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Weak labor: a real danger or a convenient excuse for doctors? Causes of prolonged labor and weak labor

One of the most common complications during the birth of a baby is weak labor, 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 is ​​either too slow or does not open at all.

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

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

In each case, the reasons for weak labor may be different. Childbirth also proceeds differently for everyone.

Symptoms are determined by doctors directly during childbirth:

  • contractions are short 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 disturbed;
  • duration of labor;
  • fatigue of the woman in labor;

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

What to do with weak labor

If a weak labor 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 stimulate labor.

  • 1. Stimulation of labor without medication

Amniotomy (a procedure for opening the fetal bladder) enhances labor. It allows the expectant mother to cope on her own, without drug stimulation.

  • 2. Drug stimulation

In some cases, amniotomy is ineffective, so labor has to be stimulated with drugs. This can be medication sleep after the introduction 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. Caesarean section

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

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

Preventive measures

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

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

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

Childbirth is the long-awaited final stage of pregnancy. Every pregnant woman looks forward to this moment, expects an easy, beautiful birth and the appearance of a healthy baby.

Unfortunately, childbirth does not always go the way both the expectant mother and the doctor would like. To understand the pathology, consider the normal course of labor.

The process of childbirth begins with a preliminary (pre-laminar) period. During this period, the so-called "pacemaker" is formed on the right side of the uterine fundus - the zone in which the contraction of muscle fibers primarily occurs, spreading throughout the uterus. It is with its activation that the process of childbirth begins.

The preliminary period differs from labor pains in the absence of an increase in labor: the contractions hold for a long time (about 6 hours) at the same level in duration and strength, and after several hours they weaken and even stop for a while. Although, sometimes the prelaminar period quickly turns into active labor.

Each woman begins labor according to her own scenario. In the pre-laminar period, a woman usually does not feel pain during contractions, but notes a "drooping" of the abdomen and tension of the uterus.

Gradually, the prelaminar period passes into the first stage of labor - the period of disclosure. During this period, the cervix smoothes (it gradually decreases in length with each contraction) and the opening of the uterine pharynx (cervical opening) at the beginning of the opening period, a plug of thick viscous mucus with blood streaks erupts from the cervical canal.

Sometimes a small amount of "front" water is released, as a result of rupture of the membranes. The first stage of labor is the longest (up to 20 hours). The further the labor progresses, the more often individual uterine contractions (contractions) occur and last longer, on average, the contraction lasts one minute, the pauses between them are at first 10-15 minutes, and by the end of the opening period - one, even half a minute.

From the very first contractions, the child's head rushes down to the inner pharynx along the path of least resistance. The pressure of the head and the special position of the muscle fibers in the uterus contribute to the expansion of the uterine pharynx. Gradually, the baby's head moves along the opening uterine pharynx.

The opening of the cervix can be likened to breathing: in the act of breathing, the chest first expands, and then the latter is filled with dilated lungs. Under normal conditions, the fetal bladder ruptures at the moment of full opening of the pharynx of the tag, but in some cases it tears earlier, and when fully opened, it opens again.

In very rare cases (for example, during a premature pregnancy), the bladder does not rupture, and the baby is born with the placenta, membranes and amniotic fluid. Such children are said to be “born in a shirt”.

Already at the end of the first stage of labor, the woman in labor can feel the first attempts. Attempts are reflex (uncontrolled) contractions of the abdominal muscles; during pushing, a woman has an uncontrollable desire to push.

The appearance of attempts speaks of a very early onset of the second stage of labor - the period of exile. During this period, instead of contractions, the woman feels pressure "on the bottom", a feeling of fullness in the rectum. Exercising activity requires the greatest expenditure of energy from the expectant mother. During the pushing, you need to take a deep breath, and push down three times in one push.

Under the action of several attempts, the head drops down to the entrance to the vagina and becomes visible during the push. This is called head penetration. As you move along the birth canal, the head stops hiding in between attempts. This is the beginning of the eruption of the head.

If you reach your crotch, you can feel your baby's hair. After the birth of the head, there is a break in pushing. The birth of the child's shoulders and calf takes one or two attempts. Immediately after the birth of the baby, the woman feels incredible relief, but the birth is not over yet.

The third (successive) period of labor begins. The afterbirth, including the placenta and fetal membranes, is separated from the uterine walls. This process is carried out by the forces of uterine contractions, and partly by the forces of the abdominal press. Postpartum contractions and attempts resemble contractions and attempts of the first and second stages of labor, but in terms of strength and duration they are significantly inferior to the latter.

