Discoordinated labor activity

Under the discoordination of labor, we understand the absence of coordinated contractions between the different parts of the uterus: the right and left halves of the uterus, the upper half (the bottom, the body) and the lower parts of the uterus, between all parts of the uterus.

The cause of uncoordinated abbreviations can be:

• malformations of the uterus (bicorneous, saddle-shaped, septum in the uterus, etc.);
• dystocia of the cervix (stiffness, cicatricial changes, cervical atresia, cervical tumors, etc.);
• clinical mismatch;
• flat fetal bladder;
• violation of innervation;
• lesions of limited areas of the uterus due to inflammatory, degenerative and neoplastic processes (myoma of the uterus).

As a result, the ability of the neuromuscular system to perceive irritation may be reduced in altered areas, or the altered musculature loses its ability to respond to the impulses received by normal contractions. Important is the irrational management of labor: inadequate anesthesia, induction in the absence of sufficient body readiness for childbirth, unreasonable rodostimulation, etc.

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

In practical activities it is expedient to distinguish the following types of non-coordinated labor:

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

Some authors distinguish three degrees of severity of discordant labor activity.

Symptoms of non-coordinated labor are characterized by the presence of painful irregular, sometimes frequent contractions, soreness in the lower back and lower abdomen. When palpation, the uterus is found to have an unequal tension in the various departments, as a result of discordant contractions. Often there is immaturity of the cervix, its slow opening, and sometimes the absence of the latter, often comes the swelling of the cervix. When discoordination of labor is often observed premature discharge of amniotic fluid, a flat fetal bladder. The present part of the fetus remains mobile for a long time or pressed to the entrance to the small pelvis. In the future comes the fatigue of the mother and the contractions can stop. The process of labor slows down or stops. In the consecutive period, an abnormality of abruption of the placenta and a delay in its parts in the uterine cavity leading to bleeding can be observed.

With discoordination of labor, the uterine-placental circulation is violated, as a result of which hypoxia of the fetus develops.

Diagnosis of discoordination of labor is established on the basis of the described clinic of prolonged labor, inefficiency of contractions, delay in the opening of the cervix. The most objective is the registration of contractile activity of the uterus with the help of multichannel hysterography or recording intrauterine pressure.

With multichannel hysterography, asynchrony, arrhythmia of contractions of various parts of the uterus is determined. Contractions of varying intensity, duration. The triple descending gradient is broken and usually there is no dominant of the bottom. The tokografic curve during discoordination takes the wrong shape during the rise of pressure or its decrease, or throughout the bout. A sharp change in tone, intensity of labor, a long "acme", a longer rise and a shortened recession, a sudden increase in the total duration of the contraction with low figures of total intrauterine pressure should be regarded as a manifestation of discoordination.

Discordination of labor is observed in the first stage of labor, usually before the opening of the cervix by 5-6 cm.

Discordination of labor should be differentiated first of all from weakness, clinical mismatch, in connection with the different tactics of treating these conditions.

In this condition, careful monitoring of the nature of labor, the opening of the cervix, insertion and promotion of the presenting part of the fetus and its condition is necessary. A good effect has an autopsy of the bladder. A gross mistake is the administration of oxytetics for the treatment of discordancy (!).

For the treatment of discoordination of labor, psychotherapy, therapeutic electro-analgesia, use of analgesic (20-40 mg promedol), spasmolytic (2-4 ml 2% solution of no-shpa, 2 ml of 2% solution of papaverine hydrochloride, 5 ml of baralgina, etc.) are recommended. , beta-mimetic agents (0.5 mg partusisten or briikanil diluted in 250 ml isotonic sodium chloride solution or 5% glucose solution and injected intravenously drip), sedatives (seduxen 10 mg).

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

To strengthen the formation of endogenous prostaglandins, linetol (30 ml) or arachidene is used in 20 drops 2-3 times throughout the birth.

If the mother is tired, she should be given a medical rest for 2 to 3 hours. It is shown that fetal hypoxia is prevented by the periodic inhalation of 60% of moistened oxygen.

If the discoordination of labor is not amenable to conservative treatment, often, especially when there are signs of intrauterine fetal distress, a long anhydrous interval, a complicated obstetric anamnesis, it is timely to raise the issue of surgical delivery by caesarean section.

[1], [2]