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For the timely diagnosis of weakness of labor activity effectively. Types and their features. Vitamins and trace elements

The weakness of labor activity is characterized by insufficient strength, duration and frequency of contractions, slow smoothing of the cervix, opening it and moving the fetus through the birth canal. All these deviations can be observed, despite correct ratios fetal and pelvic dimensions.

Weakness of tribal forces is more common in primiparous than in multiparous.

Primary weakness of labor activity - pathological condition, in which contractions from the very beginning of childbirth are weak and ineffective. Primary weakness of labor activity may continue during the first and second periods.

Primary weakness of the birth forces usually occurs in pregnant women with uterine hypotonicity (primary hypotonic dysfunction of the uterus). Importance in its etiology, it has an insufficiency of impulses that cause, maintain and regulate the contractile activity of the uterus, as well as its inability to perceive these impulses or respond to them with a sufficiently powerful contraction of the myometrium. Along with common causes(mother's diseases, genital infantilism) the following factors are important: a decrease in the concentration of acetylcholine, oxytocin, prostaglandins, an increase in blood cholinesterase activity, deformation (coarseness, thickening, and sometimes collagenization) of argyrophilic sheaths of muscle cells.

The duration of labor with primary weakness of labor activity increases significantly, which leads to fatigue of the woman in labor. Often possible untimely outpouring amniotic fluid, lengthening of the anhydrous gap, infection of the genital tract, hypoxia and fetal death.

I- normal delivery, II - primary weakness of labor activity, III - secondary weakness of labor activity

The diagnosis of primary weakness of labor activity is established on the basis of an analysis of the nature and frequency of contractions, uterine tone, and the dynamics of cervical dilatation. The weakness of labor activity is evidenced by an increase in the duration of the latent phase of labor to 6 hours or more and a decrease in the rate of cervical dilatation during the active phase to 1.2 cm/h in primiparous and 1.5 cm/h in multiparous.

The partogram speaks of the lengthening of the birth act in both the first and second stages of labor (Fig. 20.1). To assess the progression of labor, it is important to analyze the comparative data of the last two or three vaginal examinations.

It is advisable to confirm the clinical diagnosis of weakness of labor activity by indicators of objective observation (cardiotocography, hysterography).

Treatment of primary weakness of labor is primarily in correct definition causes and the choice in accordance with this differentiated methods of dealing with it. With weak labor, control over emptying is necessary. Bladder and intestines. In women in labor with polyhydramnios and longitudinal position fetus, an early artificial opening of the fetal bladder is carried out, provided that the cervix is ​​smoothed and the opening of the uterine os is not less than 2-3 cm.

With prolonged, protracted labor, fatigue of the woman in labor, she is given medical rest (sleep), if there are no emergency indications for delivery (fetal hypoxia, the threat of excessive pressing of the soft tissues of the birth canal), since the appointment of a tired woman in labor (without previous rest) can stimulate labor activity even more complicate the course of childbirth

Obstetric anesthesia (sleep-rest) should be carried out by an anesthesiologist. For this purpose, sodium hydroxybutyrate (2-4 g) is administered intravenously simultaneously with a 20-40% glucose solution. 20-30 minutes before this, premedication is carried out: intravenously 1.0 ml of a 2% solution of promedol, 1.0 ml of a 1% solution of diphenhydramine, 0.5 ml of a 0.1% solution of atropine. It should be remembered that sodium oxybutyrate increases blood pressure.

If there is no anesthesiologist, then a combination of drugs is administered intramuscularly: promedol 2 ml or moradol 1 ml, diphenhydramine 20 mg, seduxen 20 mg. The use of electroanalgesia with pulsed currents can be successful.

After rest, a vaginal examination is performed to assess the obstetric situation.

The main method of treating weakness of the generic forces is to stimulate the contractile activity of the uterus.

Before stimulating labor, it is necessary to assess the condition of the fetus using a cardiac monitor study.

For rhodostimulation with primary weakness of generic forces, the following methods are used:

Intravenous drip of oxytocin;

Intravenous drip of prostaglandin E2 (prostenon);

Vaginal administration of prostaglandin E2 tablets (prostin);

Intravenous administration of prostaglandin F2a (enzaprost, dinoprost);

Combined intravenous drip of prostaglandin F2a and oxytocin.