Of the three stages of labor, the longest is the period of disclosure (12-20 hours in primiparous and 6-12 hours in multiparous). The second stage of labor lasts about two hours for first-born women and 30-45 minutes for those giving birth. The duration of the third stage of labor is only 15-30 minutes.

This is the norm. Unfortunately, such a complication as the weakness of labor is not uncommon. Such a diagnosis is made to a woman in labor if there is insufficient strength, duration and frequency of contractions.

Contractions from the very beginning can be weak and ineffective (provided that the woman's pelvis allows the child to pass through the birth canal, that is, there is the correct ratio of the sizes of the fetus and the pelvis), in this case they speak of the primary weakness of labor. Less commonly, there is a condition called secondary weakness of labor. It is characterized by a gradual weakening of contractions, with a normal onset of labor.

Among the reasons leading to the weakness of labor, the dominance belongs to the psychogenic factor, and this is nothing more than the usual fear of childbirth. Fear often arises from the unpreparedness of the expectant mother for childbirth, she sometimes does not know what is happening with her body.

Today, in almost every city there are specialized clubs for expectant parents, maternity schools, where they help pregnant women to cope with doubts and fears, talk about the course of childbirth and ways to relieve pain.

Very often, the weakness of labor forces occurs in women who have contracted the flu or SARS shortly before childbirth. All the body's resources are busy fighting the virus, the strength for the normal course of childbirth becomes insufficient, so try not to catch a cold. Before going outside, smear your nose with Oxaline ointment, this will somewhat save you from infection.

Of course, one cannot but say about the dangers of abortion. Among the complications characteristic of abortion, there is also a weakness in labor. Abortion is not a way to prevent unwanted pregnancy, it is a serious trauma for the body.

In addition to general diseases, malformations and diseases of the genital organs can be the reasons for the weakness of labor forces. Genital infantilism (insufficient development of the genitals) is a common malformation, its mild form allows a woman to conceive and bear a child, but during the first birth, weakness of labor may occur.

With the next birth, contractions may be quite normal. A bicornuate uterus (when there is a division of the body of the uterus into two parts) can also be the reason for the weakness of contractions in the first stage of labor.

Myoma of the uterus is often an anatomical substrate for the development of weak labor. It is quite clear that the thinned, stuffed with myomatous nodes, the uterine muscle cannot contract correctly from the very beginning of labor. But if one myoma nodule is found in your ultrasound examination, do not panic, one node usually does not cause serious problems in childbirth.

Diseases of the genitals that cause weakness in labor include inflammatory diseases of the uterus. In the last decade, cases of sexually transmitted diseases (gonorrhea, chlamydia, trichomoniasis, etc.) have become more frequent, causing a lot of complications during pregnancy, including weakness of labor forces. Timely diagnosis (before pregnancy) allows you to effectively treat a couple, since most antibiotics are contraindicated during pregnancy.

Pregnancies with overstretching of the uterus can lead to primary contraction weakness during labor. These include polyhydramnios, multiple pregnancies, the transverse position of the fetus, a large (more than three) number of births in a woman.

Violation of the cervical dilatation process often occurs as a result of unjustified medical interventions before pregnancy. For example, it is not recommended to carry out radical treatment of "erosion" of the cervix in nulliparous women, since the operated cervix in childbirth is very poorly disclosed due to the formed scars.

The reasons listed above are more characteristic of the primary weakness of the birth forces.

Secondary weakness can be observed with prolonged, overly painful contractions, with a discrepancy between the pelvis and the head of the fetus, leading to fatigue of the woman in labor. Reflex secondary weakness of labor can be caused by an overflow of the bladder, therefore, in contractions, it is necessary to visit the toilet every hour.

Primary weakness is more common in the first half of the opening period. It can manifest itself in various forms. Most often, it is observed that uterine contractions develop poorly, their rhythm is slowed down, the duration of an individual contraction is insignificant.

Often there is a picture of a very slow, gradual increase in contractions throughout the entire period of opening, and the process of opening is also carried out slowly. There are cases where weak contractions alternate with periods of well-marked contractions. A typical clinical picture of the primary weakness of the contractions is its form, when the contractions are frequent, rather long, but weak.

