Department of Obstetrics and Gynecology MEDICAL AND OF HEALTH PREVENTIVE FACULTY OBSTETRICS IV course Anomalies of patrimonial activity

WOMB prostaglandins myoglobin OXYTOCIN ATP kinins actomyosin serotonin CALCIUM acetylcholine RNA catecholamines GLYCOGEN oestradiol

Downward TRIPLE GRADIENT - PEYSMEKER- pacemaker - DOMINANT BOTTOM - TOP-DOWN WITH FORCE Descending momentary MAXIMUM REDUCTION AND PAUSE

Downward TRIPLE GRADIENT

SCRUM contraction retraction distraction

contractions are characterized * Regular * Certain duration * Force

Action uterine contractions

Phase 1 stage of labor * Латентная: открытие зева до 4 см * Активная: открытие зева от 4 до 8-10см

during childbirth The rate of cervical dilatation - Nulliparous least 1 cm / hour, - Multiparous cm / hour The average duration of labor - The first birth - 8 hours, rarely 18chas - Repeated births - 5:00 seldom 12:00

Anomalies of patrimonial activity  Pathological preliminary period Weak labor FORCES - PRIMARY - SECONDARY - WEAKNESS attempts EXCESSIVE Stormy generic activities - Prompt delivery, FAST DELIVERY Incoordination of labor - incoordination - Dystocia CERVICAL - Hypertonicity of the lower segment - Uterine tetany

Pathological preliminary period Irregular contractions, sometimes sharp pain that lasts more 6-8hours These contractions disrupt the rhythm of sleep and bodrostvovaniya Fatigue mothers Do not lead to the disclosure of the cervix Lead to the appearance of fetal hypoxia

Clinical management is defined * * Severity of clinical manifestations * The status of the cervix * The status of the fetus * Is there a premature discharge of water or not.

Treatment of pathological preliminary period: medication sleep anesthesia Amniotomy - the presence of defective membranes (flat) may be the cause of pathological preliminary period. Amnitomiya promising in the presence of mature or maturing of the birth canal.

The main criterion for the flow of labor The characteristics of contractions (regular, strong enough) * The dynamics of disclosure uterine os, nulliparous disclosure uterine os 1 cm per hour in multiparous 2 cm per hour. * Promotion of the head through the birth canal

Prolonged labor: Due to the weakness of labor PRIMARY preeclampsia extragenital diseases ABORTION infantilism BIRTH AFTER 30 YEARS Uterine malformations perenashivanie Pelvic E previa Scar on the uterus gynecologic diseases MYOMA ENDOMETRITIS Prenatal outpouring of water Hyperextension of the uterus (multiple pregnancy, polyhydramnios Large fruit, multiparous) !

Because of the weakness of labor  ЭГЗ  УСТАЛОСТЬ, ГОЛОД  ГИПЕРСТИМУЛЯЦИЯ МАТКИ  НЕСООТВЕТСТВИЕ РАЗМЕРОВ ПЛОДА РАЗМЕРАМ ТАЗА МАТЕРИ ПЛОДА РАЗМЕРАМ ТАЗА МАТЕРИ

SECONDARY 1. Women aged and young age 2. Women with overstretching of the uterus (large fetus, multiple pregnancy, polyhydramnios). 3. Multiparous, mnogoberemennye, numerous abortions with curettage, ie in the presence of degenerative and inflammatory changes in the myometrium. 4. In women with menstrual dysfunction and hormonal balance 5. Hypertrichosis, obesity

DIAGNOSIS Prolonged labor 1. Characteristics of contractions: the weak, short 2. Insufficient dynamics of cervical uterus (normally 1 cm per hour) cm per hour. 3. To clarify the dynamics of the used methods for determining the external data and vaginal examination -Partogramma 4. Diagnosis should be delivered within 3-4 hours.

Treatment: amniotomy Rodostimulyatsiya cesarean

OVERTORQUE labor. The clinical picture of the turbulent labor Vaginal examination fast speed disclosure of uterine os.

treatment: antispasmodics sedation

DISKOORDINIROVANNAYA of labor Contractions -Different strength, duration, and intervals, sharply painful, mosaicism. Increased uterine tone especially in the lower segment, rigid edges of uterine os. Slowing promotion fetus through the birth canal difficulty urinating

DISKOORDINIROVANNAYA of labor CAUSES OF

Uterine malformations · Anatomical changes of the cervix (after diathermocoagulation) · Women with unstable nervous system, increased sensitivity to pain reaction

Осложнения complications: Premature rupture of membranes prolonged labor Increased percentage of septic infections fetal hypoxia A high percentage of operational delivery

TACTICS amniotomy Oxytocic Caesarian

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