Discoordinated labor activity is a deviation in the contractile activity of the uterus, characterized by uneven frequency and intensity of contractions in different parts of the organ. In this case , a violation of the consistency of abbreviations may be:
between the bottom and the body of the uterus;
between the right and left halves of the uterus;
between the upper and lower part of the uterus;
between all parts of the uterus.
The content of the article:
Causes of discoordinated labor activity
Symptoms of discoordinated labor activity
Diagnosis of discoordinated labor activity
Complications of discoordinated labor activity
Treatment of discoordinated labor activity
Prevention of discoordinated labor activity
Discoordinated labor activity
Contractions at the same time turn out to be ineffective, but at the same time quite painful, and the opening of the uterine pharynx is delayed in time. Thus, childbirth takes place haphazardly, which is considered a violation of the normal physiological process.
There are three degrees of discoordinated labor activity:
Grade 1: uterine tone is moderately elevated, contractions occur either too slowly or too quickly.
Degree 2: spasm of the circular musculature extends from the internal pharynx to other parts of the uterus, in addition, various vegetative disorders are noted in the woman in labor;
Grade 3: prolonged spasm spreads to the vagina, which can completely stop labor activity.
Accordingly, the severity of clinical symptoms and the likelihood of complications with the transition to each new degree increase.
Causes of discoordinated labor activity
Although this pathology does not occur very often (in about two percent of cases), there are quite a lot of reasons that can provoke it. They can be divided into 4 groups:
gynecological;
obstetric;
external;
somatic.
Gynecological causes of discoordinated labor activity imply that a woman has any diseases of the reproductive system that have manifested even before pregnancy (for example, various menstrual disorders or inflammatory processes in the cervical canal or in the uterus). This also includes numerous abnormalities in the development of the uterus itself:
hypoplasia;
cervical rigidity;
two – horned uterus;
separation of the cavity in two (intrauterine septum).
Finally, an abortion suffered in the past, cauterization of erosion, or any other intervention that left a scar or scar can cause discoordinated labor.
Obstetric causes, as a rule, make themselves felt during pregnancy or with the onset of labor. At risk are women in labor, whose age is beyond the limits favorable for the performance of reproductive function — both too young (under 18 years old) and old-born (over 30 years old). The main obstetric factors of the development of discoordinated labor activity:
placenta previa;
pelvic presentation of the fetus;
fetoplacental insufficiency;
early discharge of amniotic waters;
late gestosis.
Overgrowth of the uterus can also play a role in multiple pregnancies or polyhydramnios, as well as the discrepancy between the size of the fetal head and the parameters of the birth canal. Finally, risk factors are also abnormalities in fetal development:
immune conflict of mother and child by blood type;
intrauterine infection;
malformation of the brain.
External causes of discoordinated labor activity include errors in the work of obstetricians and gynecologists:
careless actions in the study;
stimulation of labor without special need;
untimely opening of the fetal bladder;
insufficient or incorrectly selected anesthesia.
And the last group of causes — somatic — includes diseases of the nervous system, anemia, infectious diseases and intoxication, which are present in the anamnesis of a woman in labor.
Symptoms of discoordinated labor activity
The symptoms of this violation of the generic process are differentiated depending on its type. Medicine knows 4 types of discoordinated labor activity:
general discoordination;
hypertonus of the lower segment of the uterus;
tetanus (tetany) of the uterus;
circular cervical dystocia.
However , in any of these types , the following manifestations of a violation of the procreation process are noted:
pain in the lower abdomen, radiating to the sacrum;
uneven tension of the uterus;
arrhythmicity of contractions;
increased uterine tone;
nausea;
an anxious state;
rapid fatigue.
Now let’s consider the symptoms of discoordinated labor activity, depending on its types.
Symptoms of general discoordination:
prolonged course of labor;
irregular contractions;
lack of certain dynamics in the strength and duration of contractions;
painful sensations.
In this case, the amniotic fluid departs earlier than it should, and the adjacent part of the fetus is above the entrance to the pelvis or even pressed against it. In this case, there is a threat of fetal hypoxia as a result of a violation of placental blood circulation.
Symptoms of hypertension of the lower segment of the uterus:
high intensity of contractions;
painful sensations;
insufficient opening of the cervix (or lack of disclosure at all);
problems with the advancement of the fetal head along the birth canal.