Secondary weakness occurs after a more or less pronounced period of vigorous labor. Initially correct and energetic contractions gradually weaken, the rhythm slows down, the duration is shortened; quite often there comes a complete cessation of contractions for a more or less long period.

The onset of weakness in labor is dangerous for its complications. Possible infection of the genital tract, retention of parts of the placenta in the uterus, postpartum hemorrhage. For a baby, this condition is dangerous by the development of asphyxia - acute oxygen starvation.

Therefore, at the first signs of weakness in labor, the obstetric team is trying with all its might to speed up delivery. Fortunately, nowadays there are many ways to help both the child and the mother.

Of course, in this case, the woman's attitude to a favorable childbirth is very important. The main thing is to correctly determine the cause and deal with it. Sometimes it is enough to empty the bladder and the intensity of the contractions will begin to increase.

With polyhydramnios, timely opening of the fetal bladder (amniotomy) prevents the development of weakness in contractions.

With prolonged, protracted childbirth, the anesthesiologist, in the absence of contraindications from the fetus (signs of hypoxia and asphyxia), conducts medication sleep - drugs are injected intravenously to provide rest for a weary woman in labor.

The main method of treating the weakness of labor is the stimulation of the contractile activity of the uterus. For this, they are used - oxytocin, which enhances the contraction of the muscles of the uterus; prostaglandin E-2 (Enzaprost, Prostenone), which, in addition to enhancing the contraction of the uterus, improves blood flow in the placenta and, accordingly, improves the delivery of nutrients to the fetus; prostaglandin F - 2 (Exaprost), which is a very strong stimulator of uterine contractile activity.

Oxytocin is usually given by intravenous drip, while prostaglandins are given as vaginal tablets (Prostin), gels (Prepidil), and intravenous solutions. With ineffective stimulation of labor, a cesarean section is indicated.

If the fetal head is already in the pelvic cavity, then obstetric forceps are applied, the perineum is often dissected (perineotomy, episiotomy).

The modern development of medicine makes it possible to very quickly and effectively cope with such a serious problem as the weakness of labor.

Preparation for pregnancy is important in the prevention of this complication, when a couple is examined for sexually transmitted infections, the woman is examined by a therapist, endocrinologist, obstetrician-gynecologist. It is necessary to constantly monitor the course of pregnancy. And, of course, the most important thing is the psychological comfort of the expectant mother.

  • Which doctors should be consulted if you have Secondary weakness of labor

What is Secondary Weakness of Labor

At secondary weakness of the birth forces initially quite normal active contractions weaken, become less frequent, shorter and gradually may stop altogether. The tone and excitability of the uterus decreases. In essence, contractions subside during active labor. This is a secondary hypotonic uterine dysfunction.

The opening of the uterine pharynx, reaching 5-6 cm, no longer progresses, the presenting part of the fetus does not advance along the birth canal, stopping in one of the planes of the pelvic cavity.

Secondary weakness of labor develops most often at the end of the opening period or in the period of expulsion of the fetus.

Secondary hypotonic weakness of labor may be the result of fatigue of the woman in labor or the presence of an obstacle that stops labor. After a certain period of attempts to overcome the obstacle, the contractile activity of the uterus - its mechanical work - weakens and may stop for some time altogether.

What provokes Secondary weakness of labor

The causes of secondary weakness are numerous.

  • The same reasons that cause the primary hypotonic weakness of the birth forces, but when they are less pronounced and show their negative effect after the depletion of protective-adaptive and compensatory mechanisms.
  • Fatigue of a woman in labor, which may be the result of a sleepless night or several nights (pathological preliminary period), stressful situations, fear of childbirth and negative emotions.
  • An obstacle to the further disclosure of the uterine pharynx or the advancement of the fetus through the birth canal: anatomical (cicatricial) changes in the neck - low location of the myomatous node; abnormal anatomical shape of the pelvis, narrowing one of the dimensions of the wide, narrow part of the pelvic cavity or the exit plane; a clinically narrow pelvis due to a violation of the biomechanism (extension of the head, asynclitic insertion).
  • Inadequacy of the abdominal muscles, causing weakness of attempts (multiple births, hernia of the white line of the abdomen).
  • Iatrogenic causes: indiscriminate and inept use of anticholinergic, antispasmodic and analgesic drugs.
  • Large fetus, posterior occipital presentation, low transverse position of the sagittal suture.

