How to understand that generic activity is weak. Weak labor activity: a real danger or a convenient excuse for doctors? Weak labor activity

Often the cause of complications in the period of delivery is a weak generic activity. As a result of this breach, Negative consequences can occur both during childbirth and in the postpartum period. Let's take a closer look this phenomenon, find out: what does weak labor activity mean, highlighting the causes, signs and methods of struggle.

"Weak generic activity" - what is it?

Before considering the pathology, let's deal with the definition and find out: what is weak labor activity in women and when it occurs. Obstetricians talk about such a violation when the contractile activity of the uterus does not have the necessary strength to expel the fetus. This is due to a change in the duration and frequency of labor pains. They are rare, short, ineffective. As a result, the process of opening the cervix slows down, the rate of advancement of the fetus decreases, and the development of weak labor activity is observed.

Weak labor activity - causes

Due to the fact that often the violation is provoked simultaneously by several factors, it is problematic to establish the causes of weak labor activity in women in a particular case. At the same time, doctors identify several groups of factors that cause a violation of the delivery process. Among those:

1. Obstetric complications:

• early effusion;
• discrepancy between the size of the fetal head and the size of the pelvis of the woman in labor;
• the presence of dystrophic structural changes in the walls of the uterus (the presence of abortions, a history of curettage, endometriosis, uterine fibroids);
• rigidity of the muscle layer of the neck (non-extensibility of the organ due to previous operations, diseases);
• incorrect placenta previa;
• gestosis.

2. Pathologies of the reproductive system:

• congenital anomalies in the structure of the uterus (bicornuate, saddle-shaped);
• sexual infantilism (underdevelopment of the reproductive organs);
• chronic inflammatory processes in the uterus;
• violation menstrual cycle;
• diseases endocrine system leading to hormonal imbalance.

3. Extragenital diseases:

• chronic diseases internal organs(pathology of the liver, kidneys, heart);
• disruption of the endocrine system (obesity, hypothyroidism, diabetes mellitus).

4. Factors due to the baby:

• intrauterine infection;
• intrauterine growth retardation;
• delayed pregnancy;
• premature delivery;
• fetal hypoxia;

5. Iatrogenic causes:

• long-term use of labor-stimulating agents;
• neglect of anesthetic measures during childbirth;
• unreasonable amniotonia (autopsy amniotic sac doctor);
• private vaginal examinations.

Is weak labor activity inherited?

The belief of some expectant mothers regarding the fact that weak labor activity is inherited is erroneous. This pathology has no connection with the genetic apparatus, therefore, it cannot be inherited from mother to daughter. In most cases, a violation occurs when the delivery process itself is not properly managed, and the woman does not comply with the requirements of the obstetrician. Evidence of the absence of a connection between the disorder and heredity is the high frequency of its development during childbirth.

Weak labor activity at first birth

In order to understand why there is a weak labor activity, it is necessary to briefly consider the mechanism of childbirth itself. So after the opening of the cervix, the end of the first period, the exile phase begins. More often, the weakness of labor activity occurs at the stage of disclosure, gradual increase the lumen of the cervical canal is suspended. As a result, this period of childbirth is delayed, the woman in labor loses strength, gets very tired. Given these features, among the causes of weak labor activity at the first delivery, one can single out:

• improper prenatal preparation of a pregnant woman;
• violation of the algorithm for conducting the first stage of childbirth - excessive drug stimulation of the process;
• non-compliance by the woman in labor with the instructions of obstetricians.

Weak labor activity during the second birth

Talking about what is associated with weak labor activity during repeated births, physicians in the first place put forward a violation of the conduct of the delivery process. A feature of the second and subsequent births is the shortening of the period of disclosure and exile. Contractions grow, become intense after a short time. At the same time, the absence of a number of competent medical staff capable of providing maternity benefits increases the risk of a decrease in the activity of uterine structures. The woman in labor herself loses strength, cannot productively push - a secondary weakness.

Weak labor activity - signs

The diagnosis of "weak labor activity" is made exclusively by the obstetrician taking delivery. At the same time, doctors evaluate the nature of contractions, the speed of cervical dilatation. Directly lengthening the period of disclosure is a symptom of a violation. At the same time, there are signs of weak labor activity:

• short duration and low intensity of contractions;
• a decrease in the rate of advancement of the fetus through the birth canal;
• increase in intervals between contractions;
• severe fatigue of the woman in labor;
• development of fetal hypoxia.

