Contraction of the uterus is weak

Outlined productivity including uterine contractility, abdominal muscles and diaphragm contractility and the levator ani muscle contraction, with the main uterine contractility. In the delivery process, contraction of the uterus rhythm, symmetry and polarity normal or intensity, frequency change as abnormal uterine contractility. Clinical more by the middle Road or abnormal fetal form factors obstructive dystocia, fetus through the birth canal resistance, secondary to abnormal productivity. Abnormal uterine contractility clinical divided into contraction of the uterus and uterine contraction weak too strong two categories. Each category is made for coordination uncoordinated contraction of the uterus and uterine contraction. Cause pathogenesis more integrated by several factors caused by common factors : 1. cephalopelvic disproportion said fetal abnormality or fetal position first revealed Ministry declined blocked, not under close of the uterus and cervix therefore not cause reflex contraction of the uterus, resulting in secondary contraction of the uterus is weak. 2. Uterine factors stunting uterus, uterine malformations (such as double-uterine horn), excessive growth of uterine wall (such as twins. macrosomia, amniotic fluid, and so on), the maternal (multipara) uterine muscle fiber degeneration or uterine fibroids. can cause contraction of the uterus is weak. 3. The spirit of early maternal factors (primipara) [especially for senior citizens over the age of 35 early maternal (elder ly primipara)], so that the spirit of excessive tension cortex dysfunction, sleep less, After eating less labor and excessive physical exertion may lead to contraction of the uterus is weak. 4. Endocrine disorders labor, the body of maternal estrogen, oxytocin, prostaglandins, such as acetylcholine secretion. slow decline in progesterone, the uterus to acetylcholine and lower sensitivity can be influenced uterine muscle exciting threshold, causing contraction of the uterus is weak. 5. The influence of drugs during labor inappropriate use of large doses of sedatives and pain-killers, such as morphine, chlorpromazine, meperidine, Phenobarbital, uterine contraction can be curbed. Clinical manifestations in accordance with the period can be divided into primary and secondary two. Primary contraction of the uterus is weak labor sluggish start contraction of the uterus, the cervix was dilated to renege, Fetal first disclosed Department could not be dropped on schedule, the extension of labor; secondary uterine contraction weakness is beginning production of normal uterine contraction, only in labor progress to a certain stage (more active period or the second stage of labor), uterine contraction weakening labor progress has been slow, even grinds to a halt. Contraction of the uterus is weak, there are two types, clinical manifestations are different. 1. Coordinated contraction of the uterus is weak (low tension weak contraction of the uterus) contraction of the uterus is a normal rhythm. and the polar symmetry, but the contraction powerlessness, intrauterine pressure low ( "2.0kPa), short duration, Intermittent long period without laws, labor "2 / 10 minutes. When the contraction of the uterus to a very period, the uterus does not uplift and stiffen, pressure Palace fingers bottom muscle wall can still be the place. labor extended or stagnation. As intrauterine low tension, little effect on the fetus. 2. Disharmony contraction of the uterus is weak (high tension weak contraction of the uterus) uterine contraction of the polarity inversion, Since labor is not with the uterine corner, the polygraph labor from the womb one or multiple, uncoordinated rhythm. Palace at the bottom of labor is not strong, but the middle - or lower, labor intermittent period uterine wall can not relax completely, performance of uncoordinated contraction of the uterus, which can make labor cervical dilation, not disclosed so that the Ministry of first births decreased be void labor. Maternal consciously sustained lower abdominal pain, according to resist, irritability, dehydration, electrolyte imbalance, intestinal flatulence, urinary retention; fetal-placental circulation obstacles, there will be the fetal distress. Inspection : a lower abdominal tenderness, in contravention of the uterus unclear, the fetal heart rate is not the law, the cervix was dilated slow or non-expansionist, Fetal first disclosed the Department of stagnation or decline delay, the labor extension. 