What is fast and rapid delivery?
Rapid and rapid delivery is one of the forms of hyperdynamic dysfunction of uterine contractile activity when an excessively strong uterine contractile activity develops.
Childbirth of this type is characterized by extreme excitability of the myometrium, a high frequency of labor (more than 5 in 10 minutes), which is called tachysystole. The amplitude of the contraction increases from 70 to 100 mm Hg. Art., intrauterine pressure increases to 200 mm Hg. Art. and higher, while the periods of relaxation of the uterus (diastole contractions) are shortened by 2 times or more compared with the norm. The total contractile activity of the uterus exceeds 300 units. Montevideo. This situation often leads to a condition called myometrial spasm and a threatening uterine rupture.
Impetuous labor is dangerous for the health of the mother and the fetus, not only by the severe complications associated with obstetric injuries, but also by the fact that they are very difficult to eliminate.
The definition of “fast delivery” or “very fast” – “fast-moving” – childbirth (partus praecipitatus) is not strictly differentiated from each other and small differences in the periods of their duration are not significant.
The concepts of fast and rapid delivery are used interchangeably. Conventionally, rapid births include their duration up to 3 hours, to fast deliveries – 4-5 hours.
Very quick deliveries, called “street”, are rare. This phenomenon plays an important role in forensic medicine, since such childbirth catches a woman unexpectedly. Expulsion of the fetus can occur on the floor, on the street, in transport, in a word, in the most unexpected place. As a rule, this does not happen in women in the supine position, but occurs with active behavior in a standing position, sitting, walking.
Such fast delivery, or rather, such a quick ending, is a big surprise for a woman. Completely no clinical manifestations of contractions and attempts, as well as any painful sensations. It is possible that due to the inexperience of the woman contractions go unnoticed. An important factor in the short duration of labor is the lack of resistance on the part of the cervix, which is more often seen in multiparous women and in ICN.
Rapid labor is pathological, as it is often accompanied by extensive ruptures of the birth canal (cervix, vagina, cavernous bodies of the clitoris, perineum), hypoxic-traumatic damage to the fetus and newborn (injury, hemorrhage in the brain, umbilical cord break), and large blood loss (hypo-or atonic bleeding).
Causes of Quick and Swift Delivery
The reasons for fast delivery are as follows:
- Excessively strong effects on the uterus of biologically active substances, mediators of the autonomic nervous system (norepinephrine, acetylcholine).
- The presence of simultaneous overexcitement of adrenergic and cholinergic parts of the autonomic nervous system, causing the convulsive nature of contractions. The “pacemaker” in these cases moves to the center of the bottom or middle of the uterus, which unduly enhances the excitation of the uterus to any effect.
- Excessive release of endogenous oxytocin.
- Decrease in the tone and, consequently, the resistance of the lower uterine segment, the inconsistency of the obturator function of the internal uterine pharynx as a result of the old deep cervical ruptures, the presence of isthmic-cervical insufficiency.
- Disruption of embryonic development during the confluence of two paramesonephric (Mullerian) ducts can form the anatomical basis of the pathogenesis of congenital functional disorders of the cervix. These developmental abnormalities can lead to dysfunction of individual segments of the uterus, causing their various contractile activity. Congenital insolvency of the cervix in a patient can often manifest as the pregnancy progresses. There is a relaxation of individual segments of the uterus by the type of adynamia (sacciform state of the lower segment or cervix).
- One-time rupture of a large amount of amniotic fluid is accompanied by a sharp decrease in the volume of the uterine cavity. At this point, a cascade release of prostaglandins, oxytocin, neurotransmitters, catecholamines arises disproportionately to the situation and the rapid delivery develops.
- Iatrogenic causes associated with overstimulation of labor (failure to follow the rules of rodstimulation, excessively large doses of injected drugs of tonotic action, unreasonable combination of strong stimulants that potentiate each other’s action, etc.).
- A history of fast (rapid) birth, birth trauma and stillbirth as a result of such birth.
- A large number of births in history (3 or more).
- Cervical insufficiency (organic or functional genesis).
- Vast pelvis, small fruit.
