Weak generic activity (distation): causes, signs, symptoms, treatment. Weakness of generic activity

The date: 19.04.2019

Discordination of labor activities occurs in 1 - 5% of cases of all kinds. Normally, the cutting of the uterus begins in the field of its bottom, it spreads down to Zev. Simultaneously with the cutting of the uterus, the cervix takes place.

Discordination of generic activity is a violation of the cutting of the uterus. It happens three species:

totania of the uterus - spasm of all separations of the uterus;
dominant of the lower segment - the distribution of muscle contraction from the lower segment upwards to the bottom of the uterus;
distation of the cervix - no relaxation of the neck at the moment of cutting in the uterus.

Causes of Discordination of Generic Activities

The reasons for the development of Discordination are not currently studied. It is generally accepted that the risk of developing this pathology is higher in women with abortions in history, as well as women with a miomer of the uterus or endometritis.

The predisposing factor is the various anomalies for the development of the uterus.

Signs and diagnosis of data discsordination

In the dyscoordination of generic activities, the feminine is excited, restless. The fights are extremely painful, and the pain is localized in the region of the sacrum, and not at the bottom of the abdomen as in normal childbirth. At the same time, there is practically no cervical disclosure.

The diagnosis is made on the basis of the assessment of the bout and the disclosure of the cervix. To confirm it, hysterography is carried out, which confirms the reduction asynchronism different departments uterus.

Danger of Discordination of Generic Activities

When the dosincordination of generic activity, the uterine-placental blood flow is disturbed due to the pronounced spasms of the uterus musculature and the fruit begins to test oxygen starvation, its hypoxia develops.

In and in early postpartum period A woman often has massive bleeding.

Treatment of data discsordination

Treatment depends on the type of discount of generic activity.

If the uterus tenania is observed, the feminine first give fluorotane anesthesia, spasmolitis and tranquilizers are introduced. After the awakening of the woman, the generic activity is normalized.

With the dominant of the lower segment and dotition, the necks first introduce adrenomimetics. If their introduction does not give the result, treatment is also carried out as when the uterus is taking.

If these measures do not lead to the normalization of generic activities, an emergency is required, since the discoordination of generic activity is extremely suffering from fruit.

III degree (total dilitation of the uterus)

The heaviest option (degree) of the discharge of the cutting of the uterus in childbirth, which is characterized by total spasm of cervical, lower segment, body, tube angles of the uterus and vagina.

At the same time, there is not one "rhythm driver", and a few (the displacement of the "rhythm driver" vertically and horizontal). The uterus is divided into several zones, each of which takes on the function of the starting center. Each uterus segment has its own rhythm, amplitude and cutting frequency, which do not coincide with each other.

The fibrillation of myometrium occurs like flickering and trembling of the heart. Tonus of the uterus all the time persists high, all muscle fibers, especially circular, are in a state of tonic tension. The total effect of action is extremely low. Birth slows down and stop.

Generic activity stops. The threshold of the excitation of some cell groups is very high, others are very low. The excitation waves and cuts cannot cover all the myometrium, since one piece of muscle beams is reduced in one rhythm, the other is different. The spread of the reduction waves has opposite directions: at the same time up and down, right to left and vice versa.

The fights become rare, short, weak, but, unlike the true weakness of the generic activity, the hypertonus of myometrium is preserved. There is no phase of relaxation and peace.

By clinical picture Total dystation of the uterus in childbirth resembles the weakness of labor activity. The main difference is the tone of the uterus. In the discoorination of the generic activity, it is always elevated, with weakness of generic activity, the uterus is reduced.

The clinical picture of the hypertensive form of weakness is very characteristic. After spastic, painful kits occurs a period of visible weakening of generic activity. The feminine is no longer shouting, does not dare, behaves more calm, but indifferent. Complains only on stupid constant pain in the sacrum and in the lower back. This often gives a reason to the doctor to establish an erroneous diagnosis of the secondary weakness of generic activity and prescribe a rhodium-immutting therapy, which is categorically contraindicated in the discount of generic activity.

Total Tetanus of the uterus indicates the paradoxical phase of the parabitony of muscle contractions. Skin Covers Pale Feelnians, there are acricyanosis, skin marble. Pulse frequent, easily compressed, weak. The feminine independently flies, with the catheterization of the bladder, small portions of urine containing protein, red blood cells, leukocytes, cylinders are distinguished.

In the outdoor obstetric study, the uterus is determined by the narrowed in the diameter due to the thetanic reduction of the myometrium. The uterus tightly covers the fruit. Palpation of the predatory part is difficult. Even with the transverse or oblique position of the fetal, the uterus retains the shape of an elongated ovoid and so squeezes the frozen, which is the impression of its longitudinal location. A strained convex dense bottom segment is often accepted for the preserved part. The fruit suffers, the heartbeat is frequent or rare, arrhythmical, deaf or ringing with a metal tint.

In the vaginal study, the tense muscles of the pelvic dna, spastically narrowed vagina, edema, thick rigid edges of the uterine zea are applied. The degree of disclosure of the uterine zoom is slowed down. Compared with the data of the previous vaginal study, it seems that the opening of the neck is not only does not progress, but becomes less.

Determine the integrity of the fruit bubble is difficult due to dense fetal shells, which are literally tensioned on the head, the front waters are practically absent.

There is a pronounced generic tumor on the head, because of which it is difficult to identify seams and springs.

Sometimes it seems that the fetus head has advanced to the pelvic bottom. However, the palpation of the entire free rear surface of the pubic symphiz indicates a high standing of the head, although the generic tumor can reach the pelvic bottom, which causes vicious sweats.

After birth, the fruit is not at all gigantic, not large, but a very medium size (2900-3100 g) or even small.

With any form of discoordination of generic activity in women with normal anatomical sizes, the pelvis is much more common than in the overall population, there is an extension of the head (frontal, rear view of the facial), high straight standing of the sagittal seam, a reckable asynclothic insert, as well as the rear view. They do not relate to adaptive mechanisms even when anomalous forms pelvis. This is a consequence of the violation of tone and contractile activity.

Spontaneous recovery normal contractual activity The uterus without drug correction is observed extremely rarely. The manufacturer quickly increases the body temperature, endomiometrite, chorionnionitis, worsening the forecast of childbirth for mother and the fetus.

With total dilution of the uterus, if the situation (no infection, increased temperature Body, lively fruit, not too long anhydrous interval) Rhodework must be carried out only by cesarean sections.

Conservative guidance, the erroneous use of contraindicated relatives can lead to a hazardous complications.

Created conditions for penetration about fruit water In the venous mother of the mother (embolism of the octoloplaw water). It may develop no less severe complication - ischemia of a separate section of the uterus and the rupture of it. Most often it is a typical localization: the left edge, the lower uterine segment, the front wall of the uterus.

Highlighting various forms Discordination (hypertensive dysfunction) of contractual activity of the uterus, two circumstances should be emphasized.

The first is the dependence of the severity of this pathology on the severity and depth of violations of the vegetative and miogenic regulation of the cutting of the uterus in childbirth.

The second is the progression and aggravation of the severity of discoordination in the insufficiency of compensatory mechanisms in the body of the pregnant and its fetus, or in the absence of timely adequate treatment and ancestration.

These literature indicate that the lack of endorphins violates the metabolism of catecholamines and supports the spasm of muscle fibers of the internal organs (including uterus, intestines, ureters).

Currently, it is proved that an excessively high emission of catecholamines reduces their protective role in ischemic damage to the neurons of the mother's brain and the fetus.

Without medication therapy, spontaneous restoration of normal generic activity is rarely observed.

We present our own clinical observation of total dilution of the uterus.

The feminizer, 27 years old, entered the maternity hospital with docking pregnancy, head preview, active generic activity, which lasts 8 hours.

Water poured 36 hours ago. Fight irregular: then long (50-60 s), then short (15-20 seconds), painful. The feminine is tired, wants to sleep. Body temperature 38.6 ° C. Hell 140 / 90-150 / 100 mm RT. Art., pulse 120 ice / min. Skin covers are hyperemic. Language dry, covered with a white bloom. The belly will be off. The uterus of an oval shape, tightly covers the fruit. In the field of the lower segment at the height of four transverse fingers above the pubic symbol, a spastic reduction of the uterus is determined in the form of a ring-shaped recess. Fetal heartbeat is not auditioned.

Vaginal study: cervical neck up to 2 cm long, hangs into the vagina. The cervical channel freely skips two fingers. The inner zev in the form of a dense spastic ring is open for 2 cm. There is no fruit bubble. The fetus head is pressed to the entrance of a small pelvis. Seams and springs cannot be determined. The tank is good. Selection of muddy, in moderate quantity.

From anamnesis: This pregnancy is not the first, as noted in the accompanying document, and the second: 10 years ago the first pregnancy is interrupted by artificial medical abortion under a period of 12 weeks. According to the patient, the neck of the uterus opened up with great difficulty and her "twice filmed from the chair" to prepare for an abortion by applying spasmolitics. Abortion passed without complications.

Sister-twin at the age of 20 died in childbirth from bleeding. The mother of the patient reported that the pregnancy in which both twin sisters were born, heavily flowed, with phenomena of the threat of interrupt. Up to 20 weeks accepted hormonal therapy. Children often hurt. Menarh has both from 15 years old, 3-4 days after 30-35 days, but pregnancy has come from both sisters in the first year of sexual life.

After an urgent and complete clinical examination, a diagnosis was made: "Pregnancy 40 weeks; head prepay; Discordination of generic activities (total disal dyat); Early expulsion spindle water; intranatal death of the fetus; endomyometritis. "

Considering the presence acute infection, the death of the fetus, the high danger of peritonitis, it was decided to refuse to abandon the operational delivery. For several hours, antispasmodic, antibacterial, detoxification therapy was carried out. A medical sleep was provided for 3 hours, conducted toocolized by the accountish system for 3 hours, which made it possible to reduce the basal tone, reduce the spastic state of the uterus. Epidural anesthesia did not apply due to skin infection.

However, the generic activity was practically absent. Against the background of continuing drip administration, careful relaxation of PGA 2 preparation was carried out with simultaneous cardiomonitorial and hysterographic control. Fights after 3 min (3 per 10 min) of 60 from the middle force. Fender hacking (drip administration of 1% mortality of morphine, sadocent). After 10 hours, the disclosure is complete, the head is a large segment in the inlet of a small pelvic.

