Pathological preliminary period

The pathological preliminar period is characterized by the following clinical signs: painful, disturbing diurnal rhythm of sleep and wakefulness, alternating in strength and sensation of contraction. Contractions occur against the background of increased uterine tone, often have a regular character (14%), in frequency and strength are similar to true generic, but do not lead to structural changes in the cervix.

The duration of the preliminaries is different - from 7 to 24-48 hours or more. It has been established that 33% of pregnant women have a preliminary period with a gestation period of 38-40 weeks.

It is important to consider the preliminaries as compared with the willingness of the body to give birth.

Psychosomatic aspect. One of the causes of the pathological preliminaries is various neurogenic disorders, emotional stress. The method of psychological evaluation revealed that in the pathological preliminar period, the index of psychosomatic disorders is higher than under normal. These data indicate, obviously, that in pregnant women with this pathology there are violations of the functional state of the nervous system, limbic complex, which determines the quality of the emotional state. Scientists have experimentally proved the presence in the uterus of highly differentiated nerve centers and receptors, thanks to which a direct reflex connection of the reproductive apparatus with the central nervous system is carried out. The established cortical regulation of contractile activity of the uterus is of great importance, since knowledge of this connection allows you to correct some violations of the contractile activity of the uterus.

Colpocytological studies of the state of the cervix with preliminaries

In the literature there are isolated reports on the features of the formation of readiness for childbirth in pregnant women in the pathological course of the preliminar period. Comprehensive clinical and physiological studies of pregnant women in combination with oxytocin test, luminescent colpocytological analyzes, assessment of the state of maturity of the cervix uteri.

In the pathological course of the preliminar period, the mature cervix of the uterus was in 42.8% of pregnant women, while ripening and immature - in 48% and 9%, respectively.

Thus, the formation of biological readiness for childbirth by the condition of the cervix in pregnant women in the pathological course of the preliminaries, despite the existing contractile activity, is delayed.

Pregnant women with a pathological preliminar period, depending on the colpositology pattern, should be divided into 2 groups:

• with the presence of estrogenic readiness (the period of delivery and the unquestionable period of labor) and
• with the absence of estrogenic readiness for childbirth (shortly before childbirth and late delivery).

In the presence of hormonal readiness, clinical tests indicate the readiness of the woman's organism for childbirth. With estrogenic readiness for childbirth, a higher oxytocin test was registered than in the group with a lack of readiness. It is important to note that in the presence of estrogenic readiness for childbirth, contractions were more frequent than usual, and in the absence of preliminaries, contractions were more often stopped and reappeared a day or more later. This time interval is probably necessary for biological preparation for childbirth.

In order to prepare for childbirth in the absence of biological readiness of the organism of a pregnant woman under the control of hysterographic and colpocytological studies, folliculin 10,000 units was administered intramuscularly on the air 2 times a day at intervals of 12 hours for 3-5 days. According to the data of luminescent colpocytology, a clear "osteogenesis" of the vaginal smear was noted after 2 days after the introduction of folliculin. At the same time, it is necessary to use central and peripheral anticholinergics: spasmolithine at a dose of 100 mg orally twice a day and a gangleron solution of 1.5% - 2 ml (30 mg) intramuscularly or intravenously in 20 ml of 40% glucose solution.

The results of the conducted studies showed that in the presence of cytotypes of the "term of labor" and the mature uterus, the preliminar period proceeds more favorably and turns into regular generic activity. In this group of pregnant patients, the appointment of zosterogenes is impractical. If a "late pregnancy" and "shortly before the birth" cytotype is identified and the maturing or immature cervix is used, estrogens and antispasmodics should be used to accelerate the biological preparation of the body for the pregnant woman to give birth.

The method of luminescent colpocytology in combination with the assessment of the maturity of the cervix can quickly and reliably reveal the degree of estrogenic readiness of the woman's organism for childbirth, and can also serve as an objective test in the appointment of estrogens and antispasmodics in order to prepare for delivery of pregnant women with a pathological course of the preliminaries. It is important to remember that in the prenatal period there is an increase in the zrogenic effect on the myometrium necessary for the initiation of labor. Of particular importance are the so-called intermediate compounds. Individual muscle cells of myometrium contact each other via intermediates (compounds). These specialized types of intermediate or intercellular contacts have been identified by the Canadian scientist Garfield in the myometrium of female rats, guinea pigs, sheep and women with delivery. The formation of intermediates in the musculature of the uterus increases under the influence of estrogens, while progesterone partially reduces this effect. When estrogen was administered late in pregnancy, a person in the early work of Pinto from Argentina showed that intravenous infusion of 100 mg of 17 beta-estradiol to women in terminated pregnancy increases uterine activity and may even lead to the onset of labor. V. V. Abramchenko, Jarvinen confirmed the results of Pinto et al. With intramuscular injection of estradiol. In most other cases, the results were negative. Danilos induced induction of contractile activity of the uterus with estradiol, studied its effect on lactation and the concentration of hormones in the serum. 28 pregnant women (of them, 18 primiparous) received intramuscular estradiol benzoate - 2 times a day for 5 mg for 3 days. Radioimmunoassay determined the levels of prolactin, estriol, estradiol, progesterone and placental lactogen in the serum of pregnant women, in whom the contractile function of the uterus was induced by estradiol. It is shown that these data differed significantly from physiological births. It also turned out that premedication of births with estradiol slows the appearance of lactation on average by 3 days.

The difference between false births and actual

Symptoms	False Roles	Virtual childbirth
Intervals between contractions of the uterus	Unstable (remain unstable)	Constant (gradually shortening)
Duration of acronyms	Unstable	Constant
Reduction intensity	Remains the same	Gradually increases
Localization of feelings of discomfort	It is localized mainly in the lower abdomen, but rarely in the sacrum	Usually in the sacrum and abdomen, extending from the back forward, surrounding nature
Action exercises	When walking, uterine contractions do not increase	When walking, uterine contractions increase
Effects of mild sedatives	Usually facilitate the condition	The abbreviations do not affect

[1], [2], [3], [4], [5]