3. Labor varicose abnormal uterine contraction led to sluggish labor abnormal curve, the following seven categories : (a) latencies : uterine contractions in labor law from the start of cervical dilation 3 cm known as latency. Primipara normal incubation period about eight hours, maximum time limit of 16 hours, more than 16 hours as latencies (Figure 1). Figure 1 cervical dilation latencies Map (2) to extend the active period : from cervical dilation 3 cm cervical began to open its mouth called the active period. Primipara active normal about four hours, the greatest time of eight hours, more than eight hours as extended active period (Figure 2). Figure 2 extended active matrix (3) active period of stagnation : Entering the active period, I no longer cervix dilated to 2 hours or more called active period of stagnation. (4) The second stage of the extension : the beginning of the second stage of maternal more than two hours, after more than one hour of maternal yet made complaisant. known as the second stage of the extension. (5) The second stage of labor; The second stage of the one-hour fetal head down without progress, as the second stage of labor. (6) decreased fetal head delay : Active advanced cervical dilation to 9 ~ 10cm, verage hourly rate declined less than 1 cm, known as fetal head drop delay. (7), head down stagnation : fetal head remain in the same location not be lowered to an hour or more, known as fetal head down stagnation. More than seven abnormal labor progress can exist independently, the merger can also exist. When the total output of more than 24-hour delay as production, we must avoid stagnation production. Treatment 1. Coordinated contraction of the uterus is weak, whether primary or secondary, when there is a coordinated contraction of the uterus is weak, should first look for the causes and whether cephalopelvic disproportion said to abnormal fetal position, the expansion and understanding of fetal cervical first disclosed the Department of decline. If there is cephalopelvic disproportion, estimated not by vaginal delivery, timely cesarean section. If no judge called cephalopelvic disproportion and abnormal fetal position, can be estimated by vaginal delivery, should consider taking measures to strengthen labor. (1) a first-class) general handling : Elimination of mental stress, more rest, encouraging more consumption. Will be unable to eat by intravenous nutritional supplement, Deng to 10% glucose solution within 500 ~ 1000 ml of vitamin C 2g. Acidosis should be accompanied by additional 5% sodium bicarbonate. Hypokalemia should be given the slow intravenous infusion of potassium chloride. Maternal fatigue, give stability and 10 mg intravenous or intramuscular meperidine 100 mg. After some time, we can make uterine contractility strengthened. Right early cervical opening of less than 3 cm, fetal membranes has not been broken, should give enema soapy water temperature, promoting them to defecate exclude excreta and gas, to stimulate uterine contraction. Natural voiding difficulties, the first induction, to be invalid when catheterization, emptying the bladder can be widened production, and promote the role of uterine contraction. 2) strengthening uterine contraction : after treatment, uterine contractility is still weak, coordination diagnosed as uterine contraction weak, labor no obvious progress can choose ways to strengthen the lower uterine contractions : ① artificial rupture : cervical dilatation 3 cm or less than 3 cm, without cephalopelvic disproportion, the fetal head has been convergence, feasible artificial rupture. Rupture, fetal head directly under close of the uterus and cervix and cause a reflex contraction of the uterus and accelerate the progress of labor. Available to scholars who fetal head is not possible convergence of artificial rupture that can promote the rupture of fetal head down canal. Rupture must first check whether the umbilical cord revealed that the rupture in labor intermittent schedule. After the rupture with the fingers should stay in the vagina, after a meeting of labor-2 canal until after the fetal head, then the person fingers removed. Bishop proposed using cervical ripening score estimated labor measures to strengthen the effectiveness, as shown in table 1. If scores in maternal three hours and three minutes following, both artificial rupture failure, it should use other methods. 