Weak uterine contractions

Weak uterine contractions
[Summary]



Including the production of uterine contractility, and the abdominal muscle contraction of the diaphragm muscle and anal contraction, with the main uterine contractility. In the delivery process, uterine contraction of the rhythm, symmetry and not normal polarity or intensity, frequency changes, known as abnormal uterine contractility. Clinical more production, or because of fetal abnormalities form factors obstruction dystocia, the fetus through the birth canal resistance increased, resulting in production of secondary abnormalities. Abnormal uterine contractility of the weak and divided into uterine contractions in the uterine contraction strong two categories, and each category, for the coordination and uncoordinated contraction of the uterus and uterine contraction.



[Treatment]




1. Weak coordination uterine contraction whether primary or secondary, when there is a coordination of uterine contraction weakness, should first look for reasons, whether cephalopelvic disproportion that the wrong position and abnormal fetal and understanding of cervical dilatation first disclosure of the decline situation. If found cephalopelvic disproportion that can not be estimated by vaginal delivery, cesarean section to be timely, if not cephalopelvic disproportion judge said the wrong position and abnormal vaginal delivery can be estimated, should consider measures to strengthen the contractions .

(1) first stage

1) General addressed: the elimination of tension, more breaks to encourage more consumption. Can not eat may intravenous nutritional supplements to Deng 10% glucose 500 to 1000 ml, and vitamin C 2g. Acidosis should be supplemented with 5% sodium bicarbonate. Hypokalemia should be given potassium chloride slow intravenous drip. Maternal fatigue, give stability and the slow intravenous injection of 10 mg or 100 mg intramuscular meperidine, after a period of time, the uterine contractility can be strengthened. On the opening of the cervix primipara less than 3 cm, fetal membranes has not been broken, should be given warm soapy water enema, and promote peristalsis, eliminate waste and Gas, stimulates uterine contractions. Natural urination difficulties, the first induction, should be null and void when catheterization for bladder emptying Road can be widened production, and promote the role of uterine contraction.

2) strengthening the uterine contraction: the normal processing, uterine contractility still weak, confirmed for the coordination of uterine contraction fatigue, no significant progress birth process, the choice of ways to strengthen the contractions:

① artificial rupture of membrane: cervical dilatation 3 cm or more than 3 cm, without cephalopelvic disproportion that the fetal head has been convergence, feasible artificial rupture of membrane. AA, fetal head directly under close of the uterus and cervix, uterus caused reflex contraction accelerating labor progress. Existing scholars advocated fetal head of convergence are also not feasible artificial rupture of membrane that AA can promote fetal head drop Rupen. AA must first check whether the umbilical cord Lu, AA should be carried out in the intermittent contractions. After the rupture of membrane of the fingers should remain in the vagina after 1 or 2 times contractions question fetal head Rupen, then fingers of those removed. Bishop proposed by the score of cervical ripening of the estimated effect of measures to strengthen contractions, as shown in table 1. If maternal and scored three points in the following three minutes, both artificial rupture of membrane failure, should use other methods. 4 to 6 pm the success rate is about 50%, from 7 to 9 pm the success rate is about 80 percent, 9 points above successfully.

Table 1 Bishop cervical maturity score

Index Score
0 1 2 3
Palace opening of the mouth (cm) 0 1 1-2 3-4 5-6
Cervical dissipated (%)
(Not dissipated 2 cm) 0 to 30 40 to 50 60 to 70 80 to 100
First open position
(Ischial spine level = 0) -3 -2 -1 ~ 0 +1 ~ +2
Cervical hardness of soft hardware
I Palace in the former location

② stability (valium) intravenous injection: stability and smooth muscle relaxation can cervix, cervical softening and promote cervical dilatation. Apply to the slow expansion of cervical and cervical edema. Commonly used dose of 10 mg intravenous injection interval of 2 to 6 hours can be repeated applications, combined with the effects of oxytocin better.

③ oxytocin (oxytocin) infusion: applicable to weak coordination of uterine contractions, fetal heart rate good, the wrong position to normal, proportionate to the first pots. U oxytocin 2.5 will be 5% glucose solution 500 ml, so that the sugar content of each droplet oxytocin 0.33 mU from 8 drops / min or 2.5 mU / min, in accordance with contractions strength to adjust, usually not more than 10 mU / min (30 drops / min), the uterine contractions, the pressure of 6.7 ~ 8.0 kPa (50 ~ 60mmHg), contractions between 2 to 3 minutes, continuing 40 to 60 seconds. For non-sensitive, increase oxytocin dose.