The state of the feminine gradually improved, the body temperature decreased to 37.3 ° C, pulse 96-100 ° C / min. AD 130 / 90-120 / 80-110 / 70 mm RT. Art. Under the presence of conditions for a fertilizing operation, craniotomy and cranioclasia are produced under endotracheal oxygen anesthesia. Fruit tractions are difficult. The fruit fruit is removed without a brain (body weight 3100 g, length 54 cm). In the field of the shoulders and at the level of the eaves of the fetus, a pronounced compression of soft tissues, a change in (blue-bugs) of fabrics, was marked. The prevention of bleeding with methyl ergometrine (1.0 ml) was carried out. After 5 minutes, it was separately separated and immediately shared. With a control manual study of the walls of the uterus, the wall integrity disorders is not detected. Sheck ruptures II degree sewn with ketgutov seams. In the postpartum period - the submissiveness of the uterus, endomyometritis, secondary healing of the crotch wound.

After 2 years repeated pregnancy. The mioma of the uterus is revealed, the size of 8 cm in diameter. It has been produced by the degree of cesarean section in a planned order with a dead pregnancy. During operation, the internal zev of the uterus is passing only for the tip of the finger.

Considering the presence of an intertensive myomatous node of large sizes, the risk of a delay of succeeds, the uterine amputation is made. The postoperative period proceeded without complications. In the study of the remote drug, the cellular proliferating mioma of the uterus was detected, almost complete atresia of the internal zone, the presence of Ba-Hall chronic endomyometritis. In the newborn - Vezikulosis, congenital pneumonia, Ommalitis. Translated to the fill in the children's hospital. Check inspection after 2 months - mother and child are healthy.

The rapid transition of pathology in a more severe stage often makes it difficult for childbirth and their maintenance. Currently, taking into account the principles of modern obstetrics, they do not allow such a long and traumatic leading of labor. Nevertheless clinical cases May take place for each practitioner doctor.

20.6.5. Diagnosis of Discordination of generic activities and its options

When receiving the guinea to the maternity hospital should be familiar with medical documentation (exchange card data, guide diagnosis). When collecting anamnesis, besides well-known information, you need to pay attention to the risk factors that threaten the violation of the coordination of the cutting of the uterus in childbirth (vegetionerevosis, stress, overwork, anomalies of the uterus, the pathology of the cervix - erase the uterus, FPN, neuroendocrine pathology, etc.). It is necessary to evaluate general status, somatic health, obstetric situation. Eliminate anatomically narrow pelvis, one or another degree of disproportion pelvis and fetal head; The inferiority of the myometrium, which can lead to the rupture of the uterus in childbirth and premature details of the placenta. Mark, there are prenatal signs of the pathology of the cutting of the uterus (dense, long neck, the pathological preliminary period, the movable head of the fetus, the prenatal expulsion of the water, the migration of the pregnancy).

To assess the nature of the generic activity should be determined every 1-2 hours:

The dynamics of the structural changes of the cervix in accordance with the past clock of labor activity, given the parity of childbirth (the first, repeated);

Opening of the cervical (ukey) in centimeters, the state of the edges of the cervix (soft, militant; dense, rigid, poorly stretch; thick - thin), including the state of the edges of the uterine zea during the contraction (soft, but are compacted throughout the circle or separate section);

The functional is the fullness of the fruit bubble (poured into the fight) or inferiority (flat shape, the shell is stretched on the head), the characteristic of the shells (dense, rough, elastic). Mark the fetus bubble voltage during and outside the contraction, as well as the number of accumulating waters (little, much, normal);

Preview, insertion, type of fetus, compliance of biomechanism for one or another period of generation, the location of the head in relation to the main planes of the pelvis, the rate of its promotion;

Frequency of kits for 10 minutes of the control time (determined by the stopwheel); rhythm; The duration of the reduction (sisteners of contractions) and relaxation (diastole contamination) of the uterus;

The basal tone of myometrium during the fight and outside the contamination using a tonic meter or comparison of the voltage of the uterus with the lateral widespread muscle of the patient (the tone of the thigh muscles is 10 mm Hg. Art.); conduct differential diagnosis between weakness and discoordination of generic activity.

For the diagnosis of native anomalies, an outdoor hysterography, an internal trocographics, KTG, use an external hysterography.

Outdoor multichannel hysterographyit gives the opportunity to identify the violation of a triple downward gradient, the hyperton of the lower segment, the irregular struggle, the decrease in the diastology of the fight and the reduction of the pause time between the fights.

The method allows you to detect complexes of dyscoordated cuts of the uterus (double, triple type of contraction). The vertex of the hysterographic curve is not a peak-shaped rounding, but a plateau with uneven gear contours, rhythm kits uneven, the amplitude of the cutting bottom of the uterus is significantly lower than in the lower segment. With the help of hysterography, you can catch thetaic cuts of the uterus, when it is not relaxing for a number of uterine cycles.

Inner topographyrepresents quantitative, and therefore a more accurate estimate of the duration mastechnic cycle, systoles and diastologies of contractions. Allows you to determine the amplitude of the reduction, basal tone of the uterus, the general intrauterine pressure during the contraction, the speed and nature of its increase during the systole period and diastologists, as well as to calculate the operation of the uterus and the uterine activity. All these indicators are expressed in numerical calculus.

The amplitude of individual cuts of the uterus during the discoordination of the generic forces can vary widely: from 20 to 80 mm Hg. Art., What confirms the unevenness of the strength of the fight. Against the background of the hypertonus of the uterus and its insufficient relaxation between the fights, the intensity (power, amplitude) contractions are reduced. The duration of the systole scaffold increases 1.5-2 times, the duration of the diastole decreases by 50-60%. The asymmetry coefficient of contractions (the ratio of the duration of systole to diastole) is equal to one and more.

Increased intrauterine pressure occurs uniformly, but jumps like it is the main cause of the late expulsion of the oily water. We have studied the main characteristics of the contractile activities of the uterus in physiological and abnormal childbirth (weakness and discoordination of generic activities).

Differential diagnosis of the pathology of the cutting of the uterus during the discsordination and weakness of the generic activity is presented in Table. 20.2.

Table 20.2. Characteristic of the contractile activity of the uterus in physiological and abnormal labor activity

Main indicators of contractile activities of the uterus in childbirth	Physiological gods	Discordination of generic activities	Primary weakness of activity
Miscurity of myometrium	Normal	Increased	Reduced
Tone of the uterus, mm Hg. Art.	Normal (10-12)	Improved (13-18)	Reduced (9-6)
Rhythm of fights	Rhythmic	Nertmichy	Rhythmic
Frequency for 10 min	3-5	Various	1-2
Duration of contractions, with	60-90	100-120	20-30
The force of the fight (the amplitude of the reduction, mm Hg. Art.)	30-35	< 30	< 30
Systole scaffold duration, with	30-40	40 or more	< 30
Duration diastole contractions, with	40-60
The asymmetry coefficient of contractions (systole ratio to diastole)	0,7	1-1,5	0,7
Soreness of fights	Low-escaled, moderately painful	Sharply painful	Undoubleseed
Opening of the cervix	Progres	Sharply slowed down	Slowed down
Promotion of fruit	»	Also	»
Food bubble fullness	Full	Defective	Defective
General intrauterine pressure, mm RT. Art.	40-60	Less than 40.	Less than 40.
Increase intrauterine pressure in systole fastener, mm RT. Art.	0,6-0,9	From 0.4 to 1.5	0,6
Reducing the intrauterine pressure in diastole, mm RT. Art.	0,5-0,7	From 1.0 to 0.8	0,5

Due to the fact that the methods of multichannel hysterography and internal trocographics are quite rarely used in practical enthusiastic institutions, attention should be paid to the symptom complex or individual clinical symptoms characteristic of hypertensive dysfunction of bages.

With confidence, it can be assumed that the reason for the disassembled discoordination of the generic activity is:

"Immature" by the date of birth of the cervix;

Pathological preliminary period;

Migration of pregnancy;

Antenatal influence of the oily water with the "immature" cervix;

Breaks and scramble cervix;

Extensive vaginal breaks;

Hypoxic-traumatic damage to the fetus.

These disorders and complications also accompany the clinically narrow pelvis, the threat of an incomplete myometrium gap. The reason is a consequence, as a result, it becomes the cause of the development of complications.

20.6.6. Treatment

When choosing corrective therapy for discooring of labor activities should be proceeding from a number of provisions.

Before taking birth through natural generics in case of complex multicomponent violations of the regulation of contractual activity of the uterus, including the Mio-Gene (the most ancient and strong in the evolutionary development of a person), it is necessary to form a generation forecast, providing outcomes for mother and fetus.

The forecast and plan for conducting births are based on the age, anamnesis, health states, the flow of pregnancies, an obstetric situation, the results of the evaluation of the state of the fetus.

Adverse factors include:

Late and young age primary age;

Burdened obstetric and gynecological history (infertility induced pregnancy, the birth of a sick child with hypoxic, ischemic, hemorrhagic damage to the central nervous system or spinal cord);

The presence of any severe diseasein which a dangerous protracted course of childbirth and physical exercise;

Heavy gestosis, narrow pelvis, transferred pregnancy, scar on the uterus;

Development of discoordination of bouts at the very beginning of childbirth (latent phase);

Late expulsion of spindlewater waters at the "immature" cervix with a small opening of the uterine diet; critical anhydrous interval (10-12 h);

The formation of a generic tumor at a high-resistant head and a small (4-5 cm) opening of the uterine zone;

Violation of the normal biomechanism of labor;

Chronic hypoxia of the fetus, its too small (less than 2500 g) or large (3800 g and more) sizes that do not correspond to the average gestational periods; Pelvic preview, rear view, reducing blood flow in the fetus.

2. With all the listed risk factors, it is advisable to elect the method of delivery by caesarean sections without an attempt to conduct corrective therapy.

Life-hazardous complications may have a vital complication: the uterus break, the embolism of the octolawic waters, the premature detachment of the placenta, extensive trips of the generic paths, combined hypotonic and coagulopathic bleeding.

3. In the absence of risk factors or in the presence of contraindications to cesarean section, a multicomponent correction of generic activity is carried out.

