Pathological preliminary period: treatment. Preliminary period is...

Preliminary period – the contractions in the lower abdomen during pregnancy, which are accompanied by minor pain and muscle tension. They irregular. Such contractions are precursors to birth. Under normal conditions the preliminary stage of labor should take approximately 6–8 hours. However, in some cases, this period may be delayed. This can happen for various reasons. In this case, there is pathology of labor that require immediate medical intervention. As the effects of prolonged preliminary period can be very serious for both mother and child: from strong discontinuities mothers and ending with the death of the fetus.

The Concept of pathological preliminary period

Physiology of each woman individually. In some cases, this period may last several hours and sometimes for a few days. This leads to the depletion of women, loss of sleep, accumulation for the time of delivery of extreme fatigue. In this case there is a pathological preliminary period births, that is, the prenatal period, which was delayed. Characterized by irregular painful contractions that do not lead to changes of the cervix, and only a drain on a woman's body.

The Essence of abnormal preliminary period

The Basic essence of the pathology can be expressed as follows:

• Physiological preliminary period is delayed.
• Increases the tone of the myometrium.
• Internal uterine fauces is reduced.
• There Are reductions in the lower segment of the uterus.
• Muscle fibers are arranged in a circle, cross and spirals;

Causes

As a rule, pathological preliminary period causes abnormalities in the body of the mother. The main causes can be divided into three groups:

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Obstetric

• The Presence of mnogonogie or water shortage.
• Multiple pregnancy
• The Fetus in the womb is a wrong position (breech presentation).
• The Placenta is low.

Emotional:

• The Woman is afraid of childbirth.
• Negative.
• Nervousness and extreme emotional stress.
• Physical fatigue of the patient.
• Age perforada women (fear of the outcome of labor at too early or late pregnancy).

Physiological

• Mothers narrow pelvis.
• Previously were held in the uterus surgical intervention (scarring after cesarean, etc.).
• Disruption of the endocrine system (obesity, anorexia, etc.).
• Labile nervous system.
• Kidney, heart, liver and other organs.
• Inflammation of the uterus.
• Preeclampsia.
• Multiple abortions.
• Miscarriage of the fetus.

Symptoms

Pathology polimernogo period help to identify the following symptoms:

• The Uterus in the preparatory and preliminary period painful reduces, in this case the contractions are not regular. They can occur both during the day and at night. In long labors does not start.
• Increased tone of the uterus and its excitability.
• The Disclosure of the uterus is not observed, it continues to be dense and long.
• The Presenting part of the fetus is not pressed against the small pelvis women.
• Due to hypertonicity of the uterus is difficult to fulfill the palpation of the fetus.
• The Uterus for a long time decreases monotonically. The strength and frequency of contractions does not change. Precursors and preliminary period are long-term in nature.
• The woman's deteriorating mental state, she becomes whiny and irritable, she has a lack of confidence in the successful completion of delivery.

Pathologies

Pathological preliminary period can be of two types:

• In the first case, the uterine muscles are not relaxed, the muscle fibers of the uterus correspond to the density of “Mature” cervix, oligohydramnios, flat fetal bladder.
• In the second case the cervix is "immature" has an oval shape, the presenting part of the fetus is not adjacent to the entrance to the pelvis. Most often, this situation occurs when perenashivanie fetus.

Duration

The abnormal Duration of the preliminary period, depending on the individual circumstances of each women may vary from 6 hours to 24–48 hours. In some women it can take several days.

Possible consequences

Pathological preliminary period, in most cases, leads to the complication of the course of labour. Many women in childbirth labors proceeds abnormally. In particular:

• Labors of the weak. In this state there is a lack of strength of contractions of the uterus, large gaps between contractions, cervix dilates slowly, the advance of the fetus is delayed.
• Labors discoordination. Appears chaotic contractions of the divisions of the uterus. There is no synchronicity in contraction and relaxation of individual sections. In the end, the contractions are accompanied by severe pain, becomes frequent and irregular, which exhausts the new mother and gives her to relax.
• Labors proceeds rapidly. For this anomaly characteristicvery strong and sharp battle and attempts. In the end, the birth occurs very quickly (up to 5 hours). This can lead to tearing of vagina and perineum from childbirth, heavy bleeding. The fetus may develop hypoxia. Quick childbirth can result in birth trauma of the fetus.
• Tetanus of the uterus – a rare anomaly. In this case there is a condition where the uterus does not relax completely. Occurs in case of multiple pacemakers in different parts of the uterus. Leads to disruption of uterine contractions and stop childbirth. The fetus may develop hypoxia, which may lead to cardiac disorders.

