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Hypertension of the lower segment of the uterus (inverse gradient)
Last reviewed: 23.04.2024
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By the hypertonus of the lower segment of the uterus, or the inverse gradient, is understood such a pathological condition, when the contraction wave begins in the lower uterine segment and spreads upward with decreasing force and duration, while the lower segment contracts more strongly than the body and the uterine fundus. Such uterine contractions are not effective to ensure the opening of the cervix, despite the fact that they can be as strong as in normal births. In fact, these cuts are aimed at closing the cervix, especially at an early stage of labor, when the lower segment of the uterus is actively contracting.
The etiology of this anomaly is not well understood, but most researchers are inclined to believe that the main cause of hypertension in the lower segment of the uterus is a violation of the mechanism of reciprocal (conjugated) relations between the body and the cervix, which is due to their different innervation. As has now been established, this anomaly in labor is often observed in the "immature" and rigid cervix of the uterus.
The clinical picture with hypertension of the lower segment is characterized by a rather pronounced labor activity, but fights are more painful than normal, there is no opening of the cervix or its dynamics are poorly expressed, the present part of the fetus does not advance. Pain is usually expressed in the lower parts of the uterus and in the lumbar region. A high uterus tone is determined in the lower parts of the uterus. Often there is a premature discharge of amniotic fluid. In the future, the secondary weakness of labor can develop. Often there is intrauterine fetal suffering. Hypertension of the lower segment of the uterus is observed in the first stage of labor and especially in the early stages of cervical dilatation.
The diagnosis is easily based on clinical data. A great help in diagnostics is provided by multichannel hysterography, where in this anomaly the dominance of contractions in the lower segment of the uterus compared with contractions in the body and uterine fundus is noted.
Differential diagnosis should be carried out primarily with clinical mismatch.
To restore a triple descending gradient with a dominant bottom, it is recommended that psychotherapy, the use of analgesic, sedative, antispasmodics, obstetric anesthesia be recommended. A good effect has therapeutic electroanalgesia, an autopsy of the fetal bladder. The mistake is the appointment of anatomical means and an attempt to expand the cervix (!).
First of all, it is necessary to find out the cause of this pathology. So, if immaturity of the cervix is established, it is necessary to carry out treatment aimed at its maturation.
In childbirth, careful monitoring of the nature of labor, the dynamics of cervical dilatation (conducting the partograph), palpitation of the fetus is important, prevention of fetal hypoxia is mandatory.
In the absence of the effect of the therapy, taking into account the condition of the mother and the fetus, the question of delivery by the cesarean section should be raised in a timely manner.
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