Convulsive contractions (tetany, or uterine fibrillation)

Convulsive fights are characterized by a prolonged contraction of the uterine musculature. In tetany, the uterus contraction follows one after another, pauses between them are not observed. With the onset of tetany, the frequency of contractions increases (more than 5 fights in 10 minutes), their intensity progressively decreases and rapidly because of incomplete relaxation, the uterine hypertonus increases. The latter is kept on high figures for a long time, bouts are practically not determined. Then the tone of the uterus slowly and gradually decreases to a normal level, as it decreases, the intensity of contractions increases.

The cause of the appearance of convulsive contractions of the uterine musculature can be:

• clinical mismatch;
• premature placental abruption;
• repeated attempts at obstetric turn, application of obstetric forceps, extraction of the fetus behind the pelvic end;
• Other interventions without anesthesia, produced unsuccessfully due to lack of obstetrical conditions or knowledge of the technique of the operation.

Spastic contractions of the musculature of the uterus can occur with the appointment in birth of ergot preparations, an overdose of quinine hydrochloride, oxytocin and other medications.

At tetany of the uterus, the condition of the intrauterine fetus is severely affected.

Clinically, the tetany of the uterus is manifested by general anxiety, continuous abdominal pains, absence of uterine relaxation, sometimes with complaints of tenesmus from the bladder and rectum, with catheterization of the bladder, small portions of stagnant urine, a feeling of pressure on the bottom, an increase in heart rate, pain in the sacral lumbar region. At palpation, the entire uterus is of stony density, painful, its shape is changed. A part of the fetus and its present part can not be squandered. With vaginal examination, the tension of the muscles of the pelvic floor, narrowing of the vagina, swollen edges of the uterine throat. If the fetal bladder is intact, it is stretched on the presenting part. In the absence of a fetal bladder, there is a marked genital tumor, which makes it difficult to identify the sutures and fontanelles.

With this form of pathology, the utero-placental circulation and gas exchange in the fetus are violated, which is manifested by intrauterine hypoxia. Palpitation of the fetus is usually not heard or listened with difficulty. The birth is suspended.

The diagnosis can be established on the basis of the given clinical picture. In hysterography, it is seen that the frequency of contractions increases sharply and uterine tone increases, and bouts are practically not determined and this state can last a considerable time (up to 10 or more minutes). Then the tone of the uterus gradually decreases to a normal level, and as it decreases, the intensity of contractions increases.

Treatment for the tetany of the uterus depends on its cause. So, when an overdose of oxytocytics should immediately stop their introduction and, if necessary, give the woman in labor a deep anesthesia with ether or ftorotan or promptly adjust intravenous beta-adrenomimetics (partusisten or briikanil, etc.).

With clinical mismatch, after anesthesia, you should proceed to a caesarean section (sometimes on a dead fruit). Obstetrical anesthesia usually removes tetany and normalizes labor. If the birth canal is prepared, then under anesthesia the fetus is extracted with the aid of obstetric forceps or by the leg (with breech presentation). With a dead fetus, a craniotomy is performed. After fetal extraction, manual removal of the placenta, isolation of the placenta and examination of the uterine cavity are shown to exclude a rupture.

With tetany of the uterus, the presence of fetal hypoxia and the absence of conditions for vaginal delivery, the operation of the caesarean section is indicated.

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