2. Discoordinated Labor Activity is an abnormal contractile
activity of the uterus during labor, characterized by a lack of
consistency of contractions between individual segments of
the uterus. Discoordinated labor activity is manifested by
irregular, ineffective and extremely painful contractions,
delaying the opening of the uterine pharynx.
3. General Information
With discoordinated labor, various parts of the uterus (its right and
left halves, bottom, body and lower parts) contract chaotically,
inconsistently, haphazardly, which leads to a violation of the normal
physiology of the labor act. The danger of discoordinated labor
activity lies in the likelihood of a violation of placental-uterine
circulation and the development of fetal hypoxia. Discoordination of
labor activity is often noted when the pregnant woman’s body is not
ready for childbirth, including immaturity of the cervix. The frequency
of development of discoordinated labor activity is 1-3%.
4. Causes
Obstetrics and gynecology distinguish several groups of factors
that determine the development of discoordinated labor activity.
Obstetric risk factors may include early outpouring of amniotic
fluid; overgrowth of the uterus caused by polyhydramnios or
multiple births; mismatch in the size of the birth canal and fetal
head; pelvic presentation of the fetus; abnormal placenta
(placenta previa) and fetoplacental insufficiency; late gestosis, the
age of a woman younger than 18 and older than 30 years.
5. Discoordinated labor activity can occur with intrauterine infection of the fetus,
anencephaly and other malformations in the child, hemolytic disease of the fetus
(immunoconflict pregnancy).
6. Gynecological factors provoking discoordinated labor activity include
various types of pathology of the reproductive system. Uterine
malformations (bicornuate uterus, septate uterus, uterine hypoplasia,
etc.), transferred endometritis and cervicitis, tumor processes (uterine
fibroids), cervical rigidity caused by impaired innervation or scar changes
(for example, after cauterization of cervical erosion) contribute to the
violation and discoordination of the labor act. The presence of an
operational scar on the uterus, menstrual cycle disorders, artificial
termination of pregnancy in the anamnesis adversely affects the
physiology of childbirth.
7. General somatic pathology, intoxication, infections, organic lesions of
the central nervous system, obesity, anemia, neurocirculatory
dystonia can contribute to the development of discoordinated labor
activity. In some cases, abnormal labor activity is provoked by
external influences – unjustified use of birth-stimulating agents,
insufficient anesthesia of childbirth, untimely opening of the fetal
bladder, rough manipulations and studies.
8. Symptoms
Clinically discoordinated labor activity can be expressed in its general
discoordination, hypertonicity of the lower segment (reverse gradient), tetany of
the uterus (convulsive contractions), circulatory dystocia.
9. General discoordination is characterized by very painful, irregular,
contractions of varying strength and duration, lack of dynamics in
smoothing and opening of the cervix, and a prolonged protracted course
of labor. In this case, the outpouring of amniotic fluid often occurs ahead
of time, the underlying part of the fetus is pressed against the entrance
to the pelvis or is located above the entrance to it. The danger of general
discoordinated labor activity lies in the violation of placental circulation
and the risks of fetal asphyxia. The course of the postpartum period may
be complicated by anomalies of placental abruption and delay of its
parts; in the postpartum period, the probability of hypotonic bleeding is
high.
10. With hypertonicity of the lower segment of the uterus, its contractions are
more pronounced than contractions of the body and the bottom of the
uterus. This type of discoordinated labor activity is typical for immaturity
and rigidity of the cervix. Clinically, with hypertension, painful intense
contractions are noted, but there is no opening of the neck and the
advancement of the fetal head along the birth canal.
11. Uterine tetany is spoken of when there are prolonged, consecutive uterine
contractions. Such an anomaly of the birth forces occurs with the incorrect
appointment of contraception drugs, an attempt to impose obstetric forceps,
rotation, fetal extraction. With tetany, the uterus becomes very dense and
painful, and the condition of the fetus is rapidly deteriorating. Discoordinated
labor activity according to the type of circulatory dystocia is due to the
absence of contraction of circular muscle fibers in the cervical region.
Childbirth in this case is delayed, which can lead to fetal asphyxia.
12. In all clinical variants of discoordinated labor, the woman in labor has
anxiety, fear, severe pain in the sacrum, nausea, urination disorders.
Despite the apparent activity of contractions, the dynamics of cervical
dilation is almost completely absent. Such unproductive contractions tire
the woman in labor, which further delays childbirth.
13. Diagnostics
The discoordinated nature of labor is diagnosed based on the condition and
complaints of the woman, the results of obstetric examination, fetal
cardiotocography. During the vaginal examination, the absence of dynamics in
the readiness of the birth canal is determined – thickening and swelling of the
edges of the uterine pharynx. Palpation of the uterus reveals its unequal tension
in different departments as a result of discoordinated contractions.
14. Cardiotocography allows to objectively assess the contractile activity of
the uterus. During hardware examination, irregular contractions in
strength, duration and frequency are recorded; their arrhythmicity and
asynchrony; the absence of a triple descending gradient against the
background of increased uterine tone. The importance of CTG in
childbirth lies not only in the ability to control labor activity, but also to
monitor the increase in fetal hypoxia.
15. Obstetric tactics
Childbirth occurring in conditions of discoordinated labor activity can be
completed independently or promptly. With discoordination and
hypertonicity of the lower segment of the uterus, electroanalgesia (or
electroacupuncture) is performed, antispasmodics are administered,
obstetric anesthesia is used. In case of deterioration of the fetal vital
activity, prompt delivery is required.
16. In the case of uterine tetany, obstetric anesthesia is administered, and α-
adrenomimetics are prescribed. Taking into account the obstetric
situation, childbirth can be completed by cesarean section or fetal
extraction with obstetric forceps. With circulatory dystocia, an infusion of
b-adrenomimetics is indicated, aimed at removing discoordinated labor
activity, and operative delivery. At the same time, therapy is carried out
aimed at preventing intrauterine fetal hypoxia.
17. Indications for operative delivery without attempts to correct
discoordinated labor activity may be situations where past pregnancies
ended in miscarriage or stillbirth. Also, the choice in favor of cesarean
section is made with prolonged infertility in the mother’s anamnesis;
cardiovascular, endocrine, bronchopulmonary diseases; gestosis,
uterine fibroids, pelvic presentation of the fetus or its large size; in
primiparous women over 30 years old. In case of stillbirth, a fruit-
destroying operation is performed, manual separation of the afterbirth
with examination of the uterine cavity.
18. Prevention
Measures to prevent discoordinated labor include pregnancy management in
women at risk with increased attention, compliance with the required settings
of an obstetrician-gynecologist, ensuring adequate anesthesia during
childbirth.
Drug prevention of discoordinated labor is necessary for young women in labor
and late-giving women, pregnant women with a burdened general somatic and
obstetric-gynecological status, structural inferiority of the uterus, fetoplacental
insufficiency, polyhydramnios, multiple births or large fetuses. Women at risk
for the development of discoordinated labor activity require psychoprophylactic
preparation for childbirth, training in muscle relaxation techniques.
19. Complications
The danger of discoordinated labor is caused by a violation of the
physiological course of labor, which can lead to complications on the
part of the fetus and mother. Delaying the delivery process increases the
risks of intrauterine hypoxia and fetal asphyxia. Due to discoordinated
labor activity, the mother increases the likelihood of atonic postpartum
bleeding. The discoordinated course of labor activity in frequent cases
requires the use of an operative aid in childbirth.
