Excessive labor activity (uterine hyperactivity)

Excessive labor activity (uterine hyperactivity) is a form of an abnormality of labor, which is manifested by excessively strong contractions (more than 50 mm Hg) or by fast alternations of contractions (more than 5 contractions per 10 min) and increased uterine tone (more than 12 mm Hg. St.).

The frequency of this form of pathology is 0.8%.

The causes of excessively severe labor were not studied enough. This anomaly of the ancestral forces is most often observed in women with increased general excitability of the nervous system (neurasthenia, hysteria, Graves' disease, etc.). It can be assumed that excessively intense labor can depend on violations of cortico-visceral regulation, in which impulses coming from the uterus of a woman giving birth to the subcortex are not properly regulated by the cerebral cortex. In this case, there may be increased formation of substances such as oxytocin, adrenaline, acetylcholine, which have a powerful effect on the contractile function of the uterine musculature.

With excessively strong labor, there is a violation of uteroplacental blood circulation and the associated gas exchange disorder in the fetus. The birth in such cases ends within 2-3 hours and earlier and they are called impetuous.

Symptoms of excessively strong labor are characterized by a sudden and violent onset of labor. At the same time very strong fights followed one after another in short pauses and lead quickly to the full opening of the uterine throat. The parturient woman with sudden and violent onset of labor, taking place with intensive and almost continuous fights, often comes to a state of excitement.

After the outflow of water immediately begins turbulent and rapid attempts, and sometimes in 1-2 attempts a fetus is born, and after it is the latter. Such a course of labor threatens the mother with the risk of premature placental abruption, often accompanied by deep ruptures of the cervix, vagina, cavernous clitoral bodies, perineum and can cause bleeding, which is dangerous for the health and even life of a woman. In connection with injuries with rapid delivery in the postpartum period, diseases are often observed. With the rapid movement of the fetal head through the birth canal, it does not have time to be configured and is subjected to rapid and severe compression, which often leads to trauma and intracranial hemorrhage, resulting in an increase in stillbirth and early infant mortality.

The diagnosis of excessively severe labor is established on the basis of the above described clinical picture and hysterography data. Sometimes the inadequate behavior of the parturient child in childbirth can be unreasonably seen as a manifestation of excessively strong labor.

To remove excessively strong fights, the use and conduct of tocolysis by beta-adrenomimetics (partus, bricanil, ritodrin, etc.) is effective. Partusisten (0.5 mg) or brikanil is diluted in 250 ml of isotonic sodium chloride solution or 5% glucose solution and injected intravenously drip, starting at 5-8 drops per minute, gradually increasing the dose until the normalization of labor. After 5-10 minutes after the initiation of intravenous administration of beta-adrenomimetics, the mother gives a significant reduction in pain, a decrease in contractile activity of the uterus, and after 30-40 minutes, termination of labor can be achieved.

Among adverse reactions in response to the administration of tocolytics, tachycardia is possible, a slight decrease in blood pressure, especially diastolic, a slight weakness, nausea. To eliminate side effects on the cardiovascular system, the administration of isoptin (40 mg orally), which is a calcium antagonist, also contributes to reducing the contractile activity of myometrium.

In the absence of beta-adrenomimetics for the removal of labor can use ethereal or ftorotanovy anesthesia. Narcosis with nitrous oxide is not suitable, as it does not reduce the tone of the uterus. In the treatment of excessive labor, it is advisable to intramuscularly administer magnesium sulfate (25% solution - 10 ml) and a solution of promedol or omepon (2% solution - 1 ml).

The woman in labor is recommended to lay on her side, opposite the position of the fetus, and take delivery on her side. In the II period of labor, pudendal anesthesia is advisable.

After delivery, carefully examine the soft birth canal in order to identify gaps. If the birth took place on the street, after the woman's admission to the obstetrical institution, the external genitalia is disinfected and the tetanus and the newborn are given tetanus antitetanus serum.

If there is a history of pregnant fast delivery, hospitalization in the maternity hospital is indicated before the onset of labor. If previous pregnancies end in rapid delivery with an unfavorable outcome for the fetus, it is necessary to raise the question of the planned cesarean section in the interests of the fetus in a timely manner.

[1], [2], [3], [4]