Childbirth is a complex physiological process that occurs and ends with the interaction of many body systems.
Regulation of motor function of the uterus is performed by nervous and humoral ways. In the regulation of uterine contractile activity, timely delivery and physiological progress, the importance of estrogens, gestagens, corticosteroids, oxytocin, prostaglandins and many biologically active substances is of great importance. Without a doubt, the leading role in the development of labor and delivery is played by its hypothalamic-pituitary and adrenal system. The central nervous system performs a high regulation of the generic act. The readiness of the pregnant woman for childbirth, the maturity of the cervix, the sensitivity of the uterus to uterotonic substances are of great importance for the onset and uncomplicated course of labor.
There are three degrees of readiness of the cervix for labor: "Mature", "not sufficiently mature" and "immature". This takes into account the consistency of the cervix, the length of the vaginal part, its location in the small pelvis according to the wire axis of the pelvis and the patency of the cervical canal. In addition, pay attention to the location of the presenting part of the fetus. Thus, with the "mature" cervix of the uterus of the presenting part fixed to the entrance to the pelvis, indicating the readiness and deployment of the lower segment of the uterus. In this case, the cervix is "mature" and palpation - soft, centered, located along the wire axis of the pelvis, reduced to 1-1.5 cm, the cervical canal passes 1.5-2 fingers. The "immature neck" of the uterus is dense, deflected to the coccyx or to the bosom, up to 2 cm in length, the external shed passes the tip of the finger, the present part is not pressed against the plane of entry into the small pelvis and is high. The "insufficiently mature neck" of the uterus occupies an intermediate position.
In addition to the willingness of the cervix to give birth for successful delivery, there are many other factors:
- The size of the bone pelvis;
- Size of the fetal head;
Intensity of uterine contractions
- Fetal head ability to the
- Presentation and position of the fetus.
Recently there has been a reduction in the length of labor. Now all maternity hospitals and institutions have adopted an actively-anticipated tactic of conducting labor, or "management" of labor is being carried out. This consists of the use of physio-preventive preparation for childbirth, the widespread use of antispasmodic and analgesic substances, the use of uterotonic drugs as indicated. The average length of labor for women who give birth for the first time is 11-12 hours, again - 7-8 hours. According to modern ideas, pathological births include those that last more than 18 hours.
Pathological births include "steep" births that last for women giving birth for the first time, up to 4 hours, again - up to 2 hours. Fast genera of duration for primiparas are called up to 6 hours, for re-born to 4 hours.
When the anomaly of labor activity, the contractile activity of the uterus is disrupted, which leads to a pathological course of the birth act, an increase in the frequency of surgical interventions, complications in the mother, fetus and newborn.
The frequency of development of anomalies of the generic loyalty is 15-17% of the total number of births.
Causes of violation of contractile activity of the uterus:
- Excessive neuropsychic stress, negative emotions;
- Violation of neurohumoral mechanisms of regulation of labor activity due to acute and chronic infectious diseases, diseases of the nervous system, lipid metabolism disorders;
- Anomalies of development and tumors of the uterus (saddle-shaped uterus, partitions in the uterus, uterine myoma, etc.);
- Pathological changes in the cervix and uterine body;
- Presence of mechanical obstruction of OD for fetal progression through the birth canal (narrow pelvis, tumors, etc.);
- Polyhydramnios, hypochlorism, multiple pregnancies;
- Mature pregnancy;
- Irrational application of uterotonic and anesthetizing substances.
In the clinical evaluation of delivery pay attention to:
- contraction of the uterus;
- Dynamics of cervical dilatation;
- Advancement of the presenting part of the fetus;
- Fetal condition.
To register the contractile activity of the uterus, external hysterography and cardiotocography methods are used, when it is possible to evaluate the contractile activity of the uterus and the fetal condition. In the absence of recording devices, palpation, auscultation, and also take into account the pain experienced by the parturient woman associated with contractions of the uterus.
Classification of anomalies of labor
Depending on the time of origin of the pathology of labor, and its manifestations, the following types of anomalies of labor are distinguished:
1. Pathological preliminaries.
2. Weakness of labor:
3. Excessive labor activity.
4. Discoordinated labor activity (discoordination, hypertension of the lower uterine segment, circulatory dystonia of the female).