Discoordinated Labor Activity and Modern Approaches to Its Correction

Abstract

The aim of the study – to evaluate the course and outcome of childbirth for the mother and the fetus by comparing various methods of correction of discoordinated labor activity (DLA).
 Materials and Methods. 120 women in childbirth were examined, of whom 90 women had DLA. Group 1 (control) consisted of 30 women with a physiological course of childbirth, group 2 – 30 women in labor, who underwent correction of the DLA according to the order of the Ministry of Health of Ukraine No. 676, dated 12/31/2004, group 3 – 30 women who underwent epidural anesthesia, group 4 – 30 women who underwent complex treatment using phosphatidylcholine.
 The subject of the study was indicators of partograms of women in labor, fetal CTG, levels of adrenaline, norepinephrine, prostaglandin F2α, oxytocin, dopplerometry, and assessment of the condition of newborns.
 Results and Discussion. In women with DLA, a premature rupture of the membranes was determined in 67 (74.5 %); indicators of adrenaline were increased (7.2±0.8) nmol/l. Under the influence of treatment, the adrenaline level decreased in group 4 to (3.5±0.5) nmol/l. There was an increase in the concentration of PGF2a during DLA to (177.2±6.9) ng/ml. The use of traditional therapy reduced the content of PGF2a to (134.1±5.1) ng/ml, the use of phosphatidylcholine to (111.7±4.8) ng/ml. Similar changes were observed in oxytocin parameters: an increase in the content during DLA (173.4±10.2) pg/ml, a decrease under the influence of traditional treatment (105.7±6.9) pg/ml and our proposed method of therapy (91.3±5.6) pg/ml.
 The results of a Dopplerometric examination of women in labor with DLA indicated an increase in resistance in the uterine arteries and in the umbilical arteries. Studies have shown that in group 2, the Caesarean section was the lowest – 33.3 %, group 3 – 66.7 %, in group 4 – 40 %. Condition of the newborn: in group 2 of pregnant women in satisfactory condition 76.7 % of newborns were born, in the group 3 – 66.7 %, in group 4 – 73.3 %.
 Conclusions. Based on the results of the evaluation of the outcome of labor, the use of phosphothydiolcholine in the complex treatment of discordination of labor can significantly reduce the frequency of operative half-divergence and improve the condition of the fetus and the newborn due to the normalization of biologically active substances in the blood of the mother and fetus, improvement of blood flow in the utero-placental complex and, as a result of normalization of maternity activities.