Weakness of labor activity is insufficient contractile activity of the uterus in terms of duration, periodicity and strength, caused by its hypotonic dysfunction. The main manifestations of weakness of labor activity are rare, ineffective and short contractions, which are accompanied by slow fetal movement and poor opening of the uterus. Vaginal examination and cardiotocography are used to diagnose pathology. Treatment of labor weakness is limited to radio stimulation. Caesarean section is quite often used, since the fetus cannot be born on its own.
The content of the article:
What is it?
Causes of weakness of labor activity
Symptoms of weakness of labor activity
Diagnosis of weakness of labor activity
Treatment of weakness of labor activity
Prevention of labor weakness and its complications
Weakness of labor activity
What is it?
Childbirth is the final and most anticipated stage of the entire pregnancy period. But childbirth does not always go well. One of the forms of violation of the contractile function of the uterus is the weakness of labor activity. This pathology is characterized by the fact that contractions are rare and irregular, the tone of the myometrium is pronounced low, and the amplitude of contractions is weak. The diastole of contractions (the period of relaxation) significantly exceeds the systole (the period of contraction), which negatively affects the opening of the uterus, and the fetus cannot move normally. The uterus ceases to perform its functions properly, which poses a threat to the child.
In gynecology and obstetrics, the weakness of labor is called one of the most common disorders and complications of the labor process. It is the weakness of labor activity that most often leads to the occurrence of pathologies in the fetus and mother. Among all birth pathologies, according to statistics, the weakness of labor activity accounts for about 7% of cases. It is worth noting that this anomaly is more common in women giving birth for the first time than in those women who have not given birth for the first time.
Types of weakness of labor activity
In modern gynecology, primary and secondary weakness of labor activity are distinguished. The first type of weakness of labor activity is characterized by the fact that contractions from the very beginning are not strong enough, inactive, irregular and prolonged. In turn, secondary weakness of labor activity, the causes of which may be different, occurs when contractions weaken at the beginning of the 2nd or at the end of the 1st period of labor, and initially labor activity is quite active and turbulent.
Convulsive and segmental contractions are also one of the types of weakness of labor activity. Convulsive contractions are protracted and last no more than 2 minutes. In turn, segmental contractions are characterized by a reduction not of the entire uterus, but only of its individual parts. The effect of this kind of contractions is almost zero.
Causes of weakness of labor activity
The development of the weakness of labor activity is influenced by a large number of factors that are associated with the insufficiency of hormonal regulation of labor, morphological inferiority of the uterus, functional inertia of nervous structures, pathology of pregnancy, extragenital diseases, etc.
Weakness of labor activity may occur under the influence of uterine pathologies: hypoplasia, fibroids, chronic endometritis, saddle-shaped or two-horned uterus. A great influence on the development of this anomaly is the structural failure of the myometrium due to diagnostic curettage, conservative myomectomy, abortions and other similar interventions earlier. Scarring changes, as a result of radical treatment of cervical erosion, can also contribute to the development of weakness of labor.
Quite often, the reason for the weakness of labor activity is hidden in the imbalance between factors that are responsible for active labor activity (mediators, estrogens, calcium, prostaglandins, oxytocin, etc.) and factors that inhibit labor activity (magnesium, enzymes, destructive mediators, progesterone, etc.).
Women with vegetative-metabolic disorders (hypothyroidism, hypothalamic syndrome, hypofunction of the adrenal cortex, obesity) are at risk of labor weakness.
The young or late age of the primiparous significantly increases the risk of weakness of labor activity. In addition, the anomaly may be due to:
gestosis;
postponed pregnancy or premature birth;
overgrowth of the uterus with polyhydramnios, large fetus, multiple pregnancy;
the disproportion between the pelvis of the woman in labor and the size of the fetus;
early departure of waters;
placenta previa;
fetal pathology (anencephaly, hypoxia);
chronic fetoplacental insufficiency, etc.
