Precipitous labor – labor lasting less than 6 hours in primiparous and less than 4 hours in repeat births. They occur with increased excitability of the nervous system, metabolic disorders, some somatic and endocrine diseases, multiple births, diseases of the reproductive system and complicated pregnancy. Precipitous labor is manifested by accelerated opening of the cervix, increased frequency and intensification of contractions and a reduction in the intervals between contractions. They may pose a threat to the health of the mother and child. They are diagnosed on the basis of anamnesis, obstetric examination data and cardiotocography results. Treatment is pharmacotherapy aimed at reducing the activity of the uterus.
Precipitous labor is an accelerated course of labor, the duration of which in primiparous is less than 6 hours, in repeat births – less than 4 hours. A type of this pathology is precipitous labor lasting less than 4 hours in primiparous and less than 2 hours in repeat births. According to various data, rapid and precipitous labor account for 0.4-2.1% of the total number of births. Such births are considered pathological in obstetrics and gynecology due to the high risk of complications for the mother and child. They may be accompanied by ruptures of the genitals, bleeding, divergence of the pubic bones, premature detachment of the placenta, birth trauma and fetal asphyxia. The probability of complications during precipitous labor directly depends on the degree of acceleration of labor activity.
Some genetic features, increased excitability of the nervous system, complicated pregnancy, an unfavorable obstetric and gynecological history, multiple births, sudden changes in the hormonal background, some somatic and endocrine diseases can cause precipitous labor. In some women, precipitous labor is detected for several generations. This is due to genetically determined features of the body – increased excitability of the myometrium (uterine cells react too strongly to normal stimuli) or functional isthmic-cervical insufficiency (violation of the relationship between connective and muscle tissue or increased sensitivity of muscle tissue to hormonal changes).
Precipitous labor is often observed in patients with increased excitability of the nervous system (with anxiety disorders, neurosis, hysteria), as well as in patients suffering from hypertension, cardiovascular diseases, anemia and infectious diseases. Experts believe that in all these cases, disorders of the nervous system become the cause of rapid labor – acceleration or inadequate processing of afferent impulses entering the brain from the uterine receptors, and subsequent disorders of the nervous regulation of labor. Another factor that increases the likelihood of precipitous labor may be thyrotoxicosis, accompanied by an acceleration of metabolic processes.
The list of causes of precipitous labor associated with the pathology of the reproductive system includes abnormalities of uterine development, inflammatory and non-inflammatory diseases, surgical interventions, previous abortions and precipitous labor, menstrual irregularities and miscarriage. Among the risk factors for precipitous labor that occur during pregnancy, late gestosis, polyhydramnios, multiple births, a large fetus, a violation of the placenta, a postponed pregnancy, incompatibility by blood group and Rh factor are indicated. Sometimes precipitous labor is provoked by a sharp change in the hormonal background caused by prolonged compression of the cervix by the fetal head or simultaneous discharge of amniotic fluid with polyhydramnios.
Periods of labor
There are three periods of labor: the first (opening of the cervix), the second (expulsion of the fetus or forced) and the third (after). The first period is the longest, its duration is 2/3 of the total duration of labor. The frequency of contractions during normal childbirth varies from one for half an hour at the beginning of the period to one for 5 minutes in the middle of the period. At the end of the period, the intensity of labor activity decreases. Gradually intensifying and increasing contractions cause a smooth opening of the obstetric throat. The walls of the uterus and cervix are not injured, the pressure on the baby’s head remains moderate. After the opening of the throat, the first period ends.
In the second period, the fetus begins to move along the birth canal. The promotion is also carried out smoothly and gradually, which avoids fetal injuries, damage to the cervix and the mother’s vagina. The second period ends after the birth of the child. In the third period, the placenta and the remnants of the fetal bladder are born. This period is the easiest and the shortest. The average duration of normal childbirth in a primiparous is 11-12 hours. The first period takes about 9 hours, the second – about 2 hours, the third – about 30 minutes.
The course of precipitous labor
There are several variants of the course of precipitous labor. Spontaneous precipitous labor is usually observed in women with a history of multiple births, as well as in patients with isthmic-cervical insufficiency and hyperestrogenism. The reason for precipitous labor is a decrease in the resistance of the tissues of the birth canal to rapidly increasing intense contractions. In the first period, contractions quickly increase to 2-3 within 5 minutes. Spontaneous rapid labor lasts no more than 4-5 hours and is usually not accompanied by serious damage to the cervix and vagina. The risk of complications in the fetus increases with a large fetus, prematurity, congenital malformations and intrauterine hypoxia.