Pathogenesis during rapid and rapid delivery
It is necessary to distinguish several options for fast delivery.
- “Street childbirth” (quick and painless).
- Rapid labor due to the low resistance of the tissues of the isthmus and cervix, which is most often caused by the ICN (organic or functional). Following the outpouring of the amniotic fluid, a fetus is born immediately.
- The rapid advancement of the fetus.
After a period of normal or even delayed opening of the uterine mouth, a sudden movement of the fetus through all the planes of the pelvis suddenly occurs. The essence of such births is that the duration of the first period of labor can be normal or even somewhat delayed, but the fetus advances through the birth canal rapidly, within a few minutes, without adaptation to the pelvic planes, often with a violation of the biomechanism of labor. As a result, scalping tears of the birth canal are possible. The fetus may form cephalhematoma, cerebrovascular accident, subdural and subarachnoid hemorrhages.
This type of labor can occur with excessive pharmacological stimulation with oxytocin and/or PGF2α drugs.
Rapid labor can be a variant of hypertensive dysfunction of the contractile activity of the uterus.
The contractions are spastic, convulsive in nature: their frequency is more than 5 in 10 minutes, the duration of the contraction is 120-180 s, the relaxation time is shortened in such a way that one contraction overlays the other up to a long tonic tension (“uterine cramps”). The hysterographic curve has a two- or three-hump look. Intra-uterine pressure rises to 200 mm Hg. Art. and higher.
The behavior of the woman in labor is restless (shouts, tossing). Observed vegetative disorders are observed: nausea, vomiting, fever, sweating, tachycardia, hypertension, vascular dystonia, indicating a strong functional overexcitation of sympathetic-adrenal and cholinergic systems. In German literature, such genera are called “Wehensturrn”, in English – “Tumoltous labour”.
With this pathology, even the separation of a circular fragment of the cervix, which is born with the head of the fetus, can occur. This pathology variant should be differentiated from the threat of uterine rupture and premature placental abruption.
Treatment Fast and rapid delivery
Currently, apart from the use of myometrium relaxants (β-adrenomimetics, tocolytics), we are not able to deal with this state of the uterus. Any mechanical resistance to the rapidly advancing head of the fetus is contraindicated, as this can lead to rupture of the uterus, intracranial hemorrhage in the fetus.
Sometimes it is necessary to apply general anesthesia (anesthesia) or administer analgesic drugs, which can weaken the excessive contractile activity of the uterus.
The main method of treatment is intravenous administration of tocolytics, adrenergic mimetics with a selective effect on myometrial β-adrenoreceptors, which reduce the concentration of calcium in myofibrils. These drugs include: ginipral, fenoterol, partusisten.
Ginipral – solution for infusion, 1 ml contains 5 μg of the active beginning of hexoprenaline sulfate. For acute tocolysis (rapid suppression of contractions) is administered intravenously slowly at a dose of 10 μg (in 10.0 ml of sodium chloride or glucose solution) for 20-30 minutes.
When using ginipral, it is necessary to control the pulse and blood pressure in the woman, and to monitor the fetus.
You should not seek a complete cessation of labor, as is done with the threat of premature birth, you just need to reduce the excitability of myometrium, normalize the tone of the uterus, reduce the frequency of contractions, increase the interval between contractions.
A mandatory component of the management of rapid (rapid) childbirth is the prevention of hypotonic (atonic) bleeding by administering methylergometrine (1 ml intravenously immediately after expulsion of the fetus) and vitamin-energy complex containing 100-150 ml of 40% glucose solution, 15 ml of 5% ascorbic solution acid, 10 ml of 10% solution of calcium gluconate and 2 ml of ATP.
It should be remembered about the numerous contraindications to the use of tocolytics:
- cardiovascular diseases;
- severe liver and kidney disease;
- uterine bleeding;
- premature detachment of the placenta;
- inflammatory diseases;
- hypersensitivity to the drug;
- bronchial asthma;
Prevention of fast and rapid delivery
Women at risk should not be prescribed drugs that stimulate the contractile activity of the uterus, as well as calcium drugs. In labor only lying position is recommended. The most effective are tocolytics, which reduce hypertonicity of the uterus.