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Weakness of labor activity: concept, classification, causes and treatment. Weak labor activity

One of the most common complications during the birth of a baby is weak labor activity, which, according to statistics, is observed in 7-8% of women in labor. It delays the process and is fraught with the fact that it can provoke hypoxia (oxygen starvation) of the fetus. What is this pathology?

It is characterized by the fact that the contractions that have begun do not intensify, but gradually weaken, increasing the duration of labor and depleting the physical strength of the woman in labor. In this case, the cervix either too slowly, or does not open at all.

The occurrence of such a weak labor activity can provoke various deviations regarding both the health of the mother and the development of the fetus:

  • neuroendocrine and somatic diseases of a woman;
  • overstretching of the uterus (often this happens with or multiple pregnancies);
  • complications during pregnancy;
  • pathology of the myometrium (uterine walls);
  • malformations of the fetus itself: disorders of its nervous system, adrenal aplasia, presentation, delayed or accelerated maturation of the placenta;
  • narrow pelvis, tumors, incorrect position of the child, rigidity (inelasticity) of the cervix - all this can become mechanical obstacles that entail weak or insufficient labor activity;
  • the readiness of the mother and baby for childbirth does not coincide, is not synchronous;
  • stress;
  • the age of the expectant mother is less than 17 and older than 30;
  • insufficient physical activity of the woman in labor.

In each individual case, the causes of weak labor activity may be different. Childbirth is also different for everyone.

Symptoms are determined by doctors directly during childbirth:

  • contractions are of short duration and low intensity;
  • the uterine pharynx opens slowly;
  • the movement of the fetus along the birth canal occurs at a very low speed;
  • the intervals between contractions increase;
  • the rhythm of contractions is broken;
  • duration of childbirth;
  • fatigue of the woman in labor;

With primary generic weakness, contractions are mild and ineffective from the very beginning. Secondary differs in that it occurs after a normally begun birth.

What to do with weak labor activity

If weak labor activity is diagnosed, doctors make a decision depending on the causes of the pathology and the condition of the woman in labor. There are various ways to help a woman in such a difficult situation. If prolonged labor becomes dangerous for the mother or child, it is customary to induce labor.

  • 1. Labor induction without medication

Enhances labor activity amniotomy (the procedure for opening the fetal bladder). It allows the expectant mother to cope on her own, without stimulation with drugs.

  • 2. Medical stimulation

In some cases, amniotomy is ineffective, so labor must be stimulated with the help of drugs. This may be drug-induced sleep after the administration of narcotic analgesics and stimulation with uterotonics (oxytocin and prostaglandins). They are administered intravenously, while the condition of the fetus is constantly monitored using a heart monitor.

  • 3. Cesarean section

It happens that even the use of stimulants does not bring results, while the fetus may die from hypoxia. Then an emergency caesarean section is performed.

The use of stimulant drugs is undesirable, since it requires the simultaneous use of analgesics, epidural anesthesia, antispasmodics due to increasing pain in parturient women, which can lead to undesirable. But if the risk of fetal death is too high, this is the only way out of this situation. The weakness of labor activity in the second birth requires exactly the same intervention as in the first.

Preventive measures

If there is a threat of weak labor activity, a whole course of preventive measures is required from the 36th week:

  1. take drugs whose purpose is to increase the energy potential of the uterus: these are vitamin B, ascorbic and folic acids;
  2. observe the correct daily routine with sufficient time for sleep;
  3. prepare mentally for childbirth.

If weak labor activity was detected in a timely manner, with proper treatment, in most cases, childbirth can be carried out naturally, ending with the long-awaited birth of a strong and healthy baby.

Weakness of labor activity is a pathological condition that is characterized by a decrease and weakening of contractions, as well as a slow opening of the cervix. At the same time, the woman in labor gets very tired and loses strength.

Weak labor activity is primary and secondary.

Primary is a decrease in uterine activity that occurs at the very beginning of childbirth. The frequency of occurrence is 5-7% of the number of all births.

