Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their harbingers, and the uterus and her cervix prepare for generic process. In particular, the cervix begins to "ripen" and expand, that is, it enters the stage of opening the uterine os. Childbirth is a complex and lengthy process and is largely dependent on the interaction of the uterus, cervix and condition hormonal background, which determines their successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity with the vagina. Directly in the neck, the vaginal part is distinguished - the visible part that protrudes into the vagina below its arches. And also there is supravaginal - top part located above the vaults. In the cervix passes the cervical (cervical) canal, the upper end of it is called the internal pharynx, respectively, the lower end is the outer one. During pregnancy, there is a mucous plug in the cervical canal, the function of which is to prevent the penetration of infection from the vagina into the uterine cavity.

The uterus is the female reproductive organ, the main purpose of which is the bearing of the fetus (fetal container). The uterus consists of 3 layers: the inner is represented by the endometrium, the middle muscle tissue and outdoor serosa. The main mass of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during the birth act.

Periods of childbirth

The birth process lasts quite a long time, and normally in primiparous women in labor it is 10-12 hours, while in multiparous women it lasts about 6-8 hours. Childbirth itself includes three periods:

• I period - the period of contractions (opening of the uterine os);
• II period is called the period of attempts (the period of expulsion of the fetus);
• III period - this is the period of separation and discharge of the child's place (afterbirth), therefore it is called the afterbirth period.

The longest stage of the birth act is the period of opening of the uterine os. It is caused by uterine contractions, during which the fetal bladder is formed, the fetal head moves along the pelvic ring and cervical opening is provided.

Contraction period

First, contractions arise and are established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30 - 40 seconds, and relaxation of the uterus 80 - 120 seconds. Prolonged relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower uterine segment, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself is stretched and lengthened.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the small pelvis, separating the amniotic fluid, as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts as a hydraulic wedge, wedged into the internal os, opening it.

In first-borns, the latent phase of disclosure is always longer than in women giving birth for the second time, which causes a longer total duration of labor. Completion of the latent phase is marked by complete or almost complete smoothing of the neck.

The active phase begins with 4 cm of cervical dilatation and lasts up to 8 cm. At the same time, contractions become more frequent and their number reaches 3–5 in 10 minutes, the periods of contraction and relaxation of the uterus equalize and amount to 60–90 seconds. The active phase lasts for primiparous and multiparous 3-4 hours. It is in the active phase that labor activity becomes intense, and the cervix opens quickly. The fetal head moves along the birth canal, the cervix has completely passed into the lower uterine segment (merged with it), by the end of the active phase, the opening of the uterine os is complete or almost complete (within 8–10 cm).

At the end of the active phase, an autopsy occurs amniotic sac and outpouring of water. If the cervical opening has reached 8 - 10 cm and the water has departed - this is called a timely outflow of water, the discharge of water at the opening of up to 7 cm is called early, with 10 or more cm of opening of the pharynx, an amniotomy is indicated (the procedure for opening the fetal bladder), which is called a belated outflow of water.

Terminology

The opening of the cervix does not have any symptoms, only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing the neck is progressing, one should decide on obstetric terms. In the recent past, obstetricians determined the opening of the uterine os in the fingers. Roughly speaking, how many fingers the uterine pharynx passes through, such is the opening. On average, the width of the "obstetric finger" is 2 cm, but, as you know, everyone's fingers are different, so measuring the opening in cm is considered more accurate. So:

• if the cervix is ​​​​opened by 1 finger, then they say about the opening of 2 - 3 cm;
• if the opening of the uterine os has reached 3–4 cm, this is equivalent to opening the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
• an almost complete opening is indicated by the opening of the neck by 8 cm or by 4 fingers;
• full disclosure is fixed when the neck is completely smoothed (the edges are thin) and passable for 5 fingers or 10 cm (the head falls on pelvic floor, turning with an arrow-shaped seam into a straight size, there is an irresistible desire to push - it's time to go to the delivery room for the birth of the baby - the beginning of the second stage of childbirth).

How does the cervix mature?

The harbingers of childbirth that have appeared indicate the imminent onset of the birth act (from about 2 weeks to 2 hours):

• the bottom of the uterus descends (during 2-3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the small pelvis, a woman feels this sign by facilitating breathing;
• the pressed head of the fetus presses on pelvic organs(bladder, intestines), which leads to frequent urination and constipation;
• increased excitability of the uterus (the uterus “hardens” when the fetus moves, the woman moves abruptly, or when the abdomen is stroked / pinched);
• appearance is possible - they are irregular and rare, pulling and short;
• the cervix begins to "ripen" - softens, skips the tip of the finger, shortens and "centers".

The opening of the cervix before childbirth proceeds very slowly and gradually over a month, and intensifies on the last day - two on the eve of childbirth. In nulliparous women, dilatation cervical canal is about 2 cm, while in multiparous, the opening exceeds 2 cm.

To determine the maturity of the cervix, a scale developed by Bishop is used, which includes an assessment of the following criteria:

• the consistency (density) of the neck: if it is dense, it is regarded as 0 points, if it is softened along the periphery, but the inner pharynx is dense - 1 point, soft both inside and out - 2 points;
• the length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - a score of 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
• the patency of the cervical canal: a closed external pharynx or skips the tip of a finger - a score of 0 points, the cervical canal is passable to a closed internal pharynx - this is estimated at 1 point, and if the canal passes one or 2 fingers through the internal pharynx - it is estimated at 2 points;
• how the neck is located in relation to the wire axis of the pelvis: directed backwards - 0 points, shifted anteriorly - 1 point, located in the middle or "centered" - 2 points.

