Labor anomalies: an overview of information
Last reviewed: 23.04.2024
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Among the factors that complicate the process of childbirth, the most important are the following: the features of the mother's pelvis; features of the presentation of the fetus, as well as types of presentation; force of uterine contractions. The disproportion of the size of the fetal head and the maternal pelvis is due to an unfavorable combination of their diameters.
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The ideal pelvis has a rounded border of the upper part of the pelvic entry (that is, it has a gynecoid form characteristic of the female pelvis structure), but in almost 15% of women the border of the upper part of the entrance to the pelvis is elongated-oval (the so-called anthropoid form - the male-type pelvis ). An excessively flat upper part of the pelvic entry (the so-called flat basin) is observed in 5% of women whose growth exceeds 152 cm and in 30% of women less than 152 cm. In scoliosis, spine kyphosis, fusion of the sacrum with V lumbar vertebra, spondylolisthesis and fractures of pelvic bones anatomy of the mother's pelvis is broken. In earlier times, the most significant problems in women arose as the consequences of rickets and poliomyelitis. Suspension of the pelvis should be suspected in cases in which the primiparous women of the Caucasian race did not have a presenting head inserted by the 37th week of pregnancy.
Type of presentation
With the head presentation, the less the head is bent, the less favorable the situation. In the case of transverse position and frontal presentation, caesarean section should be performed: with facial presentation and posterior view of the occipital presentation, although delivery through natural birth can occur, but it is more likely that there will be obstacles to this. Gluteal presentation is especially unfavorable (from the perspective of difficult births), if the body weight of the fetus exceeds 3.5 kg.
The power of uterine contractions
Uterine contractions start from the area of the uterine fundus and spread down the line. The intensity and duration of contractions are greatest in the region of the uterus, but they reach their peak in all parts of the uterus at the same time. Normal contractions should occur at a frequency of 3 times per 10 minutes, lasting up to 75 seconds. At the height of the reduction peak, the pressure should reach 30-60 mm Hg, whereas during periods of relaxation, the tone of the uterus should be maintained at a pressure of 10-15 mm Hg.
Violation of contractile activity of the uterus
Abbreviations can be hypotonic (low uterus tone during the relaxation phase, weak peaks of contractions), can be normotonic, but excessively rare. Such violations of contractile activity of the uterus are corrected (strengthened) with the help of oxytocin). In other cases, the lower segment of the uterus is hyperactive, while there is no normal dominant role of the uterine fundus and the contractions can be directed upwards from the lower segment. In such cases, the cervix does not open properly, and the mother has severe back pain and a desire to push before the cervix has opened. In such situations, the mother should be provided with adequate analgesia; especially epidural anesthesia is effective, as the uncontrollable desire to push is reduced (as in the case of intravenous administration of pethidine 25 mg).
Dystocia of the cervix
By this term is meant a situation where the rigid, inelastic cervix of the uterus is not revealed. Predisposing factors may be the preceding trauma, scar process, cone biopsy and moxibustion. Sometimes it is very difficult to determine why the cervix is not revealed: due to organic causes or as a result of discordant labor. In both cases, it is usually necessary to resort to delivery by caesarean section.
Consequences of prolonged labor
With protracted births, the risk of both neonatal mortality and maternal morbidity (primarily due to infectious complications) increases. Modern methods of conducting labor provide a constant control over the course of the birth process, thereby facilitating the task of recognizing the delay in the course of labor and timely correction of this complication.
When abnormalities of labor are to be asked in a timely manner, how safe is the delivery through the natural birth canal.