Weak labor activity. Weak labor activity: a real danger or a convenient excuse for doctors

Every woman dreams of safely bearing a child for the prescribed nine months and easily giving birth to him at the appointed time. But sometimes there are complications during childbirth, and things don't go the way you planned.

One of the most common causes of complicated childbirth is weak or insufficient labor activity, which leads to a delay in the process of childbirth and, as a result, to fetal hypoxia.

The weakness of labor activity is manifested in weak, short contractions, which slow down not only the smoothing and opening of the cervix, but also the progress of the fetus through the mother's birth canal. Weakness of tribal forces is more common in primiparous women.

Weak labor activity can be primary and secondary.

Primary weakness of labor activity

consists in the absence of normal dynamics of the opening of the uterine os, despite the fact that contractions are already underway.

The primary reason for the lack of labor dynamics may be:

Stress is one of the most important causes of weak labor activity. An unprepared woman has a fear of the upcoming birth, fear disturbs the hormonal balance. There is a violation from the fact that the hormones that stop childbirth are produced by the body in greater quantities than the hormones that accelerate childbirth. Sometimes one careless or rude word of the maternity hospital staff can become a factor that “knocks down” the hormonal balance.

Physiological features: a flat bubble that prevents the child from lowering; narrow pelvis in childbirth.

Low hemoglobin.

Endocrine and metabolic disorders.

Pathological changes in the uterus (inflammation, degenerative disorders, scar on the uterus, malformations of the uterus, uterine fibroids).

Overstretching of the uterus (polyhydramnios, multiple pregnancy, large fetus).

Age under 17 and over 30.

Weak physical activity during pregnancy.

Secondary weakness of labor activity

develops after the onset of labor, when normally started contractions at some point “fade out”.

Secondary weakness of labor activity develops less frequently than primary, and, as a rule:

It is the result of prolonged and painful contractions that lead to fatigue of the woman in labor;

Irrational use of drugs that affect the tone of the uterus. Unfortunately, in order for childbirth to go faster, doctors quite often speed them up artificially, even when it is not necessary.

In addition, childbirth, especially the first, can really take a long time, and if there is no threat of hypoxia for the fetus, it is not necessary to stimulate labor. Sometimes, to restore labor activity, it is enough for a woman in labor to calm down and rest a little.

Labor induction is a non-drug method.

The actions of the obstetrician depend, first of all, on the cause of the weakness of labor activity.

However, if prolonged labor really becomes dangerous for the child and mother, then with the weakness of labor activity, it is customary to stimulate labor.

The main non-drug method, allowing to strengthen generic activity, is amniotomy(opening of the fetal bladder), which is carried out when the cervix is dilated by 2 cm or more. As a result of amniotomy, labor activity often intensifies, and the woman in labor copes on her own, without the introduction of drugs.

Labor induction is a medical method.

If the amniotomy does not have the desired effect, then medications are used in maternity hospitals:

1. drug sleep, during which the woman in labor restores the strength and energy resources of the uterus. After waking up, on average after 2 hours, in some women in labor, labor activity intensifies. Medication sleep occurs after the introduction of drugs from the group of narcotic analgesics, which should be done only after consulting an anesthesiologist and only in cases where the side effects from the fetus are less significant than the risk of delaying childbirth for the child.

2. Stimulation with uterotonics. The most common uterotonics are oxytocin and prostaglandins. The drugs are administered intravenously through a dropper, with a careful dosage. The condition of the fetus is necessarily monitored using a heart monitor.

Disadvantages of stimulants

As a rule, their use clearly requires the use of antispasmodics, analgesics, or epidural anesthesia. This is due to the fact that a sharp increase in labor activity often increases the pain in a woman in labor. Therefore, it is clear that labor-stimulating therapy should be used only for medical reasons, when the harm from its use is lower than the harm from prolonged labor.

C-section

If the use of drugs that accelerate labor and enhance labor activity does not work, and the fetus suffers from hypoxia, an emergency caesarean section may be chosen.

Prevention of weak labor activity.

Preventive measures to prevent weakness of labor activity include, first of all:

1. Attendance by a woman of special preparatory courses, in which the woman in labor learns what is happening to her and the child, and what she needs to do in order for the birth to be successful. The expectant mother should be ready to actively participate in the birth process, should have the right to vote in decision-making and the use of non-pharmacological methods of pain relief and stimulation of the birth process. It is known that among unprepared women in labor, weakness of labor activity occurs in 65%, and women in labor who attended childbirth preparation courses or schools for future parents during pregnancy face this complication only in 10% of cases, and they, as a rule, are due to truly objective reasons.

