The weakness of labor activity (hypoactivity, inertness of the uterus) consists in insufficient intensity, duration and frequency of contractions, and therefore the smoothing of the cervix, the opening of the cervical canal and the promotion of the fetus, if it corresponds to the size of the pelvis, is slow.
The weakness of labor activity leads to a protracted course of labor, which in turn can cause fetal hypoxia, the development of endometritis during childbirth, bleeding in the postpartum and early postpartum periods.
Classification of weakness of labor activity
- primary (a woman enters labor with weak contractions that continues throughout labor)
- secondary (after a period of active labor, the uterus weakens)
Causes of weakness of labor activity
The causes of primary weakness are diverse: changes in the function of the central nervous system, disorders of the endocrine function, menstrual cycle, metabolic diseases, pathological changes in the uterus (malformations, inflammatory diseases, infantilism), etc.
The reasons for the secondary weakness of labor activity, in addition to those listed, include fatigue of the woman in labor, a narrow pelvis, stiffness of the cervical tissue, childbirth with a large fetus, etc.
Weak, short contractions, insufficient dynamics of cervical dilatation (normally 1 cm per hour) – 2-3 cm per hour.
Treatment of weakness in labor
With severe fatigue of the woman in labor, she should be given rest for 2-4 hours (obstetric anesthesia). After the end of narcotic sleep, labor activity traditionally intensifies and additional administration of labor-inducing drugs is not required. If the contractions remain weak, one of the drug schemes of labor stimulation is used.
Cesarean section with weakness of labor should be used only in cases where conservative therapy is unsuccessful and the prognosis of childbirth for the mother and fetus is unfavorable, especially when weakness of labor is combined with other pathologies (breech presentation of the fetus, aggravated obstetric history, advanced age of the woman in labor, etc. ).
With secondary weakness of labor activity that is not amenable to drug therapy, depending on the obstetric situation, obstetric forceps are applied, vacuum extraction of the fetus, extraction of the fetus by the pelvic end, etc.
With weakness of attempts due to the failure of the abdominal muscles, a Verbov bandage is sometimes used – a special device made of fabric to tighten the abdomen of a woman in labor during an attempt. Bandage Verbova can be replaced with a sheet. In cases of rigidity of the uterine os and the failure of the use of antispasmodics, sometimes they resort to its digital expansion.
If there are signs of a developing infection, also with an anhydrous interval of more than 10 hours, if the end of labor is not expected in the next 1-2 hours, antibiotics are prescribed.
Prevention of weakness of labor activity
In order to prevent anomalies of labor activity, careful observance of the medical and protective regimen, careful and painless delivery will be necessary. Drug prophylaxis is carried out in the presence of risk factors for the development of anomalies in the contractile activity of the uterus: young and old age of primiparas; burdened obstetric and gynecological history; indication of chronic infection; the presence of somatic, neuroendocrine and neuropsychiatric diseases, vegetative-vascular disorders, structural inferiority of the uterus; fetoplacental insufficiency; overstretching of the uterus due to polyhydramnios, multiple pregnancy or large fetus.
Women who are at risk of developing abnormal labor activity will need to undergo physio-psychoprophylactic preparation for childbirth, teach methods of muscle relaxation, control of muscle tone, and skills to reduce increased excitability. Night sleep should be 8-10 hours, daytime rest at least 2-3 hours. Provides a long stay in the fresh air, rational nutrition.