Spastic labor is rapid labor, manifested by a sharp increase in contractions (up to 1 every 2 minutes from the very beginning of labor). Contractions are painful, prolonged, almost not separated by periods of rest. The patient is restless. Hyperthermia, increased blood pressure, increased pulse, nausea and vomiting are often observed. Premature outpouring of water is characteristic. With such a rapid birth, there is a high probability of complications from the mother and child. Premature placental abruption, bleeding, hypoxia and traumatic damage to the fetus are possible. The duration of labor is approximately 3 hours, the fetus is born in just 1-2 attempts immediately after the opening of the obstetric throat.
Rapid birth is a rapid birth, the peculiarity of which is a violation of the ratio between the duration of the first and second periods of labor. The duration of the first period practically does not change or is slightly reduced compared to normal childbirth, the duration of the second period is reduced to several minutes. Such rapid labor usually occurs with fetal hypotrophy, a wide bone pelvis of the patient or unjustified prescription of medications. There is a high probability of damage to the birth canal of the mother, spinal cord injuries and intracranial birth injuries of the fetus.
The consequences of precipitous labor
Among the possible negative consequences of precipitous labor for the mother are damage to the perineum, vagina and cervix. A particularly severe complication is a rupture of the uterine body, threatening the patient’s life and requiring emergency surgery. With precipitous labor, hypotonic bleeding is more likely to develop, due to overwork of the uterus in the process of violent labor. There is a possibility of divergence of the pubic articulation. Premature placental abruption may occur, posing a threat to the mother and child. Possible delay of the afterbirth. In the postpartum period, some patients have mastitis and lactation problems.
Precipitous labor increases the risk of complications in the fetus. Frequent severe contractions can interfere with normal placental blood flow and provoke hypoxia. In severe cases, a violation of the blood supply to the placenta and the rapid progress of the fetus through the birth canal causes asphyxia. Possible fetal injuries during precipitous labor include subcutaneous hematomas, cephalomatomas, hemorrhages into internal organs, spinal injuries, fractures of the humerus or collarbone. Possible brain hemorrhages and increased intracranial pressure, fraught with subsequent disorders of the central nervous system.
Diagnosis of precipitous labor
With a precipitous labor, the patient often gets to a specialized medical institution late, which worsens the prognosis and increases the likelihood of complications. Therefore, one of the tasks of obstetricians and gynecologists is to identify in advance the factors indicating a high probability of acceleration of labor activity. Pregnant women with a high risk of developing rapid labor are hospitalized in advance and placed under observation.
In case of emergency hospitalization, the diagnosis of “rapid labor” is made taking into account the nature, duration, strength and frequency of contractions, the rate of opening of the cervix and the progress of the fetus along the birth canal. The specialist performs a general and gynecological examination, measures the duration of the contractions and the rest period between contractions using a stopwatch and simultaneously assesses the change in uterine tone by placing his hand on the patient’s stomach. Cardiotocography is used to clarify the nature of labor and fetal condition.
Conducting precipitous labor
The patient is hospitalized, measures are taken to normalize labor activity. They don’t do an enema. The woman is immediately placed on a gurney, transported to the department and placed on the bed on the side opposite to the fetal position. Getting up is forbidden. To reduce the contractile activity of the myometrium and improve placental-uterine blood supply, intravenously drip drugs from the group of tocolytics.
If there are contraindications to the use of tocolytics (hypertension, thyrotoxicosis, diabetes mellitus, cardiovascular diseases), calcium antagonists are used. If necessary, epidural anesthesia of childbirth is performed. A quick delivery is taken in a side position, after the end of the third period of labor, the birth canal is examined for ruptures and a manual examination of the uterus is performed to identify possible remnants of the afterbirth. After childbirth, the patient is prescribed oxytocin and methylergometrine.
The threat of uterine rupture and premature placental abruption are indications for cesarean section. When the pubic articulation diverges, bed rest is prescribed using a shield (to create a solid surface) for a period of 1-1.5 months. If the afterbirth or its remnants are delayed, manual separation is performed. When bleeding, drugs are injected that enhance the contractility of the uterus, blood and blood substitutes are transfused. With hypoxia and asphyxia of the fetus as a result of precipitous labor, resuscitation measures are carried out.