Fast and rapid delivery: causesconsequences for the child

Update: October 2018

Many future mothers dream of a quick labor, especially after listening
the stories of the girlfriends, how well and quickly they have given birth, because I
suffered with contractions less. Good or bad – most
pregnant women do not think about such a question. But obstetricians are very
and have a very negative attitude towards “accelerated program” childbirth,
that is, fast and impetuous. Such kinds of birth harbor many
dangers, and especially for the baby, but fraught with
moms.

Duration of delivery

Even in ancient times it was said that a woman should not have twice
the sun rises, that is, childbirth should not last 24 hours and
more, but not to be too short. The generic process is complex and
laborious, especially for the fetus. For the entire birth period, the baby should
not only to be born, but also to pass through the birth canal, and, in
first of all, to overcome the bone ring of the small pelvis of the mother.

Passage through the birth canal is accompanied by certain
by turning the presenting part of the fetus in one or another plane of the pelvis.
This is necessary for the optimal establishment of the fetal head at the exit from
pelvic and least traumatic birth of the baby. Besides,
the fetus in the process of labor is experiencing stress, which is necessary for
quick adaptation of the child to existence in the outside world. BUT,
accordingly, with fast deliveries, as well as with cesarean
cross-sectional adaptation mechanisms do not run, which may
adversely affect the health of the baby.

Total duration of labor:

  • for primiparas, it is 8 to 12 hours;
  • women who give birth are not the first time – 7 – 10 hours.
  • The maximum duration of labor is 18 hours.

Define the terms

The total number of births accounted for 0.8% of the “accelerated”
childbirth.

  • What kind of birth is called rapid? If the birth is “shortened” to 4
    – 2 hours for first-births and lasts 2 hours or less for
    multipy.
  • Which is fast? If childbirth lasts 6 – 4 hours at the “pervorodok” and
    from 4 to 2 hours for multiparous, they are called fast.

Separately, they talk about “street childbirth”, when the birth process and
the subsequent birth of the child takes the woman by surprise (on the street
or transport). And it happens in a vertical position.
(the woman is either standing / moving or actively moving.

This kind of childbirth, and specifically, their rapid completion –
complete surprise for a woman due to the lack of contractions and attempts and
any painful sensations. Not excluded as a woman’s inexperience
(if the first birth), and the lack of resistance of the cervix (with
normal childbirth, it performs the function of “constipation” and is revealed
gradually, preventing the rapid passage of the fetus through the generic
ways). The cervix does not resist in the case of
cervical insufficiency or in women with numerous
childbirth in history.

The reasons

The reasons стремительных и быстрых родов одинаковы:

Genetically caused myocyte pathology (muscle
cells)

In this case, the excitability of myocytes is significantly increased and
a slight force is enough to cause contractions of the myometrium
impact. This feature can be inherited, so the group
risk include women whose mothers or close relatives
перенесли быстрые либо стремительные childbirth.

Excessive excitability of the nervous system

Emotional lability, a tendency to depression, neurosis,
anxiety, as well as psychological unpreparedness for childbirth can
provoke an excessively strong generic activity. Pregnancy
in women with hypertension, anemia, infectious diseases and
pathology of the cardiovascular system is also threatened in terms of
развития скоротечных childbirth.

Diseases of the endocrine glands and metabolic disorders

This group includes thyroid disease (for example, with
thyrotoxicosis accelerates the metabolism and, accordingly, their
effect on the nervous system).  Also contribute to
diseases of the adrenal glands (increased synthesis of norepinephrine and
acetylcholine – mediators that provoke excitability
autonomic nervous system).

Burdened history

Various pathologies of the reproductive system: cycle disorders,
inflammatory diseases of the uterus and appendages, tumors and cysts,
endometriosis, uterine malformations. It matters
previous birth: fast or swift, protracted or
traumatic for both mother and baby.

Pathology of this pregnancy

Severe for early toxicosis and / or preeclampsia, many or
lack of water, large size of the fetus, placenta previa, pathology
kidney, post-term pregnancy or rhesus-conflict.