Weak labor activity - what to do?

Having experienced this violation once, women preparing to become a mother for the second time are often interested in the question of how to intensify contractions with weak labor activity. Initially, it all depends on the mood of the pregnant woman herself, her readiness for childbirth. Fears, overwork, fear for the future baby - have a bad effect on the process of delivery.

In order to reduce the risk of developing weak labor, doctors recommend expectant mothers:

• calm down using non-drug methods(massage, proper breathing);
• in the period of disclosure, it is necessary to be active - walking, light jumps in place help the cervix;
• if a woman is forced to accept horizontal position(a dropper is connected) - it is necessary to lie on the side on which the back of the fetus is located.
• status should be monitored Bladder– it must be emptied every 2 hours.

Preparations for weak labor activity

With such a violation as weak labor activity, how to intensify contractions, stimulate the process, doctors decide based on the degree of pathology, the condition of the woman in labor. chief non-drug method activation of labor activity is an amniotomy - a violation of the integrity, opening, of the fetal bladder. Manipulation is carried out with the opening of the cervix by 2 cm or more. If there is no effect within 2-3 hours, if weak labor activity does not disappear, they resort to drug intensification of childbirth. Among the drugs used:

1. Oxytocin. Enter drip, intravenously. They begin to use it when the cervix is ​​dilated by 5 cm or more and after the opening of the fetal bladder or the discharge of water.
2. Prostenon. Applied in initial stage when the neck does not yet miss 2 fingers. The drug causes coordinated contractions without disturbing blood circulation in the "fetus-placenta" system.
3. Enzaprost (dinoprost). The drug is used in the phase of active disclosure, when the lumen of the cervical canal reaches 5 cm or more. The drug actively stimulates contractions of the uterine myometrium. At the same time, there is an increase blood pressure, blood clots. This medication do not apply in the presence of preeclampsia, disruption of the blood coagulation system. Enter drip, dissolving in saline.

Cesarean section with weak labor activity

In the absence of the effect of the drug therapy, deterioration of the fetus, appoint a caesarean section with weak labor activity. emergency surgical intervention requires highly qualified doctors, the availability of conditions. If weakness arose during the period of exile (ineffective attempts and contractions), they often use obstetric forceps. This device helps to extract the fetus out. Timely delivery benefits reduce the risk of complications.

In the normal course of pregnancy, closer to its end, prenatal uterine contractions are noted, which are most often painless, mainly occur at night and lead to shortening and softening of the cervix, and opening of the cervical canal.

The main types of labor anomalies include pathological preliminary period, primary and secondary weakness of labor, excessively strong labor, discoordination of labor and uterine tetanus.

Pathological preliminary period

Unlike normal prenatal contractions of the uterus, the pathological preliminary period is characterized by spastic, painful and erratic contractions of the uterus and the absence of structural changes in the cervix, which is a sign of a prenatal violation of its contractile function. The pathological preliminary period can last up to several days. A common complication of pathological preliminary period is an untimely outpouring amniotic fluid. The main reasons that lead to the development of this complication are: nervous stress; endocrine and metabolic disorders; inflammatory changes in the uterus, the age of the primipara is over 30 years and under 17 years of age.

Treatment of the pathological preliminary period should be aimed at accelerating the "ripening" of the cervix, removing uncoordinated painful uterine contractions. When tired and increased irritability the patient is prescribed medical sleep rest, sedatives (motherwort tincture, collection soothing herbs, valerian root); antispasmodics; painkillers; β-mimetics (ginipral, partusisten). For urgent preparation of the cervix for childbirth, drugs based on prostaglandin E2 are used, which are injected into cervical canal or posterior fornix vagina. The duration of treatment of the pathological preliminary period should not exceed 3-5 days. With a "mature" cervix, taking into account a favorable obstetric situation, it is possible to open the fetal bladder early and conduct labor through the natural birth canal. In the absence of the effect of the therapy, maintaining the "immaturity" of the cervix, it is advisable to perform caesarean section.