Oxytocin infusion process, the person should be observed contractions, fetal heart rate and blood pressure listen. If there contractions continued listening to one minute or more, or there are changes in fetal heart rate, should immediately stop drip. Oxytocin in the blood half-life of the mother for 2 to 3 minutes, can be improved rapidly after treatment, if necessary that could use tranquilizers to contain its role, if high blood pressure should slow down infusion rate. Because oxytocin has been called anti-diuretic effect, the re-absorption of water increased, there will be Niaoshao, to guard against the occurrence of water intoxication.

④ prostaglandin (prostaglandin, PG) Applications: prostaglandin E2 and F2 α have the duty to promote the role of uterine contraction. For the oral route of administration, intravenous and local administration (posterior fornix placed in the vagina). PGE2 intravenous infusion of 0.5 μ g / min and PGF2 α5μ g / min, usually maintaining effective uterine contraction. If half an hour after the contractions still strong, and may, as appropriate, increase the dose, the largest dose of 20 μ g / min. Prostaglandin response to the vice excessive uterine contractions, nausea, vomiting, headache, rapid heart rate, blurred vision and go far in superficial vein, it should be cautiously uses.

⑤ acupuncture points: the effect of strengthening contractions. Acupuncture usually LI4, Sanyinjiao, Taichong, very, Kuan-yuan, and points on the way to stimulate strong, stay needle 20 ~ 30 minutes. Auricular acupuncture optional uterus, sympathetic, endocrine, and other points.

After the treatment, if no progress or labor there signs of fetal distress, to be timely cesarean section.

(2) The second stage: The second stage of the absence of cephalopelvic disproportion, a weak uterine contractions, uterine contraction should also be strengthened, given oxytocin infusion for labor progress. If fetal head biparietal diameter through the ischial spine plane has been waiting for natural childbirth, or visit Episiotomy, to attract fetal head of midwifery or forceps; if not yet convergence or fetal head with signs of fetal distress, should be held cesarean section .

(3) The third stage: for the prevention of post-partum hemorrhage, before fetal shoulder when exposed to the vagina, I can provide a new base lysergic 0.2 mg intravenous injection, and at the same time given oxytocin 10 to 20 U intravenous drip to enhance uterine contractions , and is delivered to the placenta and uterine stripping sinusoids closed. If middle-long AA long time, should be given antibiotics to prevent infection.

2. Uncoordinated contraction of the uterus is the principle of dealing with weak regulation uterine contractions and restore uterine contraction polarity. Given strong sedatives meperidine 100 mg or 10 to 15 mg of morphine injection, maternal rest, awoke to resume for more coordination of uterine contraction. In the uterine contraction resume coordination, prohibited use oxytocin. If the above treatment, uncoordinated contractions of not being corrected, or with signs of fetal distress, or with cephalopelvic disproportion said, should be to cesarean section. Without coordination of uterine contraction has been control, but still weak uterine contractions can be used coordination, strengthening weak uterine contractions in the uterine contraction method.


[Etiology:




Multi caused by several factors, the common causes are:

1. Cephalopelvic disproportion that the wrong position or abnormal fetus exposed to disruption of the decline can not keep pace with the lower and uterine cervix, which can not cause reflex contraction of the uterus, resulting in weak secondary uterine contraction.

2. Uterine factors uterine hypoplasia, uterine malformations (such as dual-angle womb), uterine wall bloated (such as twins, macrosomia, excessive amniotic fluid, etc.), the maternal (multipara) uterine muscle fiber degeneration or uterine fibroids, fatigue can cause uterine contractions.

3. Spirit of early maternal factors (primipara) [especially for senior citizens above 35 years old primigravida (elderly primipara)], the spirit of tension over the cerebral cortex dysfunction, sleep less and less labor after eating too much exhaustion can lead weak uterine contractions.

4. Endocrine disorders labor, in maternal estrogen, oxytocin, prostaglandins, such as acetylcholine inadequate secretion of progesterone decreased slowly, and the uterus to reduce the sensitivity of acetylcholine, could affect uterine muscle excited threshold , resulting weak uterine contractions.