RhodesMulatting therapy by oxytocin, prostaglandins and other drugs that increase the tone and contractile activity Uterus, with the discount of generic activity, contraindicated.

I degree (dystopia of the uterus).The main components of the treatment of discoordination of generic activity in I severity are: spasmolitis, anesthetics, tocolitics (β-adrethomimetics), epidural anesthesia.

Throughout the first and second period of labor, it is necessary to introduce (intravenously and / or intramuscularly) every 3 h drugs spasmolitical(but-Shpa, Baratgin, Diprofen, Gangleron) and anesthetic(Promedol, morpho-like drugs) actions. A 5-10% glucose solution with vitamins (ascorbic acid, vitamin B 6, E and A in the daily dosage) is used.

The use of spasmolitics starts with the latent phase of labor and finish with the full opening of the uterine.

From the most effective techniques Upon elimination of the basal hypertonus of the uterus, the use of β-adrenomimetics (PARTYSISEN, Alupent, Brikanil) should be allocated. The healing dose of one of the above preparations is dissolved in 300 ml of or 500 ml of a 5% solution of glucose or isotonic solution of sodium chloride and administered intravenously slowly at a speed of 5-8 drops / min, further every 15 minutes the frequency of droplets are increased by 5-8, reaching the maximum Frequencies 35-40 drops / min. After 20-30 minutes, the fights are almost completely stopped. There is a period of retreat of uterine activity. Tocoliz finish 30 minutes from the beginning of the normalization of the tone of the uterus or termination of the generic activity.

After 30-40 minutes, the fights independently renew and are regular.

Indications for toxolism of the uterus in childbirth are:

Hypertensive dysfunction of the contractile activity of the uterus and its options;

Fast I. rapid childbirth;

Tightening pathological preliminary period.

With unfinished pathological probinian period (no more than a day) you can apply a tocolic inside once (Brikanil 5 mg).

4. When discoordination, the fights need to eliminate the defective fruit bubble. Food shell Must be divorced (taking into account conditions and contraindications for artificial amniotomy).

Amniotomy is made immediately after intravenous administration of antispasmodics (but-shp 4 ml or baraglin 5 ml) so that the reduction of the volume of the uterus occurred against the background of the action of spasmolitics.

5. Due to the fact that the abnormalities of generic activities are accompanied by a decrease in the uterine and uterine-placental blood flow and the hypoxia of the fetus, in childbirth, the means regulating the blood flow.

These funds include:

Vasodilators (Eufillin);

Drugs, normalizing microcirculation processes (Reopolylukin, glucosonocaine mixture with agapurine or trental);

Means that improve the absorption of glucose and normalizing tissue metabolism (actovegin, cocarboxylase);

Means for the protection of the fetus (Seduksen at 0.07 mg / kg of body weight of the Body Fee).

All medical therapy must be regulated by the hour.

Birth leads under cardiomonitorial and hysterographic control. Safety spruses are constantly introduced. The base solution for antispasmodics is a glucosonocine mixture (10% glucose solution and a 0.5% novocaine solution in equal proportion) or a 5% glucose solution with a trental (5 ml), which improve microcirculation and reduce the pathological excessive pulsation of the uterus.

In case of late expulsion of accumulate waters, it is necessary to intravenously introduce antispasmodics. When the cervix is \u200b\u200bdisclosed for 4 cm - to produce epidural anesthesia.

These forms of native anomalies have various clinical manifestations and names:

contractive Ring, Distation of the cervix;
discordination of generic activities;
cuts of uterus in the form of an hourglass;
hypertensive dysfunction of the uterus;
uncorrected activity of the uterus;
tetanic cuts;
distation of the uterus.

All combine them alone general factor - It is a hypertonus myometrium, against which the contractile activity of the uterus is distorted.

For discordination of generic activities (Hypertensive dysfunction of contractual activity of the uterus) All characteristics of the bouts are disturbed. Tonus myometrium, including the lower segment, internal and outer seva. Generic activity is painful. The behavior of the girlfriend is restless.

Hypertensive disorders of contractile activities of the uterus are more common than hypotonic, but less often are diagnosed. Their forms are more diverse clinical manifestation, complex development mechanisms, more difficult to recognize.

Pathogenesis (what is happening?) During the discoorination of generic activities (hypertensive dysfunction, non-coordinated bouts)

Pathogenesis of hypertensive dysfunction.It consists in violation of the functional equilibrium of the growing nervous system. The function of the sympathetic and adrenal and predominance of the tone of the parasympathetic (cholinergic) subsystem may occur; The overexcitation of both departments or only the cholinergic part and, finally, it is possible to develop a condition that can be compared with parabitamia.

Operating principle vegetative innervation Differs from the animal nervous system. All processes occurring in the uterus are only regulated vegetative systemBut not subordinate to her entirely. Abbreviations of the uterus (automatism of generic activity) can occur in violation and even turning off the vegetative effect, but these violations or shutdowns are caused by a number of heavy disorders in the generation mechanism. In addition, the vegetative nervous system acts in close community with humoral and hormonal regulation.

It is known that the products of the thyroid hormones, pituitary glands, the adrenal glands are stimulated by the sympathetic subsystem. The innervation of adrenal glands is carried out by sympathetic fibers, and the main hormone of the adrenal glands (adrenaline) is also a mediator of the sympathetic nervous system. Function of the fork gland, immune system, parachitoid and pancreas is largely determined by the tone of the parasympathetic department.

In double innervation of the uterus, the double functional basis of this organ is laid. Most pathological processes in regulatory mechanisms are due not to the loss of the function, but a violation of vegetative equilibrium. Double innervation provides single-stage antagonism processes in one organ. During pregnancy and in kind, the upper segments of the uterus are designed to either stretch or shrink, the lower at the same time act oppositely.

Recall the main mechanism of coordinated contractions of the uterus in childbirth: coordination of the cutting of the bottom and the bodies of the uterus is conjugate with the relaxation of the lower segment and the neck, which is ensured by the dual vegetative innervation of the uterus.

The essence of coordinated generic activity is as follows.

The alternate excitation of the centers of the vegetative nervous system in the hypothalamus is accompanied by the separation of the corresponding mediator at the end of the receptor.
Under the influence of the mediator of the sympathetic nervous system (norepinephrine and adrenaline), there is a reduction in longitudinally arranged muscle beams in various layers of myometrium while simultaneously active relaxation of circular beams.
In response to the maximum excitation of the center of the sympathetic nervous system and the allocation of a certain amount of norepinephrine arises arising from the center of the parasympathetic nervous system.
Under the influence of the mediator of the parasympathetic nervous system (acetylcholine), circular muscles are reduced while relaxing longitudinal; The amplitude of the cuts of circular muscles is significantly lower than the longitudinal.
When the maximum reduction in circular muscles, the maximum relaxation of the longitudinal is coming.
After cutting the uterine (systole + diastole contamination), the period of complete relaxation of the uterus occurs (pause between the fights) when the regenerate resistance reinstate of the contracting proteins of myometrium occurs.

The mediators of the sympathetic nervous system (adrenaline and norepinence) simultaneously affect the α- and β-adrenoreceptors. At the same time, α-adrenoreceptors are located on the membrane of smooth muscle cells of longitudinal muscles, β-adrenoreceptors - on the membrane of smooth muscle circular muscles. However, the density of these receptors is different: on longitudinally oriented smooth muscle beams there is a large density of α-adrenoreceptors, on circular - β-adrenoreceptors. This explains the effect of coordinated, synchronous and alternate contractions and relaxation of individual muscle beams, combined by the connective tissue frame into a single organ - the uterus. Muscle bundles and the main collagen frame have a three-dimensional plane orientation.

In the discordination of generic activity, not only neurogenic, but also myogenic regulation of the impulses of action, i.e., this pathology is more complex for the pathogenesis than the weakness of generic activity.

Violation of the functional equilibrium of vegetative innervation, the predominance of parasympaticotone is accompanied by an increase in the density of non-β-adrenoreceptors, causing the necessary relaxation of circular muscles of the uterus, and α-adrenoreceptors, which are accompanied by spasm and tonic voltage of the lower segment, internal and external zea cervix, as well as other transverse, circular and spiral muscle fibers. Spasm causes a decrease in blood flow and blood supply - as a result, pain occurs. Discordinated contractions are always painful.

The weakening of the regulatory effect on the part of the central nervous system (stress, psychological tension, negative emotions, fear of childbirth) changes the release of brain neuropeptides (endorphins, enkephalins, dynorphins), which in turn reduce the threshold of pain sensitivity in the female in labor. The lack of endorphins affects the reduction of the products of the mediator of the sympathetic nervous system - norepinephrine and the increase in the content of the parasympathetic mediator - acetylcholine.

The centers of the sympathetic and parasympathetic nervous system are excited simultaneously. At the same time, there is an impact on all layers of the uterus, which distorts automatism, synchronization, coordination of abbreviations. Vegetative, humoral and hormonal changes violate biochemical, redox and electrolyte processes in different degrees.

Domestic scientists identified the features of local cellular regulation and the ability to violate the automatism of contractual activity of the uterus.

In the process of developing generic activity in the uterus, two and more "rhythm driver" can be formed. Since both "rhythm driver" have different rhythms of contractile activity, their action asynchronously. Waves of actions (exciting and cutting) cannot be propagated normally (from top to bottom). The myometrium is divided into segments that are reduced independently of each other, with a different amplitude, duration and frequency. The tone of the uterus is higher than normal values, reaching 15-20 mm Hg. Art., sometimes more. Discoordination options a lot.

The "rhythm driver" can be one, but shifted from the bottom of the bottom of the uterus on the body and even on the lower segment of the uterus (shift "rhythm driver" vertically). The reduction waves apply not to top to down with a decreasing force, and from the bottom up with the strength of increasing, since in the upper segments of the uterus muscle mass much larger than in the lower.

There may be a displacement of the "rhythm driver" into the right or left half of the uterus (shift "rhythm driver" horizontally), and finally, the cuts of the uterus may occur in the bottom, then in the body, then in the lower segment (the migration of the Rhythm driver " ). In this case, the simultaneous spastic reduction occurs during the contraction not only longitudinally, but also transversely arranged muscle beams, and in some cases with the predominance of the reduction force of the latter.

