The preliminary period is contractions in the lower abdomen during pregnancy, which are accompanied by minor pain and tension in the muscles. They are irregular. Such contractions are the precursors of childbirth. Under normal conditions, the preliminary period of labor should take about 6-8 hours. However, in some cases, this period may be delayed. This can happen for various reasons. In this case, there is a pathology of labor that requires immediate medical attention. Since the consequences of a prolonged preliminary period can be very serious for both the mother and the child: starting from severe breaks in the woman in labor and ending with the death of the fetus.
The concept of pathological preliminary period
The physiology of each woman is individual. In some cases, this period can be delayed for several hours, and sometimes for several days. This leads to exhaustion of the woman, loss of sleep, accumulation of severe fatigue at the time of birth. In this case, there is a pathological preliminary period of childbirth, that is, a prenatal period that has dragged on. It is characterized by irregular painful contractions, which do not lead to the appearance of changes in the cervix, but only deplete the woman's body.
The essence of the anomalous preliminary period
The main essence of the pathology can be expressed as follows:
- The physiological preliminary period is delayed.
- The tone of the myometrium rises.
- The internal uterine pharynx is reduced.
- There are contractions of the lower segment of the uterus.
- Muscle fibers are arranged in a circle, transversely and in a spiral;
Causes
As a rule, the pathological preliminary period causes the presence of disturbances in the mother's body. The main reasons can be divided into three groups:
Obstetric:
- The presence of polyhydramnios or oligohydramnios.
- Multiple pregnancy.
- The fetus in the womb is in the wrong position (pelvic presentation).
- The placenta is located low.
Psycho-emotional:
- A woman is afraid of childbirth.
- Negative mood.
- Neurosis and severe emotional stress.
- Physical fatigue of the patient.
- Age of the primiparous woman (fear of the outcome of childbirth in case of too early or late pregnancy).
Physiological:
- The woman in labor has a narrow basin.
- Previously, surgical interventions were performed in the uterus (the presence of scars after cesarean, etc.).
- Disruptions in the endocrine system (obesity, anorexia, etc.).
- Labile nervous system.
- Diseases of the kidneys, heart, liver and other organs.
- Inflammation of the uterus.
- Gestosis.
- Multiple abortions.
- Miscarriage.
Symptoms
The pathology of the prelimyr period helps to recognize the following symptoms:
- The uterus in the preparatory and preliminary periods is painfully reduced, while the contractions are not regular. They can occur both in the daytime and at night. For a long time, labor does not begin.
- The tone of the uterus and its excitability are increased.
- The opening of the uterus is not observed, it continues to remain dense and long.
- The underlying part of the fetus is not pressed against the pelvis of a woman.
- Due to uterine hypertonicity, palpation of the fetus is difficult.
- The uterus for a long time contracts monotonously. The strength and frequency of contractions do not change. The precursors and the preliminary period are long-lasting.
- A woman has a deterioration in her mental state, she becomes tearful and irritable, she has insecurity in the successful completion of childbirth.
Types of pathology
The pathological preliminary period can be of two types:
- In the first case, the uterine muscles are not relaxed, the uterine muscle fibers correspond in density to the “mature” cervix, oligohydramnios, flat fetal bladder.
- In the second case, the cervix is “immature”, has an oval shape, the part of the fetus that is not adjacent to the entrance to the small pelvis. Most often, this situation is observed when the fetus is perenashivaniya.
Duration
The duration of the abnormal preliminary period, depending on the individual characteristics of each woman, can vary from 6 hours to 24–48 hours. In some women, it can stretch for several days.
Possible consequences
The pathological preliminary period in most cases leads to a complication of the course of childbirth. In many women in labor, labor is abnormal. In particular:
- Tribal activity is weak. In this state, insufficient force of uterine contractions is characteristic, large gaps between contractions, the cervix opens slowly, fetal progress is delayed.
- Clan activities are discoordinated. Manifested by erratic contractions of the uterus. There is no synchronization in the reduction and relaxation of individual sections. As a result, contractions are accompanied by severe pain, become frequent and uneven, which exhausts the woman in labor and does not allow her to relax.
- Tribal activity proceeds rapidly. This anomaly is characterized by very strong and sharp contractions and attempts. As a result, childbirth occurs very quickly (up to 5 hours). This can lead to rupture of the vagina and perineum in women in labor, severe bleeding. The fetus may develop hypoxia. Rapid birth can lead to birth injury to the fetus.