2. Find a hospital and a doctor you trust who is not inclined to perform unnecessarily caesarean sections. It is important that he approves of your efforts to prepare for childbirth through the birth canal. Prepare a birth plan with your doctor to make sure you have the same priorities. If you have had a caesarean section in the past, discuss the psychological and practical preparation for childbirth.

3. Consider having another helper (besides your partner) who is an experienced person who shares your aspirations.

4. Take care of your health (eat well, exercise, manage stress, avoid alcohol and tobacco) and you'll be in the best possible shape for childbirth.

5. As a prevention of weakness of labor, from 36 weeks of pregnancy, pregnant women are advised to take vitamins that increase the energy potential of the uterus (vitamin B6, folic acid, ascorbic acid).

Easy childbirth!

Edition of the Voronezh Family Portal

Saint Petersburg

Childbirth begins with contractions. First tolerable, with an interval of 10-15 minutes, then more often, stronger. By the straining period, the frequency of contractions reaches 1-2 minutes, and the strength is usually noticeable.

Unfortunately, there are cases in which contractions do not increase in strength and frequency, but weaken, or are completely irregular. It may be that the contractions are training (then you won’t give birth yet), or maybe weak labor activity. What is it, the causes of this anomaly, as well as what a woman can do for her part, and we'll talk.

What are we talking about?

Weak generic activity is of two types.

Primary weakness of labor activity

The main signs are weak and short contractions, smoothing and opening of the uterus decreases or stops. Over time, the duration and frequency of contractions do not increase at all or increase slightly.

Depending on the indications of the health of the mother and fetus, doctors carry out the following activities:

amniotomy (water discharge increases contractions);
medical sleep, for a woman's rest, after the introduction of narcotic analgesics and stimulation with uterotonics (oxytocin and prostaglandins). As a rule, sleep lasts two hours;
the use of drugs that increase the intensity of contractions;
antispasmodics;
prevention of fetal hypoxia.

Secondary weakness of labor activity

It is less common than the original. Contractions weaken, duration decreases. At the same time, the previous phases of labor activity could proceed at a normal pace. Dramatically slows down or even stops the opening of the uterus and the translational movements of the fetus through the birth canal.

As indicated in the book on obstetrics (Obstetrics. National leadership - Ailamazyan E.K., Kulakov V.I. et al. - 2009 - 1200), the main behavior of doctors in secondary weak labor activity is the introduction of prostaglandins. In the absence or insufficient effect of drug stimulation of labor, as well as in the detection of fetal hypoxia, the tactics of conducting labor changes. Other methods of delivery are chosen, these can be: caesarean section, the use of obstetric band forceps (at this point I am ready to faint), dissection of the perineum (perineotomy).

Weak labor activity is observed in 8-10% of all women in labor. Moreover, in the first birth, the probability is an order of magnitude higher than in the second. This pathology threatens to delay the process, fatigue the woman in labor (there is less and less strength for attempts), fetal hypoxia, infection of the birth canal and inflammatory complications, bleeding during childbirth and the postpartum period. Doctors are forced to carry out drug stimulation of childbirth, which leads to more pain in the process, since the body does not have time to prepare and develop natural painkillers.

Causes

First you need to understand why there is such a violation of the birth process, and then how to avoid it.

nervous tension of a pregnant woman, stress;
infantilism of the genital organs (uterine hypoplasia), rigidity of genital sweat (reduced elasticity);
violation of endocrine and metabolic mechanisms in the body of a woman (insufficient thyroid function, obesity, diabetes mellitus);
damage to the uterus (as a result of a caesarean section in a past birth, treatment of endometriosis, uterine fibroids);
overstretching of the uterus (multiple pregnancy, large fetus, polyhydramnios);
anatomically narrow pelvis in a woman in labor;
the age of the pregnant woman (under 18 or over 30);
oligohydramnios and a flaccid, flat fetal bladder (since it prevents the baby from lowering);

In addition to the above, with secondary weakness of labor, the reasons may be:

fatigue of the woman in labor;
discrepancy between the size of the baby's head and the woman's pelvis;
malposition;
the presence of a tumor in the pelvis.

What to do?

As for the issues of health and physiology, being already pregnant, it is difficult to somehow prepare on your own. Here, a competent doctor whom you trust can help. We will only consider what we can influence. Moreover, we can influence at different stages, both in preparation for childbirth, and directly in the process.

