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Myometrium hyperactivity


This form of anomaly of patrimonial activity complicates a current of 0,8% of childbirth. It is shown extremely strong (more than 50-80 mm Hg), frequent (more than 5 in 10 minutes) by pains and the raised uterus tone (more than 12 mm Hg). Smoothing of a neck of uterus happens very quickly. At once after an izlitiya of waters rough, prompt attempts begin. The expulsion of the fetus and an afterbirth can occur for 1-2 attempts. The general duration of delivery at the same time is considerably reduced.

Them call bystry childbirth (to the 6th hour - at primapara, to the 4th hour - at multipara) or prompt (less 4th hour - at primapara, less 2nd hour - at multipara).

Гистологическое строение миометрия

Histologic structure of a myometrium

Myometrium Hyperactivity symptoms:

The hyperactivity of a myometrium constitutes considerable danger both to mother, and to a fruit: Women in labor often have ruptures of a neck of uterus, vagina, cavernous bodies of the clitoris, crotches. Premature placental detachment or disturbance of its department in the afterbirth period are possible. Bystry emptying of a uterus can lead to its atony. These complications are followed by the bleedings hazardous to health and even the woman's lives. Because of injuries diseases in a puerperal period are often observed.

The similar course of childbirth threatens also the child. Its hypoxia as a result of disturbances of uteroplacental blood circulation accrues. At bystry advance of a head in patrimonial ways she does not manage to configure, is exposed to a bystry and strong prelum that leads to an injury and intracraneal hemorrhages, to a rupture of cerebellar is mashed also to injury of a skull. It increases mortinatality and early child mortality.

Rapid childbirth sometimes finds the woman at work, on the street, in transport (so-called "street childbirth"). At the same time, except the specified complications, the rupture of an umbilical cord and falling of the child on a floor are possible. It causes it a severe injury, up to death. Similar cases are a reason for forensic medical examination for the purpose of an exception of violent death of a fruit.

Myometrium Hyperactivity reasons:

The etiology of a hyperactivity of a uterus is studied insufficiently. It is connected with disturbance of kortikovistseralny regulation and increase in kontraktilny substances in an organism (oxytocin, acetylcholine, adrenaline).

Mark out risk factors of bystry (rapid) childbirth: Existence in the anamnesis of bystry childbirth, a birth trauma or still births, as a result of such childbirth. A large number of childbirth in the anamnesis. Istmiko-tservikalnaya insufficiency. Extensive basin, small fruit. Vegetative neuroses.

Treatment of the Hyperactivity of a myometrium:

The main method of treatment of a hyperactivity of a uterus is intravenous administration of tokolitik, adrenomimetik with selective effect on in - myometrium adrenoceptors which reduce concentration of calcium in myofibrils. Treat such drugs: giniprat, Fenoterolum, Partusistenum. Ginipral - solution for infusion, in 5 ml contains 5 mkg of an effective agent гексопреналин sulfate. For an acute tocolysis (bystry suppression of pains) enter intravenously slowly in a dose 10 mkg (10 ml) into 100 ml of 0,9% of Na Cl solution or glucose within 20-30 minutes. At treatment by tokolitka side reactions from cardiovascular system are possible: tachycardia, decrease in the ABP (diastolic), weakness, nausea. They are warned by purpose of Isoptinum (40 mg inside) who is an antagonist of calcium and promotes also decrease in a sokratitelny uterine activity.

It is necessary to remember numerous contraindications to use of tokolitik: thyrotoxicosis; cardiovascular diseases, serious illness of a liver and kidneys; glaucoma; bronchial asthma; diabetes mellitus; uterine bleeding; premature placental detachment; inflammatory diseases of a uterus; hypersensitivity to drug; It is not necessary to try to obtain complete cessation of patrimonial activity as it becomes at threat of premature births, it is only enough to reduce excitability of a myometrium, to normalize a uterus tone, to reduce the frequency of pains, to increase duration of relaxation of a uterus after the fight.

For removal of patrimonial activity it is possible to use a radio or ftorotanovy anesthesia. Effectively intravenous administration of Promedolum or Omnoponum (2% - 1 ml). For weakening of attempts reasonablly intravenous administration of 10 ml of 25% of solution of sulfate magnesia. The woman in labor is stacked sideways opposite by fruit positions, and are delivered on one side. In the II period pudendalny anesthesia is shown. An obligatory component of conducting rapid (bystry) childbirth is prevention of hypotonic bleeding by means of administration of methylergometrine (1 ml intravenously right after an expulsion of the fetus) and the vitamin and power complex containing 20 ml of 40% of glucose, 10 ml of 5% of ascorbic acid, 100 mg of cocarboxylase and 4 ml of ATP.

Prevention of rapid childbirth consists that women of risk group should not appoint the means stimulating sokratitelny activity and a tone of a uterus, and also calcium drugs. Before childbirth and in labor only the prone position is recommended to them. It is necessary to avoid purpose of the pharmacological means breaking processes of synchronization of opening of a neck of uterus and advance of a fruit it.

The most effective therapeutic drugs are the tokolitik reducing a uterus hyper tone. Appoint them in 2-3 days prior to the estimated term of childbirth in a half one-time dosage 1-2 times a day. If the previous pregnancies came to an end with rapid childbirth from the failure for a fruit, then it is necessary to raise timely a question of planned Cesarean section for the benefit of a fruit.

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