Iatrogenic causes

Incorrectly calculated dosage during administration
stimulating drugs (oxytocin, prostaglandins). Also
unreasonable rodstimulation with the same drugs.

Water outflow

Rapid delivery can also start
emptying of the uterus in the case of polyhydramnios in the discharge of water. Sharp and
the rapid decrease in intrauterine pressure irritates myometrium and
causes hypertensive contractions of the uterus. Therefore, in the case of
early amniotomy is performed with cautious autopsy
bladder and control the rate of discharge of water.

Prolonged irritation and compression of the cervix head
fetus.

In this case, 1 period of labor is protracted, contractions
lasts 10 – 12 hours, and the presenting part is long
time remains in the same plane, which ensures compression and
irritation of the neck. After which the head begins its rapid
advance along the remaining planes of the pelvis, and the neck is stormy
revealed.

Risk factors

Predispose the development of “speed” deliveries following
factors:

  • neurosis;
  • parity (in the past 3 and more genera);
  • too wide pelvis and small size of the fetus;
  • preterm delivery;
  • age (in women younger than 18 years of age, immaturity and
    lack of preparation of the central nervous system to bear the fetus
    and maternity, and women over 30 have a burdened
    obstetric and gynecological history and chronic somatic
    diseases);
  • cervical insufficiency.

Childbirth

Suspected rapid or rapid childbirth will help knowledge of
during normal (physiological childbirth). Experienced mothers who have
there were births in the past, they know that the second (third and so on) births are more often
pass faster, therefore seek medical help when
the appearance of the first bouts. Rapid delivery, especially
primiparous, an unpredictable process not only for the mother herself
but also for the doctor. Therefore, when managing pregnant women
counseling a woman is determined in one group or another
risk, including the “accelerated” childbirth. The generic act includes
three periods:

First period

This stage begins with the onset of regular contractions.
(2 – 3 in 10 minutes), and therefore it is called the period of contractions or
cervical dilatation. It is at this stage that the intensity and
the frequency of contractions gradually increases, and the cervix dilates,
что нужно для прохождения головки fetus. At the end of the first period
the cervix (uterine throat) is fully expanded (10 – 12 cm).
The duration of the first stage of labor is 2/3 of the total
delivery time and approximately takes 8 – 10 hours.

Smooth and gradual opening of uterine pharynx under the influence
increasing contractions prevents various injuries to the birth canal
(cervix) and uterus, and also relieves the baby’s head from excessive
pressure. The completion of the first period is characterized by some
a decrease in the strength of contractions.

Second period

Once the uterus has reached full disclosure, it begins
the second period (another name “the period of expulsion of the fetus”). On this
stage every uterine contraction (contraction) contributes to the advancement
fetus through the birth canal to the vulvar ring – “exit”. Due to
stretching the vagina and cervix and pressure of the head on the rectum,
mothers there is a desire to push. Therefore, this period
also called potozhnym.

The second period is shorter than the first and is approximately 1 –
2 hours. Slow progress of the baby promotes careful
stretching the tissues of the birth canal and prevents their damage
(breaks the vagina, vulva). Besides, медленное продвижение
heads through the vagina allows the child to adapt to
expressed pressure of its walls, which prevents the occurrence of
of his intracranial hemorrhage.

Third period

This period is called sequential. He goes on not
more than half an hour and is characterized by the birth of the placenta (placenta,
remnants of fetal membranes with umbilical cord). This is the fastest period
usually lasts a few minutes and is characterized by one
a fight.

The course of “accelerated” childbirth

�”Accelerated” childbirth can occur in several scenarios:

1 option

In this case, fast delivery is characterized by uniform acceleration.
the generic process as a whole, that is, there is an acceleration as
первого, так и second periods. Begin rapid delivery from the moment
disclosure of uterine throat. Accelerated during the first two periods
due to increased elongation of the cervix, vaginal walls and
crotch As a rule, the cause of the acceleration of labor is weak
the resilience of the soft tissues of the birth canal against the background of increasing
on the strength of fights. This option is often observed in women with
hyperestrogenic, with isthmic-cervical insufficiency or in
Multigiving births.