Preparing for childbirth

Vitamins and trace elements

After 36 weeks of pregnancy, doctors prescribe vitamins B6 (pyridoxine), B9 (folic acid), C (ascorbic acid) for prevention.

Personally, it was news to me when I found out that there are actually products that contain a considerable amount of these trace elements. And you can get the necessary vitamins without interfering with the work of the body with chemical preparations. Therefore, I offer you a list of products containing the maximum amount of these three vitamins:

B6 (pyrodoxine) you will find in walnuts (0.80 mg / 100g), beef liver (0.70 mg / 100g), hazelnuts (0.70 mg / 100g), tomato paste (0.63 mg / 100g), garlic (0.60 mg/100g);
B9 (folic acid) is found in large quantities in green asparagus (262mcg/100g), peanuts (240mcg/100g), beef and chicken liver (240mcg/100g), lentils (117mcg/100g), parsley (117mcg/100g);
C (ascorbic acid) is found in dry rosehips (1200mg/100g), fresh rosehips (470mg/100g), red bell peppers (250mg/100g), sea buckthorn and black currants (200mg/100g), sweet green peppers and parsley (150 mg/100g). By the way, from time immemorial recommended oranges and lemons contain only 60 and 40 mg/100 g of vitamin C, respectively!

To make a decision to replace vitamins with products, I recommend that you study the issue in more detail and discuss it with your trusted doctor.

Have more rest!

In the last stages of pregnancy, do not forget to rest and sleep well (otherwise, tomorrow there will be a war (read, childbirth), and the heroic horse (read, pregnant) did not get enough sleep!

Solving psychological issues

You can work with the psychological component of the fear of childbirth even during pregnancy. Read more about this.

I had a chance to talk with a midwife from the city of Berdsk (Novosibirsk region), she said that residents of villages give birth easier than urban ones. This was positioned from the point of view that residents of large cities are very afraid of pain. In my experience, I suspect it's also because country girls don't seek out as much information about childbirth. Do not read the experience of giving birth to other women. “Everyone is having a baby. This is a normal process. And I'm giving birth."

About exercise

I want to warn you about something important. All physical exercises during pregnancy should be gentle and habitual. That is, you do not need to start engaging in those types of physical activity that you have never done before.

Surely you have heard about the need to perform Kegel exercises to prepare for childbirth? In fact, these exercises are designed to restore urinary control in women (what does preparation for childbirth have to do with it ???). Pregnant women are offered two types of exercises. In the first, there is “straining”, in fact, the woman pushes out the fetus, which rests against the pelvic floor, because there is nowhere to push it out.

In your opinion, are such extrusion useful for the baby? In the second exercise, a spontaneous stop and continuation of urination is proposed. A similar exercise is done in intimate gymnastics classes, and only under the supervision of a specialist, otherwise you can train to incontinence.

Intimate gymnastics is generally a very useful thing, only you need to start it before pregnancy or after childbirth (not earlier than three, but preferably after 7 months). Do not create additional stress for the pregnant body, it already has something to work on.

Do you have many questions about newborn care? This is good, because a correct understanding of these topics will do a good service to health and

the well-being of your child. Pay attention to the excellent courses of the doctor Irina Zhgareva, which will help you navigate at the beginning

your motherhood:

"Preparation for pregnancy and childbirth"

"Natural Parenthood: Myths and Reefs"

"Secrets of happy motherhood"

Shortly before the delivery room

Michel Auden, the famous ob-gyn, talks beautifully in her interviews and books about the effect of stress on the birth process. The fact is that during stress, adrenaline is released, which prevents muscle relaxation. The body prepares for protection, fight and stops the birth process. The hormone oxytocin is blocked. All this can lead to weakness of labor activity. Therefore, it would be nice:

Choose the right time

If you plan to give birth in a conventional maternity hospital, then it is important to go there on time. Contractions are divided into latent (hidden, the uterus opens up to 4 cm) phase and active. So, during the latent phase, when the contractions are weak enough, you continue to do your homework; drinking tea, taking a shower, etc. As soon as the interval between contractions is 5 minutes. All. It's time for the maternity hospital. There is already even a war, even a flood, the process of childbirth will not stop. By the way, this option helps to eliminate trips to the hospital during training bouts.

Reservation. If your mother had a rapid delivery, from the category - they delivered in two hours, then you should be prepared for the fact that you may receive the same bonus by inheritance. This happens extremely rarely. But it happens.

