In a normal pregnancy, closer to the time of delivery, prenatal contractions of the uterine walls are observed, which are often painless, but mostly occur at night and provoke softening of the cervix.
The main types of anomalies include discoordination of labor, which provokes a violation of the normal course of pregnancy. Such violations pose a serious threat to the he alth of the woman and the fetus, which is why they require timely medical intervention and medication correction.
How is labor going on
To understand what are the complications of labor, it is important to clearly understand how the birth proceeds in the normal state. A pregnant woman should clearly understand what constitutes natural labor, how the onset of labor can be recognized and what exactly determines the intensity of this process.
Labour is essentially contraction of the walls of the uterus, alternating with relaxation. The fights continue throughoutthe period of childbirth. In the body of a pregnant woman, they provoke various kinds of changes, in particular, such as:
- softening of the cervix;
- opening the cervix;
- promotion of the child through the birth canal;
- childbirth;
- separation of the placenta from the walls of the uterus;
- exit placenta.
The normal course of labor activity is characterized by dynamism and regularity. Regularity means contractions of the same duration and intensity, having equal intervals of time. Dynamism implies a gradual increase in intensity and an increase in the duration of uterine contractions.
Contractions are required to open the cervix, as well as the subsequent advancement of the fetus through the birth canal. The uterus contracts somewhat during contractions, it becomes much denser and decreases somewhat in volume, thereby pushing the baby out. Normally, while the contractions are weak and short, the opening of the cervix is quite slow, and when the contractions become more intense, the opening in the cervix is more and more stretched, and the baby begins to gradually move along the birth canal.
What provokes the occurrence of discoordination of contractions
Discoordination of labor activity is characterized by the fact that contractions are very violent, painful and often not effective enough. In this case, the opening of the cervix and the subsequent promotion of the child does not occur. Unlike many other complications of childbirth, incoordination of labor activity has symptoms from the very beginning.quite pronounced, due to which it is quite possible to recognize its course in the body. Unlike the natural course of childbirth (in which the first contractions are almost painless), with violations, the first sensations will be very sharp and painful.
In a normal state, labor activity proceeds quite slowly and gradually, since the very first contractions that a pregnant woman feels usually last for several seconds, and the duration between them is no more than 20 minutes. Discoordination of labor activity is characterized by the fact that from the very beginning the contractions become long and frequent, since they last more than 1 minute, and the intervals between them do not exceed several minutes. In addition, the contractions are quite irregular and they are felt quite painfully. At the same time, there is no positive dynamics of the course of labor and a gradual increase in contractions.
Causes of pathology
Unlike the natural course of childbirth, the pathological process is characterized by painful, spastic and irregular contractions of the uterus, as well as the absence of changes in its structure. In case of violations of the normal course of childbirth, the cervix does not soften, it becomes dense and practically does not open. The pathological process can continue for several days.
If there is a discoordination of labor, the reasons for this can be very different, inin particular lead to a similar state:
- nervous strain;
- inflammatory processes occurring in the uterus;
- metabolic and endocrine disorders.
Besides this, the discoordination of labor activity may have other reasons, since age-related changes lead to such a violation. In particular, pathology can occur if the age of the primipara is more than 30 or less than 17 years old.
Features of pathology
Many pregnant women are interested in: discoordination of labor - what is it and how does the pathology develop? Such a violation is characterized by erratic intense contractions of various parts of the uterus, resulting from a shift in the rhythm area. At the same time, a similar condition can be observed in several separate areas of the uterus. In this case, there is no synchrony of contraction and relaxation.
Discoordination of labor is a rather dangerous pathology that provokes a violation of uterine contractions, as well as untimely discharge of amniotic fluid. The cervix becomes much tighter and the edges of the cervix become tight and not stretchable.
Thus, the discoordination of labor activity (what it is and how such a pathology manifests itself, we discussed above) requires the intervention of specialists who can quickly recognize ongoing disorders in the body and select the most appropriate methods of therapy.
Symptomspathology
Discoordination of contractions is considered the most unusual and rather dangerous complication of labor. Unlike many other complications, the causes of the pathology that have arisen are not associated with the state of he alth of the pregnant woman or with the peculiarities of the course of the process of bearing a child. The main cause of the violation is related to the state of the nervous system of a woman at the time of the onset of labor.
The contractions appear due to the passage of nerve impulses sent by the brain to the uterus. If these impulses pass often enough and haphazardly, then there is a discoordination of labor activity. The main reason for this condition and disruption of the natural course of childbirth is the fear of the pregnant woman before childbirth.
As a result of failures of the nervous system, the signals responsible for the course of labor activity arrive rather unevenly and can weaken or, on the contrary, increase after a certain time. Due to the ongoing violations, contractions become much more painful and not productive enough. Often, such contractions have a bad effect on the well-being of the pregnant woman and the child.
The main signs of discoordination of childbirth are considered to be an increase in pain during childbirth, as a woman has panic tension, fear of childbirth and the presence of negative emotions. At the same time, spastic contraction of the uterus during a contraction can occur not only in the region of longitudinal nerve fibers, but also in the region of transverse ones.