Intravenous administration of oxytocin. Oxytocin has a strong uterotonic effect on the smooth muscle cells of the uterus, increases its tone, synchronizes the action of muscle bundles, and stimulates the synthesis of PGR2a by the decidual tissue and myometrium. The reaction of the uterus to oxytocin is ambiguous at the beginning and during the development of labor, since the number of oxytocin receptors increases closer to the end of labor (the end of the first, second, third periods of labor). It is by the period of fetal expulsion that oxytocin becomes a strong stimulant for the synthesis of PGR2 (X. Oxytocin is most effective when opening the uterine os by 5 cm or more.

When using oxytocin for the purpose of labor stimulation, you need to know that exogenously administered it reduces the production of your own endogenous oxytocin. Termination of intravenous administration of the drug can cause a secondary weakening of labor activity, and long-term administration for many hours can cause hypertensive and antidiuretic effects.

Oxytocin does not adverse influence for a healthy fetus. At chronic hypoxia fetus, it suppresses the surfactant system of the lungs of the fetus, which in turn contributes to intrauterine aspiration of amniotic fluid, in addition, it can lead to impaired blood circulation in the fetus and even to its intrapartum death.

It is advisable to use oxytocin when opened amniotic sac!

The introduction of oxytocin can be combined with epidural anesthesia or with antispasmodic, analgesic agents: no-shpa (2-4 ml), aprofen (1 ml of a 1% solution), promedol (1 ml of a 2% solution).

Method of administration of oxytocin: 5 IU of oxytocin is diluted in 500 ml of 5% glucose solution (dextrose) or isotonic sodium chloride solution. Intravenous infusion is started at a rate of 1 ml / min (10 drops / min), every 15 minutes the dose is increased by 10 drops. In this case, the maximum speed is 40 drops / min. It is advisable to use an infusion pump to administer oxytocin.

Against the background of an adequate dosage of oxytocin generic activity should also reach its maximum - 3-5 contractions in 10 minutes.

For the prevention of aspiration syndrome in the fetus with any type of rhodostimulation, seduxen (10-20 mg) is administered.

Childbirth with the introduction of labor-stimulating agents is carried out under cardiomonitoring control.

If the introduction of oxytocin for 1.5-2 hours does not give the desired clinical effect or the condition of the fetus worsens, then the pregnant woman should be delivered by caesarean section.

With the clinical effect of stimulation of labor activity with oxytocin, in order to avoid hypotonic bleeding, it is necessary to continue its administration after the birth of the fetus - in succession and early postpartum periods. Immediately after the birth of the fetus, additional prophylaxis of bleeding should be carried out by intravenous simultaneous administration of methylergometrine.

Intravenous administration of prostaglandin F2? used mainly in the latent phase of childbirth with insufficient "maturity" of the cervix and the primary weakness of the labor force. Unlike oxytocin and PGR2oc, PGE2 has important positive properties for the fetus:

PGE2 causes synchronous, coordinated contractions of the uterus with a fairly complete relaxation of it, which does not disturb the uteroplacental and fetal-placental blood flow;

Stimulates the activity of the sympathetic-adrenal system, suppressing the hyperactivity of the cholinergic nervous system therefore does not cause hypertonicity of the lower segment or cervical dystocia;

IN moderate degree activates the synthesis of PGR2a and oxytocin without causing hyperstimulation;

Improves peripheral blood flow, restores microcirculation;

The effectiveness of prostaglandin E2 does not depend on the level of estrogen saturation; with hypoestrogenism, it changes the mechanism for preparing the cervix for childbirth, accelerating this process tenfold;

It does not have a hypertensive and antidiuretic effect, therefore it can be used in women in labor with preeclampsia, arterial hypertension and kidney disease;

A softer contraction of the uterus without any spastic component eliminates venous congestion in the sinus collectors, which contributes to a better arterial blood supply to the uterus, placenta, and indirectly to the fetus.

PGE2 preparations are less effective in case of weakness of attempts, weakening of labor activity at the end of the period of disclosure.

The method of administration of PGE2 preparations is similar to oxytocin rhodostimulation: 1 ml of 0.1% or 0.5% prostenon solution is dissolved in 500 or 1000 ml of 5% glucose solution or 0.9% sodium chloride solution (1 ml of the solution contains 1 μg of the active substance ) and administered intravenously at a rate of 10 drops / min, increasing the dose depending on the response to the drug every 15 minutes by 8 drops. The maximum dose is 40 drops / min. For solution infusion, it is preferable to use automatic and semi-automatic systems that allow taking into account the dose of the administered drug.