The myometrium loses the main property necessary in childbirth - synchronization of reduction and relaxation, at which the coincidence of the peaks of the reduction (amplitudes) should take place.

Periods of general relaxation of the uterus disappear, the principle of a triple downward gradient is disturbed. The amount of the action of asynchronous abbreviations of individual sections of the uterus is insufficient, therefore, despite elevated tone The uterus, frequent and, it would seem, long-term contractions, the into-substitution pressure remains low.

The clinical picture seemed to be active generic activity (fastening frequent, strong, painful) essentially illusory. With a vaginal study, it is found that the opening of the neck is almost not happening. The fabric of the uterine zea is dense, rigid. Head stands for a long time in one of the planes of a small pelvis.

In case of separate forms of discoordination, there is a complete mismatch of all peaks of reduction and relaxation of various parts of the uterus: the right and left half, the upper and lower segment.

The most sustainable and ancient phylogenetic relationship of a miogenic system for regulating the contractile activity of the uterus, providing automatism, synchronization, activity and coordination of the reduction of different beams of smooth muscle cells are violated.

Depending on the nature of the violation of the vegetative regulation of generic activity, there are many variants of the hypertensive dysfunction of the uterus. Some of them are not amenable to treatment, others remain unobstructed, unrecognized.

With confidence, it can be assumed that the extensive breaks and the "smakey" of the cervix, the gaps of the vagina, and often the oversight of the walls of the uterus, the protracted flow of childbirth, seemingly strong generic activities, disruption of biomechanism of birth, generic injury from the fetus (and all this The complete proportionality of the fetus and the pelvis of the mother!) are most often due to the discharge of generic activities.

Causes of data discsordination.The reasons for this pathology are not studied, nevertheless, the main factors can be distinguished. These include:

Violations functional state The vegetative nervous system:
- overexcitation of hypothalamus;
- weakening the leading role of the CNS;
- distortion dominant delivery.

The emergence of violations of this type contribute to vegans and stress, overwork, an attempt to give birth to a child between two exams.

Pathology of myometrium and cervical cervix:
- malformations and hypoplasia of the uterus;
- congenital "bag-shaped" decrease in the tone of the lower segment, creating a duplicature of the wall of the uterus over the inner zea neck.

During the cesarean section, an error is possible when it is connected by a seamless of the edge of the cut, but the upper edge of the uterine cut with a dupicatory of the lower segment;

inflammatory and scar changes in the lower segment of the uterus (endomyometritis);
the so-called rigid neck (sclerosis, partial replacement of muscle and collagen fibers with a connecting cloth).

The presence of a mechanical obstacle in childbirth:
- narrow pelvis;
- improper position, extensible prelations and asclit insertions of the fetus;
- excessive amnion density that creates the functional inferiority of the fruit bubble;
- low locked (including cervical) Myomatous node.

The uselessness of the enhanced operation of the uterus in the presence of difficult obstacles, as a rule, leads to a violation of coordination, automatism of contractions against the background of hypertonus myometrium.

Fetoplacentar insufficiency. According to modern ideas, the friendly function of the fetoplacentage system and the parent organism is the main and determining in the nature of the course of pregnancy and childbirth.
Unynchronous preparation of mother and fetus organisms to the process of childbirth.
Reducing the protective effect of the anti-stress system of the brain (reducing the products of neurogormon - endorphins, enkephalins, dynorphins), which takes place in psychological tension, anxiety and general muscle tension. Apparently, a different threshold of pain sensitivity has a different threshold.
Yatrogenic reasons including:
relationship or relaxation with strong oxytocycic drugs in the absence of testimony or excluding contraindications;
insufficient anesthesia of genera, leading to general muscle tension;
fine elimination of a functionally defective fetal bubble, etc.

The close interaction and interdependence of the somatic and neuroendocrine status of a woman with the structural and functional fullness of the uterus and the fetoplacentar complex, the state of the uterine-placental and fruit and placental blood flow do not allow more clearly allocate possible reasonscausing the discount of generic activity.

Symptoms of discoordination of generic activity (hypertensive dysfunction, non-coordinated bouts)

Typical symptoms preceding the discoordination of labor activitiesnext.

"Immature," not enough "mature" neck of the uterus at the ended (38-40 weeks) of pregnancy, which remains for the date of birth and even with the beginning of the generic activity.
The presence of a pathological preliminary period.
The prenatal oral influence with a dense "immature" neck, a small opening of the cerval canal.
Increased uterus tone, developed before the start of labor (over 10 mm Hg. Art.), Which is easy to determine if compared with the tone of the lateral wide muscle of the femoral patient.
Lack of pressed or dense fixation of the fetus head in the inlet of a small pelvic. Before childbirth, and even with the beginning of the generic activity, the predatory part remains mobile or slightly pressed to the entrance of a small pelvis (of course, with complete proportionality of the fetus and the mother's pelvis).
Palparatory uterus is determined in the form of an elongated ovaloid and tightly covers the fruit.
There is a small way, often in combination with fetoplacental failure.

Clinical manifestations of hypertensive dysfunction of contractile activity of the uterus Very varied due to the multifaceted disorders of neurogenic, endocrine and myoyogenic regulation. The symptoms of this pathology are reduced to a change in all characteristics of bouts, spastic (painful!) Their character, hypertonus of the uterus and its lower segment, slowing the dynamics of the delivery process (and sometimes to stop the bouts), manifestation of vegetative violations.

Fights uneven in frequency, strength and duration. Occur after 1-2-3-5-7-10 minutes; The amplitude of the cutting of the uterus is reduced (20-25 mm Hg. Art.), sometimes increases sharply (60-70 mm Hg. Art.); The duration of systole and diastologies are different. The duration of systole over diastole is prevailing or inverse relations arise.
There is a sharp pain characterity (by the type of spasm). The behavior of the girlfriend is restless, asks painficiation even at the very beginning, in the latent phase, childbirth (the neck is not yet smoothed, the discovery is small). The complaints of the femoirs are characteristic of: fluttering pain in the field of the sacrum and the lower back.
Between the fights of the uterus is sufficiently not relaxing (the feeling of pain is saved between the fights). Due to the hypertonus of the lower segment, the palpation of the predatory part is hampered, determining its position relative to the plane of a small pelvic.
Difficulty of urination (with complete proportionality of the fetus and mother's pelvis!), Oliguria, paradoxical Ishuria.
The slowdown in the processes of shortening, smoothing and disclosure of the cervix, the elongation of the latent and active phase of labor, despite the seemingly active generic activity.
The nature of the opening of the cervix changes. Instead of stretching the edges of the uterine sewage, there is a violent overcoming of spastically abbreviated tissue due to breaks. Possible cerviffs, scalded vaginal breaks, deep crotch breaks, right up to III degree.
The synchronization of the advancement of the fetus is disturbed in accordance with the disclosure of the uterine. The preemptive part is long in each plane of a small pelvis, as is the case with a narrow basin. The period of expulsion of the fetus is extended.
Often a violation of the biomechanism of labor due to the hypertonus of the lower segment or individual zones of the uterus. Back view or extension of the head occurs, disrupting the fetal location. Due to a permanent or uneven increase in the tone of the uterus, the changed intamynyotic pressure often takes place of the umbilical cord, legs or knobs, the extension of the fetal spine.
Discordination of generic activities is accompanied by a decrease in the uterine-placental and fruit-placental blood flow. The spastic character of the battle, the hypertonus of the mineometry reduce perfusion and the microcirculation of the uterus, blood supply and oxygenation of the fetus.
Adnergic fibers of the vegetative nervous system in the uterus are located directly with the vessels, have a close connection with their smooth muscle cells, adjusting the bloodstream, vascular tone. Their overexcitation causes the spasm of the prokapillary sphincters and the ischemia of the fabric.
Often there is a "cord" compression of the fetus by a spastically abbreviated segment of the uterus (at the level of the neck, chest, kidneys, adrenal glands). Against the background of hypoxia, placental insufficiency traumatic for the fetus are the mechanical pressure of segmental cuts of the uterus. The newborn can be intracranial hemorrhages, spinal cord injuries (cervical), hypoxic and traumatic damage to the central nervous system, etc.
Early swells often arise as a consequence of the infringement of the cervix between the fetus head and the bones of the pelvis and the result of a long spasm, cervical swelling, vagina.
The early formation of a generic tumor on the fetus head, corresponding to the place of infringement by a spastically abbreviated uterine zev, even with its low opening (5 cm).
Characteristic symptoms and complications of the pathology of the pathology is the disitor of the cervix. Uncoordinated abbreviations and insufficient relaxation of the uterus cause a violation of the blood and lymph circulation of the region of the internal ocean - dystation of the cervix (dense, thick, rigid edges that are non-stretchable). In the fight, there is no relaxation of the edges of the cervix, but a seal (Schickele symptom).

Distation of the cervix (violation of blood and lymphorage) is a functional pathology. It should be distinguished from anatomical rigidity resulting from the cervical changes of the cervix after breaking, diathermocoagulation, cryodestruction.

Attempts to treat cervical dyes by slipping by lidase, spasmolitics, the introduction of estrogen remains absolutely inefficient.

The fetal bubble with non-coordinated fights is usually functionally defective, does not fulfill the role of the hydraulic wedge and does not contribute to the disclosure of the uterine. Amnion is not peeling from the walls of the lower segment of the uterus and goes tightly to the fetus head. Outside the bubble bubble remains tense. Bubble shells are felt as unusually dense. This symptom is easily determined during a vaginal study.
Quite often, the early influence of the accumulating waters is occurring (with an unreserved more cervical and very small opening it).

Early expulsion of water to a certain extent can normalize the contractile operations of the uterus, since it is accompanied by a decrease in the cavity of the myometrium's basal tone.

The preservation of a functionally defective fetal bubble in childbirth is dangerous, since an increase in pressure gradient at least 2 mm Hg. Art. In the veins of the uterus, an amniotic cavity or intraville spaces can lead to severe complications characteristic of hypertensive dysfunction: embolism by oily water, premature placenta detachment.

Special risk during discoordination of kits represent such complications as a rupture of the uterus, which in these cases is possible even at first-night with burded obstetric history, massive, heavy bleeding in the last and early postpartum periods, due to the combination of the pathology of the uterus and the development of coagulation pathology (DVS syndrome ).