Symptoms of Secondary Weakness of Labor

The clinical picture of secondary weakness coincides with the primary weakness of labor, but the lengthening of labor occurs most often in the active phase of labor and in the period of expulsion of the fetus. The opening of the neck is complete, and the presenting head of the fetus has not descended to the pelvic floor, it is located only by a small or large segment at the entrance to the pelvis (spaced from the spinal plane in position -2, -1, 0 or +1, +2). The woman in labor begins to push prematurely, unsuccessfully trying to speed up the birth of the child (without heeding the recommendations of the medical staff). Naturally, quick fatigue sets in, fatigue from useless, unproductive work.

Premature attempts can occur reflexively if the cervix is ​​pinched between the fetal head and the posterior wall of the pubic symphysis, or a large birth swelling occurs on the fetal head and its lower pole can irritate the receptors of the pelvic floor muscles. But this most often happens with a generally narrowed pelvis, when it has a wedge-shaped insertion of the fetal head.

Treatment of Secondary Weakness of Labor

The choice of tactics for the management of labor in case of weakness of labor

Before proceeding with the treatment of weakness in labor, it is necessary to find out the possible cause of its occurrence.

The main thing is to exclude a narrow pelvis, namely one or another degree of disproportion in the size of the fetal head and the mother's pelvis; failure of the uterine wall, unsatisfactory condition of the fetus.

With these types of pathology, any therapy that stimulates the uterus is contraindicated!

A clinically narrow pelvis is evidenced by the stop of the fetal head at the entrance to the small pelvis or in the "0" position (the spinal plane is the narrow part of the pelvic cavity). A slowdown in the advancement of the fetal head in the "+1" position and below indicates either a posterior view (antero-cephalic presentation), or a low transverse position of the sagittal suture.

Failure of the myometrium can be suspected in the presence of a corresponding burdened obstetric history (complicated abortion, postponed pathological, "difficult" childbirth, endomyometritis, operations on the uterus - myomectomy, cesarean section).

An important factor in choosing the tactics of conservative or operative delivery is the assessment of the condition of the fetus and its reserve capabilities. To assess the fetus in labor, one should take into account not only its body weight, presentation, frequency, rhythm and sonority of fetal heart sounds, but also CTG data, ultrasound echography, assessment of the biophysical profile of the fetus, as well as the results of cardiointervalography, the state of the uteroplacental and fetal-placental blood flow.

The doctor's tactics may vary depending on the specific obstetric situation. First of all, it is necessary to provide for the feasibility of delivery by cesarean section.

With a high risk of prolonged, protracted labor (late primiparous age, aggravated obstetric and gynecological history, infertility, stillbirth, induced pregnancy, breech presentation, large fetal size, post-term pregnancy), the management plan for primary labor weakness should be timely determined in favor of cesarean section.

Without prior delivery stimulation, caesarean section as the optimal method of delivery is chosen in the presence of:

  • a scar on the uterus, the usefulness of which is difficult to determine or it is questionable;
  • with anatomically narrow pelvis;
  • in multiparous because of the danger of rupture of the insolvent myometrium;
  • in case of an unsatisfactory condition of the fetus (IUGR, fetoplacental insufficiency).

Caesarean section is also indicated in case of an unsatisfactory state of health of a woman (the presence of a pathology in which heavy physical exertion is contraindicated). At the same time, young age, repeated childbirth are not decisive, leading to the motivation of refusal from cesarean section.

Radical management of labor takes place in recent years, due to the concept of modern obstetrics.

  • The child should be born alive and healthy without hypoxic-ischemic and traumatic injuries.
  • It is necessary to minimize the risk of using obstetric forceps, forcible extraction of the fetus using a vacuum extractor or manual techniques, turns and other operations.
  • It is necessary to realize the danger of unfavorable outcomes for the mother and the fetus during a prolonged course of labor with the use of medication-induced sleep-rest, prolonged, many hours, repeated rhodostimulation and the need to finally apply atypical abdominal forceps.
  • For each woman in labor, an individual birth plan is drawn up, taking into account the existing and growing risk factors.
  • The number of previous births (primiparous, multiparous) should not affect the expansion of indications for caesarean section, performed according to the indication from the fetus.

The combination of the weakness of labor with prenatal rupture of amniotic fluid with an anhydrous interval of 8-10 hours or more does not leave time for providing sleep-rest to the woman in labor, since there is a risk of intrapartum infection of the fetus and the development of an ascending infection in the mother.