Contraindications for the use of prostenon are bronchial asthma, blood diseases, individual intolerance to the drug, which is rare.

Vaginal tablets prostaglandin E2. The preparation of prostaglandin E2 - prostin, containing 0.5 mg of dinoprostone, is injected into the posterior fornix of the vagina three times with a break of 1 hour. myometrium. It is prescribed in the latent phase of labor, with a whole fetal bladder, since otherwise prosterone can enter the uterine cavity and cause hyperstimulation.

If labor activity intensified and childbirth entered into active phase further use of the drug is not advisable. This type of rhodostimulation is contraindicated in case of rupture of amniotic fluid and in case of secondary weakness of labor activity and weakness of attempts.

Intravenous administration of prostaglandin E2. Preparations of prostaglandin P2a are strong stimulators of contractile activity of the uterus. They act on alpha-adrenergic receptors of smooth muscle cells, simultaneously enhance the activity of the sympathetic-adrenal and cholinergic autonomic nervous systems, actively interact with oxytocin and PGE2- Have a vasoconstrictor effect, cause and enhance arterial hypertension, increase blood clotting, aggregation and adhesion of platelets. With untimely use of PGR2a or overdose, nausea, vomiting, and hypertonicity of the lower uterine segment may occur. Shows its effect regardless of estrogen saturation.

Method of administration: one ampoule of prostin or exaprost containing 5 mg of PGR2a is diluted in isotonic sodium chloride solution or 5% glucose solution at the rate of 1 mg per 1000 ml (1 μg per 1 ml of solution) and injected intravenously at a rate of 10 drops / min, increasing the dose every 15 minutes by 8 drops, but not more than 40 drops / min. An indication for this type of rhodostimulation is the weakness of labor activity.

A significant effect in the treatment of weakness of patrimonial forces was obtained by combining prostaglandin E2a with oxytocin.

With combined intravenous administration of prostaglandin E2? and oxytocin, the dosage of both drugs is reduced by half (2.5 mg and 2.5 U), diluted in 500 ml of 5% glucose solution and administered intravenously at a rate of 8 drops / min, adding 8 drops every 15 minutes, bringing up to 40 drops / min (maximum dosage).

With the simultaneous administration of oxytocin and prostaglandin E2? their potentiated action is noted.

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. Normal at proper development the process of childbirth 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 RSD occurs without visible reasons at the most unexpected moment. The main reasons for this diagnosis include:

  1. imbalance between factors that stimulate uterine contractility (oxytocin, calcium ions, endogenous prostaglandins) and factors that inhibit it (progesterone, magnesium ions);
  2. weak generic dominant, fear of a woman, psychological unpreparedness to childbirth;
  3. fatigue of the woman in labor, poor nutrition, concomitant diseases (influenza, SARS, arterial hypertension);
  4. the risk group for the development of this complication are pregnant women with hypothyroidism, obesity, hypogonadism, and smokers;
  5. excessive stretching of the uterine wall by a large fetus, excess amniotic fluid, twins;
  6. anomalies in the development of the uterus and the presence of myomatous nodes;
  7. operations on the uterus in history;
  8. premature birth;
  9. stimulated childbirth;
  10. 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:

  1. If a woman is tired, exhausted painful sensations, she is offered the so-called medical sleep-rest. Currently, spinal or epidural anesthesia is used with success;
  2. Additionally, solutions of glucose, B vitamins, estrogenic drugs, calcium, actovegin are administered. These infusions stimulate uterine contractions and prevent oxygen starvation fetus;
  3. In the case of polyhydramnios with a whole fetal bladder, it is advisable to carry out an amniotomy;
  4. 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 perfect way injections - using infusion pumps at a given speed. Learn more about .
  • Prostaglandins are analogues of natural mediators that stimulate labor activity. These drugs are available in different forms(gels, tablets, solutions for intravenous administration).

