Preliminaries

Discussions about the role and significance of the preliminaries are held in literature long ago. A great deal of attention to this problem is due to its serious importance for preventing the occurrence of abnormalities of labor.

Each obstetrician is well aware of cases of pregnant women entering the labor with cramping pains in the lower abdomen and in the lower back, but without structural changes in the cervix that are characteristic of the first period of labor. In foreign literature this condition is often described as "false births". According to the founder of the Kazan school of obstetricians and gynecologists V. S. Gruzdev (1922), in this period uterine contractions are often not very painful, while in some women, on the contrary, with excessive contractions, excessive soreness is observed, depending on the increased sensitivity of the uterine muscle ("uterine rheumatism "According to the figurative expression of old obstetricians), which the researchers of the older generation attached great importance to the pathology of the birth act. Ye. T. Mikhaylenko (1975) indicates that the period of cervical dilatation is preceded by a period of precursors and a preliminar period. According to the data of G. G. Khechinashvili (1973), Yu. V. Raskuratov (1975), its duration varies from 6 to 8 hours.

Different hypotheses have been made about the reasons for the appearance of the preliminar period. One of the most convincing is the interpretation of it from the point of view of the lack of biological readiness for childbirth. Thus, GG Khechinashvili, assessing the state of the cervix in pregnant women in the preliminaries, indicates the presence in 44% of cases of the mature cervix of the uterus; in 56% of the cervix was poorly prepared or insufficiently prepared. According to Yu. V. Raskuratov, who produced, in addition to the palpation evaluation of the cervix, a functional cervical-uterine test, the mature cervix of the uterus had 68.6% of pregnant women with a clinically expressed preparatory period.

Currently, a special device for determining the degree of maturity of the cervix has been developed. Some midwives consider cases of a clinically pronounced preparatory period as a manifestation of the primary weakness of labor activity and, based on this assessment, offer as early as possible rhythm-stimulating therapy.

VA Strukov (1959) considers it permissible to apply even preventive rhodostimulation, and diagnose the weakness of labor activity within 12 hours of the onset of contractions. However, it should be emphasized that rhodostimulation does not in all cases lead to a positive effect. Thus, according to PA Beloshapko, SA Arzykulova (1961), methods of rhodostimulation are effective in no more than 75% of cases.

Until now, there has not been a single tactic for managing pregnant women with a preliminar period. Some researchers claim that in the presence of a preliminary period, the use of tranquilizers, antispasmodics, estrogens is indicated. AB Gillerson (1966) believes that the untimely appointment of birth-giving agents does not give the proper effect, and often has an adverse effect on the subsequent course of labor, leading to discoordination and weakness of labor. Some other researchers hold the same opinion.

It is important to note that, according to GM Lisovskaya et al. (1966), the frequency of anomalies in the ancestral forces at birth, which began with preliminaries, was 10.6 times higher than in the group of births that began without precursors, and according to the data of GG Khechinashvili (1974), in women with physiologically developing pregnancy the primary weakness of labor was observed in 3%, and in those who underwent a clinically pronounced preparatory period - in 58% of cases.

Another very important aspect of the problem is that the pathological preliminaries period increases the number of adverse outcomes in children. So, according to Yu. V. Raskuratov (1975), in this contingent of women in 13.4% of cases the fetus experiences hypoxia, which is the result of neuroendocrine disorders at the end of pregnancy and abnormal contractile activity of the uterus.

We examined 435 pregnant women with a preliminar period. There were 316 primiparas and 119. 11.22% of the examined women had irregularities in the menstrual cycle, which probably indicates the presence of each 5 th woman under the preliminar period of hormonal disorders.

In the group of primiparas, the total percentage of complications and somatic diseases was 46.7%, in the group of the recurrent - 54.3%.

We consider it expedient to divide the preliminary period into two types: normal and pathological.

Clinical signs of a normal (uncomplicated) course of the preliminaries are rare, weak cramping pains in the lower abdomen and lower back, not exceeding 6-8 hours and appearing against the background of the normal tone of the uterus. In 11% of the examined women, there was a weakening of the contractions and their complete cessation followed by the appearance in a day or more. In 89% of the preliminaries contractions intensified and passed into the birth.