Non-medical methods of preparing pregnant women for childbirth

Electrical stimulation is currently used by a number of authors to terminate late-term pregnancy for the purpose of inducing labor in pregnant women with premature rupture of membranes.

Method of intranasal electrical stimulation.

Irritations are applied using specially designed equipment: an electrical impulse generator and a self-supporting rod-shaped sensor tip.

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

Intranasal electrical stimulation is recommended:

• firstly, with the aim of preparing pregnant women for childbirth in the absence of biological readiness for it and subsequent induction of labor, especially in case of delayed labor;
• secondly, preparation for childbirth in case of an immature cervix and premature rupture of membranes;
• thirdly, as a method of labor stimulation in cases of an immature cervix and insufficiently pronounced labor activity.

Electrical stimulation of the nipples of the mammary glands

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

• to prepare pregnant women for childbirth in order to ripen the cervix;
• for the purpose of inducing labor in case of premature termination of pregnancy;
• as a contractile test.

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

Nipple stimulation causes a more significant increase in uterine activity than previously thought, and therefore nipple stimulation in late pregnancy should be performed with caution, especially in pregnant women who have had or have symptoms of fetal dysfunction at the time of nipple stimulation, in order to avoid the occurrence of uterine hypertonicity, which may affect the condition of the fetus.

Contractile test. Stimulation of the nipples of the mammary glands has recently become increasingly recognized as a contractile test by analogy with oxytocin. The contractile test was assessed as effective if 3 or more contractions were recorded in 10 minutes.

The stress contractile test, performed by stimulating the nipples, is also used to assess uteroplacental reserves. The mechanism by which uterine contractions are induced is unclear.

Contractile stress test for determining the condition of the fetus. A number of authors consider the contractile test to be noninvasive, easy to perform, and relatively time-consuming. The appearance of contractile activity of the myometrium varied within 50 sec to 17 min and averaged 4 min 44 sec ± 3 min 36 sec.

The test should be best performed under cardiotocography conditions.

Acupuncture

Acupuncture is used to prepare pregnant women for childbirth, treat the threat of miscarriage, relieve fear, tension, pain relief and regulate labor. The most widely used method is acupuncture (acupuncture).

Acupuncture is an effective method for preparing pregnant women for childbirth, inducing labor, and regulating labor activity. In the work of A. R. Calle (1987), it was shown that acupuncture ensures the formation of the body's readiness for childbirth more fully and twice as quickly as compared to the results of drug methods.

Yu. I. Novikov, V. V. Abramchenko, R. U. Kim (1981) developed an inhibitory method of acupuncture with a transition to an exciting one to prepare pregnant women for childbirth, especially in cases of late toxicosis of pregnancy. The duration of the procedure was determined by the form of toxicosis, the peculiarity of its course and lasted 30-40 minutes, but as the symptoms of late toxicosis decreased - 15-20 minutes. The procedures were carried out daily or every 1-2 days, a total of 4-8 times. 2-4 acupuncture "points" were used simultaneously.

Acupuncture as the main method of preparing pregnant women is contraindicated in the following cases:

• severe form of late toxicosis (nephropathy grade II-III);
• in case of “combined” late toxicosis that developed against the background of a severe form of diabetes mellitus;
• in case of “combined” late toxicosis that developed against the background of any somatic pathology in the stage of severe decompensation.

Absolute (!) contraindications for acupuncture:

• abnormalities of placental attachment or suspected partial detachment of a normally located placenta;
• blood coagulation disorders;
• failure of the uterine scar.

Electroacupuncture

Electroacupuncture (ELAP) is performed by means of the action of electrical impulses of different duration and polarity on needles inserted into acupuncture points. Easily accessible points were selected for the action, the use of which minimally restricts the woman's movements.

We recommend the technique of electroacupuncture for the purpose of inducing labor in case of premature rupture of waters, taking into account the condition of the cervix, as well as for the purpose of treating abnormalities of labor and pain relief during labor.

The effect of labor induction depends largely on the initial state of the cervix. It has been established that against the background of electroacupuncture, active maturation of the cervix occurs, however, in 1/3 of cases, with an immature cervix, it was not possible to transfer labor to the active phase and additional drug labor stimulation was required. Thus, when inducing labor against the background of an immature cervix, we should talk about the combined use of electroacupuncture and oxytocin. With an immature cervix, 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 method we have developed to prepare the cervix for childbirth in order to activate its maturation and to induce labor.

Electroacupuncture is not recommended for use in women with severe obesity (II-III degree) and an estimated fetal weight over 4000 g.

Ultrasound treatment of the cervix

The proposed method is used as follows: from conventional serial ultrasound devices in the range of 880 kHz, having previously exposed the cervix with mirrors and having applied an oil solution of folliculin in the amount of 10,000 U to the emitter electrode, ultrasound is applied to the cervix. In a pulsed mode with an exposure of 6 to 12 minutes, the cervix is irradiated from its outer surface or from the side of the cervical canal. The procedures are performed daily (no more than 5 days) until a positive effect is obtained.

This method of preparing the soft birth canal allows, through the effect of ultrasound and estrogenic hormones directly on the structure of the cervix, to achieve a positive effect, most often after 1-3 procedures.

Contraindications are tumors of the cervix and placenta previa.

Laminaria

Mechanical methods of preparing the immature cervix for childbirth (vibration dilation of the cervix, cervical balloons, such as Foley catheters, isaptent, etc.) deserve attention.

It has been established that one of the factors contributing to the maturation of the cervix when using kelp is an increase in the level of endogenous prostaglandins.

Insertion of laminaria is a medical procedure, equal in complexity to insertion of an intrauterine device. For this, vaginal speculums, bullet forceps, tweezers or an abortensor for insertion of laminaria are needed. The vagina is pre-treated with an antiseptic solution. If necessary, the cervix is fixed with bullet forceps. The grip of the anterior 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 canal, you can use a uterine probe. Laminaria are inserted so that they necessarily lie completely inside the cervical canal, slightly protruding beyond the external os, with their inner end going beyond the internal os. If several sticks are used, they should all lie parallel to each other. Each subsequent one easily follows the path of the previous one until the canal is completely filled. One or two sterile, tightly rolled napkins placed at the external os help to hold the laminaria in the cervical canal. The laminaria are removed in the Cusco mirrors by pulling the thread located at its proximal end.

During 1 session, 1 to 5 laminaria are introduced. The procedure is repeated after 24 hours. Usually 2-3 sessions are carried out over 2-3 days.

After use, the kelp can be washed, dried and re-sterilized with gamma rays or 99% ethyl alcohol solution for 2 days.

There were no cases of acute pain, severe discomfort or bleeding during the insertion, wearing and removal of laminaria. There were no cases of laminaria displacement into the uterine muscle or difficulties in their removal. There are no absolute contraindications for the use of laminaria. A relative contraindication is cicatricial deformation of the cervix and a scar on the uterus after a cesarean section. The minimum degree of maturity of the cervix according to Bishop increased by 1 point per session, and by 6 points at most. When the degree of maturity of the cervix reached 8 points or more, further insertion of laminaria was abandoned. Ripening of the cervix occurs on average in 2 treatment sessions.

Thus, preparation for childbirth with the help of natural laminaria is a highly effective, inexpensive, environmentally friendly and allergic reaction-free method that allows you to achieve the optimal level of cervical maturation in 2 treatment sessions.

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

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