The incidence of infectious complications increases in proportion to the increase in the anhydrous gap. The maximum anhydrous interval until the moment of delivery should not exceed 12-14 hours! Therefore, long-term management of labor with repeated use of medicinal stimulants is possible rather as an exception in the presence of aggravating circumstances (the presence of contraindications to caesarean section) than the rule of modern labor management tactics.

Most often, conservative treatment of weakness of labor is chosen and with the elimination of the cause that caused this complication.

Before proceeding with rhodostimulation, an attempt is made to eliminate the causes that caused the violation of labor.

Possible causes to be eliminated include:

  • polyhydramnios;
  • functional inferiority of the fetal bladder (dense amnion, dense adhesion of the amnion and decidua);
  • fatigue of the woman in labor.

The complex of preparatory measures includes:

  • accelerated preparation of the cervix using prostaglandin E2 preparations;
  • amniotomy;
  • the use of an energy complex, as well as agents that improve uteroplacental blood flow.

With polyhydramnios (which causes overstretching of the uterus) or with a functionally defective fetal bladder (in which the amnion has not exfoliated from the walls of the lower segment of the uterus), an artificial opening of the fetal bladder, dilution of the membranes and slow excretion of amniotic fluid should be performed. To carry out this manipulation, the presence of conditions and contraindications should be taken into account.

Amniotomy conditions:

  • "Mature" cervix.
  • Opening of the cervical canal by at least 4 cm (the beginning of the active phase of labor).
  • Correct, longitudinal position of the fetus.
  • Head presentation.
  • Absence of imbalance in the pelvis and fetal head (confidence in full proportionality).
  • Elevated position of the upper half of the body of the woman in labor (Fowler position).
  • Full compliance with the rules of asepsis and antiseptics.

You can not open the fetal bladder when:

  • "immature" or "not mature enough" cervix;
  • small (up to 4 cm) opening of the cervix (latent phase of labor);
  • anatomically narrow pelvis;
  • incorrect position of the fetus (oblique, transverse);
  • breech (foot) presentation;
  • extension of the head, frontal presentation and posterior parietal asynclitic insertion, in which childbirth through the vaginal birth canal is impossible;
  • lower genital tract infections;
  • a scar on the uterus, if there is evidence of a possible inferiority of the myometrium (abortion, therapeutic and diagnostic curettage, endometritis, etc.);
  • old ruptures of the cervix of the III degree (rupture to the internal pharynx), in which childbirth through the vaginal birth canal is very dangerous (the risk of rupture of the internal pharynx with the transition to the lower segment of the uterus).

The main method of treating weakness of labor is rhodostimulation, which is usually performed when the fetal bladder is opened. Rhodostimulation with a whole fetal bladder can cause amniotic fluid embolism, premature placental abruption, associated with a violation of the pressure gradient in the amnion cavity and intravillous space.

Amniotomy is accompanied by a decrease in the volume of the uterine cavity, which in turn normalizes the basal tone of the uterus, 15-30 minutes after the amniotomy, the frequency and amplitude of contractions increase, labor activity, as a rule, increases.

Treatment of weakness in labor (rhodostimulation)

Stimulation is the primary treatment for hypotonic uterine dysfunction, a primary or secondary weakness in labor.

Before childbirth, it is necessary to assess the well-being and condition of the woman in labor, take into account the presence of fatigue, fatigue, if childbirth lasted more than 8-10 hours or the childbirth was preceded by a long pathological preliminary period (sleepless night). In case of fatigue, it is necessary to provide medication sleep-rest.

Before continuing the conservative management of childbirth, additional complications should be envisaged: the lack of effect from previously carried out birth stimulation, lengthening of the anhydrous gap with its characteristic inflammatory complications (endomyometritis, chorioamnionitis, intrauterine infection), deterioration of the fetus, the possibility of developing secondary weakness of labor forces and ultimately - the need to apply obstetric forceps, including abdominal forceps (atypical).

All this can lead to a very likely risk of obstetric injury for the mother and the fetus, bleeding in the successive and early postpartum periods, fetal hypoxia, inflammatory complications in the postpartum period.

So, as a result of insufficiently thought out tactics, such childbirth can have an extremely unfavorable outcome: the child will be born dead or in deep asphyxia, with severe traumatic-hypoxic damage to the central nervous system. Due to severe uterine bleeding, the question of removing the uterus may arise. After a difficult birth, neuroendocrine disorders develop later, etc.