Create comfortable conditions

If possible, create the most favorable environment during childbirth: subdued lights, no enema, no crowds of people (few people will be helped by a large number of people around when contractions), solitude, silence, warmth. It would be nice to shift the task of filling out paperwork to an assistant. These points are usually discussed with the doctor at the conclusion of the contract.

Use relaxation techniques

During contractions, a warm bath or shower is a good pain reliever. However, taking a bath can weaken the process, so showering is more versatile. Flowing water promotes relaxation, and this is the main assistant in childbirth.

If you are in the delivery room and the contractions are still weak

The mood of the mother in labor is one of the most important factors. But if something went wrong, you can try the following methods:

It is necessary to calm down, ask the doctor or attendant in childbirth to massage, help to take a comfortable position;
If possible, do not lie down - it is better to walk;
If you have to lie down (they do CTG, put a dropper), then you can lie on the side where the baby's back is (ask the doctor which side). The back of the baby presses on the uterus, which causes it to contract;
Emptying the bladder, this helps intensify the contractions.

I wish you not to be afraid to give birth. Yes, this is an exciting and difficult process, not scary. One experienced mother told me during pregnancy "it is not painful to give birth, it is difficult to give birth." And there is another important point that childbirth is not the end of the road, it is the beginning of a new path. You have a meeting with your baby, it's great! Love your child, that's the most important thing.

They are easy and fairly painless. But in some cases, complications of labor activity develop.

What is the weakness of labor activity?

Weakness of labor activity (SRD) is a cumulative concept that includes both a weakening of the strength and frequency of contractions of the uterine muscle, and the subsequent slowdown in the opening of the uterine pharynx. Normally, with the correct development of the birth process, with each contraction, the force of uterine contraction increases, contractions become more frequent. Following the contraction, which follows the direction from the bottom of the uterus through its body to the lower segment, there is a gradual opening and smoothing of the cervix. With anomalies of labor activity, including weakness, these processes are violated.

Types of weakness of labor activity and their causes

The weakness of labor activity is divided into:

Primary, in which contractions have insufficient strength and regularity from the very beginning of childbirth;
Secondary, when labor begins normally, with regular and strong contractions. After a few hours, the activity of labor activity begins to fade, sometimes to a complete stop;
Weakness of attempts is isolated in a separate item. This is a kind of weakness at the very end of childbirth, when attempts are added to the contractions, the strength of which is insufficient for the independent birth of a child.

Sometimes AD occurs for no apparent reason at the most unexpected moment. The main reasons for this diagnosis include:

imbalance between factors that stimulate uterine contractility (oxytocin, calcium ions, endogenous prostaglandins) and factors that inhibit it (progesterone, magnesium ions);
weak generic dominant, fear of a woman, psychological unpreparedness for childbirth;
fatigue of the woman in labor, poor nutrition, concomitant diseases (influenza, SARS, arterial hypertension);
the risk group for the development of this complication are pregnant women with hypothyroidism, obesity, hypogonadism, and smokers;
excessive stretching of the uterine wall by a large fetus, excess amniotic fluid, twins;
anomalies in the development of the uterus and the presence of myomatous nodes;
operations on the uterus in history;
premature birth;
stimulated childbirth;
premature rupture of amniotic fluid.

Clinic and diagnostics of RSD

Symptoms of weakness of labor activity are quite typical. To make such a diagnosis, obstetricians pay attention to the following factors:

the duration of childbirth, their anhydrous period is especially noted, that is, the time since the rupture of the fetal bladder;
the dynamics of the opening of the uterine pharynx, the degree of maturity of the cervix;
the strength, regularity and duration of contractions, which in modern obstetrics is easy to fix on the CTG chart.

Therapy for this complication of childbirth depends on the cause that caused it:

If a woman is tired, exhausted by pain, she is offered the so-called medical sleep-rest. Currently, spinal or epidural anesthesia is used with success;
Additionally, solutions of glucose, B vitamins, estrogenic drugs, calcium, actovegin are administered. These infusions stimulate uterine contractility and prevent oxygen starvation of the fetus;
In the case of polyhydramnios with a whole fetal bladder, it is advisable to carry out an amniotomy;
A cleansing enema, urine output by a catheter helps well.

A certain number of medicines are used to correct weakness.

