Physiopsychoprophylactic preparation of pregnant women for high-risk groups

Primitives of the older age. A clinical analysis of the course of pregnancy and childbirth in 400 older women, who underwent physiopsychoprophylactic training, was conducted. This method makes it possible to significantly reduce:

• frequency of late toxicosis during pregnancy and childbirth;
• frequency of birth of children with a large mass (more than 4000 g);
• 3 times the frequency of fetal hypoxia, which is threatening and has begun;
• frequency of operative delivery;
• total length of labor;
• blood loss in the consecutive and early postpartum periods;
• perinatal mortality and morbidity.

It is important to take into account the specific features of their state and physical development that we have revealed:

• presence of an excited, anxious neuropsychic state; acute desire to have a child, fear of the possibility of his loss in childbirth, fear of childbirth, insomnia, anxious sleep;
• manifestation of age-related involuntary changes in the body: violation of the speed of perception, assimilation, slow development of motor skills, the stereotype of movement, insufficient coordination of movement, limitation of mobility in articular joints, in particular, in the hip;
• increased susceptibility and sensitivity to remarks and jokes;
• vegetoneurosis with peripheral circulation disorders;
• metabolic disease;
• a significant incidence of concomitant diseases;
• simultaneously with the possible presence of these abnormalities in the general condition in primiparous over 30 years, very good endurance is noted.

Pregnant, obese. The characteristic features of their state of health:

• overweight;
• violation of metabolic processes;
• often the presence of diseases of various organs and body systems, which were the cause of obesity or resulting from obesity;
• violation of the function of external respiration (superficial, asynchronous, discoordinated - inhalation with simultaneous diaphragmatic expiration);
• propensity to hypoxia and hypoxemia;
• slowed flow of inhibitory excitatory processes in the central nervous system;
• propensity to vascular dystonia (hypertension, hypotension);
• violation of rational nutrition;
• propensity to develop late toxicosis of pregnant women;
• the birth of large children with a mass of 4000 g and above. Arterial hypotension of pregnant women. Characteristic features of their condition:
• lowered blood pressure (not higher than 100 mm Hg);
• fast fatiguability;
• decreased endurance;
• lability of vasomotor reaction, propensity to vascular dystonia;
• lability and instability of heart rate, propensity to tachycardia;
• frequent headaches;
• dizziness;
• anxious sleep;
• lethargy and apathy;
• relatively mild feeling of motherhood.

Pregnant with inflammatory diseases of internal genital organs. For this group of pregnant women is characterized by:

• absence of subjective complaints;
• propensity to spontaneous miscarriages and premature birth;
• a high percentage of abnormalities of placenta attachment.

Features of preparation for childbirth are as follows:

• a significant limitation of the motor system in the early stages of pregnancy. Absolutely contraindicated classes, which include elements of sports, swimming in natural water. Athletes should stop training and participate in competitions;
• from the 14-week gestation period, special gymnastics classes by type of treatment. Basically breathing exercises and exercises that improve blood and lymph circulation in the pelvic organs and utero-placental circulation;
• when there are first signs of a threatening abortion, immediate hospitalization in a hospital;
• after a persistent elimination of the threat of termination of pregnancy, the continuation of the FPPP for childbirth in a special group;
• pregnant women who have previous history of inflammatory diseases of the internal genitalia, general light and air baths and ultraviolet irradiation in the light cabinet or aerophotia, hydrotherapy, but with warm or indifferent temperature water, hydroaeroionization, oxygen therapy.

Varicose disease in pregnant women. The characteristic features of the general condition of pregnant women with varicose veins are:

• inferiority of the vascular system;
• phlebectasia, due to the dilatation of the venous system;
• stagnation of blood in the nodes of the dilated veins;
• pain in the lower limbs and impairment of their function;
• anomalies of attachment of the placenta and premature detachment of the placenta;
• frequent and significant postpartum and early postpartum hemorrhages.

Preparation for delivery of pregnant women with other extragenital diseases and abnormalities in the state of health.

These conditions either do not require allocation in special groups, or are subject to preparation with their combination into groups consisting of 3 people (heart defects, hypertensive disease of stages I-II, myocarditic cardiosclerosis with circulatory disturbance of I degree, neurocirculatory dystonia, etc.). .

According to the clinical picture, these pregnant women have much in common with those suffering from arterial hypotension: fast fatigue, reduced working capacity, greater sensitivity to changes in meteorological conditions, sleep disorders, emotional lability, headaches.

Preparing for childbirth of these pregnant women is conducted by us identical to the preparation of pregnant women with arterial hypotension.

Physical factors in the FPPP system.

Features of preparation for childbirth are as follows:

• physical education of pregnant women with the definition of goals, objectives, means;
• familiarization with the general provisions for the preparation of pregnant women for childbirth on the basis of physical education;
• regulation of lifestyle and daily routine;
• regulating the movement of pregnant women;
• special gymnastics classes;
• lectures and conversations of the obstetrician-gynecologist and methodologist-instructor;
• group holding of all major events.

The method of autogenous preparation of pregnant women for childbirth. It seems possible to use autogenic training in obstetrics in 3 versions:

• 1 - as a form of psychotherapeutic influence with some accompanying or arising in pregnancy diseases (functional disorders of the nervous system, the initial stages of hypertension, etc.);
• 2 - as an element in the general system of preparing pregnant women for childbirth by the method of psycho-preventive or FPPP of pregnant women for childbirth;
• 3 - as an independent form of preparation of pregnant women for childbirth.

Autogenic training is fundamentally different from what is the basis for psycho-preventive preparation for childbirth, the main purpose of which is to eliminate fear and established ideas about the presence of pain in childbirth.

Autogenic training combined with elements of physical training should be considered as a method of comprehensive preparation of a woman for childbirth, training her to mobilize all the systems of her body for delivery. Elimination of the pain component is included in the general training system, but it should not be the only or the main element of the training. Pain can not be considered in isolation from all the processes occurring in the body of a woman during pregnancy and childbirth.

Consequently, the essence of the preparation of pregnant women in accordance with the recommended method should be reduced to mastering the self-regulating methods of pregnancy and the ability to self-hypnosis.

Practice has shown that this can be achieved, however, the method of autogenous training, its mechanism of action, the effect on the organism of the pregnant and maternity wards, the antinociceptive system, endogenous opiates, and the method of application need further study.