ABOUTбновление: ABOUTктябрь 2018
Not all births occur “as expected” and without complications.
ABOUTдной из подобных проблем в родах является формирование слабости
generic activity, which can happen like a primipara,
so and in multiparative women. Weak labor contractions include
to anomalies of labor forces and are observed in 10% of cases of all
adverse childbirth, and in the first birth they
diagnosed more often than repeated.
Weakness of generic forces: what is the essence
About the weakness of generic forces say when contractile
the activity of the uterus has insufficient strength, duration and
periodicity. ATследствие этого схватки становятся редкими,
short and ineffective, leading to a slower neck opening
and the promotion of the fetus through the birth canal.
Classification of weak labor
AT зависимости от времени возникновения слабая родовая
activities can be primary and secondary. If a схватки с
the beginning of the birth process inefficient, short, and the period
uterine relaxation is long, then talk about the primary
weaknesses. AT случае ослабления и укорочения схваток after некоторого
period of time of sufficient intensity and duration
выставляется диагноз вторичной weaknesses.
Secondary weakness, как правило, отмечается в финале периода
раскрытия или же в процессе изгнания fetus. Primary weakness more often
occurs and its frequency is 8 – 10%. Secondary weakness
отмечается лишь в 2,5% случаев всех childbirth.
We also distinguish the weakness of the attempts that develops in
women with multiple births or obesity and convulsive women
segmental contractions. ABOUT судорожных схватках свидетельствует
prolonged uterine contraction (more than 2 minutes), and with segmental
contractions the uterus is reduced not all, but only separate
Causes of weak contractions
For the formation of the weakness of labor activity is necessary
certain reasons. The factors that contribute to this
pathologies are divided into a number of groups:
AT данную группу входят:
- prenatal discharge of water;
- disproportion in the size of the fetal head (large) and the mother’s pelvis
- changes in the walls of the uterus caused by dystrophic and
structural processes (multiple abortions and scraping
uterus, endometriosis of the uterus, myoma and surgery on the uterus);
- ригидность (нерастяжимость) шейки матки, возникающая after
surgical treatment of cervical disease or cervical damage
childbirth or abortion;
- high water flow and multiple fertility;
- large size of the fetus, which overstresses the uterus;
- improper location of the placenta (previa);
- fetal presentation of the pelvic end;
In addition, great importance in the occurrence of weakness plays
the functionality of the membranes (with a flat membranes,
for example, in low water, it does not act as a hydraulic wedge,
which inhibits cervical dilatation). We should not forget about fatigue
women, asthenic body type, fear of childbirth and mental
and physical overload during gestation.
Pathology of the reproductive system
Sexual infantilism and congenital malformations of the uterus
(for example, saddle or double bovine), chronic inflammation of the uterus
contribute to the development of pathology. In addition, the age of the woman
(more than 30 and less than 18) is reflected in the production of hormones,
stimulating the contraction of the uterus.
This group also includes menstrual disorders and
endocrine diseases (hormonal imbalance), habitual
miscarriage and a violation in the formation of menstrual
cycle (early and later menarche).
Extragenital diseases of the mother
This group includes various chronic diseases of women.
(pathology of the liver, kidneys, heart), endocrine disorders (obesity,
diabetes mellitus, hypothyroidism), numerous infections and
intoxication, including bad habits and production
ATнутриутробная инфекция плода и задержка развития, пороки
fetal development (anencephaly and others), postponed pregnancy
(overripe fetus) as well as premature labor can
способствовать возникновению weaknesses. Also matters
rhesus-conflict during pregnancy, fetoplacental
недостаточность и гипоксия fetus.
AT данную группу входит «увлечение» родостимулирующими
drugs that tire a woman and violate contractile
uterine function, disregard of labor anesthesia,
unreasonable amniotomy, as well as gross vaginal
As a rule, not one plays a role in the development of contractions weakness
factor, and their combination.