If the contractions of the uterine body are weaker compared to the contractions of its lower segment, then the reason may lie in the underdevelopment or rigidity of the cervix.
Symptoms of uterine tetanus:
uterine seal;
prolonged uterine contractions;
painful sensations;
deterioration of the fetus.
Usually, such a condition is provoked by medical interventions, such as the rotation of the fetus, an attempt to extract it by applying obstetric forceps, inadequate administration of stimulant drugs.
Symptoms of circulatory cervical dystocia:
prolonged course of labor;
reduction of circular muscle fibers in all segments of the uterus, except the cervix;
painful sensations in the “constriction” area.
This condition is fraught with hypoxia or fetal asphyxia.
Diagnosis of discoordinated labor activity
Following the complaints of the woman in labor, the doctor conducts an obstetric study, which, as a rule, shows the unavailability of the birth canal. It is characterized by swelling of the edges of the uterine pharynx and their thickening. When palpating the uterus body, uneven tension is recorded in its different departments.
Cardiotocography gives a more complete picture of the condition of a woman and her unborn child. This is a method that combines the principles of Dopplerometry and phonocardiography. He will characterize in dynamics not only the contractile activity of the uterus, but also the work of the fetal heart, and in some cases, its movement. During childbirth, cardiotocography allows you to track the development of hypoxia.
Complications of discoordinated labor activity
Discoordinated labor activity is a phenomenon that is dangerous for both the woman in labor and the fetus. The most serious outcomes are:
intrauterine hypoxia is oxygen starvation of the fetus, which can lead to its death;
amniotic fluid embolism is the ingress of amniotic fluid into the vessels (and later into the bloodstream), which can cause blood clotting disorders and the formation of blood clots;
hypotonic bleeding in the first few hours after delivery.
In addition, discoordinated contractions of the uterus prevent the normal progress of the fetus. As a result, its location may be disrupted, there may be an extension of the head or a rear view. There is a risk of extension of the spine, loss of limbs or umbilical cord.
A woman in labor may have complications such as swelling of the vagina or cervix caused by unproductive attempts. In such a situation, the fetal bladder turns out to be defective and does not perform its function of opening the uterine pharynx. It has to be opened in order to avoid increased pressure on the uterus, which, in turn, can cause premature detachment of the placenta or even rupture of the organ.
Treatment of discoordinated labor activity
The main goal of treatment is to reduce the tone of the uterus. In addition, it is required to relieve pain and cramps. Treatment methods are also differentiated depending on the type of discoordinated labor activity.
Treatment of general discoordination and hypertension involves obstetric anesthesia, the introduction of antispasmodics. Electroanalgesia is best suited to calm the uterus.
If the doctor is dealing with uterine tetany, then after the introduction of obstetric anesthesia, he uses α-adrenomimetics. beta—adrenomimetics are used in the case of circulatory dystocia. By the way, in the latter case, antispasmodics and lidase are absolutely ineffective. The introduction of estrogens is also undesirable here.
As for delivery, it may end naturally, or it may require surgical intervention. If the birth canal is ready for fetal extraction, then obstetric forceps are used. Otherwise, a caesarean section is prescribed.
With any method of treatment, the obstetrician should conduct therapy that prevents fetal hypoxia. If the tragedy still occurred, then a fruit-destroying operation is carried out. After the extraction of the dead fetus, the placenta is separated manually. The doctor must certainly examine the uterus in order to avoid ruptures.
Prevention of discoordinated labor activity
To prevent the threat of the development of discoordinated labor activity, first of all, can be the attentive attitude of a gynecologist who leads a pregnancy in a woman. Especially sensitive attitude is required by patients whose pregnancy is difficult. At the same time, expectant mothers should listen to the doctor’s advice so that the birth process goes without complications.
If the patient is at risk (for example, due to age or abnormalities of uterine development), then she may be prescribed medication prevention of discoordinated labor. However, in addition to medications, methods of muscle relaxation, the development of muscle control, the ability to easily overcome and remove excitability will also help. Therefore, do not neglect classes for expectant mothers.
During pregnancy, it is recommended to adhere to a healthy lifestyle:
sleep at least 9 hours;
to walk often in the fresh air;
it is enough to move (but not to overwork);
eat healthy food.
During childbirth, the maximum care of the obstetrician and adequate anesthesia is required.