Weak labor activity

The weakness of labor is characterized by insufficient strength and duration of uterine contractions, an increase in the intervals between contractions, a violation of their rhythm, a slowdown in the opening of the cervix, and a delay in the advancement of the fetus. There are primary and secondary weakness of labor activity. With primary weakness, contractions from the very beginning of labor are weak and ineffective. Secondary weakness occurs against the background of normally begun labor activity. The weakness of labor activity leads to a protracted course of labor, fetal hypoxia, fatigue of the woman in labor, lengthening of the anhydrous gap, infection of the birth canal, the development of inflammatory complications, bleeding during childbirth and postpartum periods. The reasons for the weakness of generic are very numerous. The main among them are violations of the mechanisms regulating the birth process, which include: changes in the function nervous system due to stress, anxiety endocrine functions, menstrual disorders, metabolic diseases. In a number of cases, the weakness of tribal forces is due to such pathological changes uterus, as malformations, inflammation, overstretching. Insufficiency of contractile activity during childbirth is also possible in the presence of a large fetus, with multiple pregnancy, polyhydramnios, uterine myoma, post-term pregnancy, in women with severe obesity. Among the reasons for the secondary weakness of labor activity, in addition to those already listed, it should be noted the fatigue of the woman in labor as a result of prolonged and painful contractions, an obstacle to the fetus being born due to a mismatch in the size of the head and pelvis, with wrong position fetus, with a tumor in the pelvis.

The main method of treating weakness of labor activity is labor stimulation with an open fetal bladder, which consists in intravenous drip injection medicines that enhance the contractile activity of the uterus (oxytocin, prostaglandin F2a). A significant effect in the treatment of weakness of labor forces can be obtained by combining prostaglandin F2a with oxytocin. If the woman in labor is tired, the weakness of the labor forces is revealed at night, if the cervix is ​​not ready for childbirth or if it is slightly opened, treatment should begin with giving the woman rest for 2 to 3 hours (obstetric anesthesia). Otherwise, rhodostimulation can further complicate the course of childbirth. After rest, a vaginal examination is performed to determine the obstetric situation and assess the condition of the fetus. After sleep, labor activity may intensify, and further treatment not required. If labor activity remains insufficient, uterine stimulants are prescribed. Contraindications to induction of labor are: a discrepancy between the size of the fetus and the mother's pelvis, the presence of a scar on the uterus after a cesarean section or after removal of uterine fibroids, symptoms of threatening uterine rupture, previous severe septic diseases of the genital organs. If with the introduction of drugs that enhance uterine contractions for 2 hours there is no dynamics of cervical dilatation or the condition of the fetus worsens, then further administration of drugs is not advisable. In this situation, the issue should be resolved in favor of operative delivery. The choice of method depends on the specific obstetric situation. With weakness of labor activity in the first stage of labor, a caesarean section should be performed. In the second stage of labor, it is advisable to apply exit obstetric forceps or perform vacuum extraction.

Violent labor activity

Excessively strong, violent labor activity is characterized by very strong and / or frequent contractions and attempts (after 1-2 minutes), which can lead to rapid (1-3 hours) or rapid (up to 5 hours) childbirth. The expulsion of the fetus sometimes occurs in 1-2 attempts. Violent labor activity poses a danger to the mother and fetus. Women in labor often have deep ruptures of the cervix, vagina, clitoris, perineum; premature detachment of normally located or development of bleeding is possible. Frequent, very strong contractions and rapid expulsion of the fetus often lead to hypoxia and birth trauma to the fetus.

When correcting violent labor, the woman in labor is given a position on her side, opposite to the position of the fetus, which she maintains until the end of labor. The mother is not allowed to get up. For the regulation and removal of excessive labor activity is used intravenous administration magnesium sulphate, tocolytic drugs (partusisten, ginipral, etc.), achieving a decrease in the number of contractions to 3-5 in 10 minutes.

Uterine tetanus

Uterine tetany is rare. In this case, the uterus does not relax at all, but remains in a state of tonic tension all the time, which is due to the simultaneous occurrence of several pacemakers in different parts of the uterus. At the same time, the reductions various departments uterus do not match. There is no cumulative effect of the action of uterine contraction, which leads to slowing down and stopping labor. Due to a significant violation of the uteroplacental circulation, severe fetal hypoxia develops, which manifests itself in a violation of its cardiac activity. The degree of disclosure of the uterine pharynx is reduced compared with the data of the previous vaginal examination. A woman in labor may have an increase in body temperature and develop chorioamnionitis, which worsens the prognosis for the mother and fetus. Tetany of the uterus may be one of the symptoms of such serious complications, as a threatening or incipient rupture of the uterus, premature detachment of a normally located. The reasons for this anomaly are the presence of significant obstacles to the progress of the fetus, narrow pelvis, tumor, unreasonable, erroneous prescription of labor-stimulating drugs.

