Anomalies of patrimonial activity
Anomalies of patrimonial activity – disorder of intensity, coordination, force, a rhythm, duration of sokratitelny activity of a uterus at the time of delivery. Anomalies of patrimonial activity cause bleedings and a hypoxia of a fruit, increase probability of development of infections and patrimonial injuries. Can become a fruit cause of death. The diagnosis is exposed taking into account complaints, data of survey and additional inspection. At development of anomalies of patrimonial activity conservative therapy is carried out. At impossibility of independent childbirth obstetric operations are carried out.
Anomalies of patrimonial activity
Anomalies of patrimonial activity (pathological childbirth) – violations of sokratitelny activity of a uterus in labor. Are a widespread pathological state, are observed at 10-20% of women in labor, become the reason of every third Cesarean section. In 80-85% arise at primipara. The probability of development of this pathology increases at early or late first labor. Because of serious threat to health of the woman in labor and a fruit of anomaly of patrimonial activity are considered as one of the most important problems of modern obstetrics. Among possible complications – a fruit hypoxia, patrimonial injuries, infections, massive bleedings and death of a fruit. Diagnostics of this pathological state and conducting childbirth are performed by obstetricians-gynecologists.
Reasons and classification of anomalies of patrimonial activity
Anomalies of patrimonial activity arise at disorder of synchronous work of a number of the mechanisms regulating process of childbirth. Development of such anomalies is promoted by a number of factors which can be divided into three groups: the general violations, certain conditions of reproductive system and a problem which arose during pregnancy and childbirth. Carry endocrine and somatic diseases, smoking, drug addiction, alcoholism and some features of character (hypererethism, emotional lability and low resistance to stresses) to group of the general violations.
Include age to 18 in number of the conditions of reproductive system provoking anomalies of patrimonial activity and after 30 years, abortions, postoperative hems on a uterus, anomalies of female genitals and chronic gynecologic diseases. Gestoza, congenital defects of development of a fruit, violation of provision of a fruit, uterus restretching owing to abundance of water, a mnogoplodiya and a large fruit, a perenashivaniye, problems of an arrangement and office of a placenta, early izlity waters, the prolonged preparatory period and immaturity of a neck of a uterus belong to the risk factors which arose in the period of a gestation and childbirth. All listed factors can be aggravated with unreasonable or excessive prescription of medicines.
There are several classifications of anomalies of patrimonial activity (ACOG, MKB-10). The Russian experts in the field of gynecology use the classification made taking into account the nature of disorders of sokratitelny activity a miometriya:
- Pathological preliminary (preparatory) period
- The dicoordinated patrimonial activity (spastic, tonic, total dystonia)
- Weak patrimonial activity (primary, secondary, weakness of attempts)
- Excessively strong patrimonial activity
Types of anomalies of patrimonial activity
Pathological preparatory period
The pathological preliminary period – the anomaly of patrimonial activity arising prior to active childbirth. Normal reductions of a uterus in this period appear more often at night, do not interrupt a sleep, do not influence the general condition of the pregnant woman, have coordinate character and less than 6 hours proceed. The "mature" neck – short, softened, located on a basin axis becomes result of reductions. At anomaly of patrimonial activity the preparatory period proceeds more than 6-8 hours (sometimes – up to several days). The reductions dicoordinated arise not only at night, but also in the afternoon, are followed by the expressed pains. The exhaustion increases, psychological state of the pregnant woman is broken.
The neck is long, dense, it is located not on a basin axis. The Tservikalny channel does not pass a finger. The prelying part of a fruit can remain mobile. Increase in a tone of a uterus comes to light. Perhaps premature otkhozhdeniye of amniotic waters. The forecast at early izlitiya of waters is defined by neck maturity degree. At rather mature neck restoration of patrimonial activity can be observed. The early otkhozhdeniye of waters in combination with an unripe neck and other burdening circumstances indicates high probability of further aggravation of anomaly of patrimonial activity and is considered as the indication to Cesarean section.
The plan of treatment the miometriya, normalization of physical and psychological state of the patient includes actions for stimulation of maturing of a neck, elimination of a pain syndrome, elimination of a pathological spasm. Apply spazmolitik, narcotic analgetics, soothing and sedatives. At violations of a psychoemotional state the woman in labor with anomaly of patrimonial activity needs a medicamentous dream rest.
If necessary medical actions are repeated with an interval of 8-12 hours. The general duration of conservative therapy should not exceed 2-3 days. In the absence of result perform Cesarean section. The forecast usually favorable – timely therapy gives the chance to restore sokratitelny activity of a uterus and to reach a maturity of a neck necessary for natural childbirth, however further every third pregnant woman with the pathological preliminary period in the course of childbirth has these or those anomalies of patrimonial activity.
