Dyscoordinated labor

Discoordination of labor is understood as the absence of coordinated contractions between different parts of the uterus: the right and left halves, the upper (fundus, body) and lower parts of the uterus, between all parts of the uterus.

The reasons for uncoordinated contractions may be:

• malformations of the uterus (bicornuate, saddle-shaped, septum in the uterus, etc.);
• cervical dystocia (rigidity, cicatricial changes, cervical atresia, cervical tumors, etc.);
• clinical inconsistency;
• flat fetal bladder;
• disruption of innervation;
• lesions of limited areas of the uterus due to inflammatory, degenerative and neoplastic processes (uterine fibroids).

As a result, the ability of the neuromuscular system to perceive irritation in the altered areas is reduced, or the altered muscles lose the ability to respond to received impulses with normal contractions. Irrational management of labor is of great importance: insufficient pain relief, labor induction without sufficient readiness of the body for labor, unjustified labor stimulation, etc.

The incidence of discoordination of labor is approximately 1-3%.

In practical activities, it is advisable to distinguish the following types of uncoordinated labor activity:

• discoordination (impaired coordination of contractions between different parts of the uterus);
• hypertonicity of the lower segment (reverse gradient);
• convulsive contractions (uterine tetany, or fibrillation);
• circular dystocia (contraction ring).

Some authors distinguish three degrees of severity of uncoordinated labor.

Symptoms of uncoordinated labor are characterized by the presence of painful irregular, sometimes frequent contractions, pain in the lumbar region and lower abdomen. When palpating the uterus, its tension in different parts is uneven, as a result of uncoordinated contractions. Immaturity of the cervix, its slow opening, and sometimes absence of the latter, is often noted, cervical edema often occurs. With uncoordinated labor, premature rupture of amniotic fluid, a flat fetal bladder are often observed. The presenting part of the fetus remains mobile or pressed to the entrance to the small pelvis for a long time. Later, the woman in labor becomes tired and contractions may stop. The process of labor slows down or stops. In the afterbirth period, anomalies of placental abruption and retention of its parts in the uterine cavity may be observed, leading to bleeding.

When labor is discoordinated, uteroplacental blood circulation is sharply disrupted, resulting in fetal hypoxia.

The diagnosis of labor discoordination is established based on the described clinical picture of prolonged labor, ineffective contractions, and delayed cervical dilation. The most objective method is to record uterine contractions using multichannel hysterography or intrauterine pressure recording.

Multichannel hysterography reveals asynchrony and arrhythmia of contractions of various parts of the uterus. Contractions of varying intensity and duration. The triple descending gradient is disrupted and the fundus dominant is usually absent. The tocographic curve in case of discoordination takes an irregular shape during the pressure increase or decrease, or throughout the contraction. A sharp change in tone, contraction intensity, prolonged "acme", a longer rise and a shortened fall, a sudden increase in the total duration of the contraction with low figures of the total intrauterine pressure should be regarded as a manifestation of discoordination.

Discoordination of labor activity is observed in the first stage of labor, usually before the cervix is 5-6 cm dilated.

Discoordination of labor activity should be differentiated primarily from weakness and clinical inconsistency, due to the different treatment tactics for these conditions.

In this condition, careful monitoring of the nature of labor, cervical dilation, insertion and advancement of the presenting part of the fetus and its condition is necessary. Opening the fetal bladder has a good effect. A gross error is the prescription of oxytotic agents for the treatment of discoordination (!).

For the treatment of labor discoordination, it is recommended to conduct psychotherapy, therapeutic electroanalgesia, use analgesics (20-40 mg promedol), antispasmodics (2-4 ml of 2% no-shpa solution, 2 ml of 2% papaverine hydrochloride solution, 5 ml baralgin, etc.), beta-mimetic agents (0.5 mg partusisten or brikanil diluted in 250 ml of isotonic sodium chloride solution or 5% glucose solution and administered intravenously by drip), sedatives (seduxen 10 mg).

The introduction of antispasmodics should be started as early as possible and regularly carried out every 2-3 hours throughout the entire labor. It is advisable to use a 0.1% folliculin solution in oil (20-30 thousand units), a 2% solution of synstrol in oil (10-20 mg) intramuscularly every 3 hours (up to 3 times a day).

To enhance the formation of endogenous prostaglandins, use linetol (30 ml) or arachiden, 20 drops 2-3 times during labor.

If the woman in labor is tired, she needs to be given medicinal rest for 2-3 hours. Prevention of fetal hypoxia by periodic inhalation of 60% humidified oxygen is indicated.

If discoordination of labor activity does not respond to conservative treatment, often, especially when signs of intrauterine fetal distress appear, there is a long anhydrous period, and a complicated obstetric history, the question of surgical delivery by cesarean section should be raised in a timely manner.

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