Excessively strong labor activity is a clinical disorder that occurs during delivery, characterized by hyperactivity of the uterus. Excessive labor activity is characterized by intense contractions that appear every minute and hypertonicity of the myometrium. Contractions have a rapid tendency of development, and therefore rapid childbirth occurs. The risk of irreversible consequences for the fetus and mother increases by more than 2 times. It is possible to diagnose excessively strong labor activity through CTG during childbirth. To prevent the development of labor disorders, women in labor are given drugs of the tocolytic group, and it is also possible to use fluorotane or ether anesthesia.
The content of the article:
How does an excessively strong labor activity occur?
Causes of excessively strong labor activity
Symptoms of the rapid course of labor activity
Diagnosis of excessively strong labor activity
Treatment of excessively strong labor activity
Excessively strong labor activity
How does an excessively strong labor activity occur?
Violent labor activity occurs due to hyperactivity of the uterus. During this period, the cervix opens too quickly, the fetus is rapidly forced out. With excessively strong labor activity, there is a violation of the uteroplacental blood flow, in connection with which there is a disorder of fetal gas exchange. The change in gas exchange can occur with different intensity. Due to the intensive labor activity, it is often impossible to deliver a woman in labor in a matter of minutes to the necessary medical institution. Thus, hasty “street births” occur.
Modern gynecology notes up to 1% of all clinical cases of childbirth with excessive intensity. The main characteristics for a strong labor activity are:
abnormally intense uterine tone — over 12 mmHg;
unnaturally fast contractions — the interval is up to 2 minutes maximum, the duration is more than 1 minute each.
Prevention of excessively strong labor activity
Preventive measures of excessively strong labor activity are characterized by a thorough examination of the body before the desired pregnancy. In the presence of obstetric and gynecological diseases, mental disorders, dysfunction of the neuroendocrine system, treatment is indicated until the complete disappearance or relief of diseases.
Prevention during gestation to prevent excessively strong labor activity is as follows:
preparation for childbirth in special courses;
conducting auto-training daily, starting from the second trimester of pregnancy;
mastery of muscle relaxation techniques;
exclusion of intense physical activity;
treatment of stress and depression at an early stage;
proper nutrition and optimal water balance;
frequent walks in the fresh air.
On an individual basis, according to the results of clinical indicators, it is possible to conduct drug therapy to prevent excessively strong labor activity:
antispasmodics;
sedatives;
metabolic medications.
When using them, it is mandatory to conduct a clinical ratio of benefits and harm to the development of the fetus and possible consequences for it at birth.
Causes of excessively strong labor activity
Modern gynecology today does not operate with accurate data that explain the causes of rapid childbirth. This area of clinical disability is under study.
According to statistics, about 50% of all cases of excessively strong labor occurs during premature birth.
The main reasons that can provoke excessively strong labor activity:
mental disorder;
increased excitability of a woman in labor;
neurasthenia;
bazedov ‘s disease;
dysfunction of cortical-visceral regulation during delivery, which is why there is an excessive amount of hormones, mediators. An abnormal increase in hormones in the body leads to a constant contraction of the uterine muscles;
pathology of myocytes of congenital form, manifested in their excessive excitability. In this clinical case, there is a connection with the mother of a woman in labor, in whose anamnesis there is a diagnosis of excessively strong labor activity.
Gynecological diseases are also among the provoking factors of strong labor activity:
cervicitis;
endometritis;
functional disorders of the ovaries;
severe gestosis;
too early or late childbirth according to the age of the woman in labor — up to 18 years and after 30;
increased uterine tone;
the threat of miscarriage.
Women in labor who have a narrow pelvis and transverse presentation are at risk of excessive labor activity.
Symptoms of the rapid course of labor activity
Childbirth with excessive activity tends to appear unexpectedly. Against this background, hyperactivity of contractions occurs, as a result of which the uterine pharynx opens rapidly. Contractions develop vigorously, having abnormally short pauses between their alternation. A woman with excessively strong labor activity has excessive excitability, increased blood pressure, tachycardia, rapid breathing.
After the amniotic fluid leaves the woman in labor, the fetus can be born in just a few attempts. Excessively strong labor activity can provoke both rapid labor and rapid labor. Rapid childbirth occurs in 4-6 hours at the first gestation and in 2-4 hours in repeat births. Rapid delivery is characterized by the appearance of the fetus within 2-4 hours in primiparous and up to 2 hours in repeat births.
The rapid development of labor activity is fraught with irreversible consequences for the woman in labor and the fetus. Pathology of delivery due to increased activity of the uterus can lead to the following disorders:
vulva rupture during childbirth of a complicated nature;
premature placental abruption;
deep ruptures of the perineum, vagina;
divergence of the uterine pubic bones;
uterine hypotension;
postpartum bleeding of a threatening nature;
septic disorders of a woman in labor: metrothrombophlebitis, metroendometritis.
For the fetus, excessively strong labor activity leads to hypoxia as a result of pathology of the uteroplacental blood flow. Also, rapid patency through the birth canal increases the risk of head injuries:
fetal skull injury, brain hemorrhage. In the future, there may be constantly increased intracranial pressure in the child, motor disorders, mental abnormalities.
Diagnosis of excessively strong labor activity
The identification of strong labor activity occurs on the basis of the symptoms of the woman in labor, and studies are also carried out:
cardiotocography;
vaginal diagnosis.
The development of contractions has an excessive, intensive nature of the flow. After the discharge of amniotic fluid, excessively rapid attempts are observed. Gynecological diagnostics shows a rapid, rapid opening of the uterine pharynx. On the basis of CTG, a strong labor activity is diagnosed.
To track the condition of the fetus during the violent labor activity of the mother, Doppler examination, ultrasound examination, phonocardiography are used.
Also, the diagnosis of intensive activity during childbirth is necessary to identify another abnormal process — discoordinated labor activity. It is characterized by the same clinical signs as with excessively strong activity, with the exception of uterine pharynx — with discoordinated delivery, the uterus remains closed.
Treatment of excessively strong labor activity
In the event of violent activity during childbirth, the main task of doctors is to stop the excessive activity of labor contractions. The first thing that is used in obstetrics with an abnormal course of labor is to turn the woman in labor sideways, opposite from the position of the fetus.
To reduce the intensity of contractions and regression of rapid labor activity , apply:
preparations of the tocolytic group;
anesthesia: essential/fluorotane;
medications: sodium sulfate, promedol, omnopone — administered intramuscularly;
acupuncture.
Therapy is necessarily used for the preventive treatment of fetal asphyxia.
The second period of labor is characterized by perineotomy, episiotomy, pudendal anesthesia. At the end of delivery, a thorough examination of the vaginal tract and perineum is necessary, the identification of ruptures and the degree of tissue damage. If there is severe bleeding after childbirth and there is no way to stop it, uterine extripation is used.
The presence in the anamnesis of a woman in labor of excessively strong labor activity during past gestations or the presence of such in women in the genus implies hospitalization in advance, before the development of labor activity. Also, in the presence of diseases and pathologies of the gynecological type, it is recommended to carry out a planned cesarean section in order to avoid serious consequences.
