Prolonged deceleration phase

The prolonged phase of deceleration is characterized by an increase in its duration in primiparas by more than 3 hours, in repetitive ones - by more than 1 hour. Under normal conditions, the average duration of the deceleration phase is 54 minutes in primiparas, and in 14 months - in multi-generators.

Diagnostics. To diagnose a prolonged phase of deceleration, it is necessary to perform at least 2 vaginal examinations with an interval between them equal to 3 h in primiparas and 1 h - in maternity females. Usually, more than two studies are performed within the time required for diagnosis.

During normal delivery, the slowdown phase is difficult to establish without frequent vaginal examinations at the end of the active phase. However, when anomalies appear in the deceleration phase, it is not difficult to detect it if it is not obscured by the development of other accompanying anomalies of labor. Such situations are often observed; in approximately 70% of cases, a protracted phase of deceleration occurs along with a prolonged active phase of opening the cervix or with the stopping of fetal progression through the birth canal. In such cases, the diagnosis can not be established, since the greatest attention is paid to determining the concomitant violations.

Frequency. This pathology can complicate up to 5% of births. In any case, it is the rarest of all abnormalities of labor.

Causes. The most often prolonged phase of deceleration is due to an improper presentation of the fetus. In 40.7% of mnogorozhavshih women had a head presentation of the fetus with the occiput turned to the back, in 25.4% - the transverse position of the head. Their incidence in primiparas was 26.3% and 60%, respectively. The mismatch between the fetus and the pelvis of the mother was an etiological factor in about 15% of women with this disruption of labor. The prolonged phase of deceleration is often observed in childbirth complicated by obstructed passage of the fetal humeral girdle (dystopia).

Forecast. According to Friedman (1978), more than 50% of the primiparous and about 30% of maternity females require delivery through the imposition of cavitary obstetric forceps. The use of forceps (turn when forceps were applied) required 40% of primiparous women and 16.9% of parturients with repeated childbirth; Cesarean section was performed in 16.7 and 8.5% of women giving birth, respectively. The prognosis of this abnormality is worse in women with the first pregnancy.

Maintaining a long slowdown phase

It depends primarily on the nature of the lowering of the presenting part of the fetus. If a longer duration of deceleration is observed with a correspondingly lowering of the fetal part (especially if it is below the level of the ileum of the pelvic bones), a disproportion is unlikely and the prognosis for vaginal delivery is favorable. If the slowing-down phase develops with the high-lying presenting part (especially when it is accompanied by a stopping of the lowering), then the situation is serious enough - it is very likely that the size of the fetus and the pelvis of the mother are not consistent.

In the first case - stopping at position +1 or lower standing - the most frequent reasons are incorrect presentation of the fetus (the back of the head is turned to the back, the transverse position of the head), an overdose of sedatives, epidural anesthesia.

Usually, management is cautiously stimulated with oxytocin or in the care of a pregnant woman, pending the cessation or reduction of sedation or anesthesia.

The second group of parturient women - the presenting part of the fetus is above 0 - urgent pelvimetry is needed; further development of labor is allowed only if there is no discrepancy between the size of the fetus and the pelvis of the woman in labor.

The number of previous births in women should not affect the plan of reference. With this type of birth impairment, the incidence rate is almost the same in primiparous (15.8%) and re-birth (15.3%) women.

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