Can develop the following consequences of abnormal flow of labor:

• Delayed excretion of the amniotic fluid.
• The Appearance at the beginning of contractions meconium, which means “distress” fruit.
• Prompt delivery.
• Forceps.
• Strong abnormal bleeding.
• In the postpartum period develop purulent infectious diseases.
• Fetal Hypoxia and birth of a child with cardiac disorders or coronary artery disease.

Diagnostics

If you suspect that preliminary period runs abnormally, you should immediately contact the obstetrician-gynecologist. He should do an external examination. Palpation helps to determine high or low position of the fetus. If the fetus has not dropped, this tells about the presence of pathology of labor. Also about the disease can be judged by the presence of a strong tension in the muscles of the vagina, the immaturity of the uterus for childbirth and spasms.

At the heart of diagnostic pathology preliminary period is the conduct of clinical and laboratory research, allowing to conclude that the reduction acetylcholinesterase activity of erythrocytes, increase in the blood level of the hormones epinephrine and norepinephrine.

It is Possible to conduct an instrumental study. To do this cardiotocography. It is possible to record the strength and duration of contractions.

Pathological preliminary period: treatment

When the immature cervix and the absence of independent development of labor there is a picture of perenashivanie pregnancy. Therapy will be appointed on the basis of the pathogenesis of the disease. The goal of treatment will accelerate the maturation of the uterus. Can be used, such treatments.

• Electroanalgesia.
• Electrorelease of the uterus.
• Treatment with medikamentov: antispasmodics, analgesics, prostagladin E2.

If the patient experienced severe fatigue and increased nervousness, it as treatment prescribed medicated sleep. Also are prescribed sedatives.

The Positive effect of treatment is reflected in the sharp beginning of regular contractions. Or ripening the body for childbirth. When the uterus becomes “Mature”, the SAC is opened and within two hours of the start of regular contractions. If the birth activity does not start, then intravenously administered prostaglandins.

When ineffective treatment along with other complications (obstetric history, the large size of the fetus, breech presentation, OPG-gestosis, the beginning of fetal hypoxia) performed an emergency C-section.

Approaches to the management of pregnant women who have pathological preliminary period

There are two approaches:

• At rest.
• Stimulation of labor activity with oxytocin.

Both methods have the goal of fixing labor. Successful outcome was observed in 85% of cases. When choosing a method include the following features pathology:

• Degree of anxiety and fatigue of the patient.
• The Reason why there was a complication.
• Select the method more convenient for the patient and the obstetrician.

The approach, which consists in the observance of complete rest pregnant, she administered intramuscularly 0.015 g of morphine. Then called secobarbital inside 0.2 g. This option is quite effective. As a rule, after the injection of morphine the patient falls asleep within the hour. After 4-5 hours of rest, during which the body restores exhausted strength, the woman wakes up without any signs of childbirth or active labor.

If you choose the second path, i.e. the stimulation of oxytocin, you should avoid opening the membranes. Caesarean section is justified only in the most severe cases.

Prevention

The Main preventive measures to prevent the pathology of the preliminary period are:

• Timely consultation of an obstetrician.
• Delivery of all required tests.
• Execution of doctor's instructions regarding the mode and power.
• Psychological and physical preparation of pregnant woman for the birth.

A Competent obstetrician should keep monitoring the women who are in the risk group for this pathology. Namely, first-time mothers under the age of 17 years and after 30 years, and women with diseases of some organs (liver, kidney, heart).

So, pathological preliminary period is one of the types of anomalies genericactivities. It occurs quite often. However, thanks to modern medicine 85% timely medical intervention births end happily. Therefore, the appearance of first disease symptoms should immediately contact a competent obstetrician-gynecologist. The anomalous effects of the preliminary period can be very serious, up to fetal hypoxia, the emergence of irregularities in its internal organs, death. Correctly prescribed treatment will help save the lives of both the mother and the child.