If there is no labor activity. Weak labor: a real danger or a convenient excuse for doctors? Preliminary stimulation of labor

Along with the exacerbation of maternal instinct, towards the end of pregnancy, many women experience anxiety about the upcoming birth. This is understandable, since the birth of a beloved and long-awaited baby is a fairly important and responsible event in a woman’s life. If the pregnancy proceeded without complications, all the mother needs to do for a successful birth is to trust nature. Yes, yes, precisely to nature, and not to an obstetrician-gynecologist, whose powers include monitoring the normal course of labor and providing medical care only if something does not go according to plan. The female body is initially programmed to bear offspring, therefore, everything that happens to the expectant mother during childbirth is quite natural.

Sometimes it happens that labor, for one reason or another, does not begin on time. Well, the expectant mother can’t go around forever pregnant, so various methods of inducing labor come to the rescue.

Stimulation of labor. Salvation or harm?

Undoubtedly, pregnant women do not like interference in the mysterious and amazing process of childbirth. Most women want their baby to be born without any medications or medical manipulations, but in some cases this cannot be avoided.

In the absence of special indications, labor stimulation is carried out when:

• pregnancy period is more than 40 weeks;
• pregnancy period is more than 38 weeks (with multiple pregnancies);
• there are no signs of the onset of labor.

A pregnancy is considered full-term if it reaches a full 38 weeks. After 40 weeks of pregnancy, in the absence of spontaneous labor, stimulation of labor is indicated. Starting from the 41st week of gestation, the function of the placenta decreases, which means that the baby does not receive enough nutrients and oxygen supplied through the bloodstream. Some doctors follow expectant management for 10 days, while others give the woman 2 weeks to give birth on her own. In any case, the longer the baby is in the womb after 40 weeks of pregnancy, the more difficult it will be for him during childbirth.

As for multiple pregnancies, upon reaching the full 38 weeks, it is advisable to stimulate labor, which is carried out in order to prevent complicated and pathological childbirth.

IMPORTANT! After 40 weeks, the fetal bone tissue begins to actively store calcium. This causes the bones of the baby's skull to become harder, which prevents the head from forming normally as it passes through the birth canal.

Stimulation of labor. In what cases is this really necessary?

Post-term pregnancy - more than 41 weeks.

Ultrasound shows signs of disruption of the utero-fetal-placental blood flow; ossification points are visualized in the fetus.

Premature rupture of amniotic fluid.

The lack of stimulation of labor one day after the rupture of amniotic fluid increases the risk of infection of the fetus, as well as the development of septic complications in the mother.

Overstretched uterus.

During multiple pregnancy and polyhydramnios, the walls of the uterus become thinner, resulting in a significant reduction in its contractility.

Diabetes. Induction of labor in this case is carried out after 38 weeks of pregnancy, due to the active weight gain of the fetus in the last two weeks of pregnancy.

Both pregnant women and doctors want all births to take place without complications. But, despite this, complications still occur, and one of them is weakness of labor. It is characterized by weakening and shortening of contractions, slowing down the opening of the cervix and the movement of the fetal head along the birth canal. In primiparous women, labor weakness is twice as common as in multiparous women.

Classification of weakness of labor

Weakness of labor can occur both in the first and second stages of labor, and in connection with this they distinguish:

• primary weakness of labor;
• secondary weakness of labor;
• weakness pushing.

Causes of weakness of labor

The causes of weak labor can be divided into three groups: maternal, fetal and pregnancy complications.

From the mother's side:

• diseases of the uterus (uterine fibroids, endometriosis, chronic endometritis);
• extragenital diseases (diabetes mellitus, hypothyroidism, obesity);
• infantilism of the genital organs (hypoplasia of the uterus);
• anatomically narrow pelvis;
• nervous overstrain of a woman, lack of psychoprophylactic preparation for childbirth;
• surgeries on the uterus (caesarean section, myomectomy);
• age of the woman in labor (over 30 years and under 18);
• rigidity (reduced elasticity) of the genital tract.