In the treatment of uterine tetany, anesthesia is used. Often, after anesthesia, labor activity normalizes, and childbirth ends spontaneously. With tetany of the uterus, which is a symptom of its rupture, with premature detachment normally located placenta, a mechanical obstruction to the passage of the fetus, a caesarean section is performed. If there is a complete opening of the cervix, then under anesthesia, the fetus is removed using obstetric forceps or by the leg (with breech presentation).

Discoordination of labor activity

Discoordination of labor activity is characterized by erratic contractions of various parts of the uterus due to the displacement of the pacemaker zone. Several such zones may occur simultaneously. In this case, the synchrony of contraction and relaxation of individual sections of the uterus is not observed. The left and right halves of the uterus can contract asynchronously, more often this refers to a violation of the contraction processes in its lower section. Contractions become painful, spastic, uneven, very frequent (6-7 in 10 minutes) and prolonged. Between contractions, the uterus does not completely relax. The behavior of the mother in labor is restless. There may be nausea and vomiting. There is difficulty urinating. Despite frequent, strong and painful contractions, the opening of the uterine os occurs very slowly or does not progress at all. In this case, the fetus almost does not move along the birth canal. Due to violations of uterine contraction, as well as due to incomplete relaxation of the uterus between contractions, severe fetal hypoxia often develops, and an intracranial injury to the fetus is also possible. Discoordination of uterine contractions often causes untimely discharge of amniotic fluid. The cervix becomes dense, the edges of the uterine os remain thick, tight and do not lend themselves to stretching. The development of discoordinated labor activity is facilitated by the negative attitude of the woman in labor to childbirth, the age of the primiparous woman over 30 years old, untimely discharge of amniotic fluid, gross manipulations during childbirth, developmental anomalies and tumors of the uterus.

In the treatment of incoordination of labor activity, which is aimed at eliminating excessive uterine tone, sedatives, drugs that eliminate spasm, painkillers and tocolytic drugs are used. The most optimal method of pain relief is epidural anesthesia. Childbirth is carried out under constant medical supervision and monitoring of the fetal heart activity and uterine contractions. At ineffective treatment, and also in the presence of additional complications, it is advisable to perform a caesarean section without attempting corrective therapy.

Prevention of anomalies of labor activity

In order to prevent anomalies of labor activity, careful observance of the medical and protective regimen, careful and painless management of childbirth is necessary. Medical prophylaxis carried out in the presence of risk factors for the development of anomalies of the contractile activity of the uterus: young and elderly age primiparous; burdened obstetric and gynecological history; indication of chronic infection; the presence of somatic, neuroendocrine and neuropsychiatric diseases, vegetative-vascular disorders, structural inferiority of the uterus; ; overstretching of the uterus due to polyhydramnios, multiple pregnancy or large fetus.

Normally, the birth of a child into the world should occur without any complications, both from the side female body as well as from the side of the baby. But in practice, doctors often have to deal with various problems during childbirth, and one of the most common among them is considered to be generic weakness. It is much easier for specialists to correctly resolve problem situations if the woman in labor herself has accurate information about what weak labor activity is, knows the causes and symptoms of such a violation, and roughly understands what to do in such a situation.

Causes

According to obstetrician-gynecologists, there are a lot of factors that can slow down labor activity. So such a violation can develop due to neuroendocrine, as well as somatic ailments of the woman in labor. Sometimes it is provoked by overstretching of the uterus, which is often observed with polyhydramnios or multiple pregnancy. In some cases, weak labor activity is the result of complications of gestation, pathologies of the myometrium, as well as defects in the fetus itself, for example, disorders of the nervous system, adrenal aplasia, presentation, belated or accelerated maturation placenta.

Labor activity may weaken due to the too narrow pelvis of the woman in labor, the presence of tumors in her, and insufficient elasticity of the uterine cervix.

Sometimes such a violation occurs as a result of the fact that the readiness of a woman and her child for childbirth does not coincide and is not synchronous. In certain cases, weak labor activity is caused by stress, the age of the woman in labor up to seventeen or after thirty years, as well as her insufficient physical activity.