In this regard, in each individual case, before providing sleep-rest or proceeding with childbirth, it is necessary to assess the obstetric situation, conduct an in-depth examination of the woman in labor and her fetus, decide whether the fetus will withstand the forthcoming many hours of conservative management of childbirth.

It is necessary to investigate the blood flow (uterine, placental, fetal) using ultrasound dopplerometry, to assess the reactivity of the fetal cardiovascular system using the dynamic CTG method, and also to identify the degree of protective and adaptive capabilities of the mother and the fetus, their anti-stress resistance, which is possible when using a new methodological approach with using cardiointervalography.

Obstetric sleep-rest should be carried out by an anesthesiologist. If there is no such specialist, the obstetrician-gynecologist prescribes a combination of drugs: promedol 20 mg, diphenhydramine 20 mg, seduxen 20 mg intramuscularly.

After rest, they start rhodostimulation. Often, it is enough to give the woman in labor a rest so that after waking up normal labor activity is restored. If labor has not returned to normal, then 1-2 hours after waking up, they begin to administer drugs that increase the contractile activity of the uterus.

Rodostimulation rules

  • Rhodostimulation must be careful to achieve a physiological (but no more) rate of labor.
  • They start with the minimum dosage of the drug, gradually selecting (every 15 minutes) the optimal dose, at which 3-5 contractions pass in 10 minutes. The amount of the injected drug is controlled according to this criterion.
  • Rhodostimulation with oxytocin and F2a prostaglandin preparations is carried out only when the fetal bladder is opened, with sufficient biological "maturity" of the cervix and opening the throat by at least 6 cm.
  • The use of E2 prostaglandin preparations does not always require prior amniotomy. In addition, stimulation with drugs of this class is most appropriate for small opening of the cervix or uterine pharynx.
  • The duration of delivery should not exceed 3-4 hours.
  • Due to the danger of fetal hypoxia or uterine hypertonicity, rhodostimulation is carried out against the background of drip intravenous administration of antispasmodics (no-shpa).
  • In case of insufficient effectiveness of corrective therapy within 1 hour, the dose of the drug is doubled or the treatment is supplemented with another uterine stimulating agent (for example, a combination of prostaglandins and oxytocin).
  • The drug is chosen in accordance with the imitation of the natural mechanism of development of labor: with a small opening of the neck (4-5 cm), prostaglandin E2 preparations are preferred. With a significant opening (6 cm or more), as well as in the second stage of labor, prostaglandin F2a or oxytocin preparations are used. It is advisable to combine oxytocin and prostaglandin F2a preparations in half the dosage (potentiate each other's action).
  • The intravenous route of administration of the stimulant is more manageable, controlled, and effective. The action of the drug (if necessary) can be easily discontinued. Intramuscular, subcutaneous, and oral routes of administration of stimulant drugs are less predictable.

For drug protection of the fetus, seduxen (10-12 mg) is administered. The optimal injection time is the passage of the fetal head through the narrow part of the pelvis.

Weakness in labor is the most common cause of complications in childbirth, as well as one of the most common problems faced by a woman in labor. Weak labor leads to a protracted labor process, causes fatigue in the mother and hypoxia in the child.

How can you recognize weak labor?

In the first stage of labor, contractions are very weak, short-lived, they can last for many hours and exhaust the woman. As labor continues, the contractions intensify, but not negligibly, while there is practically no cervical dilatation. All this is due to violations of the dynamics of the opening of the uterine pharynx.

What is the reason for the weakness of labor?

Oddly enough, but weak labor is often found in primiparous women. Surely, we all heard stories about how a woman quickly gave birth to a child: just an hour, and the baby was born. We hear these stories in the news, they are full of forums on the Internet, and almost every family has such a “legend”. However, there is nothing strange here - it usually happens to women who have already had previous childbirth experience. Moreover, very often these women are mothers of many children.

Quite the opposite is the case with women who are preparing to become a mother for the first time. A woman's body has to go through difficult tests: the first pregnancy is a complex hormonal restructuring of the body, and the subsequent childbirth is another hormonal “restructuring”, and a cardinal one. A few days before the onset of childbirth, the body must completely rebuild and prepare for the end of the pregnancy period, and at the beginning of the birth process - to establish the production of hormones so that the stages of childbirth pass correctly.

But here, as a rule, failures occur. The body of a primiparous woman is not yet familiar with such a hormonal surge, and therefore labor activity does not always go smoothly.