From the fetus:

• large size of the fruit;
• multiple births;
• incorrect presentation or insertion of the fetal head;
• discrepancy between the sizes of the fetal head and pelvis.

Complications of pregnancy:

• polyhydramnios (overstretching of the uterus and decreased contractility);
• oligohydramnios and flaccid amniotic sac (flat); gestosis, anemia of the pregnant woman.

Primary weakness of the generic forces

Primary weakness of labor occurs with the onset of labor and is characterized by weak, painless contractions, their frequency is no more than 1-2 per 10 minutes, and their duration is no more than 15-20 seconds. The opening of the uterine pharynx is very slow or does not occur at all. In primiparous women, the opening of the cervix to 2-3 cm from the beginning of contractions takes more than 6 hours, and in multiparous women it takes more than 3 hours.

Such ineffective labor activity leads to fatigue of the woman in labor, depletion of the energy reserves of the uterus and intrauterine hypoxia of the fetus. The fetal head does not advance, the amniotic sac does not function, it is weak. Childbirth threatens to become protracted and lead to the death of the child.

Secondary weakness of the generic forces

Secondary weakness of labor usually occurs at the end of the first or at the beginning of the second stage of labor and is characterized by a weakening of labor after a fairly intense onset and course. Contractions slow down and may stop altogether. The opening of the cervix and the advancement of the fetal head are suspended, signs of intrauterine suffering of the child appear, prolonged standing of the fetal head in one plane of the small pelvis can lead to swelling of the cervix and the occurrence of urinary or rectovaginal fistulas.

Weakness of pushing

Weakness of pushing usually occurs in multiparous women (weakening of the abdominal muscles), in women in labor with separation of the muscles of the anterior abdominal wall (hernia of the linea alba), and in obese women. It is characterized by weakness of pushing, ineffective and short-lived pushing (pushing is carried out using the abdominal muscles), physical and nervous exhaustion of the woman in labor, the appearance of signs of fetal hypoxia and stopping its movement along the birth canal.

Treatment of weakness of labor

Treatment of weakness of labor forces should be carried out individually in each case, taking into account the woman's history and clinical picture. Medicinal sleep-rest helps a lot, especially when the woman in labor is very tired.

For this purpose, antispasmodics, painkillers and sleeping pills are used. Sleep on average lasts no more than 2 hours, after which labor usually resumes and becomes intense.

In the case of a flat amniotic sac, polyhydramnios, or prolonged labor, the amniotic sac is opened (amniotomy). Also, the woman in labor is advised to lie on the side where the back of the fetus lies (additional stimulation of the uterus).

During the normal course of pregnancy, towards the end of it, prenatal contractions of the uterus are observed, which are most often painless, mainly occur at night and lead to shortening and softening of the cervix, and a slight opening of the cervical canal.

The main types of labor anomalies include a pathological preliminary period, primary and secondary weakness of labor, excessively strong labor, incoordination of labor and uterine tetanus.

Pathological preliminary period

In contrast to normal prenatal contractions of the uterus, the pathological preliminary period is characterized by spastic, painful and erratic contractions of the uterus and the absence of structural changes in the cervix, which is a sign of prenatal impairment of its contractile function. The pathological preliminary period can last up to several days. A frequent complication of the pathological preliminary period is untimely rupture of amniotic fluid. The main reasons that lead to the development of this complication are: nervous stress; endocrine and metabolic disorders; inflammatory changes in the uterus, age of primigravida over 30 years and under 17 years.

Treatment of the pathological preliminary period should be aimed at accelerating the “ripening” of the cervix and relieving uncoordinated painful contractions of the uterus. In case of fatigue and increased irritability, the patient is prescribed medicinal sleep-rest, sedatives (tincture of motherwort, collection of sedative herbs, valerian root); antispasmodics; painkillers; β-mimetics (ginipral, partusisten). To urgently prepare the cervix for childbirth, drugs based on prostaglandin E2 are used, which are injected into the cervical canal or posterior vaginal fornix. The duration of treatment for the pathological preliminary period should not exceed 3-5 days. With a “mature” cervix, taking into account a favorable obstetric situation, early opening of the amniotic sac and delivery through the natural birth canal are possible. If there is no effect from the therapy, the “immaturity” of the cervix persists, it is advisable to perform a cesarean section.

