Pathological preliminaries: treatment. Preliminaries are ...

Preliminaries are abdominal contractions during pregnancy, which are accompanied by minor pain and tension in the muscles. They are irregular. Such fights are the precursors of childbirth. Under normal conditions, the preimineral period of labor should take about 6-8 hours. However, in some cases this period may be delayed. It can happen for various reasons. In this case, there is a pathology of labor that requires immediate medical attention. Since the consequences of the protracted preliminaries can be very serious for the mother and the child: from strong gaps in the parturient woman to the death of the fetus.

The concept of the pathological preliminaries

The physiology of each woman is individual. In some cases, this period may be delayed for several hours, and sometimes for several days. This leads to exhaustion of the woman, loss of sleep, accumulation of strong fatigue at the time of delivery. In this case, there is a pathological preliminar period of childbirth, that is, the prenatal period, which was delayed. It is characterized by irregular painful contractions that do not lead to changes in the cervix, but only deplete the body of a woman.

The essence of the anomalous preliminaries

The main essence of pathology can be expressed as follows:

• The physiological preliminary period is prolonged.
• Increased myometrium tone.
• Internal uterine pharynx shrinking.
• There are contractions of the lower segment of the uterus.
• Muscle fibers are arranged in a circle, transversely and in a spiral;

Causes

As a rule, a pathological preliminary period causes the presence of disturbances in the maternity body. The main reasons can be divided into three groups:

Obstetric:

• Presence of polyhydramnios or lack of hydration.
• Multiple pregnancy.
• The fetus in the womb occupies the wrong position (pelvic presentation).
• The placenta is located low.

Psychoemotional:

• A woman is afraid of childbirth.
• Negative attitude.
• Neuroses and strong emotional stress.
• Physical fatigue of the patient.
• Age of the first-born woman (fear of the outcome of childbirth with too early or late pregnancy).

Physiological:

• The parturient has a narrow pelvis.
• Previously conducted in the uterus surgical interventions (the presence of scars after cesarean, etc.).
• Disorders in the work of the endocrine system (obesity, anorexia, etc.).
• Labile nervous system.
• Diseases of the kidneys, heart, liver and other organs.
• Inflammation of the uterus.
• Gestosis.
• Multiple abortions.
• Fetal unintention.

Symptoms

The pathology of the pre-term period helps to recognize the following symptoms:

• The uterus in the preparatory and preliminaries is painfully shortened, while fights are not regular. They can occur both in the daytime and at night. For a long time, labor activity does not begin.
• Increased the tone of the uterus and its excitability.
• Disclosure of the uterus is not observed, it continues to be dense and long.
• The present part of the fetus does not press against the small pelvis of the woman.
• Due to the hypertonicity of the uterus, it is difficult to perform palpation of the fetus.
• The uterus shrinks monotonously for a long time. The strength and frequency of contractions do not change. The precursors and the preliminaries are long-lasting.
• The woman has a worsening mental state, she becomes tearful and irritable, she has a lack of confidence in the successful completion of labor.

Types of pathology

The pathological preliminaries can be of two types:

• In the first case, the muscles of the uterus are not relaxed, the muscular fibers of the uterus correspond to the density of the "mature" cervix, low blood pressure, flat fetal bladder.
• In the second case, the cervix is "immature", has an oval shape, the present part of the fetus does not fit to the entrance to the small pelvis. Most often, this situation is observed when the fetus is overloaded.

Duration

The duration of the abnormal preliminaries, depending on the individual characteristics of each woman, can range from 6 hours to 24-48 hours. For some women, he can stretch for several days.

Possible consequences

The pathological preliminar period in most cases leads to complication of the course of labor. In many parturients, labor is abnormal. In particular:

• Generic activity is weak. In this state, the inadequate force of contraction of the uterus, large intervals between contractions, the cervix opens slowly, the fetal movement is delayed.
• Generic activity is discordant. It is manifested by indiscriminate contractions of the uterus. There is no synchronicity in the reduction and relaxation of individual sites. As a result, bouts are accompanied by severe pain, become frequent and uneven, which exhausts the mother and prevents her from relaxing.
• Generic activity is very rapid. This anomaly is characterized by very strong and sharp contractions and attempts. As a result, childbirth occurs very quickly (up to 5 hours). This can lead to rupture of the vagina and perineum in parturient women, severe bleeding. The fetus may develop hypoxia. Rapid birth can lead to birth injury to the fetus.
• The tetanus of the uterus is a rare anomaly. In this case, a condition is observed when the uterus does not relax at all. Occurs in the case of several drivers of rhythm in different parts of the uterus. It leads to violation of uterine contractions and stopping labor. The fetus may develop hypoxia, which can lead to violations of cardiac activity.