However, there are other reasons for weakened labor, and we will list them for you now:

1. Flat amniotic fluid. This is a rather rare situation, but a flat bladder interferes with the lowering of the fetus into the small pelvis and the child's progress along the birth canal.

2. Low hemoglobin. Anemia in pregnant women is not uncommon, and weak labor is one of its consequences.

3. Woman's fatigue. This is both a cause and a consequence of the weakness of labor. And all because if a woman already has a predisposition to violations of the birth process, then prolonged labor will further aggravate the situation: the body of a woman in labor, tired and exhausted by hard work, refuses to obey the hormones of childbirth and is unable to cope with an even more increasing load. As a result, the body's defenses of a woman in labor slow down labor.

4. Fear of childbirth. Fear of childbirth is inherent in many expectant mothers, and not only primiparous. In multiparous women, the cause of fear may be a negative experience of previous childbirth, which passed with complications, or simply fear of pain. Primiparous women do not know what exactly awaits them in childbirth, do not know how to behave and what to do. All this affects the process of opening the cervix: the physical tension of the muscles and the tightness of the woman is transmitted to the lower parts of the uterus, which inhibits the opening of the uterus, and therefore labor activity.

5. Inappropriate behavior during childbirth. All obstetricians-gynecologists unanimously talk about how important it is to tune in correctly for childbirth: here you need a positive psychological attitude, the ability to relax at the right time and, of course, correct breathing. A lot depends on proper breathing during childbirth. During contractions, it is advisable to breathe deeply and relax, so that the lower segment of the uterus relaxes, and this helps the cervix to open. If a woman does not relax, let alone screams during contractions, then the cervix cannot open properly.

Most of the listed signs refer to the primary weakness of labor, that is, if the woman's body is prone to prolonged labor. However, there is also such a thing as secondary weakness of labor, and it may not appear immediately. That is, childbirth can occur normally, and the dynamics of cervical dilatation is perfect, when suddenly the labor contractions of the woman in labor begin to diminish in their intensity, and sometimes even fade away altogether.

What does the doctor do when labor is weak?

The tactics of an obstetrician-gynecologist depends on many factors. First of all, the doctor assesses the duration of the period of weakness in childbirth and correlates this with the dynamics of cervical dilatation. Ideally, the cervix should open 1 cm per hour. If it lasts up to 3-4 hours, then we are talking about a weak labor, which can lead to fetal hypoxia.

The doctor resorts to stimulation of labor in the following cases:

- the duration of the labor process is more than 12 hours

- childbirth began with the outflow of amniotic fluid, and the anhydrous period is 12 to 24 hours

- fetal hypoxia was diagnosed, and therefore it is necessary to end labor as soon as possible

How can labor be stimulated?

Common methods of stimulating labor are bladder puncture and oxytocin administration.

The puncture of the bladder works, of course, only if the labor is in progress, and the outpouring of water has not occurred. As a rule, it helps the cervix dilation well and stimulates the contractions to intensify. In most cases, a woman in labor does not even need the introduction of any medication, she is able to give birth herself.

If the puncture of the bladder did not work, or labor began with the outpouring of water, but there were no significant changes in the opening, then the doctor prescribes stimulation with oxytocin. It should be noted that the introduction of oxytocin should be carried out under strict monitoring of the condition of the fetus, observation of its heartbeat. In case of violations of the fetal cardiac activity, it is necessary to stop stimulation and resort to a caesarean section, because further delivery can be dangerous for the child.

Oxytocin should be used in conjunction with pain relievers such as epidural anesthesia. However, it should be noted that the use of epidural anesthesia, although it reduces pain, inhibits labor.

It is important to know that stimulation with oxytocin is contraindicated in women with a scar on the uterus, as it can cause the uterus to rupture along the scar due to its excessive stress. Also, it is necessary to strictly control the dosage of oxytocin, otherwise, it will cause a violent, discoordinated labor activity, which is dangerous for a woman and a child, and can cause acute fetal hypoxia, threatening rupture of the uterus and placental abruption.
How to prevent the weakness of labor?

Despite the fact that in some cases the weakness of labor is hereditary, in other cases a woman is able to prepare for childbirth in the right way in order to prevent such an unpleasant phenomenon as weakness of labor.

For this, it is important to prepare yourself psychologically. Take a course for pregnant women, where the doctor will tell you in detail about childbirth. Also, take vitamins during pregnancy. Vitamin B6, ascorbic and folic acid will help you with this.

