ACCELERATED LABOR FROM THE STANDPOINT OF EVALUATION OF HEALTH AND DISEASE

Objective. To investigate the degree of abnormalities, by analyzing the course of pregnancy, delivery, and perinatal outcomes in women with accelerated labor. Subjects and methods. The investigation enrolled 180 women whose pregnancy had ended with a nonsurgical term delivery at 37- 41 weeks of gestation. 140 patients whose labor had been accelerated formed a study group (Group I). The other 40 women had a normal duration of childbirth and were assigned to a comparison group (Group II). According to the presence of perinatal complications, Group 1 women were divided into two subgroups IA and IB. Subgroup IA included women without complications seen in the mother and fetus (n = 56). The inclusion criteria in Subgroup IB (n = 84) were excessive blood loss during childbirth, acute intrapartum hypoxia, soft tissue injuries of the maternal passages, and postpartum and early neonatal complications of any origin. Questionnaires were used to study the characteristics of personal and family histories. The maturity of the cervix uteri was estimated using the scale described by Bishop in 1964. The characteristics of uterine contractility were assessed by singlechannel hysterography on an Avalon FM-300 machine (Phillips); a signal was recorded in real time. The WHO partograph (1987) was employed to monitor labor and cervical dilation. The neonatal status was assessed on the basis of clinical observations and instrumental and laboratory findings. Results. The women in study group had a high incidence of cardiovascular and gastrointestinal diseases. In the women from the study group there was a set of several signs of a nondifferential connective tissue dysplasia (NCTD) in 72% (12,5% - in comparison group) and the severity of this abnormality was significantly higher than that in the comparison group. The women in the comparison group had a set of several signs of NCTD only in 12.5% of cases and the severity of symptoms was quite low. In the study group, their family histories were characterized by the high rate of accelerated labor in the relatives in a matrilineal line. The current pregnancy in the study group women was complicated by many and different diseases. In the pattern of the diseases, there was a predominance of infectious diseases mainly in the lower genital tract. In 98.6% of the cases the labor activity was not hyperergic, accelerated labor was due to the high cervical dilation rate. The high frequency of occurrence of maternal passage soft tissue damages and uterine subinvolution was noted among the postpartum complications. The early neonatal diseases were mainly cerebral disorders and hemorrhagic syndrome. Conclusion. In 98% of cases, accelerated labor was caused by rapid cervical dilation in the presence of normergic uterine contractions. Abnormal maternal and fetal outcomes are not related to the nature of labor, but are due to infectious diseases in the mother, which complicate her medical history and current pregnancy.

accelerated labor, hypertonic uterine dysfunction, perinatal outcomes, infectious complications of pregnancy