Secondary - this is a decrease in the duration, intensity and frequency of contractions after a favorable onset of the course of labor. At the same time, the rate of opening and smoothing of the cervix also decreases, and the movement of the fetus through the birth canal slows down. It occurs in 2-3% of births.

Causes

The risk group includes pregnant women who have a history of:

  • childhood infections (rubella, chickenpox, measles);
  • late onset of the first menstruation (menarche), after 15-16 years;
  • menstrual irregularities;
  • infantilism (small uterus);
  • anomalies in the development of the uterus;
  • inflammatory diseases of the reproductive system;
  • scar on the uterus (after caesarean section, removal of fibroids, ectopic pregnancy, etc.);
  • abortions;
  • large fruit;
  • a large number of births;
  • diseases with metabolic disorders.

The reason for the weakness of the birth process can be mechanical obstacles (narrow pelvis, breech presentation of the fetus, inelasticity of the cervix). The age of the pregnant woman also plays a role - women under the age of 17 and over 30 are more prone to anomalies in labor. Obstetric reasons include:

  • prenatal outpouring of water;
  • multiple pregnancy;
  • post-term pregnancy or, conversely, premature birth;
  • large size of the fetus;
  • transverse or oblique position of the fetus;
  • pelvic presentation of the fetus;
  • fear of childbirth, great loss of strength.

The reasons may be from the side of the fetus:

  • intrauterine infection;
  • malformations and anomalies of development;
  • Rhesus conflict;

Most often, for the development of weak labor activity, several reasons or a combination of them are needed.

Signs of weak labor activity

Primary weakness of labor can be manifested by such symptoms:

  • contractions become less sensitive, rare or short;
  • the smoothing of the cervix and the opening of the uterine pharynx slow down or stop (the doctor determines during a vaginal examination);
  • the presenting part of the fetus (head or pelvic end) remains permanently movable or pressed against the entrance to the small pelvis;
  • the long course of the first stage of labor (for primiparous more than 12 hours, for multiparous more than 10 hours) and, as a result, the fatigue of the woman in labor;
  • possible untimely discharge of amniotic fluid.

Norms of disclosure and contractions in the first stage of labor

Normally, in a primiparous woman, the cervix of the uterus opens by 1-1.2 cm per hour, in a multiparous woman - 1.5-2 cm per hour. If the cervix opens more slowly, then this may indicate the development of primary weakness of labor activity.

In the first period, the normal duration of contractions is 20-30 seconds, and the interval between them is 7-10 minutes. With the pathology of labor activity, their duration decreases, and the interval between them increases.

Secondary generic weakness is characterized by a longer period of expulsion of the fetus (more than 1-1.5 hours). This is due to the weakening or cessation of contractions, which at the beginning were intense, rhythmic and prolonged. At this point, the progress of the fetus along the birth canal slows down or stops altogether.

Diagnostics

Primary weakness of labor activity is diagnosed on the basis of:

  • decrease in uterine activity (contractions weaken, become rare);
  • reducing the speed of smoothing the neck and opening the uterine pharynx;
  • prolonged standing of the presenting part of the fetus at the entrance to the small pelvis;
  • increase in delivery time.

The diagnosis is also made on the basis of partogram data, if there is no dynamics of cervical dilatation within two hours.

Partogram - a description of childbirth in a graphical way, which displays data on cervical dilatation, fetal progress, pulse, blood pressure, fetal heartbeat, amniotic fluid, contractions, etc.

Secondary birth weakness is diagnosed on the basis of the clinical picture and partogram data. In addition, it is necessary to monitor the condition of the fetus (listen to the heartbeat, install a CTG sensor), as there is a risk of developing hypoxia. After establishing the diagnosis, obstetricians need to decide on the tactics of childbirth.

Weakness of labor must be distinguished from the following pathologies:

  • pathological preliminary period (chaotic false contractions with an immature cervix);
  • discoordinated labor activity (violation of the contractile activity of the uterus, it is extremely painful; it is very rare);
  • clinically narrow pelvis (mismatch between the size of the pelvis and the head of the fetus).

