Non-pharmacological methods of preparing pregnant women for childbirth

Electrostimulation is currently used by a number of authors to interrupt pregnancy at a later date for the purpose of induction in pregnant women with premature discharge of amniotic fluid.

Technique of intranasal electrical stimulation.

Irritations are applied with the help of specially designed equipment: an electric pulse generator and a self-holding sensor-tip shaped like a rod.

The method of intranasal electrical stimulation in terms of maturation of the cervix was effective in 87% of pregnant women. The effect is probably due to the appearance of a large number of contractions of the uterus by the type of Braxton Gyx, instead of small uterine contractions of the Alvarez type.

Intranasal electrical stimulation is recommended:

• firstly, with the purpose of preparing pregnant women for childbirth in the absence of biological readiness for them and subsequent birth-giving, especially in case of delayed birth;
• second, the preparation for childbirth with the unripe cervix of the uterus and the premature passage of amniotic fluid;
• thirdly, as a method of rhodostimulation with an immature cervix of the uterus and an insufficiently expressed labor activity.

Electrostimulation of the nipples of the mammary glands

Electrical and mechanical stimulation of the nipples of the mammary glands are currently used for three main indications:

• for the preparation of pregnant women for childbirth for the purpose of maturing the cervix;
• with the purpose of induction with early termination of pregnancy;
• as a contract test.

Mechanical stimulation of the nipples of the mammary glands results in the appearance of impulses that apparently affect the supraoptic region and the paraventricular nuclei of the hypothalamus, which in turn leads to the release of oxytocin from the posterior lobe of the pituitary gland and the onset of uterine contractions and cervical ripening and in 50% of pregnant women leads simultaneously to the occurrence of regular labor.

Stimulation of the nipples causes a more significant increase in the activity of the uterus than was previously thought, and therefore, stimulation of the nipples in late pregnancy should be carried out cautiously, especially in pregnant women who already had or have symptoms of impaired fertility at the time of stimulation of the nipples, in order to avoid the appearance of hypertonia the uterus, which can affect the fetal condition.

Contract test. The stimulation of the nipples of the mammary glands has recently become more widely accepted as a contractile test in analogy with oxytocin. The contract test was evaluated as effective if 3 battles or more were recorded in 10 minutes.

A stressful contractile test performed by stimulation of the nipples is also used to assess utero-placental reserves. The mechanism of inducing uterine contractions is unclear.

A contract stress test to determine the condition of the fetus. A number of authors consider the contractile test to be non-invasive, easy to conduct and requires relatively little time. The appearance of the contractile activity of the myometrium ranged from 50 s to 17 min and averaged 4 minutes 44 s ± 3 min 36 s.

The test should be performed better in cardiotocography.

Acupuncture

Needle reflexotherapy is used to prepare pregnant women for childbirth, to treat the threat of abortion, to remove fear, stress, anesthesia and the regulation of labor. The most widely used method of acupuncture (acupuncture, acupuncture).

Acupuncture is an effective method in preparing pregnant women for childbirth, induction and regulation of labor. In work. AR Kal'e (1987) showed that acupuncture ensures the formation of organism readiness for childbirth more fully and twice faster in comparison with the results of medical methods.

Yu. I. Novikov, VV Abramchenko, RW Kim (1981) developed the inhibitory method of acupuncture with the transition to excitatory for the preparation of pregnant women for childbirth, especially for late toxicosis of pregnant women. The duration of the procedure was determined by the form of toxicosis, a feature of its course and lasted 30-40 min, but with the decrease of symptoms of late toxicosis - 15-20 min. Procedures were conducted daily or 1-2 days, up to 4-8 times. At the same time, 2-4 "points" of acupuncture were used.

Iglor reflexotherapy as the main method of preparation of pregnant women is contraindicated in:

• severe late toxicosis (nephropathy II-III degree);
• with "combined" late toxicosis, developed against a background of severe diabetes mellitus;
• at the "combined" late toxicosis, developed against a background of any somatic pathology in the stage of pronounced decompensation.

Absolute (!) Contraindications for acupuncture:

• abnormalities of placental attachment or suspicion of a partial detachment of the normally located placenta;
• disorders of the blood coagulation system;
• inconsistency of the scar on the uterus.