How pathology manifests itself
AT зависимости от вида слабости родовых сил несколько различаются
and clinical manifestations:
Contractions in the case of primary weakness initially differ
short duration and poor efficacy, not very painful
or painless at all, periods of diastole (relaxation is enough
long) and practically do not lead to disclosure of uterine throat.
As a rule, primary weakness develops. after
pathological preliminary period. Often women in labor complain
that the waters broke, and the contractions are weak, which means either
early discharge of water, or about early.
As you know, the role of the fetal bladder in childbirth is enormous, it is he
presses on the neck, causing it to stretch and shorten,
late discharge of water disrupts this process, reducing
the uterus becomes insignificant and short-lived. Frequency
contractions do not exceed one – two for a 10-minute period (and in
the norm should be at least 3), and the duration of uterine contractions
reaches 15 – 20 seconds. If the bladder has retained integrity,
then his dysfunction is diagnosed, he is sluggish and ill
poured into the fray. Slow progress is also noted.
fetal head, it is in the same plane until 8 – 12 hours, which
not only causes swelling of the cervix, vagina and perineum, but also
contributes to the formation of the “generic tumor” of the fetus. Long lasting
during childbirth exhausts a woman in labor, she gets tired, which only worsens
Secondary weakness встречается реже и характеризуется
ослаблением схваток after периода эффективной родовой деятельности
and cervical dilatation. It is observed more often in the end of the active phase,
when the uterus has already reached the opening of 5-6 cm or during the period of attempts.
Fights are intense and frequent at first, but gradually lose their strength and
shortened, and the movement of the presenting part of the fetus slows down.
This pathology (the attempts are controlled contractions of the muscles
abdomen) is more often diagnosed in women with frequent and multiple births,
having overweight or divergence of the abdominal muscles. Also weakness
the attempt can be a natural consequence of weakness in contractions due to
physical and nervous exhaustion and fatigue of the woman in labor. Manifests itself
ineffective and weak fights and attempts that slows down
promotion of the fetus and leads to its hypoxia.
To make a diagnosis of weakness contractions include:
- nature of uterine contractions (strength, duration of contractions and
relaxation time between them);
- cervical dilatation (slowing down);
- promotion of the presenting part (no progress,
the head is long in each plane of the pelvis).
A major role in the diagnosis of pathology plays a partograph
birth, which clearly shows the process of cervical dilatation and
his speed In the latent phase in figurines in the first period
uterine mouth opens about 0.4 – 0.5 cm / h (in
multiparous it is 0.6 – 0.8 cm / h). In this way,
the latent phase is normal in primiparous lasts about 7 hours, and
rehomogenous up to 5 hours. Delay shows weakness
cervical dilatation (about 1 – 1.2 cm per hour).
Fights are also evaluated. If in the first period of their
duration is less than 30 seconds, and the intervals between them
make 5 and more minutes, speak about primary weakness. ABOUT
secondary weakness is indicated by shortening contractions of less than 40
seconds at the end of the first period and in the expulsion period.
It is equally important to evaluate the condition of the fetus (hearing
heartbeat, CTG), as with weakness, childbirth becomes
protracted, leading to the development of hypoxia of the child.
Conducting childbirth: tactics
What to do in case of weakness of labor activity. AT
First of all, a doctor should decide on contraindications for
conservative treatment of pathology:
- на матке имеется рубец (after миомэктомии, кесарева сечения,
suturing perforations and other operations);
- narrow pelvis (anatomically narrowed and clinically);
- large fruit;
- true post-pregnancy pregnancy;
- fetal hypoxia;
- allergy to uterotonic agents;
- pelvic presentation;
- burdened obstetric and gynecological history (previa
and placental abruption, scars on the cervix and vagina, their stenosis
and other indications);
- first birth in women over 30.
AT подобных ситуациях роды заканчивают экстренным кесаревым
What to do the woman in labor if weak contractions?
Undoubtedly, a lot of things with weak contractions depend on the woman.