Treatment and delivery in case of weak labor activity

There are several methods of medical care. The doctor makes a decision depending on the causes of the pathology and the condition of the woman in labor and the fetus. If labor is prolonged and life-threatening, labor is induced or an emergency caesarean section is performed. Methods of medical care:

1. Stimulation of childbirth without medication. Labor activity can be strengthened by the procedure of amniotomy (opening of the fetal bladder), which allows you not to use drugs. Do not be afraid, amniotomy is completely painless.

2. Medicinal stimulation. It is carried out in case of ineffectiveness of the amniotomy. It can be carried out with the help of strong analgesics, which induce drug-induced sleep to relax and rest the woman in labor. Stimulation with oxytocin and prostaglandins is performed intravenously.

3. Cesarean section. An emergency operation is performed in case of ineffective stimulation and in case of a threat to life for the woman in labor or the fetus.

drug sleep

For therapeutic sleep, sodium oxybutyrate and glucose are administered, performed by an anesthesiologist. In his absence, the obstetrician introduces promedol, relanium, atropine and diphenhydramine. Medication sleep allows a woman in labor to rest for 2-3 hours and gain strength, and also helps to intensify contractions. If there is an indication for an emergency caesarean section, then there is no need for therapeutic sleep.

After the woman has a rest, the doctor needs to assess her condition and the fetus, as well as the degree of opening of the uterine pharynx. After that, a hormonal-energy background is created with the help of:

  • ATP, riboxin, cocarboxylase;
  • 40% glucose solution;
  • calcium preparations (to enhance uterine contractions);
  • vitamins: B1, B6, E, ascorbic acid;
  • piracetam (to improve uterine circulation).

Amniotomy

Opening the fetal bladder promotes the production of prostaglandins, which stimulate contractions. It is performed when the cervix is ​​dilated by 3-4 cm. 2-3 hours after the procedure, the doctor needs to assess the state of the dynamics of cervical dilatation, and also decide on the use of reducing drugs.

Medical stimulation

When stimulated with drugs, oxytocin and prostaglandins are used.

Oxytocin is administered intravenously through a drip. It provokes increased contractions and the production of prostaglandins. Oxytocin is administered when the uterine os opens by 5-6 cm or more, only after amniotomy or spontaneous discharge of amniotic fluid.

Prostaglandin E2 contributes to the development of normal contractions. The drug also accelerates the maturation of the cervix and its opening, while not disturbing the uteroplacental circulation. The drug is administered similarly to oxytocin. It is used until the opening of the uterine os by 2-3 cm with an insufficiently mature cervix.

Prostaglandin F2a (enzaprost or dinoprost) is used when opening the uterine os by 5 cm or more. Effects of the drug: stimulation of contractions, narrowing of blood vessels, increased blood clotting. Therefore, it is contraindicated in preeclampsia and blood diseases. Prostaglandin F2a is administered intravenously using a drip system.

With drug stimulation, it is mandatory to prevent fetal hypoxia every 3 hours. For this, a 40% glucose solution + ascorbic acid + eufillin, sigetin or cocarboxylase is injected intravenously. It also shows the inhalation of humidified air.

C-section

If all of the above methods were ineffective or there are additional indications, then a caesarean section is performed.

Contraindications for labor stimulation

  • narrow pelvis (anatomical and clinical);
  • the presence of a scar on the uterus;
  • women with a history of more than 5-6 births;
  • incorrect position and presentation of the fetus;
  • life threatening for the mother and fetus.

Possible Complications

In the case of an incorrect choice of a delivery strategy with weak labor activity, the following complications are possible:

  • abuse of stimulant drugs can lead to discoordinated labor and fetal hypoxia.
  • prolonged standing of the presenting part of the fetus in one plane of the small pelvis can lead to compression of the soft tissues, in which there is a risk of urogenital fistulas. On the part of the fetus, this can lead to impaired cerebral circulation and cerebral hemorrhage.
  • in women with weakness of labor in the postpartum period, there is a risk of hypo- and atonic bleeding, infectious diseases.

Forecast

With adequate medical care, the prognosis for the woman and the fetus is favorable. Much depends on the psychological state of the woman, there is no need to panic and be afraid, it is better to listen to the recommendations of the obstetrician. Serious complications are rare.