5. Effect of the drug on labor after the inappropriate use of large doses of sedatives and analgesics, such as morphine, chlorpromazine, meperidine, phenobarbital, uterine contraction can be curbed.


[Clinical]




In accordance with the period can be divided into primary and secondary two. Primary weak uterine contractions in labor is weak uterine contractions begin, I can not Palace on schedule expansion, the Department could not reveal fetal first time fell, the yield-extended secondary is weak uterine contractions in labor normal uterine contractions begin, but in the birth process to progress a certain stage (or more active in the second stage of labor), the weakening of uterine contraction, the slow progress of labor, even grinds to a halt. Weak uterine contractions There are two types, clinical manifestations are also different.

1. Weak coordination uterine contraction (low-uterine contraction weak) with normal uterine contractions in the rhythm, symmetry and polarity, but contraction is weak, intrauterine pressure low (<2.0 kPa), a short time, intermittent period long without laws, contractions <2 / 10 minutes. When uterine contraction of a period, not uplift and uterus, acting like a finger pressure at the bottom of the Palais muscle wall can appear Depression, middle-extended or stagnation. Tension due to intrauterine low, the effects on the babies do not.

2. Uncoordinated contraction of the uterus weak (high-uterine contraction weak) uterine contractions in the polarity inversion, the contractions began on both sides is not of the uterine horn, the exciting site from the uterine contractions of one or more, the rhythm uncoordinated. Palace at the bottom of contractions is not strong, but the middle section or paragraph under strong contractions intermittent period uterine wall can not completely relax, uncoordinated performance for uterine contraction, such contractions I can not Palace expansion, the child can not be exposed to the Department of decline Contractions are invalid. Maternal consciously under sustained abdominal pain, and rejected by, irritability, dehydration, electrolyte imbalance, intestinal bloating, urinary retention; fetus - placental circulation obstacles, there may be the fetal distress. Inspections: a lower abdominal tenderness, the wrong position to touch unclear, irregular fetal heart rate, dilated cervix slow or expansion, decreased fetal first disclosure of the delay or stagnation, the labor extension.

3. Labor varicose lead to abnormal uterine contraction weak labor curve anomalies, there are seven kinds of the following:

(1) extend the incubation period: from labor laws contractions started to cervical dilatation 3 cm known as latency. Primipara normal incubation period about eight hours, the greatest 16-hour time limit, known as the incubation period is more than 16 hours longer (Figure 1).



Figure 1 Schematic diagram of cervical dilatation incubation period extended

(2) extend the active period: 3 cm dilated cervix I started to open cervix I called the active phase. Primipara active normal about four hours, eight hours maximum time, more than eight hours as active extension (Figure 2).



Figure 2 active extended sketch

(3) active stagnation: Entering the active period, I no longer cervical expansion of more than two hours, known as active stagnation.

(4) second stage of the extension: the beginning of the second stage of maternal more than two hours, the mothers of more than one hour has not yet Wen called the second stage of the extension.

(5) The second stage of stagnation; second stage of fetal head of one hour drop no progress, as the second stage of stagnation.

(6) decreased retard fetal head: Active advanced to the Palais dilatation 9 ~ 10 cm, fetal head rate of decline of less than 1 cm per hour, known as fetal head drop delay.

(7) decreased fetal head stagnation: the fetal head does not stay in the former fell by more than one hour, known as fetal head drop stagnation.

More than seven kinds of abnormal labor progress, can stand alone, there also could be merged. When the birth process called diapause more than 24 hours of production, the need to avoid delay in production.


[Prevention]




Prenatal education to pregnant women, pregnant women thinking of lifting concerns and fear that pregnant women in pregnancy and childbirth is the understanding of physiological processes. Both at home and abroad to set up production recreation room (let wife and family members to accompany) and the family of the wards, contribute to the elimination of maternal stress, boost confidence, can prevent mental stress-induced uterine atony. Childbirth encourage more consumption and, if necessary, from intravenous nutritional supplements. Avoid excessive use of sedative drugs, to check for cephalopelvic disproportion said, is the prevention of uterine contractions and weak effective measures. Pay attention to timely rectum and bladder emptying, if necessary, feasible warm soapy water enema and catheterization.