Characteristic of the discharge of contractile activities of the uterus are true violations of varying degrees of severity: nausea, vomiting, tachycardia or bradycardia, hypertension or arterial hypotension, vegetative vascular dystonia, pallor or pronounced hyperemia of facial, sweating, increase body temperature up to 38 ° C and higher, chills, etc.

The predominance of individual symptoms, syndromes, complications depends on the degree and form of hypertensive dysfunction of the cutting of the uterus.

Severity of the Discordination of Generic Activities

Studies have shown that three severity of the discoation of generic activity should be distinguished, which to a certain extent reflect either the dynamics of the progression of pathology, or immediately manifest themselves to various gravity options.

I degree (cervical dystopia)

Due to the above, the causes of the auto-exclusion of the vegetative nervous system (sympathetic and parasympathetic), but with the preservation of the dominant of the sympathetic and adrenal system.

The emission of mediators, catecholamines, under the influence of which in the systole of the fight occurs a simultaneous reduction in longitudinal and circular muscle fibers. The triple downward gradient is preserved, the reduction force of the upper segment prevails over the reduction of the lower segment (the cage of the uterus).

The basal tone of the uterus is moderately elevated (13-14 mm Hg. Art.). The fights are frequent, long, painful, reduced the duration of the diastole (phase of relaxation).

Structural changes in the cervix (shortening, smoothing, disclosure) occur slowly. The uterine zev is revealed not only due to the reinforced stretching of circular muscles, but also due to breaks and abuses, inevitable with this pathology.

With a vaginal study, attention is drawn to the seal and stress (rigidity) of the edges of the cervix during the contraction. The fetic bubble has a flat shape, the shell - dense, the front waters are not enough, out of the contrast of the fetus bubble stress. In the fight edge of the cervix are compacted.

In case of artificial autopsy of the fetal bubble or spontaneous power of the octal water, the contractile activity of the uterus and the musometry tone can be normalized. Fights gradually become regular, more efficient, less painful, the relaxation period of the uterus increases. Births can end normally, but almost always take the cervical breaks and vagina.

If the fetal bubble is not timely eliminated, the contourization of the uterus is corrected using antispasmodic and painkillers, the coordination breach is continuing and aggravated. Hypertonus myometrium is increasing. Birth takes a long course. The feminine quickly gets tired, energy resources are depleted in the uterus.

Discordination of generic activities can go into weakness (hypotonic).

Attention should be paid to pronounced vegetative disorders in childbirth: nausea, vomiting, difficulty urination, tachycardia, moderately pronounced arterial hypertension, an increase in body temperature.

II degree (segmental dystopia of the uterus)

The second, heavier, degree of violation of the coordination of uterine reductions in childbirth occurs either independently, as an option if the initial vegetative violations are deeper, or is exacerbated by the previous degree with an irrational knowledge of childbirth or an attempt to apply notioned relatives.

Often this pathology develops with a significant mechanical obstacle in childbirth (clinically narrow pelvis).

This form of hypertensive dysfunction can be considered as a heavily form of impaired neurogenic and myogenic regulation of the cutting of the uterus.

The "rhythm driver" shifts vertically on the border of the lower segment. Instead of relaxation, the segmental spasm of the circular muscles of the lower segment and (or) the area of \u200b\u200bthe inner session by the type of long tonic voltage appears.

Despite long-term generic activities (8-10 hours or more), the cervix remains dense, long, the inner zev is determined in the form of a dense roller. The cervical channel and the vaginal part of the cervical cervix have an inactive length with a difference of 1-2 cm, which indicates the absence of the necessary deployment of the lower segment.

Because of the spastically abbreviated inner zoom and insufficient deployment of the lower segment of the uterus, which did not enter the overall part of the cervix, the predatory part remains moving over the entrance of a small pelvic.

The basal tone of myometrium is high (14-20 mm Hg. Art.), The walls of the uterus (or its individual sites) are in a state of hypertonus. Intaminiotic pressure in separate (convulsive) contractions, when 2-3 uterine cycles merge into the thetanic complex, can increase by 2-3 mm Hg. Art. Above normal values, as a result of which embolism is an accumulating waters.

The pressure gradient may change to the other side, which will cause no less severe complication - premature placenta detachment. Discordination of generic activity remains the leading cause of this complication (with the exception of gestosis in which the premature detachment of the placenta is a consequence of the formation of antibodies to the placenta).

The influence of the octal water does not change the spastic nature of the bumps. Often, the rupture of the fetal shell remains unnoticed due to the lack of anterior waters. Amnion literally stretched on the fetus head and is tightly connected to the decidual cloth of the lower segment of the uterus. It is not possible to determine the integrity of the fruit bubble or its absence.

From Discordination of I degree, segmental dystocia is distinguished by the predominance of spasm not only in the field of internal zea, but also in the overlying uterine departments.

HyperStimulation of the contractile activity of the muscles of the internal state of the uterus, the formation of the contracting ring on the border of the lower segment and the uterus body can cause the so-called hanging dalion of the cervix. The latter is characterized by the fact that it is possible to rapidly stretch the outer zev, the cervix, and the inner zev is preserved in the form of a spastic ring. There arises and gradually increases swelling swelling, vagina, crotch, as it is observed in the threat of a break of the uterus.

Discordination of generic activity of this type can simulate the picture of the clinically narrow pelvis. The uterus tightly covers the fruit, takes the shape of an elongated ovoid or the shape of the "hourglass". The head of the fetus is inflicted, the biomechanism of labor takes pathological forms.

Fights wear not only spastic, but at times the tetanic character, the automatic rhythm of the bumps is disturbed. Their frequency, duration, force - uneven. Separate contractions enjoy each other, causing a sense of the incessant stupid pain.

The pronounced symptoms of vegetative dysfunction, which quickly pass at the end of childbirth are drawn attention.

The feminine behaves restlessly, shouting, meswords, becomes unmanaged. The skin of the face is hyperemic, vomiting, increased sweating, the body temperature (38.5-39.0 ° C) increases rather quickly, tachycardia (90-100 ° C / min) occurs. Arterial pressure increases, a pronounced vascular dystonia may occur. Language dry, covered with a white bloom. It is characterized by Oliguria or even paradoxical Ishuria (a lot of urine catheter). With a passing urethra and full proportionality of the fetus and the pelvis, independent urination ceases. In urine tests, erythrocytes, leukocytes are found in blood - hyperglycemia, leukocytosis, blood formula shift to the left, signs of the acute wrench of the FDS syndrome.

When segmental dyes, the uterus can occur, the tip of the cervix of the III degree with the transition to the lower segment of the uterus. Such incomplete breaks of the cervix can be diagnosed, palp by climbing or inspecting the cervix from the cervical canal, since from the vagina side, the tip of the cervix may not reach the lower segment. Renewable uterine bleeding In the early postpartum period, there may be a consequence of an unrecognized incomplete rupture of the wall of the uterus just above the internal zea.

In a vaginal study, an increase in the tone of muscles of the pelvic bottom, a narrow vagina (reduction of circular muscles).

The edges of the cervix remain thick, dense, uneven, poorly stretched. During the fight, the neck is even more compacted (symptom of chickel). In childbirth, often take place bloody issuescaused by cervical breaks, overlooking the walls of the uterus, as well as a premature pair of placenta.

With inadequate therapy or an attempt to stimulate childbirth (when the weakness is erroneously diagnosed, instead of the discordination of generic activity), very heavy complications may occur, up to the development of the generic shock (which, however, is almost no longer found in our time).

Complications arising from the fetus are due not only to the impairment of the IPC, hypoxia, but also the so-called core compression at the level of the fetus neck or in the field of the umbilical ring, kidneys, adrenal, liver. In the Anglo-American literature, the specified impact on the fruit is indicated by the term "Constrictor Ring" - "spastic ring".

Spastic segmental dystation should be distinguished from a bandl ring arising from the threat of a break of the uterus in a narrow basin. The Bandl Ring is the border between the body and the lower segment of the uterus. The spastic ring can be formed at the level of the lower segment.

Segmental dyes is accompanied by focal uterine ischemia. If there is a myomatous node in this place, necrosis may occur.

When conducting births complicated by segmental dyes, it is necessary to pay special attention to the chronometry of the bouts, CTG-control over the heartbeat of the fetus during the delivery process.

Spastic dystation, hypertonus myometrium, frequent and long-term contractions cause an overflow of intervalic spaces with venous blood with a reduced arterial inflow.

Initially, the violations are partially offset due to hypertension, increasing heart rate, increase the minute heart rate. The fetus develops moderate, and then pronounced tachycardia (180 ° C. or more), replacing moderate and severe bradycardia (less than 100 oct / min), arrhythmia.

The presence of arrhythmic palpitations of the fetus and a change in the tone soundness (muffled, metal sound, deafness) indicate the need for immediate delivery. However, these signs should be attributed to late.

Permanent cardiomonitorial control in childbirth allows you to identify early and late decelerations that appear in response to Discordated contractions.

The introduction of glucose, vitamins does not have a positive effect on the fruit, since this type of heart activity disorders is associated not only with biochemical changes in blood and hypoxia, and with mechanical heads of the head and neck with a spastic segmental ring of the uterus.

Combined damaging effect on the fruit is hypoxia, acidosis, metabolic disorders in combination with mechanical long-term compression. Numerous toxic damage to the nervous, endocrine system, parenchymal bodies of the fetus are developing. In the blood of the mother, the products of paracoagulation, proteolysis, free histamine, etc., penetrating the placenta to the fetus through the microchannels are accumulated.

It has been established that with this pathology in the blood of the newborn, the content of acetylcholine and norepinephrine is increased. It is possible that this is one of the reasons for the disorder of respiratory movements in a newborn. Increased in the blood of the mediators of the vegetative nervous system causes the gaping of the voice slot in the fetus and deep respiratory movements, which may cause aspiration of spindle water, often contaminated by admixture of meconium.

The high level of acetylcholine in the blood of the fetus determines the increased secretion of the bronchi and the pulmonary fabric, the development of respiratory distress syndrome.

