Pathological preliminary period of childbirth

Description:

The pathological preliminary period of childbirth – the prolonged predrodovy preparatory period proceeding with the irregular painful contractions which are not leading to structural changes of a neck of uterus. The pathological preliminary period is characterized is long (over 6-8 hours) the proceeding inefficient colicy pains which break the daily mode of wakefulness and the woman's dream, cause exhaustion of the woman in labor and increase risks of a hypoxia of a fruit.

Reasons of the pathological preliminary period of childbirth:

Disturbances of the preliminary period of childbirth are more often noted at pathology of a maternal organism: at pregnant women with a labile nervous system, neurosises, NTsD; metabolic and endocrine disturbances (obesity, insufficient body weight, menstrual dysfunction, sexual infantility, etc.); the accompanying somatic pathology (heart diseases, arrhythmia, arterial hypertension, diseases of kidneys, a liver, adrenal glands); inflammatory changes of a uterus (endometritises, tservitsita); a gestosis, dystrophic processes after the postponed abortions.
Besides, tightening of the preliminary period can be promoted by negative installation of the woman on the child's birth, fear of childbirth, the age of primapara is younger 17 or 30 years are more senior.
Polycarpous, small pregnancy abounding in water, large fruit, placental presentation, the wrong provisions of a fruit, anatomically narrow basin, etc. belong to the obstetric reasons of the complicated preliminary period of childbirth.

Symptoms of the pathological preliminary period of childbirth:

The pathological preliminary period is characterized by the following clinical signs.

Preparatory prenatal reductions of a uterus painful, arise not only at night, but also in the afternoon, have irregular character and long time do not turn into patrimonial activity. Duration of the pathological preliminary period can make from 24 to 240 h, depriving the woman of a dream and rest.
Structural changes of a neck of uterus ("maturing") do not happen. The neck of uterus remains long, excentricly located, dense, an outside and internal pharynx are closed. Sometimes the internal pharynx is defined in the form of the dense roller.
There is no due expansion of the lower segment in which (at a "mature" neck) also the supravaginal portion of a neck of uterus has to be involved. Excitability and a tone of a uterus are increased.
The prelying part of a fruit does not nestle on an entrance of a small pelvis (in the absence of any disproportion between the sizes of a fruit and the woman's basin).
Because of a uterus hyper tone the palpation of the prelying part and small parts of a fruit is complicated.
Reductions of a uterus long time have monotonous character: their frequency does not increase, force does not increase. The behavior of the woman (active or passive) does not exert any impact on them (does not strengthen and does not weaken).
The psychoemotional condition of the pregnant woman is broken: it is not counterbalanced, irritable, whining, is afraid of childbirth, it is not sure of their happy end.
The essence of the pathological preliminary period consists in the raised myometrium tone, spastic reduction of an internal uterine pharynx and the lower uterine segment where muscle fibers have the circular, cross and spiral directions.

Existence of the pathological preliminary period testifies to the pathology of reduction of a uterus, insufficient, asynchronous readiness of mother and a fruit preceding childbirth to unleashing of patrimonial activity.

The pathological preliminary period passes or into a diskoordination of patrimonial activity, or into primary weakness of pains; quite often is followed by the expressed vegetative disturbances (perspiration, a sleep disorder, a neurangiosis). The pregnant woman complains of pains in the field of a sacrum and a waist, a bad dream, heartbeat, an asthma, the dysfunction of intestines increased and painful stir of a fruit.

In the absence of treatment of the pathological preliminary period quite often there are symptoms of a hypoxia, decrease in a biophysical profile of a fruit.

Diagnosis:

Clinical and laboratory trials allowed to reveal disturbance of vegetative balance at these patients: increase in blood of level of adrenaline and noradrenaline, decrease in atsetilkholinesterazny activity of erythrocytes. Take place also increase in maintenance of a prekallikrein, decrease in Atfazny activity of a myosin, antioxidant protection, intensity of exchange processes in a uterus (low level of activity glyukozo-6-fosfatdegidrogenazy - G-6-FDG, reduction of maintenance of proteinaceous and nonprotein SH-group), dominance of a glycoclastic way of metabolism of glucose.

Increase in level of noradrenaline (in the absence of change of content of adrenaline and decrease in atsetilkholinesterazny activity of erythrocytes) at pregnant women with the pathological preliminary period demonstrates intensive synthesis and release of noradrenaline from presynaptic membranes, i.e. a simultaneous hyperactivity of adrenergic and cholinergic systems. By comparison of amount of adrenaline, noradrenaline and atsetilkholinesterazny activity of erythrocytes to results of definition of sokratitelny activity of a uterus at the pathological preliminary period sharp increase in excitability and a tone of a uterus is revealed.

