Nikitin D.A., Boris I.V., Tsareva S.N.*
UZ "6th GKB G. Minsk", *GUO "Belarusian State Medical University", Department of Obstetrics and Gynecology
In recent years, an increase in the frequency of induction of childbirth (birth) and in developed countries has been observed in obstetricity, the frequency of induced birth reaches 20–25%. The induction of childbirth is not a safe procedure, and the effectiveness depends on the correct choice of indications and contraindications, time, method or sequence of application of methods justified in a specific clinical situation.
Preparation of the cervix for childbirth- measures aimed at ripening the cervix in the absence or insufficient readiness for childbirth.
Indication of childbirth:
From the mother:
- moderate preeclampsia (including prolonged, not amenable to therapy);
- gestational and chronic arterial hypertension;
- diabetes, gestational diabetes mellitus (level of evidence B);
- cholestatic hepatosis;
- other somatic, as well as cancer, requiring early delivery;
- the immaturity of the birth canal during pregnancy is 40 weeks 4 days or more (for pre -induction), 41 weeks - for induction;
- The premature outcome of the amniotic fluid (depending on the obstetric situation: with a mature cervix after 4-6 hours, with immature - after the maturity of the cervix is achieved by conducting the pre -induction).
From the side fetus:
- the phenomena of isosensitization according to the Rh factor or by the AVO system, taking into account clinical laboratory data;
- non -guide or multi -guide in a term of pregnancy;
- phenomena of placental failure in the compensated condition of the fetus;
- stillbirth.
In some cases, the logistics reasons can be considered as evidence: remoteness from the obstetric institution, quick or rapid births in the history, if there is a risk of childbirth without qualified medical care.
Contraindications to pre -induction and induction of childbirth:
- Anatomically narrow pelvis (3-4 degrees).
- Incorrect positions of the fetus (transverse, oblique).
- Exposure of the head (facial, frontal) with premature surplus of waters.
- Pelvic presentation of the fetus.
- The arrangement of the placenta (placenta, low location).
- The presentation of the vessels of the umbilical cord.
- Ultimate scar on the uterus
- Tumors of the uterus that prevent the birth of the fetus.
- The pathology of the cervix (pronounced cicatricial deformation, malignant neoplasms).
- Acute and chronic renal and liver failure, and other somatic diseases of the mother in the stage of decompensation.
- Severe preeclampsia, in which delivery is necessary by surgery of cesarean section.
- Sub- and decompensated fetoplacental deficiency, including moderate and severe fetal hypoxia according to cardiotocography, centralization of fruit blood circulation according to Dopplerometry, hemo-dynamic disorders of the 2nd or 3rd degree, medium and severe fetal development syndrome.
- Frequent development of the fetus in which abdominal delivery is recommended.
- Other states that determine the impossibility or increased risk of complications during childbirth through natural birth canal.
- Bloody discharge during pregnancy from the genital tract of unsuitable etiology.
Currently, both drug and mechanical methods for preparing the cervix for childbirth are used.
Medication methods include: the use of analogues of prostaglandin E1(Misoprostol), prostaglandina e2(dinoprostone), antiprogestine (mifepristone) and oxytocin. The most commonly used drugs are prostaglandins and antiprogenestins (mifepepristone).
Of the mechanical methods, the introduction of cylinder expanders, laminiria is most often used into the cervix.
As cylinder expanders, foil catheters with a cuff volume from 25 to 50 ml are usually used, but sometimes special devices are used that have two cylinders for the cervix and vaginal.
After the introduction to the cervical canal in the projection of the inner pharynx, the cuff (cylinder) is filled with physiological solution in accordance with its capacity. If at the same time it turns out to be outside the internal pharynx, it is positioned after filling. The catheter in the cervical canal is left up to 12 hours or until spontaneous loss.
The outcomes of induced genera are largely determined by the quality of the preparation of the cervix for childbirth. Therefore, a lot of attention is paid to the choice of the preinduction method.
The appointment of the induction method is carried out when a consultation in a hospital is visited by a hospital. The choice of induction method depends on many factors (gestational periods, the parity of childbirth, the “maturity” of the neck of the makti, the intrauterine state of the fetus, etc.).
When prescribing induction of labor, the registration of the patient’s informed consent is mandatory.