In pathogenesis respiratory failure The newborn has the importance of impaired microcirculation of light fetus when squeezing the chest is a spastically reduced uterine ring. Hemodynamic disorders, insufficient perfusion alveoli lead to the destruction of the surfactant - the substance on which the strength of the surface tension in the alveoli. Atelectases arise, an increase in alveolar permeability, pulmonary edema and hyaline membranes.

But most often in a child born in the conditions of spastic segmental dyes, ischemic-hypoxic and traumatic damage to the central nervous system, brain substances, intracranial hemorrhages.

Last weeks intrauterine development The fetal brain is characterized by the formation of protective mechanisms from mechanical overloads, which are experiencing a fruit in the process of birth. Perestroika occurs in the vascular system of the fetus brain. Arteriovenous anastomoses are formed, playing an important role in the redistribution of blood flow in mechanical compression of the fetus head.

Hypoxic-traumatic damage to the central CNS of the fetus is dangerous not only by the appearance of intracranial, subarachnoid, subdural hemorrhages, but also by the damage of the substance of the brain at the cellular level. The brain trunk is the main brainwater distributor through adrenergic and cholinergic fibers, innervating spinal and brain vessels.

The asphyxia and long-term compression of the neck (or head) of the fetus initially causes an increase in blood flow in the spinal cord and in the brain trunk (these zones are most vital). Then white substance and bark big Brain exposed to ischemic exposure. There is a disunity of neurons, violation of correlative ties, metabolism. brain. In some structures of the brain there comes a decrease in blood flow, in others - a violation of exchange.

When self-defense mechanisms are exhausted, irreversible changes in brain cells occur. And then, the intranatal death of the fetus is not the worst outcome of the childhood, rather than the birth of a child who will be a deep disabled since childhood.

Due to excessive mechanical overloads with dyscoordated fights, spinal cord injuries may occur. The cervical department is especially affected. vertebral artery. Segmental disitor of the uterus, which comes on the lumbar fetus, can cause a long compression of the umbilical ring and the adrenal glands of the fetus. Foci of hemorrhage in spinal canal Fetal, damage to nerve plexuses with subsequent paresis, paralysis of the upper and lower extremities.

III degree (total dilitation of the uterus)

The heaviest option (degree) of the discharge of the cutting of the uterus in childbirth, which is characterized by total spasm of cervical, lower segment, body, tube angles of the uterus and vagina.

At the same time, there is not one "rhythm driver", but several (shift "rhythm driver" vertically and horizontal). The uterus is divided into several zones, each of which takes on the function of the starting center. Each uterus segment has its own rhythm, amplitude and cutting frequency, which do not coincide with each other.

The fights become rare, short, weak, but, unlike the true weakness of the generic activity, the hypertonus of myometrium is preserved. There is no phase of relaxation and peace.

According to the clinical picture, total dilution of the uterus in childbirth resembles the weakness of labor. The main difference is the tone of the uterus. In the discoorination of the generic activity, it is always elevated, with weakness of generic activity, the uterus is reduced.

Total Tetanus of the uterus indicates the paradoxical phase of the parabitony of muscle contractions. The skin of the labels are pale, there are acricyanosis, skin marble. Pulse frequent, easily compressed, weak. The feminine independently flies, with the catheterization of the bladder, small portions of urine containing protein, red blood cells, leukocytes, cylinders are distinguished.

Determine the integrity of the fruit bubble is difficult due to dense fetal shells, which are literally tensioned on the head, the front waters are practically absent.

There is a pronounced generic tumor on the head, because of which it is difficult to identify seams and springs.

After birth, the fruit is not at all gigantic, not large, but a very medium size (2900-3100 g) or even small.

With any form of discoordination of generic activity in women with normal anatomical sizes, the pelvis is much more common than in the overall population, there is an extension of the head (frontal, rear view of the facial), high straight standing of the sagittal seam, a reckable asynclothic insert, as well as the rear view. They do not relate to adaptive mechanisms even with abnormal shapes of the pelvis. This is a consequence of the violation of tone and contractile activity.

Spontaneous restoration of normal contractual activity of the uterus without drug correction is extremely rare. The manufacturer quickly increases the body temperature, endomiometrite, chorionnionitis, worsening the forecast of childbirth for mother and the fetus.

With a total dilution of the uterus, if the situation (the absence of infection, elevated body temperature, live fruit, not too long anhydrous gap) is considered to be carried out only by cesarean sections.

Conservative guidance, the erroneous use of contraindicated relatives can lead to a hazardous complications.

Conditions are created for the penetration of accumulating waters into the venous system of the mother (embolism of the octoloplodic waters). It may develop no less severe complication - ischemia of a separate section of the uterus and the rupture of it. Most often it is a typical localization: the left edge, the lower uterine segment, the front wall of the uterus.

Having highlighting various forms of discordination (hypertensive dysfunction) of contractile activity of the uterus, two circumstances should be emphasized.

The first is the dependence of the severity of this pathology on the severity and depth of violations of the vegetative and miogenic regulation of the cutting of the uterus in childbirth.

These literature indicate that the lack of endorphins violates the metabolism of catecholamines and supports the spasm of muscle fibers of the internal organs (including uterus, intestines, ureters).

Currently, it is proved that an excessively high emission of catecholamines reduces their protective role in ischemic damage to the neurons of the mother's brain and the fetus. Without medication therapy, spontaneous restoration of normal generic activity is rarely observed.

Diagnostics of the discount of generic activity (hypertensive dysfunction, non-coordinated bouts)

Upon receipt of the guinea to the maternity hospital, you should familiarize yourself with medical records (exchange card data, a guide diagnosis). When collecting anamnesis, besides well-known information, you need to pay attention to the risk factors that threaten the violation of the coordination of the cutting of the uterus in childbirth (vegetionerevosis, stress, overwork, anomalies of the uterus, the pathology of the cervix - erase the uterus, FPN, neuroendocrine pathology, etc.). It is necessary to evaluate the general condition, somatic health, an obstetric situation. Eliminate anatomically narrow pelvis, one or another degree of disproportion pelvis and fetal head; The inferiority of the myometrium, which can lead to the rupture of the uterus in childbirth and premature details of the placenta. Mark, there are prenatal signs of the pathology of the cutting of the uterus (dense, long neck, the pathological preliminary period, the movable head of the fetus, the prenatal expulsion of the water, the migration of the pregnancy).

To assess the nature of the generic activity should be determined every 1-2 hours:

the dynamics of the structural changes of the cervix in accordance with the past clock of labor activity, given the parity of childbirth (the first, repeated);
opening of the cervical (ukey) in centimeters, the state of the edges of the cervix (soft, militant; dense, rigid, poorly stretch; thick - thin), including the state of the edges of the uterine zea during the contraction (soft, but are compacted throughout the circle or separate section);
the functional is the fullness of the fruit bubble (poured into the fight) or inferiority (flat shape, the shell is stretched on the head), the characteristic of the shells (dense, rough, elastic). Mark the fetus bubble voltage during and outside the contraction, as well as the number of accumulating waters (little, much, normal);
preview, insertion, type of fetus, compliance of biomechanism for one or another period of generation, the location of the head in relation to the main planes of the pelvis, the rate of its promotion;
frequency of kits for 10 minutes of the control time (determined by the stopwheel); rhythm; The duration of the reduction (sisteners of contractions) and relaxation (diastole contamination) of the uterus;
the basal tone of myometrium during the fight and outside the contamination using a tonic meter or comparison of the voltage of the uterus with the lateral widespread muscle of the patient (the tone of the thigh muscles is 10 mm Hg. Art.); Conduct differential diagnosis between weakness and discoordination of generic activities.

For the diagnosis of native anomalies, an outdoor hysterography, an internal trocographics, KTG, use an external hysterography.

Inner topographyit represents quantitative, and therefore a more accurate estimate of the duration of the uterine cycle, systole and diastole contractions. Allows you to determine the amplitude of the reduction, basal tone of the uterus, the general intrauterine pressure during the contraction, the speed and nature of its increase during the systole period and diastologists, as well as to calculate the operation of the uterus and the uterine activity. All these indicators are expressed in numerical calculus.

With confidence, it can be assumed that the reason for the disassembled discoordination of the generic activity is:

"immature" by the date of birth of the cervix;
pathological preliminary period;
migration of pregnancy;
antenatal influence of the oily waters with the "immature" cervix;
breaks and scramble cervix;
extensive vaginal breaks;
hypoxic-traumatic damage to the fetus.

Treatment of discount of generic activity (hypertensive dysfunction, non-coordinated bouts)

When choosing corrective therapy for discooring of labor activities should be proceeding from a number of provisions.

Before taking birth through natural generics in case of complex multicomponent violations of the regulation of contractual activity of the uterus, including the Mio-Gene (the most ancient and strong in the evolutionary development of a person), it is necessary to form a generation forecast, providing outcomes for mother and fetus.

The forecast and plan for conducting births are based on the age, anamnesis, health states, the flow of pregnancies, an obstetric situation, the results of the evaluation of the state of the fetus.

Adverse factors include:

late and young age primary age;
burdened obstetric-gynecological history (infertility, induced pregnancy, the birth of a sick child with hypoxic, ischemic, hemorrhagic damage to the CNS or spinal cord);
the presence of a severe disease in which a dangerous protracking flow and physical exertion;
heavy gestosis, narrow pelvis, transferred pregnancy, scar in the uterus;
development of discoordination of bouts at the very beginning of childbirth (latent phase);
untimely influence of the oily water with the "immature" neck of the uterus with a small opening of the uterine zoom; critical anhydrous interval (10-12 h);
the formation of a generic tumor at a high-resistant head and a small (4-5 cm) opening of the uterine zone;
violation of the normal biomechanism of labor;
chronic hypoxia of the fetus, its too small (less than 2500 g) or large (3800 g and more) sizes that do not correspond to the average gestational periods; Pelvic preview, rear view, reducing blood flow in the fetus.

With all the listed risk factors, it is advisable to elect the method of delivery by caesarean sections without an attempt to conduct corrective therapy.

In the absence of risk factors or in the presence of contraindications to cesarean section, a multicomponent correction of generic activity is carried out.

Rhodesumulating therapy by oxytocin, prostaglandins and other drugs that increase the tone and contractile activity of the uterus, during the discordination of generic activities, is contraindicated.