The analysis of results of definition of activity of kinin system showed that at women at an "unripe" neck of uterus and the pathological preparatory period high content in a blood plasma of a prekallikrein who under certain conditions easily passes into kallikrein is noted.

The Sokratitelny uterine activity depends on the level of the substances participating in exchange processes in myometriums, and activities of oxidation-reduction processes about which indirectly judge by concentration of sulphhydryl (SH) groups, activity of a transketalaza and enzymes of a pentozofosfatny way of oxidation of glucose.

We obtained data on increase in maintenance of proteinaceous and nonprotein SH-group at healthy women at the end of pregnancy in comparison with patients at whom the pathological preliminary period not less than 2-3 days was observed. It can be regarded as compensatory increase in power of antioxidant system in organism redoxreactions in response to long unproductive reduction of a uterus. Reduction of number of nonprotein SH-group at the pathological preliminary period confirms tension of mediator system of sokratitelny proteins of a myometrium which determine reduction force.

At a research of the enzymes characterizing a pentozofosfatny way of oxidation of glucose much lower is revealed (more than on 1/3) the level of activity G-6-FDG in blood of women with the pathological preliminary period after comparison with healthy pregnant women that demonstrates decrease in intensity of exchange processes and biosynthesis of estrogen, and also insufficient endocrine stimulation of a uterus with dominance of a glycoclastic way of metabolism of glucose. It is established that G-6-FDG and a transketalaza are the regulating link in synthesis of estrogen and provide ways of metabolism of the carbohydrates necessary for synthesis of molecules of RNA.

Results of studying of the indicators characterizing functional activity of adrenergic and cholinergic systems at the full-term pregnancy and the long pathological preliminary period (of 1-3 days), confirm dominance of a tone of a parasympathetic nervous system. A superactivity of a cholinergic nervous system, higher content in blood of serotonin, a histamine and prekallikrein is found in these women that is followed by increase in excitability and a hyper tone of a uterus. Reduction of number of SH-group, decrease in maintenance of a transketalaza and activity of enzymes of pentozofosfatny oxidation testify to the low level of reserve opportunities of a sokratitelny uterine activity.

Characteristic complication of the pathological preliminary period is prenatal izlity amniotic waters which reduces the volume of a uterus and reduces a myometrium tone. If at the same time the neck of uterus has sufficient "maturity", sokratitelny activity of a uterus can be normalized and turn into normal patrimonial activity.

Conducting childbirth at the pathological prelaminarny period:

Tactics at a pathological current of the preliminary period of childbirth is defined by its duration, a condition of the pregnant woman, expressiveness of clinic, a condition of a fruit and patrimonial ways. In all situations accompanying the pathological preliminary period of childbirth use of estrogen, analgetik, sedative, and antispasmodics is shown.
If the preliminary period of childbirth lasts less than 6 hours, is followed by a maturity of a neck of uterus and standing of a head of a fruit in an entrance to a small pelvis, treatment begin with carrying out an electroanalgesia or acupuncture. At a safe bag of waters and a maturity of patrimonial ways the amniotomy is carried out.
In case of duration of the preliminary period of childbirth till 6 o'clock, but immaturity of a neck of uterus, sedation (introduction of Seduxenum) and medicamentous preparation of a neck (purpose of E2 prostaglandins, oestradiol of Dipropionas, folliculin etc.) is shown.
At the long preliminary period of childbirth (10-12 hours and more) which is followed by exhaustion of the woman in labor medication sleep is applied. After awakening at 85% of women there comes the active patrimonial phase with normal sokratitelny activity of a uterus. At other 15% due to the lack or not expressiveness of pains careful purpose of uterotonik (oxytocin, prostaglandin) is shown.
Except everything listed, for removal of the pathological preliminary period of childbirth, are applied β-adrenomimetik (giniprat, brikanit, Partusistenum, etc.).
At impossibility of achievement of vigorous and regular patrimonial activity, and also at the burdened obstetric anamnesis, a large fruit, pelvic presentation, extragenital diseases, symptoms of a hypoxia of a fruit, carrying out delivery by Cesarean section is reasonable.
The maximum term of treatment of the pathological preliminary period of childbirth should not exceed 3-5 days.