Weakness of patrimonial activity
Weakness of patrimonial activity is diagnosed for every tenth woman in labor. It is shown by insufficiently intensive, short fights divided by too big time intervals. Can be primary or secondary. Primary weakness of patrimonial forces – anomaly of patrimonial activity at which weak, insufficiently effective fights come to light since the beginning of childbirth. Usually arises at decrease in the tone of a uterus caused by restretching of muscular tissue, endocrine violations and other factors. Significantly increases duration of childbirth and causes exhaustion of the patient. Often is followed early izlitiy waters, a hypoxia of a fruit and bleedings. Infectious complications are possible.
The diagnosis is exposed after 6-8 hours of observation at not streamed waters or after 2-4 hours of observation at the streamed waters. Tactics of treatment is defined taking into account the cause of anomaly of patrimonial activity. At a mnogovodiya carry out an amniotomiya. Control depletion of pelvic bodies. At exhaustion appoint a medicamentous dream rest. Carry out stimulation by prostaglandins, oxytocin or their combination. Stimulation is contraindicated after operations, at clinically narrow basin, an otsloyka of a placenta and a hypoxia of a fruit.
Secondary weakness of patrimonial forces – the anomaly of patrimonial activity arising after the normal fights at the end of I or in the II period of childbirth. Fights become weak, rare and short, disclosure of a neck is slowed down, advance of a fruit stops. This pathology is provoked by the same factors, as primary weakness. A certain value has exhaustion of the patient. Anomaly of patrimonial activity is confirmed by results of observation, a kardiotokografiya. Therapy is begun with a medicamentous dream rest. At preservation of clinical manifestations after rest carry out stimulation with use of oxytocin, prostaglandins or their combinations. At inefficiency of conservative therapy perform Cesarean section.
Weakness of attempts – the anomaly of patrimonial activity arising when weakening muscles of a stomach as a result of a bad physical condition, obesity, infantility, a myasthenia, paresis and paralyzes, hernias in the field of a forward belly wall or numerous childbirth in the anamnesis. The plan of treatment of this pathology provides cancellation of anesthetics and tranquilizers in combination with purpose of oxytocin. At inefficiency of medicamentous therapy carry out a rodorazresheniye with use of obstetric nippers.
Excessively strong patrimonial activity
Excessively strong patrimonial activity – the anomaly of patrimonial activity which is characterized by considerable acceleration of process of childbirth (so-called bystry childbirth). Usually comes to light at the increased emotionality and excitability. Is followed by private intensive fights. Duration of first labor can be reduced till 1-3 o'clock. "childbirth on the street", before arrival of ambulance and delivery of the patient to specialized institution is frequent. Severe injuries of the child as a result of falling on a floor at childbirth in a standing position are possible.
This anomaly of patrimonial activity quite often becomes complicated an otsloyky placenta, gaps, bleedings, a hypoxia of a fruit and patrimonial injuries of the newborn. The patient is urgently transported in medical institution, appoint a high bed rest, stacked sideways, opposite to a fruit position. Perform infusions of tokolitik. After restoration of patrimonial activity of a tokolitika replace spazmolitikam.
Diskoordination of patrimonial activity
Diskordination of patrimonial activity – anomaly of patrimonial activity at which the driver of a rhythm (group of the cages providing reductions of a uterus in childbirth) is displaced from a uterus corner in the middle or lower part of body. Some patients have several drivers of a rhythm. Synchronism of reductions a miometriya is broken. Normal the wave of reductions extends from top to down, at a diskoordination the direction of waves changes on opposite. Fights become frequent, strong, painful, uneven and inefficient. Because of spasms also the lymph flow worsens local krovo-.
At this anomaly of patrimonial activity the premature otkhozhdeniye of waters is quite often observed. The neck of a uterus either reveals very slowly, or "stiffens" at a disclosure stage to 4-5 cm. The concern, nausea, vomiting, difficulty of an urination and reduction of amount of the emitted urine are observed. The fruit hypoxia, an otsloyka of a placenta and massive bleedings is possible. Therapy – anesthetics, soothing and spazmolitichesky means. In the absence of result Cesarean section is required.
Tetanus of a uterus – the rare anomaly of patrimonial activity arising at further aggravation of a diskoordination of patrimonial processes and which is followed by titanic reductions of a uterus. The reductions of certain sites frequent, short, spasmodic, uncoordinated among themselves a miometriya reminding reductions of a cardiac muscle at fibrillation or trembling come to light. Sharp painful contractions are replaced by a stop of patrimonial activity. Deterioration in the general state, pallor of skin, tachycardia and the termination of an independent urination is noted. Patients with this anomaly of patrimonial activity need Cesarean section.