uterine atony
Introduction
Brief introduction of uterine contraction Uterine contraction is the polarity of uterine contractions, symmetry and rhythm is normal, but the contractions are weak and weak, the duration is short, the interval is long or irregular, the disease is not in the fetal position, the head basin is not called and multiple pregnancy The incidence of uterine local factors such as twins and amniotic fluid is high, and it is also seen in people with mental stress. If the pregnancy and labor process can be properly and timely treated, the occurrence of uterine contraction fatigue can be reduced. The uterine contraction weakness needs to be differentiated from the false labor. The identification method is to give a 100 mg intramuscular injection of a strong sedative, stilbene, which can cause the uterine contraction to be a temporary labor, and the uterine contraction should not be a primary uterine contraction. basic knowledge The proportion of illness: 0.001% Susceptible population: pregnant women Mode of infection: non-infectious Complications: intrauterine distress
Cause
Cause of uterine contraction
Uterine dysplasia (30%):
Uterine malformations (such as double-horned uterus, etc.), excessive expansion of the uterine wall (such as twins, huge fetuses, polyhydramnios, etc.), maternal (multipara) uterine muscle fibrosis or uterine fibroids, etc., can cause uterine contraction fatigue.
Mental factors (30%):
Primipara (especially older women over 35 years old (elderly primipara)], excessive mental stress causes cerebral cortical dysfunction, less sleep, less food intake after labor and excessive consumption of physical strength, can lead to uterine contraction.
Endocrine loss (20%):
After the delivery of labor, maternal estrogen, oxytocin, prostaglandins, acetylcholine and other secretions, progesterone decreased slowly, the sensitivity of the uterus to acetylcholine, etc., can affect the uterine muscle excitation threshold, resulting in uterine contraction. Drugs affect the inappropriate use of large doses of sedatives and analgesics, such as morphine, chlorpromazine, dipyridamole, barbital, etc. after labor, can inhibit uterine contractions.
Abnormal fetal position (10%):
The decline of the first exposed part of the fetus is blocked, and can not be close to the lower uterus and the cervix, so it can not cause reflex uterine contraction, resulting in secondary uterine contraction.
Prevention
Uterine contraction fatigue prevention
Prenatal education should be carried out for pregnant women to relieve pregnant women's ideological concerns and fears, so that pregnant women can understand that pregnancy and childbirth are physiological processes. At present, there are recreational and labor rooms at home and abroad (letting their loved ones and their families accompany them) and family wards to help eliminate Maternal nervousness, enhance confidence, can prevent uterine contraction caused by mental stress, encourage more food during childbirth, supplement nutrients from the vein if necessary, avoid excessive use of sedative drugs, pay attention to check whether there is a head basin, etc. They are effective measures to prevent uterine contraction and fatigue. Pay attention to emptying the rectum and bladder in time, and if necessary, warm soapy water enema and catheterization.
Complication
Uterine contraction fatigue complications Complications of the fetus
Delayed or stagnant fetal head decline, causing delayed labor, prone to fetal distress, neonatal asphyxia or intracranial hemorrhage and other complications.
Symptom
Uterine contraction fatigue symptoms Common symptoms uterine weakness fatigue fatigue irritability dehydration pregnant women abdominal lumps flatulence
1, coordinated uterine contraction fatigue (hypertension uterine contraction fatigue)
Uterine contraction has normal rhythm, symmetry and polarity, but weak contraction force, low uterine pressure (<2.0kPa), short duration, long interval and irregular, uterine contractions <2/10 minutes, when When the uterus contraction reaches the extreme stage, the uterus does not bulge and harden. The muscle wall at the bottom of the uterus can still be depressed with fingers, and the labor process is prolonged or stagnant. Because of the low intrauterine tension, it has little effect on the fetus.
2, uncoordinated uterine contraction fatigue (hypertension uterine contraction fatigue)
The polarity of the uterus contraction is inverted. The contractions are not from the uterine horns on both sides. The excitement of the contractions comes from one or more parts of the uterus. The rhythm is not coordinated. At the end of the contraction, the bottom of the palace is not strong, but the middle or lower part is strong. The uterine wall of the uterus contraction period can not be completely relaxed, which is manifested as uncoordinated uterine contraction. This kind of contraction can not make the cervix dilate, can not make the first dew of the fetus decline, is an invalid contraction, the mother consciously sustained pain in the lower abdomen, refused to press , irritability, dehydration, electrolyte imbalance, intestinal flatulence, urinary retention, fetal-placental circulation disorder, fetal distress may occur, examination, tenderness in the lower abdomen, unclear fetal position, irregular fetal heart, slow expansion of cervix or Without expansion, the first exposed part of the fetus is delayed or stagnated, and the labor process is prolonged.
3, abnormal varicose
Absence of uterine contraction leads to abnormal labor curve, which can be as follows:
(1) Prolonged incubation period: 3cm from the routine contraction of labor to the expansion of the cervix is called the incubation period. The incubation period of primipara is about 8 hours, and the maximum time is 16 hours. The longer than 16 hours is called the latency extension.
(2) Prolonged active period: from the expansion of the cervix to 3cm from the beginning of the cervix to the cervix, it is called the active period. The active period of the primipara is about 4 hours. The maximum time is 8 hours. The more than 8 hours is called the active period.
(3) Stagnant active period: After entering the active period, the cervix no longer expands for more than 2 hours, which is called active period stagnation.
(4) Extension of the second stage of labor: the second stage of labor is more than 2 hours, and the mother has not delivered for more than 1 hour, which is called the second stage of labor extension.
(5) The second stage of labor stagnation: the second stage of labor for 1 hour of fetal head decline without progress, known as the second stage of labor stagnation.
(6) Delayed fetal head decline: 9~10cm in the active late stage to the cervix, and the fetal head descending speed is less than 1cm per hour, which is called the fall of the fetal head.
(7) The fetal head falls and stagnate: the fetal head stays in the original place and does not fall for more than 1 hour, which is called the fetal head drop stagnation.
The above 7 kinds of labor processes are abnormally advanced and can exist alone or in combination. When the total labor period exceeds 24 hours, it is called delayed production, and it is necessary to avoid the occurrence of delayed production.
Examine
Uterine contraction examination
1. The inspection frame limit "A" is the most basic, but the conditional unit should include "B".
2, suspected fetal intrauterine hypoxia check box should include "C".
Diagnosis
Diagnosis and differentiation of uterine contraction
diagnosis
1, uterine contractility is weak and weak, long labor.
2, primary uterine weakness, refers to the uterine contraction weakness that occurs at the beginning of the labor process.
3, secondary uterine weakness, refers to the stage of labor progress to a certain stage of uterine contraction.
Differential diagnosis
Need to identify with the temporary labor, the identification method is to give a strong sedative to the acetaminophen 100mg intramuscular injection, can make the uterine contraction stop for the temporary labor, can not make the contraction stop for the primary uterine contraction.
