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Weakness of attempts
Last reviewed: 20.11.2021
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Weakness of attempts can be primary and secondary.
Primary weakness is observed in cases of weakness in the muscles of the abdominal press in multifaceted women with excessively stretched and relaxed abdominal muscles, with infantilism, obesity, and abdominal wall defects in the form of hernias of the white abdominal line, umbilical and inguinal hernias, with myasthenia gravis and spine injuries. Overflow of the bladder, intestines and stomach have a retarding effect on the development of attempts. Negative emotions, fear of childbirth in the period of exile in primiparous women are often accompanied by weakness attempts. The latter can be observed due to an impairment of innervation on the soil of organic lesions of the central nervous system (poliomyelitis, the consequences of brain and spinal trauma, etc.).
Often, weakness of attempts is observed with primary and secondary weakness of labor activity due to lack of reflex reactions due to lack of proper pressure of the presenting part on nerve endings in the small pelvis.
Secondary weakness of attempts is observed in case of muscular fatigue and general fatigue of the parturient woman in overcoming obstructions from the birth canal, after suffering exhausting extragenital diseases. It is often found in parturient women who develop, in order to accelerate childbirth, the so-called "premature attempts".
Weakness attempts can arise reflexively in severe pain caused by compression of intestinal loops between the anterior abdominal wall and the uterus, observed during epidural anesthesia.
Symptoms of weakness tensions are expressed in the elongation of the period of exile. Attempts become short-lived, weak and rare. The advancement of the presenting part of the fetus is delayed or suspended. Elongation of the period of exile leads to swelling of the external genitalia, there are signs of compression of neighboring organs and the development of endometritis in childbirth. The fetus is threatened with asphyxiation and death. With hysterography, a low amplitude of contractions of the striated musculature is noted.
Diagnosis is established based on clinic and hysterography.
The management of labor in case of weakness in attempts is essentially the same as in the case of secondary weakness of labor. In case of weakness, attempts usually refrain from obstetric anesthesia and use stimulant funds (oxytocin intravenously or in the form of tablets).
If the abdominal press is untenable, a Verbov bandage or a modification from the sheet is used. According to the indications, perineo or episiotomy is used.
If the above measures are unsuccessful and there are indications for rapid delivery (acute fetal hypoxia, endometritis, prolonged exile period), application of obstetric forceps or vacuum extractor is applied. Squeezing the fetus according to Kristeller is traumatic and dangerous for the mother and fetus and should not be used.