Symptoms

Manifestations of weak labor activity are determined by doctors directly during childbirth. At the same time, the woman in labor has short contractions of not high intensity. The opening of the cervix occurs rather slowly, and the fetus, in turn, moves along the birth canal at a low speed. The intervals between contractions, instead of decreasing, begin to increase, and the rhythm of uterine contractions is also disturbed. Childbirth is characterized by a special duration, which causes severe fatigue of the woman in labor. With weak labor activity, the fetus experiences a lack of oxygen, which can be traced with the help of CTG.

If we are talking about primary type generic weakness, then contractions are characterized by low severity and insufficient effectiveness from their very appearance. The secondary form of pathology begins to develop after the normal onset of labor.

What to do?

The actions of an obstetrician-gynecologist in the development of generic weakness depend primarily on the causes of such a violation. Unfortunately, now doctors decide to hasten labor more often than may be necessary. Quite often, the first birth really takes a very long time, and if the fetus is not threatened by hypoxia, there is simply no point in stimulation. In certain cases, in order for labor activity to be restored, the woman in labor needs to calm down and rest a little.

In the event that generic weakness really poses a threat to the mother or child, specialists take measures to stimulate it.

Amniotomy, the process of opening the fetal bladder, is considered to be a fairly safe non-drug method to enhance labor activity. Such a procedure can be carried out if the uterine cervix has opened two centimeters or more. The outpouring of water often leads to increased contractions, as a result of which the woman in labor can do without medicines.

In some cases, experts decide to put a woman into drug-induced sleep for about two hours, which allows her to somewhat restore the strength and resources of her body. To carry out such a manipulation, consultation with an anesthesiologist and a competent analysis of the child's condition are required.

To directly accelerate and intensify contractions, ureotonic stimulants can be used. Most often, obstetricians prefer oxytocin and prostaglandins, they are usually administered intravenously using a dropper. At this time, the fetal heart rate is monitored using CTG.

In parallel with stimulant drugs, antispasmodics, analgesics or epidural anesthesia are often used, since a sharp increase in contractions against the background of drug administration is extremely painful. And such a list of drugs can adversely affect the condition of the child, respectively, they are used only according to indications, if the harm from such a correction is lower than from a protracted birth.

If all of the above measures fail positive result A decision is made to perform an emergency caesarean section.

What can a future mother do?

You need to prepare for childbirth long before date X. It is advisable to choose a maternity hospital where the woman in labor will feel comfortable, you also need not be afraid upcoming birth and get as much information about this process as possible. To prevent birth weakness, it is extremely important to actively behave after the onset of contractions - walk, use fitball, wall bars, etc. The right approach to childbirth, confidence in a favorable outcome, support from close and qualified obstetricians help to reduce the likelihood of developing birth weakness to a minimum.

- insufficient in strength, duration and frequency of contractile activity of the uterus, due to its hypotonic dysfunction. The weakness of labor activity is manifested by rare, short and ineffective contractions, slowing down the opening of the cervix and advancement of the fetus. Pathology is diagnosed through observation, cardiotocography, vaginal examination. In the treatment of weakness of labor, rhodostimulation is used; according to indications, a caesarean section is performed.

General information

Weakness of labor is one of the forms of violation of the contractile function of the uterus, characterized by low tone of the myometrium, a rare frequency of contractions, and a weak amplitude of contractions. There is a predominance of diastole of contractions (a period of relaxation) over systole (a period of contraction), which slows down the opening of the cervix and the progress of the fetus through the birth canal.

The weakness of labor activity may be due to the late or young age of the primipara; preeclampsia; premature birth or post-term pregnancy; overstretching of the uterus with multiple pregnancy, large fetus, polyhydramnios; disproportion between the size of the fetus and the pelvis of the woman in labor (narrow pelvis); early discharge of water. Placenta previa, the course of pregnancy in conditions of chronic placental insufficiency, fetal pathology (hypoxia, anencephaly, etc.) can lead to the development of weakness in labor activity.

In addition, the weakness of labor activity can be aggravated by the asthenization of a woman (overwork, excessive mental and physical activity, inadequate nutrition, insufficient sleep); fear of the woman in labor, uncomfortable environment, inattentive or rude service. The weakness of labor activity is often a direct continuation of the pathological preliminary period of childbirth.