- Uterus tetanus is a rare anomaly. In this case, a condition is observed when the uterus does not relax at all. Occurs when several pacemakers occur in different parts of the uterus. It leads to disruption of uterine contractions and termination of labor. The fetus may develop hypoxia, which can lead to impaired cardiac activity.
The following consequences of the abnormal course of labor can develop:
- Untimely removal of amniotic fluid.
- The appearance of meconium at the very beginning of contractions, which means "distress" of the fetus.
- Operative delivery.
- The imposition of obstetric forceps.
- Severe pathological bleeding.
- In the postpartum period, purulent-infectious diseases develop.
- Hypoxia of the fetus and birth of a child with impaired cardiac activity or coronary artery disease.
Diagnostics
If you suspect that the preliminary period is abnormal, you should immediately contact an obstetrician-gynecologist. He must do an external examination. Palpation helps determine the high or low position of the fetus. If the fetus does not fall, this indicates the presence of pathology of labor. Also, pathology can be judged by the presence of strong tension of the muscles of the vagina, immaturity of the uterus for childbirth and cramping.
The basis for the diagnosis of pathology of the preliminary period is the conduct of clinical and laboratory studies, which allow us to conclude that the acetylcholinesterase activity of erythrocytes decreases, and the level of hormones adrenaline and norepinephrine in the blood increases.
Perhaps an instrumental study. To do this, cardiotocography. With it, you can record the strength and duration of contractions.
Pathological preliminary period: treatment
With an immature cervix and the absence of independent development of labor, a pattern of pregnancy overtaking is observed. In this case, therapy will be prescribed taking into account the pathogenesis of pathology. The aim of the treatment will be to accelerate the process of uterine maturation. The following treatment methods can be used:
- Electroanalgesia
- Uterus electrorelaxation.
- Treatment with medications: antispasmodics, analgesics, prostaglatin E2.
If the patient has severe fatigue and increased nervousness, then she is prescribed medication sleep as a treatment . Sedatives are also prescribed.
A positive treatment result is reflected in the abrupt onset of regular contractions. Or in the ripening of the body to childbirth. When the uterus becomes “mature”, the fetal bladder is opened and regular contractions begin within two hours. If labor does not begin, then prostaglandins are administered intravenously.
In case of ineffective treatment, along with other complications (obstetric history, large fetal size , pelvic presentation, OCG gestosis, onset of fetal hypoxia), an emergency cesarean section is performed.
Management approaches for pregnant women who have a pathological preliminary period
There are two approaches:
- Complete peace.
- Stimulation of labor with oxytocin.
Both methods have as their goal the elimination of violations in labor. A successful outcome is observed in 85% of cases. When choosing a method, the following pathology features are taken into account:
- The degree of anxiety and fatigue of the patient.
- The reason for the complication.
- Choosing a method that is more convenient for the patient and the obstetrician.
When choosing an approach consisting in observing the complete rest of a pregnant woman, 0.015 g of morphine is administered intramuscularly to her. Then secobarbital inside 0.2 g. This option is quite effective. As a rule, after administration of morphine, the patient falls asleep within an hour. After 4-5 hours of rest, during which the exhausted body regains strength, a woman wakes up either without any signs of childbirth or with active labor.
When choosing the second path, i.e. stimulation with oxytocin, it is worth avoiding the opening of the fetal bladder. Caesarean section is justified only in the most severe cases.
Prevention
The main preventive measures to prevent pathology of the preliminary period are:
- Timely consultation of the obstetrician.
- Submission of all necessary tests.
- Compliance with the doctor's instructions regarding the regimen and nutrition.
- Psychological and physical preparation of a pregnant woman for childbirth.
A competent obstetrician-gynecologist should keep under control women who are at risk for this pathology. Namely: primiparous under the age of 17 years and after 30 years, as well as women with diseases of certain organs (liver, kidneys, heart).
So, the pathological preliminary period is one of the types of anomalies of labor. It is quite common. However, thanks to modern medicine, in 85% of timely intervention by doctors, childbirth ends safely. Therefore, when the first signs of pathology appear, you should immediately contact a competent obstetrician-gynecologist. The consequences of an abnormal preliminary period can be very serious, up to fetal hypoxia, the appearance of disturbances in the functioning of its internal organs, and death. Properly prescribed treatment will help save the life of both mother and baby.