Excessively strong labor (uterine overactivity)

Excessively strong labor activity (uterine hyperactivity) is a form of labor anomaly that manifests itself in excessively strong contractions (more than 50 mm Hg) or rapid alternation of contractions (more than 5 contractions in 10 minutes) and increased uterine tone (more than 12 mm Hg).

The frequency of this form of pathology is 0.8%.

The causes of excessively strong labor activity have not been sufficiently studied. This anomaly of labor forces is most often observed in women with increased general excitability of the nervous system (neurasthenia, hysteria, Graves' disease, etc.). It can be assumed that excessively strong labor activity may depend on disturbances of cortico-visceral regulation, in which impulses coming from the uterus of a woman giving birth to the subcortex are not properly regulated by the cerebral cortex. In this case, increased formation of substances such as oxytocin, adrenaline, acetylcholine can be observed, which have a powerful effect on the contractile function of the uterine muscles.

In case of excessively strong labor activity, there is a violation of the uteroplacental blood circulation and associated gas exchange disorder in the fetus. Labor in such cases ends within 2-3 hours or earlier and is called rapid.

Symptoms of excessively strong labor are characterized by a sudden and violent onset of labor. In this case, very strong contractions follow one another with short pauses and quickly lead to a full opening of the cervix. The woman in labor, with a sudden and violent onset of labor, proceeding with intense and almost continuous contractions, often becomes agitated.

After the waters have been released, violent and rapid pushing immediately begins, and sometimes in 1-2 pushings the fetus is born, followed by the placenta. Such a course of labor threatens the mother with the danger of premature placental abruption, is often accompanied by deep ruptures of the cervix, vagina, cavernous bodies of the clitoris, perineum and can cause bleeding, which is dangerous to the health and even life of the woman. Due to injuries during rapid labor, diseases are often observed in the postpartum period. With the rapid advancement of the fetal head through the birth canal, it does not have time to configure and is subject to rapid and strong compression, which often leads to trauma and intracranial hemorrhages, as a result of which the stillbirth rate and early infant mortality increase.

The diagnosis of excessively strong labor is established on the basis of the above-described clinical picture and hysterography data. Sometimes the inadequate behavior of the woman in labor during labor can be unreasonably assessed as a manifestation of excessively strong labor.

To relieve excessively strong contractions, it is effective to use and conduct tocolysis with beta-adrenergic agonists (partusisten, brikanil, ritodrine, etc.). Partusisten (0.5 mg) or brikanil is diluted in 250 ml of isotonic sodium chloride solution or 5% glucose solution and administered intravenously by drip, starting with 5-8 drops per minute, gradually increasing the dose until labor activity is normalized. After 5-10 minutes from the start of intravenous administration of beta-adrenergic agonists, the woman in labor notes a significant reduction in pain, a decrease in uterine contractility, and after 30-40 minutes, labor can be terminated.

Side effects in response to the introduction of tocolytics may include tachycardia, some decrease in blood pressure, especially diastolic, slight weakness, nausea. To relieve side effects on the cardiovascular system, it is recommended to prescribe isoptin (40 mg orally), which is a calcium antagonist and also helps to reduce the contractile activity of the myometrium.

In the absence of beta-adrenergic agonists, ether or fluorothane anesthesia can be used to relieve labor. Anesthesia with nitrous oxide is unsuitable, since it does not reduce uterine tone. In the treatment of excessive labor, intramuscular administration of magnesium sulfate (25% solution - 10 ml) and promedol or omnopon solution (2% solution - 1 ml) is advisable.

It is recommended that the woman in labor be placed on her side opposite to the position of the fetus, and that the birth be delivered on her side. In the second stage of labor, it is advisable to perform pudendal anesthesia.

After the birth, the soft birth canal is carefully examined to detect ruptures. If the birth took place outside, then after the woman is admitted to the maternity hospital, the external genitalia are disinfected and the mother and newborn are given anti-tetanus serum.

If there is a history of precipitous labor in pregnant women, hospitalization in a maternity hospital is indicated before labor. If previous pregnancies ended in precipitous labor with an unfavorable outcome for the fetus, it is necessary to promptly raise the issue of a planned cesarean section in the interests of the fetus.

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