Preliminarian period

Discussions about the role and significance of the preliminary period have been going on in the literature for a long time. Much attention to this problem is due to its serious importance for the prevention of the occurrence of anomalies of labor.

Every obstetrician is familiar with cases of pregnant women admitted to labor with cramping pains in the lower abdomen and lower back, but without the structural changes in the cervix typical of the first stage of labor. In foreign literature, this condition is often described as "false labor". According to the founder of the Kazan school of obstetricians and gynecologists V. S. Gruzdev (1922), during this period, uterine contractions are often slightly painful, while in some women, on the contrary, with weak contractions, there is excessive pain, depending on the increased sensitivity of the uterine muscle ("uterine rheumatism" in the figurative expression of old obstetricians), to which older researchers attached great importance in the pathology of labor. E. T. Mikhailenko (1975) points out that the period of cervical dilation is preceded by a period of precursors and a preliminary period. According to G. G. Khechinashvili (1973), Yu. V. Raskuratov (1975), its duration ranges from 6 to 8 hours.

There are various hypotheses about the causes of the preliminary period. One of the most convincing interpretations seems to us to be the lack of biological readiness for childbirth. Thus, G. G. Khechinashvili, assessing the condition of the cervix in pregnant women in the preliminary period, indicates the presence of a mature cervix in 44% of cases; in 56%, the cervix was poorly or insufficiently prepared. According to Yu. V. Raskuratov, who performed a functional cervical-uterine test in addition to palpation of the cervix, 68.6% of pregnant women with a clinically expressed preparatory period had a mature cervix.

A special device has now been developed to determine the degree of maturity of the cervix. Some obstetricians consider cases of clinically expressed preparatory period as a manifestation of primary weakness of labor activity and, based on this assessment, suggest using labor-stimulating therapy as early as possible.

V. A. Strukov (1959) considers it acceptable to use even prophylactic labor stimulation, and to diagnose weakness of labor within 12 hours from the onset of contractions. However, it should be emphasized that labor stimulation does not always lead to a positive effect. Thus, according to P. A. Beloshapko, S. A. Arzykulov (1961), labor stimulation methods are effective in no more than 75% of cases.

To date, no uniform tactics for managing pregnant women with a preliminary period have been developed. Some researchers claim that in the presence of a preliminary period, the use of tranquilizers, antispasmodics, and estrogens is indicated. A. B. Gilerson (1966) believes that untimely administration of labor inducers does not produce the desired effect, and often has an adverse effect on the subsequent course of labor, leading to discoordination and weakness of labor. Some other researchers are of the same opinion.

It is important to note that, according to G. M. Lisovskaya et al. (1966), the frequency of anomalies of labor forces during labor that began with preliminary contractions was 10.6 times higher than this indicator in the group of labors that began without precursors, and according to G. G. Khechinashvili (1974), in women with physiologically developing pregnancy, primary weakness of labor was observed in 3%, and in those studied who had undergone a clinically expressed preparatory period - in 58% of cases.

Another very important aspect of the problem is that a pathologically proceeding preliminary period increases the number of unfavorable outcomes in children. Thus, according to Yu. V. Raskuratov (1975), in this contingent of women, in 13.4% of cases the fetus experiences hypoxia, which is the result of neuroendocrine disorders at the end of pregnancy and pathological contractile activity of the uterus.

We examined 435 pregnant women with a preliminary period. There were 316 primiparous women and 119 multiparous women. 23.2% of the examined women had menstrual cycle disorders, which probably indicates that every 5th woman has hormonal disorders during the preliminary period.

In the group of primiparous women, the overall percentage of complications and somatic diseases was 46.7%, in the group of multiparous women - 54.3%.

We consider it appropriate to divide the preliminary period into two types: normal and pathological.

Clinical signs of a normal (uncomplicated) preliminary period are rare, weak cramping pains in the lower abdomen and lower back, not exceeding 6-8 hours and occurring against the background of normal uterine tone. In 11% of the examined women, contractions weakened and completely ceased, with subsequent occurrence a day or more later. In 89%, preliminary contractions intensified and turned into labor contractions.