Some research on pregnancy

Often the cause of complications in the period of delivery is a weak labor activity. As a result of such a violation, negative consequences can occur both during childbirth and in the postpartum period. Let us consider this phenomenon in more detail, find out: what does weak labor activity mean, highlighting the causes, signs and methods of struggle.

"Weak generic activity" - what is it?

Before considering the pathology, let's deal with the definition and find out: what is weak labor activity in women and when it occurs. Obstetricians talk about such a violation when the contractile activity of the uterus does not have the necessary strength to expel the fetus. This is due to a change in the duration and frequency of labor pains. They are rare, short, ineffective. As a result, the process of opening the cervix slows down, the rate of advancement of the fetus decreases, and the development of weak labor activity is observed.

Weak labor activity - causes

Due to the fact that often the violation is provoked simultaneously by several factors, it is problematic to establish the causes of weak labor activity in women in a particular case. At the same time, doctors identify several groups of factors that cause a violation of the delivery process. Among those:

1. Obstetric complications:

  • early effusion;
  • discrepancy between the size of the fetal head and the size of the pelvis of the woman in labor;
  • the presence of dystrophic and structural changes in the walls of the uterus (the presence of abortions, a history of curettage, endometriosis, uterine fibroids);
  • rigidity of the muscle layer of the neck (non-extensibility of the organ due to previous operations, diseases);
  • incorrect placenta previa;
  • gestosis.

2. Pathologies of the reproductive system:

  • congenital anomalies in the structure of the uterus (bicornuate, saddle-shaped);
  • sexual infantilism (underdevelopment of the reproductive organs);
  • chronic inflammatory processes in the uterus;
  • violation of the menstrual cycle;
  • diseases of the endocrine system leading to hormonal imbalance.

3. Extragenital diseases:

  • chronic diseases of internal organs (pathologies of the liver, kidneys, heart);
  • disruption of the endocrine system (obesity, hypothyroidism, diabetes mellitus).

4. Factors due to the baby:

  • intrauterine infection;
  • intrauterine growth retardation;
  • delayed pregnancy;
  • premature delivery;
  • fetal hypoxia;

5. Iatrogenic causes:

  • long-term use of labor-stimulating agents;
  • neglect of anesthetic measures during childbirth;
  • unreasonable amniotonia (opening of the fetal bladder by a doctor);
  • private vaginal examinations.

Is weak labor activity inherited?

The belief of some expectant mothers regarding the fact that weak labor activity is inherited is erroneous. This pathology has no connection with the genetic apparatus, therefore, it cannot be inherited from mother to daughter. In most cases, a violation occurs when the delivery process itself is not properly managed, and the woman does not comply with the requirements of the obstetrician. Evidence of the absence of a connection between the disorder and heredity is the high frequency of its development during childbirth.

Weak labor activity at first birth

In order to understand why there is a weak labor activity, it is necessary to briefly consider the mechanism of childbirth itself. So after the opening of the cervix, the end of the first period, the exile phase begins. More often, the weakness of labor activity occurs at the stage of disclosure, the gradual increase in the lumen of the cervical canal is suspended. As a result, this period of childbirth is delayed, the woman in labor loses strength, gets very tired. Given these features, among the causes of weak labor activity at the first delivery, one can single out:

  • improper prenatal preparation of a pregnant woman;
  • violation of the algorithm for conducting the first stage of childbirth - excessive drug stimulation of the process;
  • non-compliance by the woman in labor with the instructions of obstetricians.

Weak labor activity during the second birth

Talking about what is associated with weak labor activity during repeated childbirth, doctors put forward a violation of the delivery process in the first place. A feature of the second and subsequent births is the shortening of the period of disclosure and exile. Contractions grow, become intense after a short time. At the same time, the absence of a number of competent medical staff capable of providing maternity benefits increases the risk of a decrease in the activity of uterine structures. The woman in labor herself loses strength, cannot productively push - a secondary weakness.

