IMPROVEMENT OF ASSISTANCE IN THE PROLONGED LATENT PHASE OF THE FIRST PERIOD OF LABOR IN WOMEN WITH PRIMARY ARTERIAL HYPOTHONY
DOI:
https://doi.org/10.11603/24116-4944.2019.1.10188Keywords:
pregnancy, primary arterial hypotension, prolonged latent phase of the first period of laborAbstract
The aim of the study – to improve the assistance in the prolonged latent phase of the first period of labor in the obstetric patients with primary arterial hypotension to provide the reduction of perinatal pathology.
Materials and Methods. For realization of research tasks the following clinical groups of pregnant women were formed: I – 50 parturients with primary arterial hypotension, who underwent correction of hemodynamic disorders in the latent phase of the first period of childbirth; ІІ – 48 parturients with primary arterial hypotension in the latent phase of the first period of labor; ІІІ – 30 parturients with primary arterial hypotension with physiological course of deliveries in the term 39–41 weeks. All pregnant women gave birth for the first time. Dopplerometric examination included evaluation of blood flow in the uterus (UA) and the spiral arteries (SA). In an ultrasound study, the M-method evaluated the respiratory motion of the fetus in a longitudinal and transverse section.
Results and Discussion. In both groups of surveillance of the parturients with primary arterial hypotension there was a prolonged latent phase of the first period of labor. In the 2nd group of observation without conducting hemodynamic correction, the duration of the latent phase was (14.5±2.5) (8.0–18.5) hours. Indicators of vascular resistance in UA and SA exceeded the normative by 21–35 %. In assessing the respiratory movements of the fetus, the manifestations of pathological biophysical activity occurred in 16.7 % of cases. Given that the enhancement of the parasympathetic nervous system is one of the pathogenetic links of gestational complications both during pregnancy and in pregnant women, a selective blocker of m-cholinoreceptors Buskopan was used to correct hemodynamic disorders. The use of Buscopane contributed to a decrease in vascular resistance in UA and SA in 1.3 and 1.2 times respectively; provided acceleration of the process of opening the cervix in childbirth by 1.2 times and shortening the duration of the latent phase to (10.2±1.3) (5.5–13.5) hours. Manifestations of pathological biophysical activity of the fetus occurred only in 6.0 % of cases.
Conclusion. Correction of hemodynamic disorders in the prolonged latent phase of the first period of childbirth in the parturient with primary arterial hypotension ensures the progress of labor in 94 % of cases, reduces the incidence of children in the state of asphyxiation by 2.8 times and reduces the incidence of operative delivery in 2.7 times.
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