Electroacupuncture

Electroacupuncture (ELAP) is carried out by means of the action of electric pulses of different duration and polarity on the needles introduced into the acupuncture points. For exposure, easily accessible points were chosen, the use of which minimizes the movement of the woman.

The procedure for electroacupuncture is recommended by us for the purpose of labor excitement in the premature removal of water taking into account the state of the cervix, and also for the purpose of treating abnormalities of labor and the anesthesia of childbirth.

The effect of induction is largely dependent on the initial state of the cervix. It was found that active maturation of the cervix takes place against the background of electro acupuncture, however, in 1/3 of cases with an immature cervix of the uterus, it was not possible to transfer the delivery to the active phase, and additional medication rhythmostimulation was required. Thus, with induction on the background of the immature cervix, we should talk about the combined use of electroacupuncture and oxytocin. With the immature cervix of the uterus, the effect of electroacupuncture on the lower segment develops more slowly (which corresponds to the maturation of the cervix).

Thus, it is advisable to use electroacupuncture according to the technique developed by us for preparing the cervix for delivery in order to activate its maturation and for induction.

Electroacupuncture is not recommended for women with severe obesity (grade II-III) and an estimated fetal mass over 4000 g.

Ultrasound on the cervix

The proposed method is used as follows: from conventional serial ultrasonic devices in the 880 kHz range, exposing the cervix of the uterus with mirrors and applying 10,000 units of folliculin oil solution to the electrode-emitter, the ultrasound is pumped to the cervix. In pulsed mode, exposures from 6 to 12 minutes produce irradiation of the cervix from the outer surface of the cervix or from the side of the cervical canal. The procedures are performed daily (no more than 5 days) until a positive effect is obtained.

Such a method of preparing soft generic pathways allows, through ultrasound and estrogenic hormones, directly on the cervical structure to achieve a positive effect most often after 1-3 procedures.

Contraindications are tumors of the cervix and placenta previa.

Laminaria

Noteworthy are the mechanical methods of preparation of the immature cervix for childbirth (vibrodilation of the cervix, cervical balloons, such as the Foley catheter, iZapentent, etc.).

It was found that one of the factors contributing to the maturation of the cervix in the application of kelp is an increase in the level of endogenous prostaglandins.

The introduction of laminaria is a medical manipulation, which is equal in complexity to the introduction of an intrauterine device. This requires vaginal mirrors, bullet forceps, tweezers or abortsang for the introduction of kelp. The vagina is pretreated with an antiseptic solution. If necessary, the cervix is fixed with bullet forceps. The grip of the front lip is more reliable. Lubricating the stick or several sticks with an antiseptic solution facilitates their passage through the cervical canal. To clarify the direction of the cervical channel, you can use the uterine probe. Laminaria is injected so that they necessarily lie completely inside the cervical canal, slightly protruding from the outer throat, with its inner end going behind the inner pharynx. If several sticks are used, they must all lie parallel to each other. Each successive follows easily along the path of the previous one until the channel is completely filled. One or two sterile, tightly folded napkins placed at the outer throat, allow to retain laminaria in the cervical canal. Remove laminaria in the mirrors of Cuzco by sipping at the thread located at its proximal end.

For 1 session is introduced from 1 to 5 laminaria. The procedure is repeated after 24 hours. Usually 2-3 sessions are carried out for 2-3 days.

After use, the laminaria can be washed, dried and re-sterilized in gamma rays or 99% ethanol solution for 2 days.

When injecting, wearing and removing laminaria, there were no cases of acute pain, severe discomfort or bleeding. There were no cases of displacement of laminaria in the uterine muscle, difficulties in removing them. There are no absolute contraindications for laminaria. Relative contraindication is cicatricial deformity of the cervix and a scar on the uterus after a caesarean section. Minimal degree of maturity of the cervix for Bishop for 1 session increased by 1 point, maximum by 6 points. When the degree of maturity of the cervix 8 points or more from further introduction of laminaria refused. Maturation of the cervix on average occurs for 2 treatment sessions.

Thus, the preparation for childbirth with the help of natural kelp is highly effective, cheap, environmentally friendly and devoid of allergic reactions, which allows to achieve the optimal level of maturation of the cervix in 2 treatment sessions.

The technique of preparing pregnant women for birth with natural laminaria in primipara shortens the duration of labor by 29% and reduces the number of cesarean sections by 3 times

[1], [2], [3], [4]