Types of weakness of labor activity

According to the time of occurrence, primary weakness of labor activity and secondary are distinguished. The primary weakness is considered a situation in which, from the very beginning of childbirth, insufficiently active (weak in strength, irregular, short) contractions develop. They speak of secondary weakness if there is a weakening of contractions at the end of the 1st or the beginning of the 2nd period of labor after the initially normal or violent nature of labor.

The varieties of weakness of labor activity include segmental and convulsive contractions. Convulsive contractions are characterized by prolonged (more than 2 minutes) uterine contractions. With segmental contractions, not the entire uterus is contracted, but its individual segments. Therefore, despite the continuity of segmental contractions, the effect of them is extremely small. Definition clinical form weakness of labor activity allows you to choose differentiated tactics in relation to the treatment of disorders.

Symptoms of weakness in labor

Clinical manifestations of the primary weakness of labor activity are: decreased excitability and tone of the uterus; frequency of contractions - 1-2 within 10 minutes; the duration of contractions is not more than 15-20 seconds; amplitude (strength) of contractions of the myometrium - 20-25 mm Hg. Art. The period of contraction of the uterus is short, the period of relaxation is 1.5-2 times longer. There is no increase in intensity, amplitude, frequency of contractions over time.

Contractions with primary weakness of labor activity can be regular or irregular, painless or slightly painful. The course of structural changes in the cervix (shortening, smoothing and opening of the cervical canal and uterine os) is slowed down. The weakness of the contractile activity of the uterus often accompanies the period of exile, as well as successive and early postpartum period leading to hypotonic bleeding. The primary weakness of labor activity leads to a delay in the duration of labor, fatigue of the woman in labor, untimely discharge of amniotic fluid, lengthening of the anhydrous period.

In the case of secondary weakness of labor activity, initially effective contractions weaken, become shorter and less frequent, up to a complete cessation. This is accompanied by a decrease in the tone and excitability of the uterus. The opening of the uterine os can reach 5-6 cm without further progression; the progress of the fetus through the birth canal stops. The danger of weak labor is an increased risk of ascending infection of the uterus, the development of fetal asphyxia or intrauterine death. With prolonged standing of the fetal head in the birth canal, birth injuries of the mother (hematomas, vaginal fistulas) may develop.

Diagnosis of weakness of labor activity

To determine the nature of labor activity, clinical assessment the effectiveness of contractions, the tone of the uterus, the dynamics of childbirth. During childbirth, monitoring of uterine contractions (tocometry, cardiotocography) is carried out; analysis of the frequency, duration, strength of contractions and their comparison with the norm. So, in the active phase of the 1st period, contractions lasting less than 30 seconds are considered weak. and intervals over 5 minutes; for the 2nd period - shorter than 40 sec.

With the weakness of labor activity, the opening of the cervix occurs by less than 1 cm per hour. The degree and speed of opening are assessed during the vaginal examination, as well as indirectly - by the height of the contraction ring and the advancement of the head. Weakness of labor activity is said if the 1st stage of labor lasts more than 12 hours for primiparas, and more than 10 hours for multiparous ones. Weakness of labor forces should be differentiated from discoordinated labor activity, since their treatment will be different.

Treatment of weakness in labor

The choice of treatment regimen is based on the causes, the degree of weakness of labor, the period of labor, the assessment of the condition of the fetus and mother. Sometimes, to stimulate the intensity of contractions, it is enough to catheterize the bladder. If the weakness of labor activity is due to

In the process of pregnancy management by an obstetrician-gynecologist, it is necessary to assess risk factors for the development of weakness in labor, and if such factors are identified, preventive medication and psychophysical training should be carried out. The weakness of labor activity almost always leads to a deterioration in the condition of the fetus (hypoxia, acidosis, cerebral edema), therefore, simultaneously with labor stimulation, prevention of fetal asphyxia is carried out.

This article will address the issue of weakness of labor activity. We will tell you in detail about the causes, symptoms, consequences and resolution of childbirth.

Let's define what it is. The weakness of labor activity is insufficient activity uterus. That is, childbirth is difficult and lengthy, since the uterus does not contract well, the cervix opens with difficulty, and the fetus comes out very slowly and difficultly. Childbirth does not always go well, as expected, there are anomalies in labor activity. You will learn about one of them in great detail from this article.

Weak labor activity

No matter how sad it may sound, but anomalies of labor activity are quite common. The reasons for this phenomenon are quite numerous. Now we will talk about weakness birth process.