The following consequences of abnormal course of labor can develop:

• Untimely removal of amniotic fluid.
• Appearance of meconium at the very beginning of labor, which means "distress" of the fetus.
• Operational delivery.
• Imposition of obstetric forceps.
• Severe pathological bleeding.
• In the postpartum period, purulent-infectious diseases develop.
• Hypoxia of the fetus and the birth of a child with impaired cardiac activity or ischemic disease.

Diagnostics

If you suspect that the preliminaries are abnormal, you should immediately go to the obstetrician-gynecologist. He must do an external examination. Palpation helps to determine the high or low position of the fetus. If the fetus does not descend, this indicates the presence of a pathology of labor. Also about the pathology can be judged by the presence of a strong strain of the muscles of the vagina, immaturity of the uterus for childbirth and spasms.

Diagnosis of the pathology of the preliminaries is based on clinical and laboratory studies, which allow to conclude that the acetylcholinesterase activity of erythrocytes decreases, the level of adrenaline and norepinephrine in the blood increases.

It is possible to conduct an instrumental study. For this, cardiotocography is done. With her, you can record the strength and duration of bouts.

Pathological preliminaries: treatment

With the immature cervix of the uterus and the lack of independent development of labor activity, there is a pattern of masturbation of pregnancy. Therapy in this case will be prescribed taking into account the pathogenesis of pathology. The goal of treatment will be to accelerate the process of ripening of the uterus. Such methods of treatment can be applied:

• Electroanalgesia.
• Electrorelaxation of the uterus.
• Treatment with medication: antispasmodics, analgesics, prostaglandins E2.

If the patient is experiencing severe fatigue and increased nervousness, then her medication is prescribed as medication. Sedatives are also prescribed.

A positive result of treatment is reflected in the sharp onset of regular labor. Or in the ripening of the organism for childbirth. When the uterus becomes "mature," a fetal bladder is opened and regular fights begin for two hours. If labor activity does not begin, then intravenous drip is injected with prostaglandins.

In case of ineffective treatment together with other complications (obstetric anamnesis, large fetal size , pelvic presentation, OPG gestosis, fetal hypoxia), an emergency cesarean section is performed.

Approaches to the management of pregnant women who have a pathological preliminaries

There are two approaches:

• Full rest.
• Stimulation of labor with oxytocin.

Both methods aim at eliminating abnormalities in labor. A successful outcome of the case is observed in 85% of cases. When choosing a method, the following pathological features are taken into account:

• Degree of anxiety and fatigue of the patient.
• The reason for the complication.
• The choice of a method that is more convenient for the patient and obstetrician.

When choosing the approach, which consists in observing complete dormancy of the pregnant woman, 0.015 g of morphine is administered intramuscularly. Then secobarbital inside 0.2 g. This option is quite effective. As a rule, after the introduction of morphine, the patient falls asleep within an hour. After 4-5 hours of rest, during which the exhausted body regains strength, the woman wakes up or without any signs of birth, or with active labor.

When choosing the second path, i.e. Stimulation with oxytocin, it is worth to avoid opening the fetal bladder. Cesarean section is justified only in the most severe cases.

Prevention

The main preventive measures to prevent the pathology of the preliminaries are:

• Timely advice of an obstetrician.
• Delivery of all necessary tests.
• Fulfillment of prescriptions of the doctor concerning a regimen and a delivery.
• Psychological and physical preparation of a pregnant woman for childbirth.

A competent obstetrician-gynecologist should control women who are at risk of this pathology. Namely: primiparous in the age of 17 years and after 30 years, as well as women with diseases of certain organs (liver, kidney, heart).

So, the pathological preliminar period is one of the types of abnormalities of labor. He meets quite often. However, thanks to modern medicine, in 85% of the timely intervention of doctors, the birth ends safely. Therefore, when the first signs of pathology appear, you should immediately contact a competent obstetrician-gynecologist. The consequences of an abnormal preliminaries period can be very serious, up to the fetal hypoxia, the appearance of disturbances in the work of its internal organs, and death. Correctly appointed treatment will help to save the life of both mother and child.