Oxytocin, similar to a woman's own oxytocin, directly affects the contraction of the muscle fibers of the uterus. It is introduced slowly, drip. The ideal way of administration is with the help of infusion pumps with a given speed. Learn more about .
Prostaglandins are analogues of natural mediators that stimulate labor activity. There are these drugs in different forms (gels, tablets, solutions for intravenous administration).

In case of ineffectiveness of drug therapy and persistent weakness, the diagnosis is made: "Weakness of the birth forces (primary or secondary), not amenable to drug correction." This is a direct indication for an emergency caesarean section.

In case of weakness of attempts, a caesarean section is often done late, since the fetal head has left the cavity of the bone pelvis into the birth canal. Therefore, in this situation, they resort to the old methods:

Episio- or perineotomy - an incision in the perineum to facilitate the birth of the head;
The imposition of obstetric forceps or a vacuum extractor on the head of the fetus. In this case, the force applied by the obstetrician compensates for a weak attempt or contraction;
Bandage Verbova is an old, but quite effective way to help in attempts. With the help of a dense cloth thrown over the stomach, the doctor and midwife created additional pressure from the bottom of the uterus to the exit;
The Christeller method is a technique prohibited in many countries, fraught with the loss of a license for an obstetrician. However, sometimes, when the life of a child is at stake, it is also applicable. Its essence lies in the fact that the doctor, putting pressure on the bottom of the uterus with his elbow or forearm, literally pushes the child out.

Prevention of weakness of labor activity

Measures to prevent complications in childbirth a woman should take even before pregnancy. The main ones are:

proper nutrition, vitamin therapy;
physical activity, sports, especially developing abdominal and pelvic muscles;
correction of all chronic diseases before pregnancy;
psychological preparation for childbirth, including training courses, breathing and relaxation techniques;
body weight control.

During pregnancy, it is important to keep fit, active, walk a lot, breathe fresh air. Pregnancy must necessarily take place under the supervision of a gynecologist, who, at the right time, will identify risk factors for RDD and prescribe treatment.

Alexandra Pechkovskaya, obstetrician-gynecologist, specially for website

Useful video:

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.

Women who are at risk of developing abnormal labor activity need to carry out physio-psychoprophylactic preparation for childbirth, teach methods of muscle relaxation, control of muscle tone, and skills to reduce increased excitability. Night sleep should be 8-10 hours, daytime rest at least 2-3 hours. Provision is made for a long stay in the fresh air, rational nutrition.

Weak labor activity is a common reproductive problem that occurs more often during the first birth. The disease is considered directly generic and manifests itself at the onset of contractions. Despite the seemingly obvious and in no way frightening name, the problem can result in a number of unpleasant consequences, the worst of which is the death of a newborn.

What is the weakness of labor activity?

Under this concept, an anomaly of childbirth is hidden, characterized by not intense uterine motility, as a result of which the strength of contractions is not enough to move the fetus to the exit. As a result of weak or rare contractions of the uterus, the duration of labor increases to a critical point. At the same time, the woman is very exhausted during contractions, she does not have the strength left to push and push the child to the exit. The danger also lies in the fact that the waters could already have departed for a long time, so the fetus is susceptible to various infections, as well as death as a result of suffocation or lack of oxygen.

Violation is assigned 10% of cases of the total number of all generic problems.

The essence of the violation is expressed in the fact that due to the physiological characteristics of the female body, the characteristics of the course of pregnancy or obstetric errors, the uterus does not contract to such a level at which normal contraction intensity is possible. As a result, they become weak, short and rare.

How can you recognize weak labor activity?

This feature of the female body is diagnosed if childbirth lasts longer than usual. For example, the first-born is born, on average, in 11-12 hours, and the second and subsequent babies - in 8. If the birth process dragged on for a longer period, we can conclude that the labor activity is weak. Based on some parameters of the birth process, pathology can be assumed earlier.

The signs are:

Barely noticeable contractions;
The dynamics of the uterus is disturbed (contractions and disclosures occur randomly, with different intensity and frequency);
Long-term presence of the child at the base of the small pelvis;
Untimely release of amniotic fluid;
Increase in the duration of labor;
No progress in uterine dilatation for more than 120 minutes (according to partogram).

Analyzing the external state of the expectant mother, the main indicators of labor activity, experts draw a conclusion about the presence or absence of pathology and, if necessary, prepare to stimulate labor.

What is the reason for the weakness of labor activity?