Weak labor activity - signs

The diagnosis of "weak labor activity" is made exclusively by the obstetrician taking delivery. At the same time, doctors evaluate the nature of contractions, the speed of cervical dilatation. Directly lengthening the period of disclosure is a symptom of a violation. At the same time, there are signs of weak labor activity:

  • short duration and low intensity of contractions;
  • a decrease in the rate of advancement of the fetus through the birth canal;
  • increase in intervals between contractions;
  • severe fatigue of the woman in labor;
  • development of fetal hypoxia.

Weak labor activity - what to do?

Having experienced this violation once, women preparing to become a mother for the second time are often interested in the question of how to intensify contractions with weak labor activity. Initially, it all depends on the mood of the pregnant woman herself, her readiness for childbirth. Fears, overwork, fear for the future baby - have a bad effect on the process of delivery.

In order to reduce the risk of developing weak labor, doctors recommend expectant mothers:

  • calm down using non-drug methods (massage, proper breathing);
  • in the period of disclosure, it is necessary to be active - walking, light jumps in place help the cervix;
  • if a woman is forced to take a horizontal position (a dropper is connected), it is necessary to lie on the side on which the back of the fetus is located.
  • you should monitor the condition of the bladder - it must be emptied every 2 hours.

Preparations for weak labor activity

With such a violation as weak labor, how to intensify contractions, stimulate the process, doctors decide based on the degree of pathology, the condition of the woman in labor. The main non-drug method of activation of labor activity is amniotomy - a violation of the integrity, opening, of the fetal bladder. Manipulation is carried out with the opening of the cervix by 2 cm or more. If there is no effect within 2-3 hours, if weak labor activity does not disappear, they resort to drug intensification of childbirth. Among the drugs used:

  1. Oxytocin. Enter drip, intravenously. They begin to use it when the cervix is ​​dilated by 5 cm or more and after the opening of the fetal bladder or the discharge of water.
  2. Prostenon. Apply in the initial stage, when the neck does not yet miss 2 fingers. The drug causes coordinated contractions without disturbing blood circulation in the "fetus-placenta" system.
  3. Enzaprost (dinoprost). The drug is used in the phase of active disclosure, when the lumen of the cervical canal reaches 5 cm or more. The drug actively stimulates contractions of the uterine myometrium. At the same time, there is an increase in blood pressure, thickening of the blood. This medication is not used in the presence of preeclampsia, disruption of the blood coagulation system. Enter drip, dissolving in saline.

Cesarean section with weak labor activity

In the absence of the effect of the drug therapy performed, the deterioration of the fetus, a caesarean section is prescribed for weak labor activity. Emergency surgical intervention requires highly qualified doctors, the availability of conditions. If weakness arose during the period of exile (ineffective attempts and contractions), obstetric forceps are often used. This device helps to extract the fetus out. Timely delivery benefits reduce the risk of complications.

Both pregnant women and doctors want childbirth to take place without any complications. However, despite this, anomalies of labor activity still happen, and one of them is the weakness of labor activity. This complication is characterized by weakening and shortening of contractions, slowing down the opening of the cervix and, accordingly, the advancement of the baby's head through the birth canal. If a woman has a second birth, weak labor activity is unlikely, more precisely, in multiparous women, it occurs twice as rarely as in primiparas. Why is this happening and how to correct the weakness of tribal forces?

· Anomalies of labor activity: classification of weakness of labor forces


Weakness of labor can occur both in the first stage of labor and in the second, so it happens:

1. primary weakness of tribal forces;

2. secondary weakness of labor activity;

3. as well as weakness of attempts.

· Weak labor activity: causes

The causes of weakness in childbirth can be divided into three conditional groups: on the part of the woman in labor, on the part of the child, and complications of pregnancy.

Causes of weakness of labor activity on the part of the mother:

  1. infantilism of the genital organs (uterine hypoplasia);
  2. diseases of the uterus (endometriosis, chronic endometritis, uterine fibroids);
  3. extragenital diseases (obesity, diabetes, hypothyroidism);
  4. anatomically narrow pelvis;
  5. operations on the uterus (myomectomy, caesarean section);
  6. lack of mental preparation for childbirth, nervous strain of the woman in labor;
  7. the age of the woman (under 18 and over 30);
  8. rigidity of the genital tract (reduced elasticity).