Weak labor

Weakness of labor is characterized by insufficient strength and duration of uterine contractions, increased intervals between contractions, disruption of their rhythm, slower dilation of the cervix, and delayed fetal advancement. There are primary and secondary weakness of labor. With primary weakness, contractions from the very beginning of labor are weak and ineffective. Secondary weakness occurs against the background of normal labor. Weakness of labor leads to a protracted course of labor, fetal hypoxia, fatigue of the woman in labor, prolongation of the anhydrous interval, infection of the birth canal, the development of inflammatory complications, bleeding during childbirth and the postpartum period. The causes of generic weakness are very numerous. The main ones are violations of the mechanisms regulating the birth process, which include: changes in the function of the nervous system as a result of stress, disorders of endocrine functions, menstrual disorders, and metabolic diseases. In a number of cases, the weakness of labor forces is caused by such pathological changes in the uterus as malformations, inflammation, and overdistension. Insufficiency of contractile activity during childbirth is also possible in the presence of a large fetus, multiple pregnancy, polyhydramnios, uterine fibroids, post-term pregnancy, and in women with severe obesity. Among the reasons for secondary weakness of labor, in addition to those already listed, we should note the fatigue of the woman in labor as a result of long and painful contractions, an obstacle to the birth of the fetus due to a discrepancy in the size of the head and pelvis, with incorrect position of the fetus, with the presence of a tumor in the pelvis.

The main method of treating weakness of labor is labor stimulation when the amniotic sac is opened, which consists of intravenous drip administration of drugs that enhance the contractile activity of the uterus (oxytocin, prostaglandin F2a). A significant effect in the treatment of weakness of labor can be obtained by combining prostaglandin F2a with oxytocin. If the woman in labor is tired, weak labor forces are detected at night, if the cervix is ​​poorly prepared for childbirth or is not open enough, treatment should begin by allowing the woman to rest for 2 to 3 hours (obstetric anesthesia). Otherwise, labor stimulation may further complicate the course of labor. After rest, a vaginal examination is performed to determine the obstetric situation and the condition of the fetus is assessed. Labor may intensify after sleep and no further treatment is required. If labor remains insufficient, uterine stimulating agents are prescribed. Contraindications to stimulation of labor are: discrepancy between the size of the fetus and the mother's pelvis, the presence of a scar on the uterus after a cesarean section or after removal of uterine fibroid nodes, symptoms of impending uterine rupture, previous severe septic diseases of the genital organs. If, with the introduction of drugs that enhance uterine contractions, no dynamics of cervical dilatation are observed within 2 hours or the condition of the fetus worsens, then further administration of drugs is not advisable. In this situation, the issue should be resolved in favor of operative delivery. The choice of method depends on the specific obstetric situation. If labor is weak in the first stage of labor, a caesarean section should be performed. In the second stage of labor, it is advisable to apply exit forceps or perform vacuum extraction.

Violent labor activity

Excessively strong, violent labor is characterized by very strong and/or frequent contractions and pushing (every 1-2 minutes), which can lead to rapid (1-3 hours) or rapid (up to 5 hours) labor. Expulsion of the fetus sometimes occurs in 1-2 attempts. Violent labor poses a danger to the mother and fetus. Women in labor often experience deep ruptures of the cervix, vagina, clitoris, and perineum; premature detachment of a normally located one or the development of bleeding is possible. Frequent, very strong contractions and rapid expulsion of the fetus often lead to hypoxia and birth injury to the fetus.

