The course of labor with various types of preliminaries

For practical obstetrics, the special features of the subsequent course of labor are important, depending on the duration of the preliminaries preceding them.

A significant difference was established between the duration of the preliminary period in the first and the re-birth and the duration of the birth act. At the same time, as the duration of preliminar contractions increases, especially over 12 hours, the duration of labor increases. A more gradual, but progressively increasing lengthening of labor due to the duration of preliminaries (preliminaries - up to 6 h, 7-12, 13-18, 19-24, over 24 h) are observed in primiparas, less noticeably in the re-birth.

With a protracted period of preliminaries (more than 24 hours), the length of labor for both the first and the parasitic increases almost 2-fold. So, if the average length of labor for a preliminar period of up to 6 hours is 11.6 hours for primiparous and 7.2 h for maternity, then for a preliminar period of more than 24 hours the average duration of labor in primiparous animals was 19.6 hours, and in maternity wards, 14, 2 hours

The study of the frequency of development of weakness in labor activity in primiparas, as a function of the duration of the preliminaries preceding the birth, showed the following. If the duration of the preliminary period was up to 12 hours, the weakness of labor activity in primiparas was detected in 5.08%, and with an increase of more than 24 hours the incidence of development of weakness of labor activity increased to 12.3%. The total percentage of development of weakness in labor activity in primiparas was 23.07%. The analysis of the obtained data in the re-births shows that out of 120 examined only 16 had a weakness of labor (13.3%). At the same time, the development of the weakness of labor activity in the re-parenting is most often observed with the duration of the preliminaries over 24 hours.

A significant role in the development of the pathological preliminaries is the presence of a large fetus. Thus, out of 435 examined in 75, large fetuses weighing more than 4000.0 g (17.2%) were recorded.

Premature outpouring of amniotic fluid was noted in 11.1 ± 1.6% of cases, in the control group - in 2.4 ± 1.5%. The early outflow of amniotic fluid increased with the duration of the preliminaries over 7 hours (32.9 ± 5.01%) and remained high in all subsequent time groups (in the control group - 4.7 ± 2.12%). The total percentage of untimely discharge of water in labor with the previous preliminar period was 36.8 ± 2.3%, and in the control group - 7.1 ± 2.6%.

Operative interventions, depending on the duration of the preliminaries, accounted for 14.2% of cases. Most often they were given to women in labor with a preliminar period of more than 24 hours. Cesarean section produced 56.2% of parturient women, operation of applying obstetrical forceps - 45.4%, vacuum extraction of the fetus - 41.6%. In total, 16 women (3.6%) were delivered to the cesarean section. The operation of manual examination of the uterine cavity and manual separation and recovery of the afterbirth was performed in 13 cases (3.2%). The average blood loss was 187 ± 19 ml. At the same time, of women who had a blood loss of more than 400 ml, 52.2% were women with a duration of the preliminaries over 24 hours. The total percentage of pathological bleeding was 11.1%. In the control group, the incidence of pathological bleeding was 3%.

Complicated postpartum period was observed in 23 (5.28%) - infected subinvolution of the uterus, metroendometritis, metrotrombophlebitis, secondary anemia, threatening mastitis, etc.