This is one of possible violations tribal activity. With this diagnosis, the contractile function of the uterus, which is necessary for the expulsion of the fetus, is weakened. This is due to:

• low ;
• rare contractions;
• weak amplitude of contractions;
• the predominance of diastole;
• the contraction period lags far behind the relaxation period;
• slow opening of the cervix;
• slow progress of the fetus.

More detailed symptoms will be presented in another section. Now let's look at some statistics. This diagnosis in obstetrics and gynecology is the most popular, as it is very common complication birth and cause various pathologies both mother and child. Statistics claim that more than seven percent of childbirth is complicated by the weakness of labor activity. And one more fact: this diagnosis is established more often by women who give birth to their first child. As a rule, subsequent births pass without any difficulties, however, there are cases of diagnosing weakness of labor activity during subsequent births.

Causes

We explained what the weakness of labor activity is. The reasons can be many factors. We propose to list them. The reasons for the weakness of labor activity can be:

• morphological inferiority of the uterus;
• failure hormonal regulation generic process;
• functional inertness of nervous structures;
• extragenital diseases;
• hypoplasia;
• myoma;
• chronic endometritis;
• adenomyosis;
• bicornuate uterus;
• saddle uterus;
• medical board;
• scraping;
• conservative myomectomy;
• scars after treatment of cervical erosion (if the woman has not previously given birth).

There are some other reasons that can be noted. Weakness of tribal forces may arise due to an imbalance of factors that affect labor activity. TO positive factors can include the following:

• prostaglandins;
• estrogens;
• oxytocin;
• calcium;
• mediators and so on.

Negatively affect:

• progesterone;
• magnesium;
• enzymes that destroy mediators and others.

It is very important to note that women suffering from some disorders (vegetative-metabolic) often face this problem during childbirth. Such violations include:

• obesity;
• hypothyroidism;
• hypofunction of the adrenal cortex;
• hypothalamic syndrome.

The age of the primiparous also has a great influence. If the girl is very young or her age exceeds 35 years, then labor can be difficult. The period at which labor activity began is also important. Weakness of the uterus can be the cause of a delayed pregnancy or premature.

If the pregnancy is multiple, then it is possible this pathology during childbirth. With multiple pregnancy, the uterus is overstretched. Overstretching can also occur with a large fetus or polyhydramnios.

Often, miniature girls face difficulty in labor activity, since a narrow pelvis is also the cause of weak work of the uterus. The reason is the disproportion between the size of the child and the woman's pelvis.

The reasons are still very numerous, unfortunately, it will not be possible to list them all. Now let's highlight some of the most popular ones:

• overwork;
• mental stress;
• physical exercise;
• poor nutrition;
• lack of sleep;
• fear of childbirth;
• discomfort;
• poor care of the woman in labor and so on.

Thus, it is possible to classify all causes as follows:

• from the mother's side;
• pregnancy complications;
• from the side of the child.

Kinds

Weakness of labor activity can occur absolutely at any stage of childbirth. In this regard, it is customary to highlight some types of weakness:

• primary;
• secondary;
• weak pushes.

Let's take a closer look at each type separately.

The primary weakness of labor activity is characterized by inactive contractions in the first stage of labor. They are very weak, short and not at all rhythmic. It is important to note that with primary weakness, an underestimated uterine tone (less than 100 mm Hg) is noticed. On this stage a woman is able to diagnose the problem herself. How to do it? Record ten minutes and count the number of contractions during this period. If the number does not exceed two and you practically do not feel them, then the diagnosis was confirmed. You can also measure the time of one contraction, it should be more than 20 seconds in the absence of weakness in labor. Diastole, or rest period, is almost twice as long. How can the palpability of contractions indicate a problem? It's simple, if they are painless or slightly painful, then the pressure from the uterus is not enough to open the cervix.

Secondary weakness of labor activity is characterized by a weakening of the intensity of the work of the uterus. Prior to this, contractions may have been normal. The causes of development are the same as with the primary weakness of the ancestral forces. Another indicator is the progression of the opening of the uterine os. If progress is not visible after five or six centimeters of dilatation, then we can confidently speak of secondary hypotonic dysfunction of the uterus.

