Course of labor in different types of preliminaries

For practical obstetrics, the characteristics of the subsequent course of labor, depending on the duration of the preliminary period preceding it, are of great importance.

A reliable difference was established between the duration of the preliminary period in primiparous and multiparous women and the duration of labor. At the same time, with an increase in the duration of preliminary contractions, especially over 12 hours, the duration of labor increases. A more gradual, but progressively increasing prolongation of labor due to the duration of preliminary contractions (preliminary period - up to 6 hours, 7-12, 13-18, 19-24, over 24 hours) is observed in primiparous women, less noticeably in multiparous women.

With prolonged preliminary contractions (over 24 hours), the duration of labor for both primiparous and multiparous women increases almost 2-fold. Thus, if the average duration of labor with a preliminary period of up to 6 hours is 11.6 hours for primiparous women and 7.2 hours for multiparous women, then with a preliminary period of over 24 hours, the average duration of labor for primiparous women was 19.6 hours and for multiparous women - 14.2 hours.

A study of the incidence of labor weakness in primiparous women depending on the duration of the preliminary period preceding labor showed the following. If the duration of the preliminary period was up to 12 hours, labor weakness in primiparous women was detected in 5.08%, and when it increased beyond 24 hours, the incidence of labor weakness increased to 12.3%. The overall incidence of labor weakness in primiparous women was 23.07%. An analysis of the data obtained in multiparous women showed that out of 120 examined women, only 16 had labor weakness (13.3%). Moreover, labor weakness in multiparous women is most often observed when the preliminary period lasts beyond 24 hours.

The presence of a large fetus is of known importance in the development of the pathological preliminary period. Thus, out of 435 examined, 75 were noted to have large fetuses weighing more than 4000.0 g (17.2%).

Premature rupture of membranes was observed in 11.1 ± 1.6% of cases, in the control group - in 2.4 ± 1.5%. Early rupture of membranes increased with a preliminary period duration of over 7 hours (32.9 ± 5.01%) and remained high in all subsequent time groups (in the control group - 4.7 ± 2.12%). The overall percentage of premature rupture of membranes in labor with a preceding preliminary period was 36.8 ± 2.3%, and in the control group - 7.1 ± 2.6%.

Surgical interventions depending on the duration of the preliminary period accounted for 14.2% of cases. They were most often performed on women in labor with a preliminary period of over 24 hours. Caesarean section was performed on 56.2% of women in labor, forceps application - 45.4%, vacuum extraction of the fetus - 41.6%. A total of 16 women (3.6%) delivered by Caesarean section. Manual examination of the uterine cavity and manual separation and extraction of the placenta were performed in 13 cases (3.2%). The average blood loss was 187 ± 19 ml. Moreover, of the women in labor who had a blood loss of more than 400 ml, 52.2% were women with a preliminary period of over 24 hours. The overall percentage of pathological bleeding was 11.1%. In the control group, the incidence of pathological bleeding was 3%.

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