Causes of weakness of labor activity on the part of the fetus:

  1. incorrect insertion or presentation of the fetal head;
  2. multiple pregnancy;
  3. large size of the fetus;
  4. discrepancy between the size of the pelvis and the head of the fetus.

Complications of pregnancy:

  1. anemia, preeclampsia in a pregnant woman;
  2. polyhydramnios (overdistension of the uterus can reduce its contractility);
  3. oligohydramnios and flaccid, flat fetal bladder.
  • Primary weakness of labor activity


There is a primary weakness of labor activity with the onset of labor, it is characterized by weak, painless contractions, their low frequency (no more than 1-2 contractions within 10 minutes), and duration (no more than 15-20 seconds). If labor activity is weak, the opening of the uterine os occurs very slowly or does not occur at all. In nulliparous women, the opening of the cervix to a size of 2-3 cm in diameter (or 2-3 fingers, as obstetricians often “measure”) takes longer than 6 hours from the onset of contractions, and in multiparous women - longer than 3 hours.

Such a weak, ineffective labor activity greatly tires the woman in labor, depletes the energy reserves of the uterus and leads to intrauterine fetal hypoxia. Due to weakness, the fetal bladder does not function properly, the baby's head does not move along the birth canal. Childbirth threatens to be seriously delayed and end in the death of the fetus.

· Secondary weakness of labor activity

Usually, the secondary weakness of labor activity occurs at the beginning of the second or at the end of the first period of labor, it manifests itself in the form of a weakening of labor activity after an intensive onset and course of labor. The contractions slow down and may eventually stop altogether. The opening of the cervix stops, as does the advancement of the fetal head, all this is accompanied by signs of intrauterine suffering of the child, if the fetal head stands in one place of the small pelvis for a long time, this can result in swelling of the cervix and the appearance of rectovaginal or urinary fistulas in a woman in labor.

· Weakness of attempts

As a rule, weakness of attempts occurs in women who have repeatedly or multiparous (due to weakening of the abdominal muscles), with a divergence of the muscles of the anterior abdominal wall (in the case of a hernia of the white line of the abdomen), with obesity of the woman in labor. The weakness of the attempts is manifested by their inefficiency and short duration (the implementation of attempts occurs due to the abdominal muscles), nervous and physical exhaustion of the woman in labor. As a result, there may be signs of fetal hypoxia and stop the movement of the child through the birth canal.

· Weak labor activity: treatment

Treatment of weakness in childbirth should be carried out individually in each individual case, taking into account the anamnesis of the woman giving birth and the clinical picture, that is, the condition of the woman in labor and the child and the current situation.

Provides good help medical sleep-rest, especially with severe fatigue of a woman. For this, painkillers, antispasmodics and hypnotics are used. On average, the duration of medical sleep is no more than 2 hours, and labor activity usually recovers after that and becomes intense.

If weak labor activity occurs due to a flat fetal bladder, a long course of labor or polyhydramnios, then they can resort to help- open the fetal bladder, pierce it. It is also recommended for a woman in labor to lie exactly on the side where she is, i.e. the back of the fetus is present - thus, additional stimulation of the uterus occurs.

In case of ineffectiveness of all measures, the treatment of weakness of labor activity is carried out intravenous administration of uterotonics(means that enhance uterine contraction). Uterotonics are dripped very slowly, in parallel, a diagnosis of the condition of the fetus is necessarily carried out - the heartbeat of the child is constantly monitored. These drugs include. Prostogladins, in addition to their contractile properties, also stimulate cervical dilatation. Moreover, it is impossible to stop intravenous infusion of reducing agents, even when a good labor activity has been established. In addition to the treatment of weakness of labor, the prevention of fetal hypoxia is carried out with the help of such medicines as Actovegin, Sigetin, glucose preparations, cocarboxylases. If the effect of treatment, in the form of activation of labor activity, intensification of contractions, promotion of the child through the birth canal, is absent, it is necessary to carry out an emergency.