In case of inefficiency drug therapy and stubborn weakness, the diagnosis is made: "Weakness of generic forces (primary or secondary), not amenable to medical correction." This is a direct indication for 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 Werbow - old but enough effective method help in pushing. 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:

  1. proper nutrition, vitamin therapy;
  2. physical activity, sports, especially developing abdominal and pelvic muscles;
  3. correction of all chronic diseases before pregnancy;
  4. psychological preparation for childbirth, including training courses, breathing and relaxation techniques;
  5. body weight control.
During pregnancy, it is important to keep physical form, activity, 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

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This is insufficient in duration, frequency and strength of the contractile activity of the uterus, caused by its hypotonic dysfunction. The main manifestations of weakness of labor activity are rare, ineffective and short contractions, which are accompanied by slow fetal movement and poor uterine opening. To diagnose pathology, vaginal examination and cardiotocography are used. Treatment of weakness of labor is limited to radiostimulation. Quite often, a caesarean section is used, since the fetus cannot be born on its own.

What it is?

Childbirth is the final and most anticipated stage of the entire period of pregnancy. But childbirth doesn't always go well. One of the forms of violation of the contractile function of the uterus is the weakness of labor activity. This pathology is characterized by the fact that contractions are rare and irregular, myometrial tone is pronounced low, and the amplitude of contractions is weak. The diastole of contractions (relaxation period) significantly exceeds the systole (contraction period), which negatively affects the opening of the uterus, and the fetus cannot move normally. The uterus ceases to perform its functions properly, which poses a threat to the child.

In gynecology and obstetrics, weakness of labor activity is called one of the most common disorders and complications of the birth process. It is the weakness of labor activity that most often leads to the occurrence of pathologies in the fetus and mother. Among all birth pathologies, according to statistics, the weakness of labor activity accounts for about 7% of cases. It is worth noting that this anomaly is more common in women giving birth for the first time than in those women who have not given birth for the first time.

Types of weakness of labor activity

In modern gynecology, primary and secondary weakness of labor is distinguished. The first type of weakness of labor activity is characterized by the fact that contractions from the very beginning are not strong enough, inactive, irregular and prolonged. In turn, the secondary weakness of labor activity, the causes of which may be different, occurs when contractions weaken at the beginning of the 2nd or at the end of the 1st period of labor, and initially labor activity is quite active and stormy.

Convulsive and segmental contractions are also one of the varieties of weakness of labor activity. Convulsive contractions are protracted and last no more than 2 minutes. In turn, segmental contractions are characterized by contraction not of the entire uterus, but only of its individual parts. The effect of such fights is almost zero.

Causes of weakness of labor activity

The development of weakness of labor activity is affected a large number of factors that are associated with a lack of hormonal regulation of the birth act, morphological inferiority of the uterus, functional inertness of nervous structures, pathology of pregnancy, extragenital diseases, etc.

Weakness of labor can occur under the influence of pathologies of the uterus: hypoplasia, fibroids, chronic endometritis, saddle or bicornuate uterus. The structural failure of the myometrium, caused by diagnostic curettage, conservative myomectomy, abortions and other similar interventions earlier, has a great influence on the development of this anomaly. Also, cicatricial changes can contribute to the development of weakness of labor, as a result of radical treatment of cervical erosion.

Quite often, the reason for the weakness of labor activity is hidden in the imbalance between the factors that are responsible for active labor activity (mediators, estrogens, calcium, prostaglandins, oxytocin, etc.) and factors that inhibit labor activity (magnesium, enzymes that destroy mediators, progesterone and etc.).

Women with vegetative-metabolic disorders: hypothyroidism, hypothalamic syndrome, hypofunction of the adrenal cortex, and obesity are at risk of developing weakness in labor activity.

Young or late age primiparous significantly increases the risk of weakness of labor. In addition, the anomaly may be due to:

  • preeclampsia;
  • delayed pregnancy or premature birth;
  • overstretching of the uterus with polyhydramnios, large fruit, multiple pregnancy;
  • disproportion between the pelvis of the woman in labor and the size of the fetus;
  • early discharge of water;
  • placenta previa;
  • fetal pathology (anencephaly, hypoxia);
  • chronic placental insufficiency, etc.

The weakness of labor activity is aggravated:

  • overwork;
  • excessive mental, physical activity;
  • insufficient sleep;
  • poor nutrition;
  • excessive mental disorders;
  • the fear of the woman in labor;
  • rude or inattentive service;
  • uncomfortable environment.

Often, the weakness of labor activity is nothing more than a continuation of the pathological preliminary period of childbirth.