Since more often this problem concerns primiparous women, its main cause is the peculiarity of a young organism that did not know childbirth. During the birth of a baby, the female body experiences a tremendous load, as a result of which the immune system tries to stop this process. To protect against excessive stress, special mechanisms are activated that try to relieve a woman of pain and restore the normal functioning of all organ systems.

Age plays an important role: the weakness of labor activity is inherent in girls under 17 years of age and women after 30 years of age.

There are also several more groups of causes.

1. Physiological - associated with the characteristics of women's health.

Infectious childhood diseases (rubella, measles, chickenpox);
Inflammation of the uterus, ovaries, appendages, fallopian tubes, etc.;
Neoplasms of the pelvic organs;
Multiple previous births;
Late first menstruation;
irregular menstrual cycle;
Little uterus;
Endocrine diseases, metabolic disorders;
abortion;
Scar on the uterus;
Anomalies in the development of the uterus;
Narrow pelvis;
Low elasticity of the uterus.

2. Obstetric reasons:

Excessive proportion of amniotic fluid;
Expecting two or more children;
Abnormal location of the placenta;
Large size of the fetus;
The exit of the waters before the start of contractions;
Premature birth or post-term pregnancy;
Malposition;
Psycho-emotional problems, physical impotence (lack of strength).

3. Causes on the part of the fetus:

Rhesus mismatch between mother and child;
infectious processes;
Fetoplacental insufficiency;
Congenital anomalies of development.

Usually several causes are detected at the same time.

Classification

In medicine, two types of weak labor activity are defined - primary and secondary. The essential difference is that with secondary weakness, no signs are initially observed, but the rhythm, intensity and duration of contractions gradually decrease.

Primary weakness appears immediately:

Contractions become more and more rare, short and less sensitive;

The rate of smoothing of the cervix and opening of the uterine os slows down, or these processes stop altogether;
The head or pelvis of the fetus remains mobile or pressed against the entrance to the small pelvis for too long;
The impotence of a woman due to the long first period of childbirth (from 12 hours in a primiparous woman and from 10 in a second-born woman).

At the first birth, the rate of opening the neck of the T-shirt is 1-1.2 cm per hour for women giving birth to their first child, and 1.5-2 cm per hour if the child for the woman in labor is at least the second. The primary weakness of labor activity is determined if the speed is less. In the same period, matchmaking should last 20-30 seconds with a break of about 8 minutes. Pathologies of labor activity reduce the duration of contractions, but increase the interval between them.

For secondary weakness labor activity is characterized by a long period of expulsion of the fetus - more than 1.5 hours. This is due to the fact that contractions weaken sharply, their rhythm slows down.

What does the doctor do with weak labor activity?

Analyzing the condition of the mother, the child and the intensity of labor, the doctor decides on future actions. With a high probability of risk, an emergency caesarean section is done, childbirth is stimulated. The methods of medical care are as follows:

Amniotomy- opening of the fetal bladder, in which you can not use drug stimulation of childbirth. The procedure is completely painless.
Taking or injecting drugs. This method is resorted to if the amniotomy was ineffective. Strong painkillers may be recommended, which lead to drug-induced sleep, during which the woman in labor can rest and recuperate. Oxytocin and prostaglandins are also administered intravenously.
C-section- an emergency operation is performed as a last resort, if there is a threat to the life of the mother or child. In this case, an incision is made in the abdominal region and uterus (with anesthesia) and the fetus is removed.

There are also special contraindications to the stimulation of childbirth. These include a narrow pelvis, abnormal position and presentation of the fetus, 3 or more births in the woman's history, scarring of the uterus, the risk of death for the woman or the fetus.

What can be dangerous weak contractions?

If a woman is in the hands of professionals who will be able to provide assistance in time, nothing threatens her life and the life of the baby. Only a favorable psychological mood, calmness and focus on a good result depend on the woman in labor.

What are the possible complications and why?

Excessive stimulation with medications can lead to abnormal uterine contractions, and ultimately to death of the fetus from suffocation;
When a baby in the womb occupies the same position for a long time, soft tissues begin to squeeze, which often causes circulatory disorders or cerebral hemorrhage;
The risk of various kinds of bleeding and infectious diseases in a woman in labor.

Weak labor activity is one of those ailments that cannot be diagnosed in advance and take any measures to avoid it. Therefore, pregnancy planning, constant monitoring by the same doctor and a positive psychological attitude are important. If a woman will listen to the doctor, follow all the recommendations, childbirth will be easy and without harm to her and the baby.

Especially for- Elena Kichak