Abnormal labor are disorders of intensity, coordination, strength, rhythm, duration of contractile activity of the uterus during childbirth. Abnormal labor cause bleeding and fetal hypoxia, increase the likelihood of infections and birth injuries. They can cause fetal death. The diagnosis is made taking into account complaints, examination data and additional examination. With the development of labor anomalies, conservative therapy is carried out. If it is impossible to give birth independently, obstetric operations are performed.
O62 Disorders of labor activity
Abnormal labor – violations of the contractile activity of the uterus during childbirth. They are a common pathological condition, observed in 10-20% of women in labor, cause every third cesarean section. In 80-85% occur in primiparous. The probability of developing this pathology increases with early or late first childbirth. Due to the serious threat to the health of the woman in labor and the fetus, labor anomalies are considered as one of the most important problems of modern obstetrics. Possible complications include fetal hypoxia, birth trauma, infections, massive bleeding and fetal death. The diagnosis of this pathological condition and the management of childbirth are carried out by obstetricians and gynecologists.
Abnormal labor occur when the synchronous operation of a number of mechanisms regulating the process of childbirth is disrupted. A number of factors contribute to the development of such anomalies, which can be divided into three groups:
- General violations. This group includes endocrine and somatic diseases, smoking, drug addiction, alcoholism and some character traits (increased excitability, emotional lability and low resistance to stress).
- Pathology of the reproductive system. The conditions of the reproductive system that provoke labor anomalies include age before 18 and after 30 years, abortions, postoperative scars on the uterus, anomalies of the female genital organs and chronic gynecological diseases.
- Complications of pregnancy and childbirth. Risk factors that have arisen during gestation and childbirth include gestosis, birth defects of fetal development, fetal position disorders, overgrowth of the uterus due to polyhydramnios, multiple births and large fetuses, overgrowth, problems of placenta placement and separation, early outpouring of water, prolonged preparatory period and immaturity of the cervix. All of these factors may be aggravated by unreasonable or excessive prescribing of medications.
There are several classifications of labor anomalies (ACOG, ICD-10). Russian specialists in the field of obstetrics use a classification based on the nature of disorders of contractile activity of the myometrium:
- Pathological preliminary (preparatory) period
- Discoordinated labor activity (spastic, tonic, total dystonia)
- Weak labor activity (primary, secondary, weakness of attempts)
- Excessively strong labor activity.
Pathological preparatory period
The course of labor
The pathological preliminary period is an anomaly of labor activity that occurs before the beginning of active labor. Normally, uterine contractions in this period appear more often at night, do not disturb sleep, do not affect the general condition of the pregnant woman, have a coordinated character and last less than 6 hours. The result of contractions is a “mature” neck – short, softened, located along the axis of the pelvis. In case of an anomaly of labor activity, the preparatory period lasts more than 6-8 hours (sometimes up to several days). Contractions are discoordinated, occur not only at night, but also during the day, accompanied by severe pain. Fatigue increases, the psychological state of the pregnant woman is disturbed.
The neck is long, dense, located not on the axis of the pelvis. The cervical canal does not pass the finger. The adjacent part of the fetus may remain mobile. An increase in uterine tone is detected. Premature discharge of amniotic fluid is possible. The prognosis for early outpouring of water is determined by the degree of maturity of the neck. With a sufficiently mature neck, there may be a recovery of labor activity. Early discharge of water in combination with an immature neck and other aggravating circumstances indicates a high probability of further aggravation of the anomaly of labor and is considered as an indication for cesarean section.
The treatment plan includes measures to stimulate the maturation of the cervix, eliminate pain, eliminate pathological spasm of the myometrium, normalize the physical and psychological state of the patient. Antispasmodics, narcotic analgesics, sedatives and sedatives are used. In case of violations of the psychoemotional state, a woman in labor with an anomaly of labor activity requires medication sleep-rest.
If necessary, therapeutic measures are repeated at intervals of 8-12 hours. The total duration of conservative therapy should not exceed 2-3 days. In the absence of a result, a caesarean section is performed. The prognosis is usually favorable – timely therapy makes it possible to restore the contractile activity of the uterus and achieve the maturity of the cervix necessary for natural childbirth, however, in the future, every third pregnant woman with a pathological prelim period during childbirth has certain Abnormal labor.