When correcting rapid labor, the woman in labor is given a position on her side, opposite to the position of the fetus, which she maintains until the end of labor. The woman in labor is not allowed to get up. To regulate and relieve excessive labor, intravenous administration of magnesium sulfate and tocolytic drugs (partusisten, ginipral, etc.) is used, achieving a reduction in the number of contractions to 3-5 in 10 minutes.

Tetanus of the uterus

Uterine tetany is rare. In this case, the uterus does not relax at all, but remains in a state of tonic tension all the time, which is due to the simultaneous appearance of several pacemakers in different parts of the uterus. In this case, contractions of different parts of the uterus do not coincide with each other. There is no overall effect of the contraction of the uterus, which leads to a slowdown and stop of labor. Due to a significant disruption of the uteroplacental circulation, severe fetal hypoxia develops, which manifests itself in a disturbance in its cardiac activity. The degree of dilatation of the uterine pharynx decreases compared to the data of the previous vaginal examination. A woman in labor may experience an increase in body temperature and develop chorioamnionitis, which worsens the prognosis for the mother and fetus. Uterine tetany can be one of the symptoms of such serious complications as threatening or incipient uterine rupture, premature detachment of a normally located uterus. The reasons for this anomaly are the presence of significant obstacles to the advancement of the fetus, a narrow pelvis, tumor, and unreasonable, erroneous prescription of birth-stimulating drugs.

When treating uterine tetany, anesthesia is used. Often, after anesthesia, labor activity returns to normal, and labor ends spontaneously. In case of uterine tetany, which is a symptom of its rupture, in case of premature detachment of a normally located placenta, or mechanical obstruction to the passage of the fetus, a cesarean section is performed. If there is a complete opening of the cervix, then under anesthesia the fetus is removed using obstetric forceps or by the pedicle (in case of breech presentation).

Discoordination of labor

Discoordination of labor is characterized by erratic contractions of various parts of the uterus due to a displacement of the pacemaker zone. Several such zones can appear at the same time. In this case, the synchronism of contraction and relaxation of individual parts of the uterus is not observed. The left and right halves of the uterus can contract asynchronously, but more often this refers to a disruption of the contraction processes in its lower section. Contractions become painful, spastic, uneven, very frequent (6-7 in 10 minutes) and prolonged. The uterus does not relax completely between contractions. The behavior of the woman in labor is restless. Nausea and vomiting may occur. There is difficulty urinating. Despite frequent, strong and painful contractions, the opening of the uterine pharynx occurs very slowly or does not progress at all. In this case, the fetus almost does not move along the birth canal. Due to disturbances in uterine contraction, as well as due to incomplete relaxation of the uterus between contractions, severe fetal hypoxia often develops, and intracranial injury to the fetus is also possible. Discoordination of uterine contractions often causes untimely release of amniotic fluid. The cervix becomes dense, the edges of the uterine pharynx remain thick, tight and cannot be stretched. The development of discoordinated labor is facilitated by the mother's negative attitude towards childbirth, the age of the first-time mother over 30 years, untimely rupture of amniotic fluid, rough manipulations during childbirth, developmental anomalies and tumors of the uterus.

When treating incoordination of labor, which is aimed at eliminating excessive uterine tone, sedatives, anti-spasm drugs, painkillers and tocolytic drugs are used. The most optimal method of pain relief is epidural anesthesia. Childbirth is carried out under constant medical supervision and monitoring of the fetal cardiac activity and uterine contractions. In case of ineffective treatment, as well as in the presence of additional complications, it is advisable to perform a cesarean section without attempting corrective therapy.

Prevention of labor anomalies

In order to prevent labor anomalies, careful adherence to the medical and protective regime, careful and painless management of childbirth are necessary. Drug prophylaxis is carried out in the presence of risk factors for the development of abnormalities of uterine contractility: young and old age of first-time mothers; complicated obstetric and gynecological history; indication of chronic infection; the presence of somatic, neuroendocrine and neuropsychiatric diseases, vegetative-vascular disorders, structural inferiority of the uterus; ; overdistension of the uterus due to polyhydramnios, multiple pregnancies or a large fetus.