The reason for the weakness of labor most often the same factors are as with pathological precursors, sometimes the weakness of labor activity is a continuation of the pathological preliminary period.

So, the weaknesses of labor activity contribute to:
insufficient production of factors that contribute to the development of labor activity (low concentration of estrogens, prostaglandins, oxytocin, mediators, calcium, etc.), or an increased concentration of factors that inhibit the development of labor activity (progesterone, magnesium, enzymes that destroy mediators, etc.) ;
asthenization of a woman (overwork, excessive physical and mental stress, poor nutrition, insufficient sleep);
overstretching of the uterus (due to a large fetus, polyhydramnios, multiple pregnancy);
pathology of the uterus, which occurs as a result of anomalies, tumors, cicatricial changes, the consequences of an abortion;
physical inactivity of a woman, insufficient physical development can also lead to weakness in labor activity.

Weakness of labor most often occurs with premature, delayed birth, in women with a burdened obstetric-gynecological and somatic history, in young or elderly primiparas.
Fear, uncomfortable environment, poor service for women exacerbate risk factors. Often, weakness of labor activity occurs in the case of premature or early discharge of water.

Prevention. In the last week of pregnancy, and even more so in childbirth, it is necessary to assess the risk factors and the degree of readiness of the woman for childbirth. In the presence and identification of predisposing factors, it is necessary to carry out preventive training - both medication and psycho-physio-prophylactic (see the section "Overwearing").

Types of weakness of labor activity. Distinguish between primary and secondary weakness. It is also possible to distinguish between the weakness of contractions (in the I stage of labor) and attempts (already in the II period of labor). The primary situation is considered to be such a situation when the contractions from the very beginning were not active enough, sometimes pathological precursor contractions turn into weakness of labor activity.
There may be a secondary weakness of labor activity, when, after normal or even violent labor activity, its weakening occurs. Weakness in the second stage of labor (weakness of attempts) may be the result of weakness that developed in the first period.

Diagnosis of weakness of labor activity. The diagnosis is established on the basis of an assessment of contractile activity, which is judged by the subjective sensations of the woman, objective observations made by a midwife or doctor, and also on the basis of tocometry or hysterography. The frequency, duration, strength of the cotton wool and the correspondence of these data to the period and phase of labor are taken into account in comparison with indicators of normal labor.

For example, for the active phase of the first stage of labor, contractions shorter than 30 seconds with intervals of more than 5 minutes are considered insufficient.
For the end of the period of childbirth and the II period, contractions shorter than 40 seconds are weak. The rate of cervical opening is taken into account, which should not be less than 1 cm in 1 hour. The degree of disclosure is assessed objectively according to the vaginal examination and indirectly by the height of the contraction ring and the advancement of the head. With a duration of labor of more than 12 hours in a primipara and 10 hours in a multiparous, we can talk about the weakness of labor activity. Maintaining a partogram can facilitate the diagnosis of labor anomalies.

Treatment of weakness of labor activity. Treatment methods depend on the cause that caused it, the individual characteristics of the woman, the degree of weakness, the period and phase of childbirth, the likelihood of complications for the mother and fetus, and the conditions in which childbirth occurs. It is impossible without special indications to accelerate the course of labor in order to avoid other complications. If the reason for the weakness of labor activity is overwork, a sleepless night, then in the latent phase, especially with whole waters, medication sleep-rest is prescribed. With the depletion of reserves of strength, the creation of an estrogen-vitamin-glucose-calcium background is shown. Even in ancient times, broth, strong sweet tea with lemon, coffee, decoctions and infusions of tonics were used.

To replenish energy costs, the following means can be used:
Khmelevsky's method. In a modified form, this method involves the introduction of intravenous 20 ml of a 40% glucose solution, 10 ml of a 10% solution of calcium chloride, intramuscular injection of 1 ml of a 6% solution of vitamin B1.
Triad of Professor Nikolaev and its modifications. This is not only a method of preventing fetal hypoxia, but also an energy support for a woman, a means to improve microcirculation.
To replenish energy costs, the use of ATP, cocarboxylase, Essentiale, Actovegin is effective.