In some cases it maydiscoordination of labor activity occurs according to the type of cervical dystocia, which occurs as a result of the presence of anomalies in the fetus or pregnant woman. A similar condition can be observed due to the presence of a rather narrow pelvis in a woman, which provokes a complex course of labor.
In violation of normal labor activity, multiple ruptures of the cervix, vagina, as well as tears of the walls of the uterus can occur. In addition, there may be a protracted course of childbirth, and in some cases there is a birth trauma in the child.
Severity of pathology
In the process of childbirth, discoordination of labor can often be observed. The classification of such a pathology is based on the severity and possible complications of the disease.
The first stage of the disease is characterized by the occurrence of prolonged, frequent and painful contractions. The relaxation period is significantly reduced. The opening of the cervix is very slow, and as a result, significant tears can occur. During the examination, it is found that there is very little fetal water. If there is an opening of the fetal bladder, then the contractions can immediately normalize.
The second degree of pathology often manifests itself in the presence of a narrow pelvis in a woman or as a result of the use of a certain rhodostimulation, which is prohibited for a pregnant woman. In addition, the 2nd degree occurs as a result of the aggravation of the course of the 1st stage of the pathology. This stage is characterized by a rather long and painful course of labor.activities. The cervix can remain immature for up to 10 hours after the onset of labor. The fetus remains motionless throughout the entire time and does not move towards the entrance to the small pelvis. Such a condition threatens to rupture the walls of the uterus, as well as injuring some organs of the fetus.
The third stage of the pathology is the most difficult, since the uterus in this case is divided into several separate zones, where each takes on the function of a kind of trigger center. Each section of the uterus contracts according to its own rhythm, which do not coincide at all with one another. In this case, labor activity may completely stop.
The uterus compresses the fetus very strongly, as a result of which it suffers very much and sometimes a tumor can be diagnosed during natural childbirth. With the course of this degree of pathology, a caesarean section is indicated, if there are no contraindications for such an operation.
Diagnosis of incoordination of labor
We already know what discoordination of labor is. Diagnosis and treatment require a competent, integrated approach. It is very important to recognize the existing violations in a timely manner, as this will allow you to choose the required method of therapy.
Diagnosis involves cardiotocography. When it is performed, sensors are attached to the belly of the pregnant woman, fixed with elastic bands. One of these sensors captures the baby's heartbeat.
Another sensor helps control the processcontractions. All results obtained are recorded in the form of graphs. By analyzing the results, the doctor can get a complete picture of the course of labor and its possible violations.
Treatment of labor disorders
Treatment of discoordination of labor should be primarily aimed at eliminating the pathological process. If there is a strong spasm of the uterus, then the pregnant woman is prescribed tranquilizers and antispasmodics. After the termination of the effects of the substances used, labor activity returns to normal.
Therapy should be aimed at eliminating painful contractions of the uterus, as well as accelerating the opening of the cervix of the organ. Painkillers, antispasmodics, and sedatives are used to treat discoordination of labor activity. For the rapid preparation of the cervix for disclosure and the onset of labor, drugs based on prostaglandin are used. The duration of the course of therapy largely depends on the characteristics of the course of the pathological process, but it should not last more than 3-5 days. In the absence of the desired effect from the ongoing therapy, a caesarean section is indicated.
What to do if the expectant mother suspects that she has labor incoordination? The pregnancy pathology clinic has all the necessary facilities for high-quality complex therapy, so it is important to consult a doctor in a timely manner.
Prevention
For the purpose of preventionDiscoordination of childbirth shows careful observance of the regimen prescribed by the doctor, as well as painless and careful management of the entire process and full control by specialists. Drug therapy is mandatory as a preventive measure in the presence of risk factors for abnormalities in uterine contraction.
Women at risk must definitely carry out physiological and psychological preparation for childbirth, and it is also important to teach pregnant women muscle relaxation techniques. It is imperative to control muscle tone and avoid stressful situations. The duration of night sleep should be at least 8-10 hours, and it is also important to correctly organize daytime rest. Long walks in the fresh air and properly selected food are provided.
Procedure of childbirth with discoordination
Delivery with incoordination goes naturally or a caesarean section is prescribed - it all depends on the severity of the pathology and the complications that have arisen.
In the absence of indications for surgery, drug therapy is performed. For this, the introduction of antispasmodics is prescribed, in particular, such as "Baralgin" or "No-Shpa". In addition, painkillers are used. To eliminate uterine hypertonicity, "Brikanil", "Partusisten", "Alupent" are used, after which literally half an hour later the contractions resume and proceed normally.
Prophylaxis is mandatoryfetal hypoxia, and when the cervix is 4 cm open, mandatory epidural anesthesia is performed (the drug is injected into the spine).
If drug therapy does not help, then a caesarean section is performed., The main indications for surgery are:
- poor outcome of previous births;
- presence of comorbidities;
- large fruit;
- narrow pelvis;
- prolongation of pregnancy;
- mal position of the fetus.
In the presence of the pathology we are considering, an experienced gynecologist, anesthesiologist-resuscitator and neonatologist must be present during childbirth.
