The dicoordinated patrimonial activity
Contents:
Description:
At the dicoordinated patrimonial activity various departments of a uterus (the right and left its half, a bottom, a body and lower parts) are reduced chaotically, discordantly, irregularly that leads to disturbance of normal physiology of a childbed. Danger of diskoordinorovanny patrimonial activity consists in probability of disturbance of placental and uterine blood circulation and development of a hypoxia of a fruit. Diskoordination of patrimonial activity is quite often marked out at unavailability of an organism of the pregnant woman to childbirth, including at immaturity of a neck of uterus. Frequency of development of the dicoordinated patrimonial activity makes 1-3%.
The reasons for the dicoordinated patrimonial activity:
The obstetrics and gynecology allocate several groups of the factors causing development of the dicoordinated patrimonial activity.
Obstetric risk factors can consist in early izlitiya of amniotic waters; the uterus restretching caused by a hydramnion or a multiple pregnancy; discrepancy of the sizes of patrimonial ways and heads of a fruit; pelvic presentation; misplaced of a placenta (placental presentation) and fetoplacental insufficiency; a late gestosis, age of the woman is younger 18 and 30 years are more senior. Diskoordinorovanny patrimonial activity can arise at pre-natal infection of a fruit, anencephalia and other malformations at the child, a hemolitic disease of a fruit (immunoconflict pregnancy).
Different types of pathology of reproductive system belong to number of the gynecologic factors provoking the dicoordinated patrimonial activity. Disturbance and a diskoordination of a childbed are promoted by defects of a uterus (a two-horned uterus, an intrauterine partition, a uterus hypoplasia, etc.), the postponed endometritises and tservitsita, tumoral processes (hysteromyoma), the rigidity of a neck of uterus caused by disturbance of an innervation or cicatricial changes (for example, after cauterization of an erosion of a neck of uterus). Adversely on physiology of childbirth existence affects a uterus of an operational hem, frustration of a menstrual cycle, abortion in the anamnesis.
Development of the dicoordinated patrimonial activity can be promoted somatic pathology, by intoxications, infections, organic lesions TsNS, obesity, anemia, neurocirculatory dystonia.
In some cases abnormal patrimonial activity is provoked by external influences - the unreasonable use of rodostimuliruyushchy means, an insufficient labor pain relief, untimely opening of a bag of waters which are roughly conducted by manipulations and researches.
Diagnosis:
The dicoordinated nature of patrimonial activity is diagnosed on the basis of a state and complaints of the woman, results of an obstetric research, a fruit kardiotokografiya.
During vaginal examonation lack of dynamics in readiness of patrimonial ways - a thickening and puffiness of edges of a uterine pharynx is defined. The palpation of a uterus reveals its unequal tension in different departments as a result of the dicoordinated reductions.
Objectively carrying out a kardiotokografiya allows to estimate a sokratitelny uterine activity. At a hardware research are registered irregular on force, duration and frequency of reduction; their arrhythmy and asynchrony; lack of the triple descending gradient against the background of increase in a tone of a uterus. KTG value in labor consists not only in an opportunity to control patrimonial activity, but to monitor increase of a hypoxia of a fruit.
Treatment of the dicoordinated patrimonial activity:
The childbirth proceeding in the conditions of the dicoordinated patrimonial activity can come to the end independently or quickly.
At a diskoordination and a hyper tone of the lower segment of a uterus the electroanalgesia is carried out (or electroacupuncture), spasmolysants are entered, the obstetric anesthesia is used. At deterioration from life activity of a fruit operational delivery is required.
In case of development of a tetany of a uterus giving of an obstetric anesthesia, purpose of α-adrenomimetik is made. Taking into account an obstetric situation childbirth can come to the end Caesarian with the section or extraction of a fruit with obstetric nippers.
At a circulator dystocia are shown the infusion of b-adrenomimetikov directed to removal of the dicoordinated patrimonial activity, and operational delivery. The therapy directed to the prevention of a pre-natal hypoxia of a fruit is at the same time carried out.
To operational delivery without attempts to correct the dicoordinated patrimonial activity situations when last pregnancies came to an end with not incubation or a still birth can be indications. Also the choice for Cesarean section is made at long infertility in the anamnesis of mother; cardiovascular, endocrine, bronchopulmonary diseases; gestosis, hysteromyoma, pelvic presentation or its large sizes; at primapara 30 years are more senior.
At death of a fruit fetaldestructive operation, manual department of an afterbirth with inspection of a cavity of the uterus is performed.
Prevention:
Measures for the prevention of the dicoordinated patrimonial activity include conducting pregnancy at women of risk groups with special attention, observance of the pregnant woman of required installations of the obstetrician-gynecologist, ensuring adequate anesthesia in labor.
Medicamentous prevention of the dicoordinated patrimonial activity is necessary for young women in labor and pozdnorodyashchy women, pregnant women with the burdened somatic and obstetric and gynecologic status, structural inferiority of a uterus, fetoplacental insufficiency, a hydramnion, a multiple pregnancy or a large fruit.
Women of risk groups on development of the dicoordinated patrimonial activity need psychoprophylactic preparation for childbirth, training in methods of muscular relaxation.