If primary and secondary weakness is observed in ten percent of cases of unfavorable births and is characteristic of primiparas, then weakness of the straining period is extremely rare (two percent of all cases of difficult births), and it is characteristic of multiparous women or with obesity.

Symptoms

Symptoms of primary weakness of labor activity include:

• decreased excitability of the uterus;
• decreased uterine tone;
• reduced frequency of contractions (up to two in ten minutes);
• short duration of contractions (up to twenty seconds);
• the force of contractions does not exceed 25 mm Hg. Art.;
• short period of reduction;
• extended rest period;
• there is no increase in intensity and frequency;
• painless or painless contractions;
• slow change in the structure of the cervix (this includes shortening, smoothing and opening).

All this can significantly increase the overall time of delivery. This, in turn, affects the mother and the child badly. The woman in labor is very overworked, early expulsion of waters is possible.

Symptoms of secondary weakness:

• weakening of the intensity of contractions (perhaps even their complete cessation);
• weakening of the tone;
• decrease in excitability;
• there is no progression of the opening of the uterine pharynx;
• stopping the progress of the fetus through the birth canal.

This is no less dangerous than the primary weakness. The child may develop asphyxia or may die. For mom, it is dangerous with the possibility of infection of the uterus, birth trauma. Prolonged standing of the baby's head in the birth canal can lead to the formation of hematomas or fistulas.

Diagnostics

In this section we will talk about diagnosing the problem of weakness (primary and secondary) of labor activity. The diagnosis of primary weakness is based on the following:

• decreased activity of the uterus;
• reduced rate of neck smoothing;
• delayed opening of the uterine pharynx;
• long standing fetus;
• extended delivery time.

It is important to note that big influence a partogram (or a graphic description of childbirth) helps to make a diagnosis. This chart shows it all:

• neck opening;
• promotion of the fetus;
• pulse;
• pressure;
• baby's heartbeat
• fights and so on.

If there is no progress in dilating the cervix within two hours, which is clearly shown in the partogram, then this diagnosis is made.

Diagnosis of secondary weakness is based on these indicators:

• partogram;
• listening to the heartbeat.

This is necessary so that the fetus does not develop hypoxia. There are some complexities of the birth process that are symptomatically similar to weakened labor. These include:

• pathology;
• discoordination of labor activity;
• clinically narrow pelvis.

Treatment

It is important to note that the treatment is selected individually for each woman in labor. When treating, the doctor must take into account all the data that he has (the condition of the woman and the baby).

A good remedy for weak labor activity - a technique For this, special preparations so that the woman rests, then labor activity may intensify.

If this does not help, then they resort to a puncture of the fetal bladder. After this procedure, labor activity becomes much more intense. It should be noted that the puncture is carried out only if the neck is ready.

Sometimes doctors resort to medical stimulation. Now we will briefly consider the drug "Miropriston" to stimulate labor. This drug should be taken strictly under the supervision of doctors. It suppresses progesterone, which has a beneficial effect on contractile activity uterus.

delivery

If no methods have helped, including Miropriston to stimulate labor, then the doctor may emergency operation caesarean section. What techniques are performed before the operation:

• medical sleep;
• amniotomy;
• medical stimulation.

Among other things, there may be additional indications for the operation. There is a certain list of contraindications to the stimulation of labor (narrow pelvis, life threatening, and so on).

Prevention

We examined in detail the issue of weakness of labor activity. prevention can be given by an obstetrician-gynecologist who is managing your pregnancy. He should talk about possible complications during childbirth and conduct physical and psychological preparation women in labor. In addition to labor stimulation, prevention is mandatory. possible complications at the fetus.

Consequences

What are the complications of labor weakness? For a mother, this could be:

• the formation of hematomas;
• fistula formation;
• possible infection.

For a child, the following complications are possible:

• hypoxia;
• acidosis;
• swelling of the brain;
• death.

It all depends on the professionalism of the doctor. With proper stimulation and strict control of the condition of the child and mother, there should be no consequences.

Forecast

Now briefly about predicting the weakness of labor activity. As mentioned earlier, it all depends on the professionalism of the doctor and psychological state women. Do not panic, but listen to the recommendations of a specialist. Complications after obstructed childbirth are quite rare.

The course of subsequent births

The weakness of labor activity during the first birth does not mean that all subsequent ones will proceed in the same way. Primary and secondary weakness is common in women who give birth to their first child. A small percentage of multiparous women may experience weakness in the labor period.