The weakness of labor activity is aggravated:
overwork;
excessive mental and physical exertion;
insufficient sleep;
unsatisfactory nutrition;
excessive mental disorders;
fear of a woman in labor;
rude or inconsiderate service;
uncomfortable environment.
Often, the weakness of labor activity is nothing more than a continuation of the pathological preliminary period of labor.
Symptoms of weakness of labor activity
The main symptoms of primary weakness of labor activity can be called:
the duration of contractions is no pain for 15-20 seconds;
the frequency of contractions is 1-2 within 10 minutes;
decreased tone and excitability of the uterus;
the amplitude of contractions of the myometrium is 20-25 mm Hg;
short period of uterine contraction;
lengthening of the relaxation period by 1.5-2 times, etc.
With primary weakness of labor, contractions can be irregular or regular, slightly painful or painless. The cervix undergoes delayed structural changes (shortening, smoothing and opening of the uterine pharynx and cervical canal).
Delayed uterine contraction is accompanied by an early postpartum period, which can cause hypotonic bleeding. The primary type of weakness of labor activity tires the woman in labor, leads to an elongation of the anhydrous interval, prolongation of the duration of labor, untimely outpouring of amniotic fluid.
Secondary weakness of labor activity is characterized by the following symptoms:
initially effective contractions weaken;
each reduction becomes shorter and shorter;
decreased tone and excitability of the uterus;
the fetus does not move through the birth canal;
the opening of the uterine pharynx stops at 5-6 cm .
The danger of weakness of labor activity is as follows:
risk of infection of the uterus;
the occurrence of numerous birth injuries;
development of fetal asphyxia;
intrauterine death of a child.
Diagnosis of weakness of labor activity
It is possible to determine the nature of the weakness of labor activity through diagnostics, which includes a clinical assessment of the dynamics of labor, uterine tone, and the effectiveness of contractions.
During childbirth, the doctor monitors how the labor process develops and monitors how long each contraction takes. All results are checked against the norm, the only way to understand how labor activity occurs. The active phase of the first period is characterized by contractions for 30 seconds every 5 minutes, for the second period — shorter than 40 seconds.
The opening of the cervix with weakness of labor occurs at less than 1 cm per hour. The speed and degree of disclosure are assessed using a vaginal examination.
The diagnosis of weakness of labor activity is confirmed if the primary labor period of a woman in labor lasts more than 12 hours. If we talk about repeat births, then for them this indicator is more than 10 hours.
It is necessary to distinguish between discoordinated labor activity and weakness of labor activity, the treatment of which will be different.
Treatment of weakness of labor activity
The treatment regimen for the weakness of labor activity will depend on the causes of the anomaly, the period of labor, the degree of weakness of labor activity, the assessment of the condition of the mother and fetus. Also, a lot will depend on what kind of pregnancy a woman has on the bill.
In some cases, one session of bladder catheterization is enough to stimulate the intensity of contractions. If the reason for the weakness of labor activity is polyhydramnios, then an amniotomy procedure is performed. Medication sleep is prescribed when the woman in labor is tired, but there is no risk of asphyxia and fetal hypoxia. With asthenization, it is advisable to create an estrogenic-calcium background as a treatment.
Treatment of weakness of labor activity cannot be imagined without labor-stimulating therapy, this is the main method in the fight against deviation. Prostaglandin F-2 (Enzaprost), prostaglandin E-2 (Prostenone) and intravenous oxytocin infusion are administered. If the birth stimulation does not help, a caesarean section is prescribed. In this process, much depends on how the pregnancy went.
In the case when the fetal head is in the pelvic cavity, they resort to the imposition of obstetric forceps or to dissection of the perineum (episiotomy, perineotomy).
Prevention of labor weakness and its complications
The doctor who leads the pregnancy should assess the risk of developing labor weakness. If such risks exist, a specialist should take care of conducting psychophysical and preventive drug preparation.
The weakness of labor activity always leads to a deterioration of the fetus, therefore, labor stimulation and prevention of fetal asphyxia are carried out simultaneously and without fail.
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