Symptoms of weakness in labor

The main symptoms of primary weakness of labor activity can be called:

  • the duration of contractions is not more than 15-20 seconds;
  • frequency of contractions 1-2 within 10 minutes;
  • decreased tone and excitability of the uterus;
  • amplitude of contractions of the myometrium 20-25 mm Hg. V;
  • short period of uterine contraction;
  • lengthening by 1.5-2 times the relaxation period, etc.

With primary weakness of labor, contractions may be irregular or regular, painless or painless. The cervix undergoes delayed structural changes (shortening, smoothing and opening of the uterine os and cervical canal).

Slow contraction of the uterus is accompanied by an early postpartum period, which can cause hypotonic bleeding. The primary type of weakness of labor activity tires the woman in labor, leads to lengthening of the anhydrous period, delaying the duration of labor, and untimely discharge of amniotic fluid.

Secondary weakness of labor activity is characterized by the following symptoms:

  • initially effective contractions weaken;
  • each contraction becomes shorter and shorter;
  • decreased tone and excitability of the uterus;
  • the fetus does not move through the birth canal;
  • the opening of the uterine os stops at around 5-6 cm.

The danger of weakness of labor is as follows:

  • risk of infection of the uterus;
  • the occurrence of numerous birth injuries;
  • development of fetal asphyxia;
  • intrauterine death of a child.

Diagnosis of weakness of labor activity

It is possible to determine the nature of the weakness of labor activity through diagnostics, which includes a clinical assessment of the dynamics of labor, uterine tone, and the effectiveness of contractions.

During childbirth, the doctor monitors the development of birth process and keeps track of how long each contraction takes. All results are compared with the norm, the only way to understand how labor occurs. The active phase of the first period is characterized by contractions for 30 seconds every 5 minutes, for the second period - shorter than 40 seconds.

The opening of the cervix with the weakness of labor activity occurs by less than 1 cm per hour. The rate and extent of dilation is assessed by vaginal examination.

The diagnosis of weakness of labor activity is confirmed if the primary birth period the woman in labor lasts over 12 hours. If we talk about multiparous, then for them this indicator is over 10 hours.

It is necessary to distinguish between discoordinated labor activity and weakness of labor activity, the treatment of which will be different.

Treatment of weakness in labor

The treatment regimen for weakness of labor will depend on the causes of the anomaly, the period of labor, the degree of weakness in labor, and the assessment of the condition of the mother and fetus. Also, a lot will depend on what kind of pregnancy a woman has in a row.

In some cases, one session of bladder catheterization is sufficient to stimulate the intensity of contractions. If the reason for the weakness of labor activity is polyhydramnios, then an amniotomy procedure is performed. Medication sleep is prescribed when the woman in labor is tired, but there is no risk of asphyxia and fetal hypoxia. With asthenia, it is advisable to create an estrogen-calcium background as a treatment.

Treatment of weakness of labor cannot be imagined without labor-stimulating therapy, this is the main method in the fight against deviation. Prostaglandin F-2 (Enzaprost), prostaglandin E-2 (Prostenon) and intravenous infusion of oxytocin are administered. If labor stimulation does not help, a caesarean section is prescribed. IN this process A lot depends on how the pregnancy went.

In the case when the fetal head is in the pelvic cavity, they resort to the imposition of obstetric forceps or to the dissection of the perineum (episiotomy, perineotomy).

Prevention of weakness of labor activity and its complications

The doctor who leads the pregnancy must assess the risk of developing weakness of labor. If such risks exist, the specialist should take care of psychophysical and preventive drug preparation.

The weakness of labor activity always leads to a deterioration in the condition of the fetus, therefore, labor stimulation and prevention of fetal asphyxia are carried out simultaneously and without fail.

Secondary weakness of ancestral forces occurs less frequently than primary - only in 2% of births. This is such an anomaly of labor activity, in which initially quite normal and strong contractions weaken, become less and less frequent, shorter and may gradually stop altogether. The tone and excitability of the uterus are reduced. The opening of her pharynx, having reached 5-6 cm, no longer progresses, the presenting part of the fetus does not move along the birth canal. Secondary weakness develops most often in the active phase of labor or at the end of the disclosure period. Its cause is the fatigue of the woman in labor or the presence of an obstacle that stops childbirth (anatomically and clinically narrow pelvis, breech presentation fetus, stubborn or cicatricial tissues of the birth canal, excessive pain in contractions and attempts). It can also be caused by the indiscriminate and inept use of anticholinergic, antispasmodic and analgesic drugs.