AT первую очередь все зависит от ее настроя на благополучный исход
childbirth. Fear, fatigue and pain adversely affect the generic
process, and, of course, the child.
- A woman should calm down and take advantage of non-drug
methods of labor pain relief (massage, proper breathing,
special poses during labor).
- In addition, it has a positive effect on childbirth
woman’s behavior – walking, jumping on a special ball.
- If she is forced to be in a horizontal position
(“Worth dropper”), then you should lie on the side where the
the back of the fetus (the doctor will tell). The back of the baby puts pressure on
uterus, which enhances its reduction.
- In addition, it is necessary to monitor the condition of the bladder.
(empty approximately every 2 hours, even in the absence of
- ABOUTпорожненный мочевой пузырь помогает усилить схватки. If a
it is impossible to urinate independently, urine is removed
What can doctors do?
ATрачебная тактика ведения родов с данной патологией зависит от
reasons period childbirth, the type of weakness contractions, the state of the woman and
fetus. AT латентной фазе, когда открытие шейки еще не достигло 3 – 4
see, and the woman is experiencing significant fatigue, appointed
drug sleep rest.
- Drug sleep is performed by the anesthetist with the help of
the introduction of sodium hydroxybutyrate, diluted with 40% glucose.
- In the absence of an anesthesiologist, the obstetrician prescribes a complex
the following drugs: promedol (narcotic analgesic), Relanium
(sedative), atropine (enhances the effect of the drug) and diphenhydramine
(hypnotic). Such a dream allows a woman to rest for 2 to 3 hours,
regain strength and contributes to increased contractions.
- But medical rest is not prescribed if there are indications to
emergency caesarean section (fetal hypoxia, its abnormal
position and others).
After the rest of the woman in labor, the condition of the fetus, the degree
cervical dilatation, as well as the functionality of the fetal bladder.
It creates a hormonal and energy background using the following
- ATP, cocarboxylase, riboxin (energy support
women in labor);
- glucose 40% – solution;
- intravenous calcium preparations (chloride or gluconate) – increase
- витамины AT1, Е, AT6, аскорбиновая кислота;
- Piracetam (improves uterine circulation);
- estrogen on the air intrauterine (in myometrium).
If a имеет место плоский плодный пузырь либо многоводие,
Early amniotomy is shown, which is performed during cervical dilatation
3 – 4 cm, which is a prerequisite. ATскрытие плодного
bladder – completely painless procedure, but contributes to
the release of prostaglandins (increase contractions) and enhance generic
activities. Через 2 – 3 часа after проведения амниотомия вновь
a vaginal examination is performed to determine the extent
cervical disclosure and addressing the issue of gene stimulation by reducing
To enhance contractions, use the following methods.
drug-induced drug stimulation:
ABOUTкситоцин вводится внутривенно капельно. ABOUTн усиливает сокращение
myometrium and contributes to the development of prostaglandins (which are not
only intensify contractions, but also affect the structural changes in
the neck). But it should be remembered that the input is exogenous (alien)
oxytocin inhibits the synthesis of its own oxytocin, and when canceled
infusion of the drug develops secondary weakness. But also not
desirable and long, for several hours the introduction
oxytocin, as it increases blood pressure and
delays urination. The drug begins to enter with cervical
открытии на и больше 5 см и только after отхождения вод или
produced amniotomy. ABOUTкситоцин в количестве 5 Ед разводится в
500 ml of saline and drip starting at speed 6 –
8 drops per minute. You can add 5 drops every 10
minutes, but exceeding 40 drops per minute. Of the disadvantages of oxytocin
it can be noted that it inhibits the production of surfactant in the lungs
fetus, which in the presence of chronic hypoxia can cause
intrauterine aspiration with water, circulatory disorders in a child
и смерть во время childbirth. Oxytocin infusion is performed with
mandatory (every 3 hours) administration of antispasmodics with either
carrying out ED.
