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The use of antispasmodic agents in parturients with pelvic presentation of the fetus
Last reviewed: 20.11.2021
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When preparing for childbirth and in the process of the birth act, it is necessary to systematically introduce antispasmodics at 2-3 h intervals, taking into account the nature of labor, the type of abnormality of labor and the pharmacodynamics of the antispasmodics used.
The use of antispasmodic agents in parturients with pelvic presentation of the fetus leads to a shortening of the duration of labor for an average of 3-4 hours in both the first and the re-birth. With the weakness of labor and the lack of biological readiness for childbirth, the highest spasmolytic effect is produced by the central anticholinergic agent, spasmolithine in a dose of 100-200 mg (0.1-0.2 g).
In the hypodynamic form of the weakness of labor activity against the background of a decreased basal tone of the uterus, the highest antispasmodic effect is the use of a solution of halidor in a dose of 0.05 g intramuscularly or intravenously slowly with a glucose solution of 20% to 40 ml. The use of the halidor solution has a pronounced antispasmodic effect at various degrees of opening of the uterine throat, even with the preserved cervix in the primiparous.
In case of non-coordinated labor at delivery in women with pelvic presentation of the fetus to regulate uterine contractions, a pronounced central analgesic effect is introduced by the spasmoanalgetik baralgin. The latter is used in a dose of 5 ml of a standard solution, preferably intravenously very slowly with 20 ml of a 40% solution of glucose.
In primiparas, the spasmolytic effect of baralgina and the normalization of the contractile function of the uterus are manifested with the preserved and mature cervix of the uterus. In the protracted course of the birth act, due to the discoordination of the ancestral forces, in primiparas it is most expedient to use it when opening the uterine pharynx for 4 cm or more. In cases of excessive labor in women with breech presentation of the fetus, it is recommended to use combinations of neurotropic agents (2.5% to 1 ml propazine solution) in combination with a 2 ml solution of pipolphene and 1% to 2-4 ml or 2% to 1-2% ml (0,02-0,04 g) intramuscularly in one syringe, and in the absence of effect - additionally apply ethereal anesthesia by hardware in combination with O 2. A high regulating effect gives the use of inhalations of fluorotan at a concentration of 1.5-2.0% by volume, with the normalization of labor activity occurring in the first 5 minutes (with an increase in the concentration of fluorotan from 2% and more, almost complete stop of labor activity occurs). Simultaneously, the normalization of palpitation of the fetus is noted. The duration of inhalations of ftorotan should be at least 20-30 minutes, since excessive labor can again occur. Inhalation of fluorotan is carried out only by an experienced anesthesiologist using the Trilan apparatus, where there is a calibration for fluorotan, or an apparatus for inhalation anesthesia.
In recent years, beta-adrenomimetics are becoming more widespread in the treatment of excessive labor.