Throughout the first and second period of delivery, it is necessary to administer (intravenously and / or intramuscularly) every 3 hours of antispasmodic preparations (but-shpa, Baratgin, Diprofen, Gangleron) and anesthetic (commotal, morphine-like drugs). Also used 5-10% glucose solution with vitamins (ascorbic acid, vitamin B6, E and A in the daily dosage).

The use of spasmolitics starts with the latent phase of labor and finish with the full opening of the uterine.

Of the most effective methods for eliminating the basal hypertonus of the uterus, the use of β-adrenomimetics (PARTYSISEN, Alupent, Brikanil) should be allocated. The healing dose of one of the above preparations is dissolved in 300 ml of or 500 ml of a 5% solution of glucose or isotonic solution of sodium chloride and administered intravenously slowly at a speed of 5-8 drops / min, further every 15 minutes the frequency of droplets are increased by 5-8, reaching the maximum Frequencies 35-40 drops / min. After 20-30 minutes, the fights are almost completely stopped. There is a period of retreat of uterine activity. Tocoliz finish 30 minutes from the beginning of the normalization of the tone of the uterus or termination of the generic activity.

After 30-40 minutes, the fights independently renew and are regular.

Indications for toxolism of the uterus in childbirth are:

hypertensive dysfunction of the contractile activity of the uterus and its options;
fast and rapid labor;
tightening pathological preliminary period.

With a non-elone pathological principal period (no more than a day), you can apply a tocolic inside once (briquanyl 5 mg).

When discoordination, the fights need to eliminate the defective fruit bubble. Fercent shells should be divorced (taking into account conditions and contraindications for artificial amniotomy).

Due to the fact that the abnormalities of generic activities are accompanied by a decrease in the uterine and uterine-placental blood flow and the hypoxia of the fetus, in childbirth, the means regulating the blood flow.

These funds include:

vasodilators (Eufillin);
drugs, normalizing microcirculation processes (Reopolylukin, glucosonocaine mixture with agapurine or trental);
means that improve the absorption of glucose and normalizing tissue metabolism (actovegin, cocarboxylase);
means for the protection of the fetus (Seduksen at 0.07 mg / kg of body weight of the Body Fee).

All medication therapy must be regulated by the hour.

In case of late expulsion of accumulate waters, it is necessary to intravenously introduce antispasmodics. When the cervix is \u200b\u200bdisclosed for 4 cm - to produce epidural anesthesia.

In the second period of genera, the cutting of the crotch is needed to reduce the mechanical effect on the fetal head.

Drug bleeding prophylaxis is carried out using one-time intravenous administration with 1 ml of methyl ergometrine or syntometer (methyl eetometrine and 0.5 ml oxytocin in one syringe).

When bleeding in the early postpartum period, 1 ml is introduced in the early postpartum period in the thickness of the uterus (above the uterine zoom). 150 ml of 40% glucose solution (subcutaneous - 15 Uzinulin), 10 ml of 10% solution of calcium gluconate, 15 ml of 5% solution of calcium, is transfused intravenously with quick drops. ascorbic acid, 2 ml ATP and 200 mg of cocarboxylase.

Childbirth during discoordination battle must conduct an experienced obstetrician-gynecologist (senior doctor) together with a resuscitative anesthesiologist. At the birth of a child must be a neonatologist who knows how to provide the necessary resuscitation assistance.

Control over the course of childbirth is carried out with a constant medical observation, cardiomonitorial recording of the palpitations of the fetal and cutting of the uterus, using an outer or internal strain. Combination Fights are carried out in a stopwatch for 10 minutes of each hour of birth. It is advisable to lead a partograph.

II degree (segmental dotation of the uterus).Given the adverse effect of segmental dyes on the fruit and the newborn childbirth through the natural generic paths is not appropriate. The cesarean section should be made in a timely manner.

The most effective is epidural anesthesia.

Epidural anesthesia blocks the spinal cord segments of TH8-S4, inhibits the action of oxytocin and PGG2α, has a spasmolitical and analgesic effect, which significantly reduces, and sometimes eliminates the spastic state of the uterus. Seduksen (Relanium, Fentanyl) affects the limbic structures of the fetus brain, providing its protection against pain and mechanical overloads arising from hypertensive uterine dysfunction in childbirth.

It is advisable to first introduce 30 mg of the fortroom, which ensures an increase in the stability of the fetus to pain. Fortrel is similar to the structure and protective effect of the endogenous opiate anti-stress system of mother and fetus. Therefore, in severe cases of discoordination of generic activities, the use of morphine-like drugs (FRTL, Lexir, etc.) can protect the mother and the fetus from the generic shock. The drug is administered once in order to avoid addiction, do not apply large doses and do not prescribe it close to the intended birth of a child, as it oppresses the fetal respiratory center.

Special attention is paid to the main period of childbirth. Until the birth of the fetus, intravenous administration of spasmolitics (but-shpa or barallgyin) continues, as the retention of the fruit's shoulders in a spastically abbreviated uterine zea may arise.

As with other forms of discoorination of labor activity is necessary medical prophylaxis Hypotonic bleeding with methyl ergometrine.

In the discoorination of the contractile activity of the uterus, in the last and early postpartum period, there is a risk of receipt of a large number of thromboplastic substances in the uterine and a common circle of blood circulation, which can cause the acute wheat-sidrome. Therefore, labor in hypertensive dysfunction of the uterus is the risk of coagulopathic bleeding.

In the event that after the tocolese, the generic activity weakened, the tone of the mineometrium was normalized, the fights are rare, short, proceed to cautiously relate to PGE2 preparations (1 mg of transplane per 500 ml of 5% glucose solution). Rules of RhodesMulation are the same as in the treatment of hypotonic weakness of labor activity, but it should be extremely careful, controlling the frequency and duration of the battles in the stopwatch. However, such management can be carried out only in cases where it is impossible to produce a cesarean section.

It should be emphasized once again that in the discount of generic activity, it is impossible to use means that stimulate the contractile activity of the uterus (oxytocin, PGF2α preparations). However, in cases where hypendynamic generic activity goes into hypodynamic, the tone of the uterus decreases to the values \u200b\u200btypical for the weakness of kits, cautious relaxation of PHA2 preparations on the background of epidural anesthesia or intravenous administration of tocologists.

III degree (spastic total dilution of the uterus).The basic principle of conducting birth at the total spastic dyation of the uterus is an attempt to translate hypendynamic generic activities in the hypotonic weakness of kits, reduce the basal tone of myometrium with the help of tokolysis.

It is necessary to completely remove the general muscle and mental tension, restore the vegetative equilibrium, eliminate constant pain.

A favorable outcome of childbirth can be achieved either in a timely conducted cesarean cross section, or adhering to a certain system to eliminate the spastic (segmental or total) cutting of the uterus.

Given the violation of the leading regulatory role of the CNS in the development of this type of generic anomaly, the woman in labor must first provide a sleep-vacation for 2-3 hours. If a fruit bubble is intact, it must be eliminated by amniotomy with the preliminary administration of spasmolitics. Amniotomy delay exacerbates the negative effect of a flat fret bubble on discoordinated cuts in the uterus.

After rest, if the generic activity has not normalized, they carry out acute toxas (the technique is described earlier) or produce epidural anesthesia. Before epidural anesthesia, intravenous administration of crystalloids is carried out with the aim of adequate legalization and preventing the risk of arterial hypotension. If the patient prepared the preparations of a tocolic (β-adrenomimetic) action, the adrenaline cannot be used and its compounds.

After Tokoliza (if the generic activity has not resumed and did not normalize for 2-3 hours), it is proceeded by the cautious administration of PGET preparations in order to relate to relatives.

The choice of the operational method of the roosity is due to the great difficulties that arise in the restoration of the normal contractual activity of the uterus in the discount of generic activity of the III severity.

However, in case of late receipt of the guide or late diagnosis of this type of generic activity, the cross section is not easy to decide on Cesarean.

First, the clinical symptoms of vegetative dysfunction (increase in body temperature, tachycardia, hyperemia of the skin, shortness of breath are developing.
Secondly, there is a violation of the state of the fetus (hypoxia, asphyxia). With a cesarean section, you can extract a dead or unpromising child.
Thirdly, a long anhydrous gap is often observed, the presence of an acute infection.

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Now they talk a lot about the benefits of active behavior in childbirth, when the future mother goes during the battles, takes convenient poses, moves or sits on a special ball. In this case, the disclosure and the baby becomes easier to descend generic canal. It is about this that they write in the articles preparation for childbirth and traine in courses for future parents. However, sometimes during childbirth, doctors speak future momthat it is impossible to get up. What could be associated with such a ban, and in what situations a giving birth to give birth to lying?

Premature expulsion of water with multi-way

Prematurely refer to the exit of water to the development of regular generic activities, that is, before the start of the bout. Despite the fact that such a scenario of the beginning of childbirth is a deviation from the norm, it is not rarely found - in 25-30% of the feminine - and in itself is not dangerous. However, with an excessive amount of water (from 1.5 liters and more), their premature expulsion can serve the poor service to mom and baby. Excessive water allows the child until the last moment move in the uterus freely and easily change the position of the body, and its head is not pressed against the cervix, as it should be normal. If the fruit bubble breaks with multi-way, the whole weight of the water rushes into the hole and often turns the crumb into the wrong position (transverse or oblique), in which natural labor is impossible. Another danger in this situation is the loss of the loop of the umbilical, knobs or legs of the baby. Therefore, after the deposition of waters, with a future mother, the future mom is not allowed to get up - after all, the power of gravity is working, and the water rushes down a sharp jet, which significantly increases the risk of listed complications. In the position when a woman gives birth to lying, on the contrary, the water flows gradually and the baby has less opportunity to take the wrong position. As the attack increases, it is pressed by the head to the neck of the uterus, and after that the risk of the bundle of the umbilical cord or small parts of its body is no longer. After the toddler's head clung to the cervix, in the absence of other contraindications, the future mother is allowed to get up and behave more actively.