Clinical manifestations: на протяжении первого часа  начала
fast delivery strength and duration of contractions increases
inadequate (2 – 3 contractions in 5 minutes), total duration
is about 4 – 5 hours, but not accompanied by significant
damage to the birth canal. Such a birth scenario is more dangerous.
for a child, especially in the case of prematurity or on the contrary
the size of the fetus, or when there is intrauterine pathology
(hypoxia, delay or malformations).

Option 2

Childbirth по Option 2у характеризуется спастическими
convulsive fights. Clinical manifestations:

  • abrupt and sudden onset of frequent, long and very
    painful contractions;
  • gaps between contractions are practically absent;
  • the number of contractions reaches 5 or more in 10 minutes;
  • restless state of the woman in labor;
  • nausea and vomiting;
  • increased sweating;
  • tachycardia.

Due to very intense, frequent and abrupt bouts damaged
(tearing) cervix, vagina, perineum, and possibly
damage to the body of the uterus. Childbirth can be complicated by premature
placental abruption, violation of placental blood flow and hypoxia
fetal and uterine bleeding. High probability of development
complications and for the fetus.

Duration of labor is not more than 3 hours, childbirth
occurs in 1 – 2 attempts that appear immediately after full
disclosure of uterine throat (the biomechanism of labor is violated, which leads to
serious injury to the fetus).

3 option

This scenario of childbirth is characterized by rapid
birth of the fetus and radically different from the first two options.
The main difference is in the broken ratio of the first and
second periods. More often childbirth proceeds normally in the first period.
or may be somewhat accelerated, but the second period (exile
fetus) takes only 3 – 5 minutes. A similar option of rapid
childbirth (first or second / third) is characteristic of premature
childbirth or hypotrophy of the fetus, the broad pelvis of the woman. Make childbirth
quick and even swift able unreasonable
drug-induced drug stimulation.

The rapid course of the period is fraught for the woman heavy
soft tissue damage to the vulva and vagina, and for the child
traumatic brain and spinal injuries.

Conducting childbirth

As already mentioned, at the stage of conducting a pregnant woman’s
consultations reveal the predisposing factors of “accelerated” labor
and at high risk women are hospitalized in the maternity hospital
in advance, 1 – 2 weeks before the expected date of delivery.

If the rapid or rapid course of labor began outside
the walls of the medical facility, the woman in labor is urgently hospitalized in
a maternity hospital (on a gurney from the moment a woman was found to transportation
her in the ward) and take all measures to “slow down” generic
activities:

Cleansing enema

Cleansing enema is mandatory for all
mothers to stimulate contractions, but in the case of rapid birth
she is contraindicated.

Horizontal position

Mothers all the first and second periods of lying down. During
contractions, it should lie on its side opposite to the position of the fetus (not
на той стороне, где прилежит спинка, а наоборот) –  снижает
frequency and intensity of contractions.

Introduction of tocolytics

In the absence of contraindications, intravenous infusion is performed.
tocolytic drugs (relax the uterus): partusisten,
ginipral, brikanil). Otherwise, intravenous “drip”
calcium antagonists: nifedipine, verapamil. Also injected intravenously
magnesia sulphate, antispasmodics and narcotic analgesics
(promedol, baralgin).

Epidural Anesthesia

If necessary, perform EDA (anesthetic in the
supraspinal space of the lumbar spinal cord
vertebrae).

Maintaining 2 and 3 periods

The second period of the woman also spends on her side with intravenous
the introduction of drugs that improve uteroplacental
circulation. Immediately after the birth of the fetus, oxytocin is connected or
methylergometrine intravenously and carry out manual control of the cavity
uterus for the remaining lobes of the placenta and membranes.