Normally, the birth of a child should occur without any complications, both from the female body and from the baby. But in practice, doctors often have to deal with various problems during childbirth, and one of the most common among them is considered to be labor weakness. It is much easier for specialists to correctly resolve problematic situations if the woman in labor herself has accurate information about what weak labor is, knows the causes and symptoms of such a disorder, and roughly understands what to do in such a situation.

Causes

According to obstetricians and gynecologists, there are many factors that can slow down labor. So, such a disorder can develop as a result of neuroendocrine, as well as somatic ailments of the woman in labor. Sometimes it is provoked by overstretching of the uterus, which is often observed with polyhydramnios or multiple pregnancies. In some cases, weak labor is a consequence of complications of pregnancy, pathologies of the myometrium, as well as defects of the fetus itself, for example, disorders of the nervous system, adrenal aplasia, presentation, delayed or accelerated maturation of the placenta.

Labor may be weakened due to the woman's pelvis being too narrow, the presence of tumors, or insufficient elasticity of the uterine cervix.

Sometimes such a violation occurs as a result of the fact that the readiness of a woman and her child for childbirth does not coincide and is not synchronous. In certain cases, weak labor is caused by stress, the age of the woman in labor before seventeen or after thirty years, as well as her lack of physical activity.

Symptoms

Manifestations of weak labor are determined by doctors directly during childbirth. In this case, the woman in labor experiences short contractions of low intensity. The opening of the uterine cervix occurs quite slowly, and the fetus, in turn, moves along the birth canal at a low speed. The intervals between contractions, instead of decreasing, begin to increase, and the rhythm of uterine contractions is also disrupted. Childbirth is particularly long, which causes extreme fatigue for the woman in labor. With weak labor, the fetus experiences a lack of oxygen, which can be monitored using CTG.

If we are talking about the primary type of labor weakness, then contractions are characterized by low severity and insufficient effectiveness from their very appearance. The secondary form of pathology begins to develop after the normal onset of labor.

What to do?

The actions of an obstetrician-gynecologist with the development of labor weakness depend primarily on the causes of such a disorder. Unfortunately, doctors now decide to speed up labor more often than may be necessary. Quite often, the first birth actually takes a very long time, and if the fetus is not threatened by hypoxia, there is simply no point in stimulation. In certain cases, in order for labor to resume, the woman in labor needs to calm down and rest a little.

If labor weakness actually poses a threat to the mother or child, specialists take measures to stimulate it.

Amniotomy, the process of opening the amniotic sac, is considered to be a fairly safe non-drug method for enhancing labor. This procedure can be carried out if the cervix is ​​dilated by two centimeters or more. The rupture of water often leads to intensified contractions, as a result of which the woman in labor can do without medications.

In some cases, specialists decide to put a woman into medicated sleep for about two hours, which allows her to somewhat restore the strength and resources of her body. To carry out such a manipulation, a consultation with an anesthesiologist and a competent analysis of the child’s condition are required.

To directly accelerate and intensify contractions, ureotonic stimulants can be used. Most often, obstetricians prefer oxytocin and prostaglandins; they are usually administered intravenously using a drip. At this time, the fetal heartbeat is monitored using CTG.

In parallel with stimulant drugs, antispasmodics, analgesics or epidural anesthesia are often used, since a sharp increase in contractions due to the administration of drugs is extremely painful. And such a list of drugs can negatively affect the child’s condition; accordingly, they are used only according to indications, if the harm from such a correction is lower than from a protracted labor.

If all the measures described above do not give a positive result, a decision is made to perform an emergency caesarean section.

What can an expectant mother do?

You need to prepare for childbirth long before date X. It is advisable to choose a maternity hospital where the woman in labor will feel comfortable, you also need not to be afraid of the upcoming birth and get as much information as possible about this process. To prevent labor weakness, it is extremely important to be active after the onset of contractions - walking, using a fitball, wall bars, etc. The correct approach to childbirth, confidence in a favorable outcome, and the support of loved ones and qualified obstetricians help reduce the likelihood of developing labor weakness to a minimum.