A good factor and the key to a successful birth is a careful approach to choosing a doctor for childbirth. A woman should completely trust her doctor and feel comfortable. It will be good if you start looking in advance for a doctor who is taking part in childbirth.

Happy pregnancy and childbirth!

Normally, the birth of a child into the world should take place without any complications, both from the female body and from the baby. But in practice, doctors often have to deal with various problems during childbirth, and one of the most common among them is considered to be birth weakness. It is much easier for specialists to correctly resolve problem situations if the woman in labor herself has accurate information about what weak labor is, knows the causes and symptoms of such a violation, and roughly understands what to do in such a situation.

Causes

According to obstetricians-gynecologists, there are many factors that can slow down labor. So such a violation can develop as a result of neuroendocrine, as well as somatic ailments of the woman in labor. Sometimes it is provoked by overstretching of the uterus, which is often observed with polyhydramnios or multiple pregnancies. In some cases, weak labor is a consequence of complications of gestation, pathologies of the myometrium, as well as defects of the fetus itself, for example, disorders of the nervous system, aplasia of the adrenal glands, presentation, delayed or accelerated maturation of the placenta.

Labor activity may weaken due to a too narrow pelvis of the woman in labor, the presence of tumors in her, insufficient elasticity of the uterine neck.

Sometimes such a violation occurs as a result of the fact that the readiness of a woman and her child for childbirth does not coincide and is not synchronous. In certain cases, weak labor is caused by stress, the age of the woman in labor up to seventeen or after thirty years, as well as her lack of physical activity.

Symptoms

Manifestations of weak labor are determined by doctors directly during childbirth. At the same time, the woman in labor has short contractions of low intensity. The opening of the uterine cervix occurs rather slowly, and the fetus, in turn, moves along the birth canal at a low speed. The intervals between contractions, instead of shortening, begin to increase, and the rhythm of the uterine contractions is also disturbed. Childbirth is distinguished by a special duration, which becomes the cause of the strongest fatigue of the woman in labor. With weak labor, the fetus experiences a lack of oxygen, which can be traced using CTG.

If we are talking about the primary type of generic weakness, then contractions are characterized by low severity and insufficient effectiveness from the very beginning. The secondary form of pathology begins to develop after the normal onset of labor.

What to do?

The actions of an obstetrician-gynecologist with the development of birth weakness depend primarily on the causes of such a violation. Unfortunately, doctors now decide to speed up labor more often than is necessary. Quite often, the first birth really takes a very long time, and if the fetus is not threatened by hypoxia, there is simply no point in stimulation. In certain cases, in order for labor to recover, a woman in labor needs to calm down a little and rest.

In the event that birth weakness really poses a threat to the mother or child, experts take measures to stimulate it.

Amniotomy, the process of opening the fetal bladder, is considered to be a fairly safe non-drug method to enhance labor. Such a procedure can be carried out if the uterine cervix has opened by two centimeters or more. The outpouring of water often leads to increased contractions, as a result of which the woman in labor can do without medicines.

In some cases, experts make a decision to introduce a woman into a drug-induced sleep for about two hours, which allows her to somewhat restore the strength and resources of her body. To carry out such a manipulation, an anesthesiologist's consultation and a competent analysis of the child's condition are required.

Ureotonic stimulants can be used to directly accelerate and intensify contractions. Most often, obstetricians prefer oxytocin and prostaglandins, they are usually administered intravenously using a dropper. At this time, fetal heartbeat is monitored using CTG.

In parallel with stimulating drugs, antispasmodics, analgesics or epidural anesthesia are often used, since a sharp increase in contractions against the background of drug administration is extremely painful. And such a list of drugs can adversely affect the condition of the child, respectively, they are used only according to indications, if the harm from such a correction is lower than from prolonged childbirth.

In the event that all of the above measures do not give a positive result, a decision is made to conduct an emergency caesarean section.

What can an expectant mother do?

You need to prepare for childbirth long before the date of X. It is advisable to choose a maternity hospital where the woman in labor will feel comfortable, you also need not be afraid of the upcoming birth and get as much information about this process as possible. To prevent birth weakness, it is extremely important to actively behave after the onset of contractions - to walk, use fitball, wall bars, etc. The correct approach to childbirth, confidence in a favorable outcome, support of loved ones and qualified obstetricians help to reduce the likelihood of developing birth weakness to a minimum.