disclosure of the uterine pharynx is reduced compared with the data of the previous vaginal examination. A woman in labor may have a rise 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. The reasons for this anomaly are the presence of significant obstacles to the progress of the fetus, a narrow pelvis, a tumor, unreasonable, erroneous prescription of labor-stimulating drugs.

In the treatment of uterine tetany, anesthesia is used. Often, after anesthesia, labor activity normalizes, and childbirth ends spontaneously. With tetany of the uterus, which is a symptom of its rupture, with premature detachment of a normally located placenta, a mechanical obstruction to the passage of the fetus, a caesarean 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 leg (with breech presentation).

Discoordination of labor activity

Discoordination of labor activity is characterized by erratic contractions of various parts of the uterus due to the displacement of the pacemaker zone. Several such zones may occur simultaneously. In this case, the synchrony of contraction and relaxation of individual sections of the uterus is not observed. The left and right halves of the uterus can contract asynchronously, more often this refers to a violation of the contraction processes in its lower section. Contractions become painful, spastic, uneven, very frequent (6-7 in 10 minutes) and prolonged. Between contractions, the uterus does not completely relax. The behavior of the mother in labor is restless. There may be nausea and vomiting. There is difficulty urinating. Despite frequent, strong and painful contractions, the opening of the uterine os occurs very slowly or does not progress at all. In this case, the fetus almost does not move along the birth canal. Due to violations of uterine contraction, as well as due to incomplete relaxation of the uterus between contractions, severe fetal hypoxia often develops, and an intracranial injury to the fetus is also possible. Discoordination of uterine contractions often causes untimely discharge of amniotic fluid. The cervix becomes dense, the edges of the uterine os remain thick, tight and do not lend themselves to stretching. The development of discoordinated labor activity is facilitated by the negative attitude of the woman in labor to childbirth, the age of the primiparous woman over 30 years old, untimely discharge of amniotic fluid, gross manipulations during childbirth, developmental anomalies and tumors of the uterus.

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

Prevention of anomalies of labor activity

In order to prevent anomalies of labor activity, careful observance of the medical and protective regimen, careful and painless management of childbirth is necessary. Drug prophylaxis is carried out in the presence of risk factors for the development of anomalies in the contractile activity of the uterus: young and old age of primiparas; burdened obstetric and gynecological history; indication of chronic infection; the presence of somatic, neuroendocrine and neuropsychiatric diseases, vegetative-vascular disorders, structural inferiority of the uterus; ; overstretching of the uterus due to polyhydramnios, multiple pregnancy or large fetus.

Weakness of labor is a very common pathology, especially in women giving birth for the first time, which often causes the use of serious drugs to stimulate labor and even an emergency caesarean section.

The primary weakness of labor activity is often the result of many days of preparatory contractions that exhaust the woman physically and psychologically. With such symptoms, it is better to be in the hospital, where they can gently relieve unproductive contractions with the help of sedatives and antispasmodics. In the future, this does not cause weakness of the birth forces, does not provoke the "fixing" of the cervix, only improves the well-being of the expectant mother. And doctors at this time monitor the condition of the child. Other possible causes of weak labor:

• hormonal imbalance (lack of estrogen, prostaglandins, oxytocin and excess progesterone);
• polyhydramnios;
• multiple births, as a result of this, overstretching of the walls of the uterus;
• large fruit;
• excess weight;
• neoplasms of the uterus;
• early discharge of amniotic fluid;
• premature or delayed birth;
• too early or late age of the woman in labor.

But it happens that problems arise already in the process of childbirth: secondary weakness can occur during childbirth in impressionable women even because of one rude word honey. personnel. But mostly due to fatigue. Indeed, in most primiparous women, the first stage of labor lasts more than 8 hours. That is 8 hours of constant contractions. And the cervix does not open as quickly as we would like.

Obstetrician-gynecologists are well aware of the types of weakness of labor and make a diagnosis without problems if this pathology occurs during childbirth. An examination is usually sufficient to make this diagnosis. The doctor notes a very slowly opening cervix, the absence of hypertonicity. In addition, the diagnosis of contractions is carried out using the CTG apparatus. With the help of this device, they not only look for symptoms of weakness in labor, but also monitor the fetal heartbeat so as not to miss the possible onset of hypoxia. A bad symptom is the duration of the first stage of labor in primiparous more than 12 hours and in multiparous more than 10 hours. Timely diagnosis of weakness of labor activity allows doctors to take timely measures and normalize the situation so that the child does not suffer, and an emergency caesarean section does not have to be performed.

Possible complications of weakness of labor activity are not only operative delivery, but even fetal death, especially if there is a long, more than 12 hour anhydrous interval. In addition, women with this diagnosis very often have heavy postpartum bleeding, the uterus is poorly reduced and restored to the pre-pregnancy state.

Treatment of weakness of labor activity usually begins with medical sleep, which is administered with the help of narcotic analgesics to the woman in labor. Of course, this may not always be possible. Usually only at the beginning of labor, and before the amniotic fluid has departed.

If, after awakening, active contractions have not begun, labor is stimulated with the help of a drip of prostaglandins E-2 and (or) oxytocin. And only in extreme cases is surgical delivery performed. Fetal squeezing, the forbidden Kresteller method, and obstetric forceps continue to be practiced in some maternity hospitals. The most gentle way to speed up labor, more precisely, their second period, exile, is an episiotomy - an incision in the perineum.

Prevention of weakness of labor activity consists in strict adherence to all medical recommendations. Like, for example, limited weight gain during pregnancy. As well as a positive attitude and, if necessary, taking light herbal sedatives - motherwort and valerian.