Fast and rapid flow

Rapidly called childbirth lasting less than 6 hours; With the rapid flow of the process, the childbirth takes less than 4 hours. At first glance, it may seem that there is nothing bad in the accelerated course of childbirth - indeed, which of the future mothers in secret does not dream of "to otkattendy"?! However, in fact, rapid labor is much heavier and painful than the normal process lasting 8-10 hours. It is simply explained: the body does not have time to adapt to the growing fights to too fast, and at the very beginning of birth, the feelings of the women in labor become much more painful than they would be in the normal development of the process, and short gaps between the fights are not enough to relax and restore the forces. For the same reason, during the rapid labor, it is necessary to also become a baby - due to frequent and strong contractions of the uterus, it is experiencing constant pressure and a lack of oxygen. In addition, rapid labor is three times more often accompanied by dangerous complications, among which significant gaps of generic pathways, bleeding and various generic injuries of the fetus. Unfortunately, medical methodsTo "slow down" too rapidly developing generic activities, there is practically no, and the only method in the arsenal of physicians for this case is a strict bed regime for the guinea. In the horizontal position of the body, the pressure of the fetus head on the cervix during the bouts is less than in the vertical; This allows you to slow down the disclosure process and, thus, reduce the risk of generic injuries for mom and baby.

Premature birth

Premature is considered to be childbirth, which began earlier than the term of 37 weeks of pregnancy. With such kinds, a woman will have to give birth to the end. There are several reasons for such a strict restriction. First, with premature birth of the tissue of the relatives of the future mother, it is not enough elastic and is more often injured (ruting) during the opening of the cervix and the progress of the baby along the generic canal. Secondly, the fetal is immature nervous system and too soft heads of the head, which entails the risk of generic injuries due to the pressure of the walls of the generic channel in the process of childbirth. Finally, thirdly, premature birth In 70% of cases, they leak quickly or even rapidly, which is also dangerous for mom and baby. Obviously, when the power of gravity acts on the fruit, only aggravates the risk of developing these complications - therefore, with the first signs of the birth of the birth, the future mother is asked to lie on the bed and not to get up 3 hours after the delivery is completed - so as not to provoke postpartum bleeding.

Childbirth in pelvic preview

The so-called the position of the baby in the uterus, at which the head is not at the bottom, but the "pelvic end" of the crumbs, that is, its berries and legs. Birth in pelvic preview have their own characteristics. Unlike a solid and round head, the soft butter's soft buttles do not form the necessary dense belt of contact with the lower part of the uterus, do not have enough pressure on it, and therefore, they are not able to "pull" the uterus down. Quite often, the premature oral influence occurs: due to the lack of tight contact of the pelvic end of the fetus with the lower part of the uterus, it does not separate the fruit waters on the "front" (that is, located at the entrance to the small pelvis in front of the buttocks) and "rear". In this case, at the first fighting, the entire volume of water rushes down, a sharply stretching the fetal bubble and contributing to it to a quick break. At the same time, the feet of legs or umbilical umbilies may occur, so during childbirth in the future mom you can only give birth to lying.

Low placentating

This term indicates the attachment of the placenta in the lower part of the uterus, in close proximity to the exit of it. With this placement of the placenta, there is a risk of its premature detachment in the process of opening the cervix. This may occur due to pressure on the edge of the placenta, which creates the head of the fetus during the battle, pressed against the cervix. If the placenta starts separating from the wall of the uterus before the birth of the baby, it will not be able to get oxygen in the process of childbirth, which will create a real danger to the life of crumbs. For the guinea, the premature separation of the placenta is also very dangerous, as it is always accompanied by very strong bleeding. You can avoid these complications only if you reduce the pressure of the head on the "problem zone" during the disclosure period, therefore, during the entire process of childbirth, the future mother is not allowed to get out of bed.

Hypoxia fruit

Hypoxia is a reduced oxygen flow to the fetus. During the entire process of childbirth, doctors are watching the toddler's well-being, controlling his heartbeat with the help of KTG. O is evidenced by the resistant change in the heart rate, which goes beyond the permissible norm (120-160 beats per minute). An indirect feature of this state is the green staining of the accumulate waters. Any additional load in this situation may worsen the condition of the baby, so when signs of hypoxia, the fetus of the future mother prescribe strict bed regime for the entire period of birth.

Discordination of generic activity

Discordination of generic activity is called such a complication of genera, in which it is very painful, but at the same time it is not integuctive, i.e. The cervical disclosures and the progress of the kid on the generic channel does not occur. With this course of childbirth, any attempts of the woman in labor stand up and behave actively enhance the pain and the frequency of contractions, so it is not allowed to rise from the bed, forcing it to give birth lying.

Did a cervix

This complication is characterized by the lack of disclosure of the cervix on the background of intense increasing contractions due to the biological immaturity of the genital tract. This term denote the inconsistency of the state of the cervix and the walls of the vagina period of pregnancy. Normally, before childbirth, the cervix is \u200b\u200bgradually shortened and begins to slowly open, the tissue of the vagina and necks become soft and elastic. Such changes usually occur on the period of 37-39 weeks of pregnancy. If at the time of the start of regular generic activity, the cervix remains dense and long, as in the middle of pregnancy, and its channel is closed, the disclosure does not occur, despite active cuts in the uterus. This option of developing childbirth, of course, is pathology and is dangerous to health mom and fetus: Against the background of enhanced killers, cervical breaks can occur, the neck of the cervix from the bodies and the breaks of the lateral walls of the uterus. These complications are extremely dangerous, they are accompanied by massive bleeding, require emergency operational intervention And they can lead to the death of the guide (from blood loss) and the fetus (from acute hypoxia). In order not to strengthen the pressure of the fetus head on the neck of the uterus, with the distation of the future mom, they are not allowed to get up until the full disclosure and starts dug.

Most importantly, during childbirth - the prosperous course of the process and the health of mom and baby. And if for this will have to stay in bed - it does not matter. After all, burning lying, the future mother can use almost all methods of self-adhesive using breathing and relaxation, search convenient position Body and help yourself with massage!

4 proven ways to anesthetize

The optimal position in the bed during the contraction - the "Embryo Pose": on the side, bent the legs in the knees and hip joints.
Moves during the fight - swinging the pelvis, turns from the side on the side, springing movements of the hips, mixing and breeding legs.
Massage "pain points": the zones of the sacrum, outdoor and internal surface Hungs, Niza Belly. Massage can be carried out both in one and two hands, massaging the zone with the pads and knuckles of the fingers, the base of the fist, the base of the palm, the inner side of the palm or manual massager. Moves during massage may be stroking, pressing, can be patted, pinching and even gently tapping the field of exposure.
Respiratory techniques. At the beginning of childbirth, lying when the fights are almost painless, it is recommended to use "abdomen's breathing": a relaxed slow breath and slow breath (as if blowing on the water). This helps to relax, removes the nervous excitement and gives high blood saturation with oxygen, stimulating and painting contractions. By the middle of the first birthday period, when the fights are growing and become painful, well helps the "breath of candle". This is a frequent surface breathing at which the short breath is made through the nose, and the breath is the mouth (as if the candle is sharply blown). As the battles are gained, breathing becomes more intense, but still remains very frequent. At the time of the full disclosure of the cervix, when the fights become especially long and frequent, it is more effective to breathe "the train": at the beginning of the fight, the future mother uses his abdomen, as the pain breathing is increased and the fight becomes the most intense at the peak, and as "subsidiaries "The fighting of the woman inherine soothes and lines breathing. At the beginning of the waiting period, when a future mother should be avoided premature fence and relax as much as possible, helping the baby to descend to the generic canal. This is a frequent surface breathing in the mouth, in which the diaphragm is the main muscle of the abdominal press - is in a continuous movement, which makes it impossible. Breathing has the maximum painkillers and relaxing effect. It should be breathing only during the fight. At the end pain sensations The future mother needs to restore breathing and relax until the next contraction.

Even if everything is fine

In addition to the complications of childbirth, there are stages in which the future mother needs to be lying and at an absolutely normal course of the process. This is the third period of childbirth (from the moment of the birth of the baby before the birth of the last) and the first 2 hours after childbirth, when vertical position Can provoke bleeding. In addition, there are a number medical manipulationsrequired during childbirth that are conducted in a horizontal position: inspections, recording of the CTG, intravenous and intramuscular administration medicines, puncture of the fetus bubble and others.

Keeping dystation

The crooked dystation may be a consequence of functional or organic changes in the cervix. Functional gear distation is associated with the features of innervation and receptor apparatus, Because of which, at the time of the spread of the excitation wave through the muscle of the uterus, it causes no disclosure of the cervix, but of circular fibers. The cervical dyes with organic changes in the cervix is \u200b\u200bcaused by the impossibility of opening the cervix due to its anatomical features. At the same time, there is a significant predominance of connective tissue that is not capable of stretching. Such features of the cervix are observed with cervical changes of the cervix, arising after delivery, abortions, surgical operations, diathermoelectro-adaging, after inflammatory diseases of the cervix.

Clinic:The fights are different in strength, painful, mainly with pain in the lumbar-sacrum region. Prior vaginal research is possible various options cervix. However, the main feature is the spasmodization of the cervix in the fights and with a vaginal study. At the same time, the predatory part follows the neck of the uterus and puts on it. A generic tumor appears on the head of the fetus. The magnitude of it corresponds to the opening of the cervix, the boundaries coincide with the edges of the external zea of \u200b\u200bthe cervix. For dynamic observation The slow down opening of the cervix, despite the presence of good generic activity. With the outer hysterography, various variants of SDM (normo, hyper-, or hypodynamic) are detected, with or without discordination elements.

Guiding childbirth:When the cereal dotition is detected, a fundamental decision on the choice of the tactics of the root separation should be made. In the case of high risk factors for the fetus, the issue is solved in favor of the cesarean section. When conducting labor through natural labor pathways, the CDM correction is performed.

1. As a whole, the fruit bubble produces amniotomy.

2. Spasmolitis (aproofen, but-shpa, Galidor, Baratgin, etc.) are introduced. According to the testimony, the introduction of spasmolitics can be repeated after 2 hours. Assigned Sedukesen, Relanium Per OS.

3. In the hypidamic type of SDM after amniotomy, a GVEK is entered, which can be repeated after 2 hours.

4. In the fater of the feminine, the medical obstetric anesthesia (GOM with premedication) is given.

5. When weakening the generic activity after sleep, it is possible to use a GVEK, active regime, cleansing enema.

6. With the secondary weakness of labor activity, with a satisfactory state of the fetus, the correction of the SDM intravenous drip administration of uterotonic means is shown.