The clinic of secondary weakness is characterized by a long duration of the birth act, mainly due to the period of exile. The contractions, which were quite intense, long and rhythmic at the beginning, become weaker and shorter, and the pauses between them increase. In some cases, the contractions stop. The progress of the fetus through the birth canal sharply slows down or stops. Childbirth is delayed, this leads to fatigue of the woman in labor. Endometritis in childbirth, asphyxia and fetal death may occur. If labor activity sharply weakens or stops, then the opening of the cervix does not progress, its edges begin to swell as a result of infringement between the fetal head and the mother's pelvic bones. Fetal head stuck in the pelvis long time compressing the birth canal, is adversely affected. This causes a violation of cerebral circulation and hemorrhage, accompanied not only by asphyxia, but also by paresis, paralysis, and even death of the fetus.

In the afterbirth and early postpartum periods, women with weak labor activity often experience hypo- and atonic bleeding, as well as postpartum infectious diseases. Diagnosis of secondary weakness of generic forces is based on the above clinical picture. Great help render results objective methods its registration (hystero- and cardiotocography) in the dynamics of labor, as well as partogram data.

It is necessary to establish the cause of secondary weakness, and then decide on the tactics of childbirth: if the membranes are too dense, amniotomy is indicated; the best remedy the fight against the secondary weakness of the labor force in the first period is a medical sleep - rest, and if necessary, after 1-1.5 hours, labor stimulation; clinical inconsistency is an indication for emergency caesarean section (in the presence of infection, the method of choice is extraperitoneal access); With symptoms of a developing infection, as well as with anhydrous period more than 6 hours, antibiotic therapy is indicated; in childbirth, fetal hypoxia is always treated. When prescribing labor-stimulating agents, their administration should be continued in the afterbirth and early postpartum periods due to the risk of hypotonic bleeding. After the birth of the fetus, it is advisable for the woman in labor to additionally simultaneously inject 1 ml of methylergometrine intravenously. With persistent weakness of the labor forces, it is necessary to revise the plan for conducting labor in a timely manner in favor of a caesarean section.

Weakness of attempts:

The weakening of labor activity in the period of expulsion of the fetus is called weakness of attempts (primary or secondary). Weakness of attempts refers to the secondary weakness of the generic forces and occurs as a result of the inferiority of the abdominal muscles or the general fatigue of the woman in labor and the depletion of the energy capabilities of the muscles of the uterus. This is observed in multiparous women with excessively stretched and relaxed muscles, in obese women, with infantilism, muscle defects (hernia of the white line of the abdomen, umbilical hernia, inguinal hernia), with myasthenia gravis, spinal injuries and other organic lesions of the central nervous system (poliomyelitis, trauma). Overflow of the bladder, intestines and stomach, as well as epidural anesthesia, have an inhibitory effect on the development of attempts.

The clinic of weakness of attempts is expressed in an increase in the II-nd period: attempts are weak, short, rare. The movement of the presenting part is suspended. Edema of the external genital organs develops, signs of compression of neighboring organs and chorioamnionitis. The fetus is threatened by asphyxia and death. With hysterography, a low amplitude of contractions of the striated muscles is noted.

With weakness of attempts, uterine stimulants (oxytocin, prostaglandins F2b) are used. In the absence of the effect of drug therapy, they resort to episiotomy, the imposition of typical (weekend) obstetric forceps, less often - vacuum extraction of the fetus. The use of the Christeller method is unacceptable due to the high traumatism of both the fetus (injury of the spine) and the mother (injury of the pancreas). With a dead fetus, a fruit-destroying operation is performed.

- insufficient in strength, duration and frequency of contractile activity of the uterus, due to its hypotonic dysfunction. The weakness of labor activity is manifested by rare, short and ineffective contractions, slowing down the opening of the cervix and advancement of the fetus. Pathology is diagnosed through observation, cardiotocography, vaginal examination. In the treatment of weakness of labor activity, rhodostimulation is used; according to indications, a caesarean section is performed.

The weakness of labor activity may be due to late or young age primiparous; preeclampsia; premature birth or post-term pregnancy; overstretching of the uterus with multiple pregnancy, large fetus, polyhydramnios; disproportion between the size of the fetus and the pelvis of the woman in labor (narrow pelvis); early discharge of water. Placenta previa, the course of pregnancy in conditions of chronic placental insufficiency, fetal pathology (hypoxia, anencephaly, etc.) can lead to the development of weakness in labor activity.