Prostaglandin E2 (prostanon)
Prostenon is used in the latent phase, before the opening of the neck at 2
finger when diagnosed with primary weakness in the background
�”Not enough mature” cervix. The drug causes coordinated
contractions with a good relaxation of the uterus that does not violate the blood circulation
in the system, the fetus – placenta – mother. In addition, prostenon
promotes the production of oxytocin and prostaglandin F2a, as well as
accelerates the ripening of its neck and disclosure. AT отличие от окситоцина
Prostenon does not cause an increase in pressure and does not possess
antidiuretic effect, which makes possible its use in
women with preeclampsia, kidney disease and hypertension. Of
contraindications can be noted bronchial asthma, diseases
blood and drug intolerance. Prostenon divorced and dripped
in the same dosage (1 ml of 0.1% of the drug), as oxytocin.
Prostaglandins of this group (enaprost or dinoprost)
effectively used in the active phase of cervical opening, that is
at the opening of the pharynx by 5 and more, see. These preparations are
strong stimulants of uterine contractions, constrict blood vessels,
which leads to an increase in pressure and also thickens the blood and
increase its clotting. Therefore, they are not recommended to enter
with preeclampsia and blood pathology. Of побочных эффектов (в случае
overdose) should be noted nausea and vomiting, lower hypertonicity
uterine segment. Dosage regimen: 5 mg enaprost or dinoprost
(1 ml) diluted in 0.5 liters of saline. A drug
begin to be administered intravenously drip from 10 drops per minute.
You can increase the number of drops every 15 minutes, adding 8
drops. Maximum speed – 40 drops per minute.
ATозможно сочетанное введение окситоцина и энзапроста, но
the dosage of both drugs is reduced by half.
ABOUTдновременно с медикаментозной родостимуляцией held
профилактика гипоксии fetus. To do this, use the triad on
Nikolaev: 40% glucose with ascorbic acid, aminophylline, sigitin
or intravenous cocarboxylase, inhalation of humidified oxygen.
Prevention is prescribed every 3 hours.
In the absence of the effect of drug stimulation generic
activities, as well as in the case of deterioration of the fetus in the first
the period of childbirth end operationally – caesarean
In case of weakness of attempts and contractions in the period of exile either
obstetric forceps are applied (with mandatory bilateral
Эпизиотомией), либо бинт ATербова (простыня, перекинутая через живот
women in labor, the ends of which on both sides are pulled down by assistants,
squeezing the fruit).
- I had a weakness of labor during the first birth.
ABOUTбязательно ли развитие данной патологии при вторых родах?
No, not at all. Moreover, if the reason that
led to the occurrence of this complication in the first birth, will
absent. For example, if there was a multiple pregnancy or
large fetus, which caused overdistension of the uterus and the development of weakness,
most likely the similar reason will not repeat in the following
- What threatens the weakness of the tribal forces?
This complication contributes to the development of fetal hypoxia,
infection (with a long anhydrous period), edema, and
некрозу мягких тканей родовых путей с afterдующим образованием
свищей, afterродовым кровотечениям, субинволюции матки, и даже
- How to prevent the occurrence of generic weakness
To prevent this complication of a pregnant woman should visit
special courses, which describes the methods of self
pain relief in labor, the very generic process and set up a woman
на благоприятный исход childbirth. She also needs to stick.
proper and rational nutrition, monitor weight and perform
special exercise that not only warns
large fetus formation and placental development
failure, but also supports the tone of the uterus.
- AT первые роды мне сделали кесарево сечение по поводу слабости
contractions, can I give birth in the second birth by myself?
Yes, this probability is not excluded, but in the absence of
those indications that led to the operation for the first time (pelvic
previa, narrow pelvis, and others) and the viability of the scar. Wherein
childbirth will be planned in a special maternity hospital or perinatal
center, where there is the necessary equipment and doctors with experience
childbirth with a scar on the uterus.