Abnormalities of Labor Pains
Abnormal uterine contractions during labor named abnormalities of labor pains are one of the most important complications leading to worsening of the maternal and fetal condition.
Incidence of abnormalities of labor pains is 10-20% among other obstetrical complications in labor.
Classification. I. Abnormalities of uterine contractions before labor.
1. Pathological preliminary period.
II. Abnormalities of uterine contractions during labor.
1. Weak labor pains: a) primary, b) secondary, c) weakness of expulsive pains.
2. Excessive labor pains (precipitate labor).
3. Incoordinated labor pains: a) spastic lower segment, b) constriction ring,
c) cervical dystocia, d) uterine tetanus.
Etiology. A lot of factors may change the uterine activity: nervous stresses, endocrine disorders, infantilism, and metabolic disorders.
Thus, there are 5 groups of clinical factors associated with the development of abnormalities of labor pains.
· Obstetrical factors (premature rupture of membranes, cephalo-pelvic disproportion, alteration of the uterine muscles, overdistension of the uterus due to a big fetus, hydramnios, twins).
· Factors connected with pathology of the reproductive system (infantilism, congenital anomalies of genitalia, advancing age, especially in the first birth, menstrual disorders, neuroendocrine diseases, artificial abortions, myoma of the uterus).
· Extragenital diseases, general infections.
· Fetal factors (hypotrophy of the fetus, intrauterine infections of the fetus, anencephalia, postmaturity).
· Iatrogenic factors (incorrect inducing of the uterine contractions, incorrect anaesthesia during labor, etc.).
Pathological Preliminary Period. The clinical signs of pathological preliminary period are:
· painful, irregular uterine contractions, various in intensity, duration and intervals, which continue more than 6 hour;
· the dilation of the cervix is absent in spite of the uterine contractions;
· the patient cannot sleep at night due to pains and becomes tired and irritable;
· worsening of the maternal condition;
· worsening of the fetal condition (intrauterine hypoxia of the fetus connected with the duration of this period);
· an increased tonus of the lower segment of the uterus;
· the presenting part is situated above the pelvic inlet and movable.
Treatment. Correction of uterine contractile activity until optimal biological readiness for childbirth with β-adrenomimetics and antagonists calcium, non-steroidal anti-inflammatory drugs:
- infusion of hexoprenaline 10 μg, terbutaline 0.5 mg or orciprenaline 0.5 mg in a 0.9% solution of sodium chloride;
- infusion of verapamil 5 mg in a 0.9% solution of sodium chloride;
- ibuprofen 400 mg or naproxen 500 mg orally.
• Normalization of the psychoemotional state of a woman.
• Regulation of the daily rhythm of sleep and rest (medication sleep in the night time of day or when pregnant):
- preparations of benzodiazepine series (diazepam 10 mg 0.5% solution w / m);
- narcotic analgesics (trimeperidine 20-40 mg 2% solution w / m);
- non-narcotic analgesics (butorphanol 2 mg 0.2% or tramadol 50-100 mg IM;
- antihistamines (chloropyramine 20-40 mg or promethazine 25-50 mg IM;
- antispasmodics (drotaverin 40 mg or benzyclan 50 mg IM);
• Prevention of intoxication of the fetus (infusion of 500 ml of 5% solution
Dextrose + sodium dimercaptopropanesulfonate 0.25 g + ascorbic acid-lots of 5% - 2.0 ml.
• Therapy aimed at "maturation" of the cervix:
- PG-E2 (dinoprostone 0.5 mg intracervical).
With a pathological preliminar period and optimal biological readiness for childbirth with full-term pregnancy is shown to be medicated stimulation of labor and amniotomy.
Date added: 2022-12-25; views: 264;