Pathologic preliminaries

The pathological preliminary period is characterized by the following clinical signs: painful contractions that disrupt the daily rhythm of sleep and wakefulness, alternating in strength and sensations. Contractions occur against the background of increased uterine tone, are often regular (14%), are similar in frequency and strength to true labor contractions, but do not lead to structural changes in the cervix.

The duration of the preliminary period varies - from 7 to 24-48 hours or more. It has been established that the preliminary period occurs in 33% of pregnant women at 38-40 weeks of pregnancy.

It is important to take into account preliminary contractions in comparison with the body's readiness for childbirth.

Psychosomatic aspect. One of the causes of the pathological preliminary period are various neurogenic disorders, emotional stress. The method of psychological assessment has found that during the pathological preliminary period, the index of psychosomatic disorders is higher than during the normal period. These data obviously indicate that pregnant women with this pathology have disorders of the functional state of the nervous system, the limbic complex, which determines the quality of the emotional state. Scientists have experimentally proven the presence of highly differentiated nerve centers and receptors in the uterus, due to which a direct reflex connection of the reproductive system with the central nervous system is realized. The established cortical regulation of the contractile activity of the uterus is of great importance, since knowledge of this connection allows correcting some disorders of the contractile activity of the uterus.

Colpocytological examination of the cervix with preliminary contractions

There are isolated reports in the literature on the peculiarities of the formation of readiness for childbirth in pregnant women with a pathological course of the preliminary period. Comprehensive clinical and physiological studies of pregnant women were conducted in combination with the oxytocin test, luminescent colpocytological analyses, and an assessment of the state of maturity of the cervix.

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

Thus, the formation of biological readiness for childbirth based on the state of the cervix in pregnant women with a pathological course of the preliminary period, despite the existing contractile activity, is delayed.

Pregnant women with a pathological preliminary period, depending on the colpocytological picture, should be divided into 2 groups:

• with the presence of estrogenic readiness (due date and undoubted due date) and
• with a lack of estrogenic readiness for childbirth (shortly before childbirth and late childbirth).

In the presence of hormonal readiness, clinical tests indicate the readiness of the woman's body for childbirth. In the case of estrogenic readiness for childbirth, a higher oxytocin test was recorded than in the group with no readiness. It is important to note that in the presence of estrogenic readiness for childbirth, contractions were more often regular, and in the absence of preliminary contractions, they often stopped and reappeared after a day or more. This period of time is probably necessary for biological preparation for childbirth.

In order to prepare for childbirth in the absence of biological readiness of the pregnant woman's body, folliculin was administered at a dose of 10,000 U intramuscularly on ether 2 times a day with an interval of 12 hours for 3-5 days under the control of hysterographic and colpocytological studies. According to luminescent colpocytology, clear "estrogenization" of the vaginal smear was noted 2 days after the introduction of folliculin. At the same time, it is necessary to use central and peripheral anticholinergics: spasmolytin at a dose of 100 mg orally 2 times a day and a solution of ganglerone 1.5% - 2 ml (30 mg) intramuscularly or intravenously in 20 ml of a 40% glucose solution.

The results of the conducted studies showed that in the presence of the cytotypes "term of delivery" and a mature uterus, the preliminary period proceeds more favorably and turns into regular labor. In this group of pregnant women, the administration of estrogens is inappropriate. If the cytotype "late pregnancy" and "shortly before delivery" is detected and the cervix is ripening or immature, it is necessary to use estrogens and antispasmodics to accelerate the biological preparation of the pregnant woman's body for labor.

The method of luminescent colpocytology in combination with the assessment of the maturity of the cervix allows for a quick and reliable detection of the degree of estrogenic readiness of the woman's body for childbirth, and can also serve as an objective test when prescribing estrogens and antispasmodics to prepare pregnant women with a pathological course of the preliminary period for childbirth. It is important to remember that in the prenatal period there is an increase in the estrogenic effect on the myometrium, which is necessary for the unleashing of labor. Of particular importance are the so-called intermediate connections. Individual muscle cells of the myometrium contact each other through intermediate links (connections). These specialized types of intermediate or intercellular contacts were discovered by the Canadian scientist Garfield in the myometrium of female rats, guinea pigs, sheep and women during childbirth. The formation of intermediate connections in the uterine muscles increases under the influence of estrogens, while progesterone partially reduces this effect. When introducing estrogens in late pregnancy in humans, Pinto from Argentina showed in early works that intravenous infusion of 100 mg of 17 beta-estradiol to women at full term increases uterine activity and can even lead to the onset of labor. V. V. Abramchenko, Jarvinen confirmed the results of Pinto et al. with intramuscular administration of estradiol. In most other observations, the results were negative. Danilos induced uterine contractility with estradiol, studied its effect on lactation and hormone concentration in the blood serum. Estradiol benzoate was administered intramuscularly to 28 pregnant women (18 of whom were primiparous) - 5 mg twice a day for 3 days. The radioimmune method was used to determine the levels of prolactin, estriol, estradiol, progesterone and placental lactogen in the blood serum of pregnant women whose uterine contractile function was induced by estradiol. It was shown that these data differed significantly from physiological labor. It was also found that premedication of labor with estradiol delayed the onset of lactation by an average of 3 days.

Distinguishing false labor from real labor

Signs	False rolls	Actual birth
Intervals between uterine contractions	Inconstant (remain inconstant)	Constant (gradually shortening)
Duration of contractions	Inconstant	Constant
Intensity of contractions	Remains the same	It is gradually increasing
Localization of discomfort	It is localized mainly in the lower abdomen, but rarely in the sacrum	Usually in the sacrum and abdomen, spreading from the back forward, of a girdle-like nature
Effect of exercises	When walking, uterine contractions do not increase	When walking, uterine contractions become stronger
Action of mild sedatives	Usually alleviate the condition	The reductions are not affected

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