Weak labor is a fairly serious pathology that occurs in approximately every 15th woman. First of all, it can be very dangerous for an unborn baby, since it quite often provokes oxygen starvation of the brain structures. In addition, this disorder significantly delays the process of childbirth and greatly depletes the physical strength of the woman in labor.

In most cases, such a pathology is observed during the second birth, however, it is not at all excluded in first-time women.

In this article we will tell you what reasons can cause weak labor, what symptoms and signs characterize it, as well as how medical workers should act in this situation and what the pregnant woman herself should do.

What reasons cause weakness of labor?

The causes of weak labor can be several different factors, in particular:

• multiple pregnancy or large fetus, as well as other reasons that lead to
  hyperextension of the uterus;
• various somatic, cardiological and neuroendocrine diseases of a pregnant woman;
• some pathologies of the myometrium;
• fetal malformations - adrenal aplasia, various disorders of the nervous system, and so on;
• placenta previa, as well as its delayed or accelerated maturation;
• mechanical obstacles, such as various malignant and benign neoplasms, too narrow a pelvis, incorrect placement of the baby in the uterus, inelasticity of the cervix and others;
• the age of the woman giving birth is less than 17 and over 35 years;
• insufficient motor activity of the expectant mother during pregnancy, bed rest associated with various diseases and complications, excessive weight, obesity;
• stress, overwork and mental strain of the mother in labor.

What signs characterize weak labor?

Weak labor is characterized by the following symptoms:

• short contractions of low intensity;
• too slow movement of the fetus along the birth canal;
• violation of the rhythm of contractions;
• slow opening of the uterine os;
• increasing the intervals between contractive movements;
• excessive fatigue of the woman in labor;
• protracted period of labor;
• fetal hypoxia.

All these signs can be diagnosed only after the birth process has begun. In addition, a distinction is made between primary and secondary weakness. In the first case, one or more symptoms are observed from the very beginning of labor, and in the second, labor begins normally, but then changes in character.

What to do if a woman in labor experiences weak labor?

Health care workers must decide on tactics in each specific situation depending on the condition of the mother and the unborn child.

In the event that the weakness of labor threatens the life and health of the expectant mother and baby, doctors can act as follows:

• Strengthen labor by opening the amniotic sac. This procedure is called amniotomy. As a rule, it allows the woman in labor to cope with the task assigned to her independently without the use of medications. However, there are significant contraindications for amniotomy, such as placenta previa or umbilical cord loops, malposition of the fetus, or exacerbation of genital herpes. In such cases, the staff of the medical institution must choose a different tactic to help the expectant mother;
• If amniotomy is ineffective, labor can be induced with medication. The most commonly used uterotonics here are oxytocin and prostaglandins, as well as putting the patient into medicated sleep after using narcotic analgesics. Typically, such drugs are administered intravenously by installing a dropper, however, in some cases, the woman in labor may be offered a tablet or capsule for oral administration;
• Finally, in cases where stimulation does not have the desired effect, and also if the woman in labor is completely exhausted or there is a serious threat to the life of the fetus or the expectant mother, an emergency cesarean section is performed.

If labor is stimulated artificially, the life and development of the child is at risk, so constant monitoring of the condition of the unborn baby is required using a heart monitor.

Measures to prevent weak labor

As you know, any pathology is much easier to prevent than to treat.

That is why throughout pregnancy, and especially after the 36th week, a number of measures should be taken that will reduce the likelihood of a weak labor process, including:

• in order to increase the energy potential of the uterus, it is recommended to take a complex of vitamins for pregnant and lactating women, containing folic and ascorbic acids, as well as B vitamins;
• eat properly and nutritiously, follow a daily routine, sleep at least 8 hours a day;
• psychologically prepare for childbirth, if necessary, attend special courses.

The reasons for weak labor can be different and in some situations it cannot be predicted.