Previously, decoctions of plants containing contractile substances (ergot, shepherd's purse, cinchona) were used to stimulate labor. However, ingestion of poorly controlled agents can cause severe complications.
Since the second half of the XX century. The following methods have been used:
The Stein-Kurdinovsky scheme and its various modifications, in which:
- a hormonal estrogen background was created by introducing folliculin or sinestrol at a dose of 30 to 60 thousand units. actions. 1 ml of a 0.1% solution of sinestrol contains 10,000 IU of the drug. Therefore, it is necessary to enter 3 ml (30,000 IU). A 2% solution is administered at a dose of 0.15-0.30 ml intramuscularly. For fast action add 0.3 ml of ether;
- an hour later, agents were used to stimulate intestinal activity (castor oil orally at a dose of 30 to 50 ml) and an hour later a cleansing enema;
- after bowel cleansing, contractile agents were prescribed: quinine in powders at a dose of 0.05-0.1 g (from 4 to 6 powders in 30 minutes); oxytocin (or pituitrin before oxytocin) at a dose of 1-1.25 IU 4-5 times in 30 minutes. Pure oxytocin (1 ml or 5 IU) was diluted to 4-5 ml with saline or no-shpa and injected once every 30 minutes, 1 ml of the already diluted solution. Prozerin and pachycarpin were used as contractile substances, but now these drugs, as well as quinine, are not used without special indications.

Currently, labor-stimulating therapy is carried out most often with the help of intravenous drip administration of oxytocin at a dose of 5 ME (1 ml), diluted in 400-500 ml of saline, the rate of administration at the beginning is 4-6 drops per minute, can gradually increase to 12, up to a maximum of 20 drops per minute. Increasingly, prostaglandins, sometimes referred to as intracellular hormones, have been used. Prostaglandins E-2 (prostenon at a dose of 1 mg) are used more often in the latent phase of the disclosure period, prostaglandins F-2a (enzoprost at a dose of 5 mg) are used in the active phase of labor. The drug is diluted in 400-500 ml of saline and injected intravenously, as well as oxytocin. It is possible to simultaneously introduce both oxytocin and prostaglandins, but at a lower dose.

In some clinics, obzidan or anoprilin, related to beta-blockers, was used for labor stimulation (5 mg, diluted in 500 ml of saline, are administered intravenously at a rate of 20 drops per minute). It should be borne in mind that these drugs contribute to a decrease in heart rate and a decrease in blood pressure, therefore, they are used only for special indications, taking into account hemodynamic indicators.

Of the surgical methods with persistent weakness of labor, when conservative methods are not effective and complications for the mother and fetus are possible, the most rational is caesarean section, and in the second stage of labor - obstetric forceps. For late miscarriages, skin-head forceps are used.
The previously used Verbov bandage, when the uterus was covered with a thick towel, the ends of which were pulled by two assistants, pushing the fetus out of the uterine cavity, is practically not used, since it is a traumatic and ineffective method. ,
The Kresteller method is also traumatic, in which in the second stage of labor during labor, to enhance the movement of the fetus, the back surface of the forearm was pressed against the bottom of the uterus. If this method is used incorrectly and excessively, there may be injury to the uterus, fetus, there have been cases of rib fractures and liver injury.

Complications with weakness of labor activity: prolonged anhydrous period, development of infection, fetal hypoxia, retained placenta, postpartum hemorrhage, subinvolution of the uterus in the postpartum period and postpartum inflammation of the uterus. With improper use of labor stimulation, the weakness of labor activity can turn into another type of anomaly - violent labor activity or discoordination. Therefore, the midwife should be well aware of stimulation techniques and carefully monitor all the changes that occur.

The midwife must understand that when a dropper is installed, a woman is often deprived of the opportunity to move and take care of herself. Prolonged horizontal position does not contribute to the normalization of labor activity. Therefore, it is necessary to install a flexible catheter that makes intravenous infusion safer and also allows the woman in labor to walk.