Weakness of labor activity
The course of labor
Weakness of labor activity is diagnosed in every tenth woman in labor. It is manifested by insufficiently intense, short contractions, separated by too long time intervals. It can be primary or secondary. Primary weakness of labor forces is an anomaly of labor activity, in which weak, insufficiently effective contractions are detected from the beginning of labor. It usually occurs with a decrease in uterine tone due to overstretching of muscle tissue, endocrine disorders and other factors. Significantly increases the duration of labor and causes fatigue of the patient. It is often accompanied by early outpouring of water, fetal hypoxia and bleeding. Infectious complications are possible.
Secondary weakness of labor forces is an anomaly of labor activity that occurs after normal contractions at the end of the I or II period of labor. Contractions become weak, rare and short, the opening of the cervix slows down, the progress of the fetus stops. This pathology is provoked by the same factors as primary weakness. The patient’s fatigue has a certain significance.
Weakness of attempts is an anomaly of labor activity that occurs when the abdominal muscles weaken as a result of poor physical condition, obesity, infantilism, myasthenia gravis, paresis and paralysis, hernias in the anterior abdominal wall or multiple births in the anamnesis.
The diagnosis is made after 6-8 hours of observation with non-overflowing waters or after 2-4 hours of observation with overflowing waters. The weakness of the birth forces is confirmed by the results of observation, cardiotocography. Treatment tactics are determined taking into account the cause of the anomaly of labor activity. With polyhydramnios, an amniotomy is performed. They control the emptying of pelvic organs. In case of fatigue, a drug-induced sleep-rest is prescribed. Stimulation is carried out with prostaglandins, oxytocin or a combination of them. Stimulation is contraindicated after surgery, with a clinically narrow pelvis, placental abruption and fetal hypoxia. If conservative therapy is ineffective, a caesarean section is performed.
The treatment plan for the weakness of attempts provides for the abolition of anesthetics and tranquilizers in combination with the appointment of oxytocin. If drug therapy is ineffective, delivery is performed using obstetric forceps.
Excessively strong abnormal labor
The course of labor
Excessively strong labor activity is an anomaly of labor activity characterized by a significant acceleration of the labor process (so-called rapid labor). It is usually detected with increased emotionality and excitability. Accompanied by private intense contractions. The duration of the first birth can be reduced to 1-3 hours. “childbirth on the street” is not uncommon, before the arrival of an ambulance and the delivery of the patient to a specialized institution. Severe injuries of the child are possible as a result of falling to the floor during childbirth in a standing position. This anomaly of labor activity is often complicated by placental abruption, ruptures, bleeding, fetal hypoxia and birth injuries of the newborn.
The patient is urgently transported to a medical institution, prescribed strict bed rest, laid on the side opposite to the fetal position. Infusions of tocolytics are carried out. After the restoration of labor activity, tocolytics are replaced with antispasmodics.
Discoordination of abnormal labor
The course of labor
Discordance of labor activity is an anomaly of labor activity in which the rhythm driver (a group of cells that provide contractions of the uterus during childbirth) shifts from the corner of the uterus to the middle or lower part of the organ. Some patients have several pacemakers. The synchronicity of myometrial contractions is disrupted. Normally, the wave of contractions spreads from top to bottom, with discoordination, the direction of the waves changes to the opposite. Contractions become frequent, strong, painful, uneven and ineffective. Due to spasms, the local blood and lymph flow worsens.
With this anomaly of labor activity, premature discharge of water is often observed. The cervix either opens very slowly, or “freezes” at the stage of opening up to 4-5 cm. Anxiety, nausea, vomiting, difficulty urinating and a decrease in the amount of urine excreted are observed. Possible fetal hypoxia, placental abruption and massive bleeding.
Tetanus of the uterus is a rare anomaly of labor activity that occurs with further aggravation of discoordination of labor processes and is accompanied by tetanic contractions of the uterus. Frequent, short, irregular, uncoordinated contractions of individual sections of the myometrium are revealed, resembling contractions of the heart muscle during fibrillation or fluttering. Sharp painful contractions are replaced by a stoppage of labor activity. There is a deterioration in the general condition, pallor of the skin, tachycardia and cessation of self-urination.
Therapy – anesthetics, sedatives and antispasmodics. In the absence of a result, a caesarean section is required.