Discoordinated labor occupies one of the first places among the anomalies of the uterus contractile activity because of the frequency of traumatic complications on the part for a mother and a fetus. In this case the frequency of cesarean section is from 10 to 30% and the fetus distress is 35%. The lack of prediction criteria, the impossibility of identifying groups of pregnant women, threatening the development of discoordinated labor make obstetricians and gynecologists develop clinical and diagnostic criteria with the search and study of the newest therapeutic options for regulation of anomalies of the uterus contractile activity. The purpose of our study was to study the causes of discoordinated labor and the possibilities of its therapeutic treatment based on the results of clinical and instrumental examination of women with a violation of contractile function of the uterus. Material and methods. We examined 90 women with discoordinated labor (main group) and 30 women with physiological course of labor (control group). The average age of women in the main group was 26.5 ± 3.2 years, in the control group the average age was 23.4 ± 2.3 years. Depending on the method of treatment of discoordinated labor women were divided into three clinical subgroups: the 1st group included women with the traditional correction of discoordinated labor in accordance with the orders of the Ministry of Health of Ukraine; the 2nd group had women who were performed epidural anesthesia for the treatment of discoordinated labor; and the 3rd group encompassed women who were given Phosphatidyl Choline for correction of discoordinated labor (Biolik, Ukraine). Results and discussion. To determine the causes of discoordinated labor development, we analyzed the somatic and obstetric clinical records of women, parity, the presence of occupational and domestic hazards, parameters of their partograms, the rate of the womb opening, the results of hysterography and cardiotocography. While studying the uterus contractile function in women with discoordinated labor, we revealed the violation of duration, frequency and amplitude of contractions, the reduction of the lower segment contradictions in comparison with similar indices in physiological delivery. It clinically was manifested by increased pain in the uterus contractions, slowing of the cervix opening and the lack of moving of the lying part of the fetus along the birth canal. Histerograms showed irregular contradictions (40%), with low amplitude (19%), and changes in the coordination of uterine contractions (9%). The ultrasound data detected different thickness of myometrium in the body of the uterus and in the lower segment in the main and control groups (1.9 ± 0.2 mm and 2.8 ± 0.3 mm, respectively). According to doplerometry there was a violation of hemodynamics of uterine arteries and uterine-placental blood flow in each second woman with discoordinated labor. The 1st clinical subgroup had the lowest level of cesarean section which was 33.3%; the percentage of cesarean section reached 66.7% in the 2nd group; in the third group, where the correction of the discoordinated labor was carried out with the drug, the active substance of which is Phosphatidyl Choline, the number of births, which resulted in surgical intervention, equaled 40%. Conclusion. Thus, the study proved the high efficiency of using Phosphatidyl Choline in the complex therapy of discoordinated labor in comparison with existing methods at the expense of normalization of labor activity, improvement of the condition of the woman and the state of the fetus, a decrease in the percentage of surgical interventions, and a decrease in the number of perinatal complications.
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