In addition, the weakness of labor activity can be aggravated by the asthenization of a woman (overwork, excessive mental and physical stress, poor nutrition, insufficient sleep); fear of the woman in labor, uncomfortable environment, inattentive or rude service. The weakness of labor activity is often a direct continuation of the pathological preliminary period of childbirth.

Types of weakness of labor activity

According to the time of occurrence, primary weakness of labor activity and secondary are distinguished. The primary weakness is considered a situation in which, from the very beginning of childbirth, insufficiently active (weak in strength, irregular, short) contractions develop. They speak of secondary weakness if there is a weakening of contractions at the end of the 1st or the beginning of the 2nd period of labor after the initially normal or violent nature of labor.

The varieties of weakness of labor activity include segmental and convulsive contractions. Convulsive contractions are characterized by prolonged (more than 2 minutes) uterine contractions. With segmental contractions, not the entire uterus contracts, but its individual segments. Therefore, despite the continuity of segmental contractions, the effect of them is extremely small. Definition clinical form weakness of labor activity allows you to choose differentiated tactics in relation to the treatment of disorders.

Symptoms of weakness in labor

Clinical manifestations of the primary weakness of labor activity are: decreased excitability and tone of the uterus; frequency of contractions - 1-2 within 10 minutes; the duration of contractions is not more than 15-20 seconds; amplitude (strength) of contractions of the myometrium - 20-25 mm Hg. Art. The period of contraction of the uterus is short, the period of relaxation is 1.5-2 times longer. There is no increase in intensity, amplitude, frequency of contractions over time.

Contractions with primary weakness of labor activity can be regular or irregular, painless or slightly painful. The course of structural changes in the cervix (shortening, smoothing and opening of the cervical canal and uterine os) is slowed down. The weakness of the contractile activity of the uterus often accompanies the period of exile, as well as successive and early postpartum period leading to hypotonic bleeding. The primary weakness of labor activity leads to a delay in the duration of labor, fatigue of the woman in labor, untimely discharge of amniotic fluid, lengthening of the anhydrous period.

In the case of secondary weakness of labor activity, initially effective contractions weaken, become shorter and less frequent, up to complete cessation. This is accompanied by a decrease in the tone and excitability of the uterus. The opening of the uterine os can reach 5-6 cm without further progression; the progress of the fetus through the birth canal stops. The danger of weak labor is an increased risk of ascending infection of the uterus, the development of fetal asphyxia or intrauterine death. With prolonged standing of the fetal head in the birth canal, birth injuries of the mother (hematomas, vaginal fistulas) may develop.

Diagnosis of weakness of labor activity

To determine the nature of labor activity, a clinical assessment of the effectiveness of contractions, uterine tone, and labor dynamics is carried out. During childbirth, monitoring of uterine contractions (tocometry, cardiotocography) is carried out; analysis of the frequency, duration, strength of contractions and their comparison with the norm. So, in the active phase of the 1st period, contractions lasting less than 30 seconds are considered weak. and intervals over 5 minutes; for the 2nd period - shorter than 40 sec.

With the weakness of labor activity, the opening of the cervix occurs by less than 1 cm per hour. The degree and speed of opening are assessed during the vaginal examination, as well as indirectly - by the height of the contraction ring and the advancement of the head. Weakness of labor activity is said if the 1st stage of labor lasts more than 12 hours for primiparas, and more than 10 hours for multiparous ones. Weakness of labor forces should be differentiated from discoordinated labor activity, since their treatment will be different.

Treatment of weakness in labor

The choice of treatment regimen is based on the causes, the degree of weakness of labor, the period of labor, the assessment of the condition of the fetus and mother. Sometimes, to stimulate the intensity of contractions, it is enough to catheterize the bladder. If the weakness of labor activity is caused In the process of conducting pregnancy by an obstetrician-gynecologist, it is necessary to assess risk factors for the development of weakness of labor activity, and if such factors are identified, preventive medication and psychophysical training should be carried out. The weakness of labor activity almost always leads to a deterioration in the condition of the fetus (hypoxia, acidosis, cerebral edema), therefore, simultaneously with labor stimulation, prevention of fetal asphyxia is carried out.