Effects

Impetuous labor can do without consequences, as for
child, and for mom, but the risk of their development remains high.

Maternal complications

  • Damage to the soft tissues of the birth canal. Breaks 3 – 4
    degree of the neck, vaginal walls and arches, perineum, tearing
    cervix as well as uterine rupture accompanied by strong
    bleeding and threaten the life of a woman.
  • The divergence of the symphysis pubis. Characterized by a strong pain
    syndrome and requires either surgery (osteosynthesis) or prolonged
    (up to a month or more) being in a fixed position (lying on
    back with legs bent at the knees).
  • Premature detachment of the placenta. Extremely dangerous complication and
    for women and for the fetus. Childbirth ends with emergency cesarean
    cross section.
  • Violation of uteroplacental blood flow. Leads to development
    acute intrauterine hypoxia and also requires immediate
    delivery (cesarean section).
  • Violation of the placenta. Accompanied by delayed closures
    afterbirth and membranes in the uterus, provokes bleeding and requires
    manual control of the uterus.
  • Hypotonic bleeding. Develops in early postpartum
    period (the first 2 hours after completion of labor). Intravenous administered
    uterotonics (oxytocin), with inefficiency manual
    control of the uterus and massage of the uterus on the fist.

Effects для ребенка

  • Injuries to the soft tissue of the child. Hemorrhage different
    intensity in the subcutaneous layer.
  • Damage to the clavicle and humerus. Due to violation
    biomechanism of childbirth the fetus does not have time to complete the turn after birth
    heads and hangers are born in an oblique amount that
    accompanied by fractures of the clavicle and humerus.
  • Cephalohematomas The rapid advancement of the fetal head
    violates the biomechanism of labor, the head does not have time to be configured,
    which leads to hemorrhage under the periosteum cranial bones).
  • Hemorrhages in the internal organs. Massive
    hemorrhages in parenchymal organs (liver, kidneys and
    adrenal glands).
  • Violation of cerebral circulation. Due to brain spasm
    blood vessels in the brain is disturbed, leading to
    strokes and brain cell death. Also impairs blood flow to the brain.
    increased intracranial pressure. These factors may
    lead to the death of the child or his disability in the future.
  • Spinal injuries.
  • Acute hypoxia and birth of the fetus in asphyxia. Requires holding
    resuscitation. В отдаленном будущем  ребенка не
    excluded his backlog in the neuro-psychological and physical
    development.

Question answer

Does the risk of complications decrease with the second
fast delivery?

Not. The development of complications accompanies almost all
rapid delivery, and the number of previous deliveries does not play
roles

My delivery was easy and fast. Bore 4.5 hours (childbirth
first) and without any complications, including for the child.
So doctors just scare moms with the effects of fast
(rapid) childbirth?

No, doctors absolutely correctly warn of high
the likelihood of complications in the case of “accelerated” course
childbirth. And you are just lucky that there were no complications.

Is it necessary that the next birth will be shortened after
fast delivery?

There is no single answer to this question. Of course you are tall
the risk of so-called speed labor, especially if there are
predisposing factors, but the normal course is also likely
childbirth.

I gave birth a total of 12 hours. Child “fired” for one
will potugu. The discharge from the maternity hospital says that the birth is swift.
Why?

You yourself answered your question. The rapid happens
the birth of a fetus, and the period of contractions in duration is approaching
to normal performance, and the second period is one or two
attempts That’s it on the basis of a significant shortening
During the period, obstetricians and gynecologists diagnosed swift
childbirth.

How to prevent an accelerated course of labor?

First, in determining high risk by
swift or fast delivery should strictly adhere to
recommendations of the midwife antenatal clinic. Avoid physical
loads and weight lifting, if necessary, pass
prophylactic hospital treatment (the threat of premature
childbirth, ICN, fetal development delay), attend courses on
psycho-prophylactic preparation for childbirth and be prepared for prenatal
hospitalization in the hospital.

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