4 ~ 6 hours, the success rate is about 50%, 7-9 pm The success rate is about 80%, more than nine hours was successful. Table 1 Bishop cervical ripening score index score 0 1 2 3 Palace at the time of (cm) 0 1 ~ ~ 2 3 4 5 ~ 6 dissipated cervical canal (%) (not dissipated to 2 cm) 30 40 0 ~ ~ ~ 50 60 70 80-100 first disclosed location (ischial spine level = 0) -3 -2 -1 0 +1 ~ ~ +2 hardness hard cervical soft mouth Palace before the middle of a location ② diazepam (valium) intravenous injection : stability and smooth muscle relaxation can cervix to soften the cervix and cervical promote expansion. Apply to the cervix and cervical slow expansion edema. Usual dose of 10 mg intravenous injection, spacing 2 ~ 6 hours to be repeated, and oxytocin combined effects better. ③ oxytocin (i. c. v) infusion : apply to the coordination of contraction of the uterus is weak, the fetal heart rate good, normal fetal position, The first pots were commensurate. Oxytocin to 2.5 U to 5% glucose solution 500ml, every drop of sugar containing oxytocin 0.33mU. drop from 8 / 2 hours that .5mU/min began, according to labor intensity adjustment, usually not more than 10 mU / min (30 drops /), maintenance labor at the intrauterine pressure is ~ 6.7 kPa (50 ~ 60mmHg). labor interval 2 ~ 3 minutes, sustained 40 ~ 60 seconds. For those not sensitive to increase the dose of oxytocin. Oxytocin infusion process, the person should observe labor and listen to the fetal heart and blood pressure measurement. If there is a sustained uterine contractions minutes or listen to fetal heart rate changes, should immediately stop the drip. Oxytocin in maternal blood has a half-life of 2 ~ 3 minutes, stop quickly after improvement that could be necessary to curb the use of sedatives its role, if found elevated blood pressure, slowed infusion rate. Because oxytocin has long been known as anti-diuretic effect, water absorption, there will be the disturbance, the need to be vigilant against the occurrence of water intoxication. ④ prostaglandin (PG) applications : Prostaglandin E2 and F2α are promoting the role of uterine contraction. For oral administration route, intravenous drug use and partial (placed in the vagina). Intravenous infusion of PGE2 0.5 μg / min and PGF2 α5μg/min. usually able to maintain an effective contraction of the uterus. If after half an hour of labor is still not strong, and the discretion to increase the dose, the largest dose of 20 μg / min. Prostaglandin reaction to the contraction of the uterus too strong, nausea, vomiting, headache, rapid heart rate, blurred vision and rheumatoid superficial vein, it should be pursued cautiously. ⑤ Acupuncture : increase contraction of the uterus results. Acupuncture usually LI4, Sanyinjiao, Taichong, very, Guan dollars Point, with strong stimulation practices, needle retention 20 ~ 30 minutes. Auricular acupuncture optional uterus, sympathetic and endocrine Point. After the above treatment, if labor is still no progress or any signs of fetal distress, timely cesarean section. (2) the second stage : the second stage of the absence of cephalopelvic disproportion, the contraction of the uterus appeared weak, we should also strengthen the contraction of the uterus, give intravenous oxytocin promote the progress of labor. If fetal head biparietal diameter has passed ischial spine plane, waiting for natural childbirth, or Episiotomy OK, OK vacuum extraction or forceps delivery; If the fetal head has not yet been accompanied by a convergence or signs of fetal distress, cesarean section. (3) The third stage : to prevent postpartum hemorrhage, shoulder before fetal exposure to vaginal mouth, give ergometrine 0.2 mg intravenous injection and given oxytocin 10-20U intravenous drip, enhanced so that contraction of the uterus, placenta separation and promote the delivery of uterine sinusoids and closed. If labor long, long time to rupture, should be given antibiotics to prevent infection. 2. Disharmony contraction of the uterus is weak handling principles regulating contraction of the uterus, uterine contraction resume polarity. Given strong sedatives meperidine 100 mg or 10-15mg of morphine injected maternal adequate rest, Peter can be recovered after the coordination of the contraction of the uterus. The contraction of the uterus to resume coordination, prohibited use of oxytocin. If, after the above, disharmony of labor can not be corrected, or accompanied by signs of fetal distress, or with cephalopelvic disproportion said, Cesarean section should be OK. If coordinated contraction of the uterus is under control, but the contraction of the uterus is still weak, can be coordinated uterine contraction strengthen weak contraction of the uterus. Prevent pregnant women for prenatal education, pregnant women thinking of lifting the concern and fear. to enable pregnant women to understand pregnancy and childbirth is the biological process. At home and abroad are based Leisure labor room (and their families allowed to accompany his wife) and the Ward family, contribute to the elimination of maternal stress, boost confidence, preventable mental stress-induced uterine inertia. Maternity encouraged to eat more, when necessary from intravenous nutritional supplements. Avoid excessive use of sedative drugs, to check for the presence of cephalopelvic disproportion said, is the prevention of uterine contraction amid the effective measures. Timely attention to the rectum and bladder emptying, if necessary, feasible and warm soapy water enema catheterization.