When summing the points, the maturity of the cervix is ​​​​estimated. An immature neck is considered with a score of 0 - 2 points, 3 - 4 points is regarded as an insufficiently mature or ripening neck, and with 5 - 8 points they speak of a mature neck.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to the maternity hospital and at 38-39 weeks at the appointment at the antenatal clinic).

If a woman is already in the maternity ward, a vaginal examination to determine the process of opening the uterine os every 4 to 6 hours or according to emergency indications:

• discharge of amniotic fluid;
• carrying out a possible amniotomy (weak birth forces, or a flat fetal bladder);
• with the development of anomalies of generic forces (clinically narrow pelvis, excessive labor activity, discoordination);
• before regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
• the occurrence of discharge with blood from the genital tract;
• in the case of established regular labor activity (preliminary period that turned into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of disclosure, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on soft tissues genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the swept suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. Be sure to evaluate the fetal bladder (integrity, functionality).

According to the subjective signs of disclosure and the data of the vaginal examination, a partogram of childbirth is compiled and maintained. Contractions are considered subjective signs of childbirth, in particular, the opening of the uterine os. Criteria for evaluating contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). Partogram of childbirth allows you to visually record the dynamics of the opening of the uterine os. A graph is drawn up, along which the duration of labor is indicated in hours, and the cervical dilatation in cm is indicated vertically. Based on the partogram, the latent and active phases of labor can be distinguished. The steep rise of the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

The opening of the cervix during pregnancy, that is, long after childbirth, is called isthmic-cervical insufficiency. This pathology characterized by the fact that both the cervix and the isthmus do not fulfill their main function in the process of gestation - obturator. In this case, the neck softens, shortens and smoothes, which does not allow the fetus to be kept in the fetus and leads to spontaneous abortion. Termination of pregnancy, as a rule, occurs in 2 - 3 trimesters. The failure of the cervix is ​​evidenced by the fact of its shortening to 25 mm or less at 20-30 weeks of gestation.

Isthmic-cervical insufficiency is organic and functional. organic form pathology develops as a result of various cervical injuries - artificial abortions (see), cervical ruptures during childbirth, operational methods treatment of cervical diseases. The functional form of the disease is due to either hormonal imbalance, or increased load on the neck and isthmus during pregnancy (multiple pregnancies, excess water or large fetus).

How to keep a pregnancy when dilating the cervix

But even with a cervical opening of 1 - 2 fingers in a period of 28 weeks or more, it is likely to keep the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases are appointed:

• bed rest;
• emotional peace;
• sedatives;
• antispasmodics (magne-B6, no-shpa,);
• tocolytics (ginipral, partusisten).

Be sure to carry out treatment aimed at the production of surfactant in the lungs of the fetus (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature opening of the cervix is ​​​​surgical - stitches are applied to the neck, which are removed at 37 weeks.

The cervix is ​​immature - what then?

The opposite situation is possible, when the cervix is ​​“not ready” for childbirth. That is, hour X has come (the expected date of birth), and even several days have passed - weeks, and structural changes in the neck is not observed, it remains long, dense, deviated backwards or anteriorly, and the internal os is impassable or passes the tip of the finger. How do doctors act in this case?

All methods of influencing the neck, leading to its maturation, are divided into drug and non-drug. TO medical methods includes the introduction into the vagina or into the cervix of special gels and suppositories with prostaglandins. Prostaglandins are hormones that accelerate the process of maturation of the cervix, increase the excitability of the uterus, and in childbirth they intravenous administration practice in case of weakness of tribal forces. Local administration does not produce prostaglandins systemic action(No side effects) and contribute to the shortening and smoothing of the neck.

From not medical methods cervical dilatation stimulation is used:

Sticks - kelp

Sticks are made from dried kelp algae, which are highly hygroscopic (absorb water well). Such a number of sticks are introduced into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for opening the cervix is ​​represented by a flexible tube with a balloon fixed at one end. A catheter with a balloon at the end is inserted into the cervical canal by a doctor, the balloon is filled with air and left in the neck for 24 hours. Mechanical action on the neck stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, in some maternity hospitals they refused to conduct a cleansing enema for a woman who came to give birth, but in vain. The free intestine, as well as its peristalsis during defecation, increases the excitability of the uterus, increases its tone, and, consequently, accelerates the process of opening the cervix.

Question answer

How can you speed up the opening of the cervix at home?

• long festivities fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the small pelvis, further stimulating the opening of the cervix;
• follow bladder and intestines, avoid constipation and prolonged abstinence from urination;
• eat more salads fresh vegetables seasoned with vegetable oil;
• take a decoction of raspberry leaves;
• stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
• Are there any specific neck opening exercises?

At home, walking up the stairs, swimming and diving, bending and turning the torso accelerates the maturation of the neck. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, yoga classes. In maternity hospitals there are special gymnastic balls, the seat and jumps on which, during the period of contractions, accelerate the opening of the uterine os.

Does sex really help prepare the cervix for childbirth?

Yes, sex in last days and weeks of pregnancy (subject to the integrity of the fetal bladder and the presence of a mucous plug in the cervical canal) contribute to the maturation of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, the semen contains prostaglandins, which have a beneficial effect on the process of maturation of the cervix.

At what opening do attempts begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in a woman in labor already at 8 cm. But until the cervix opens completely (10 cm), and the head sinks to the bottom of the small pelvis (that is, it can be felt by a doctor by pressing on the labia) - you can’t push.

I share my experience:
PDR - May 1-2, pregnancy and childbirth first. On Monday, April 20, I surrendered to the maternity hospital department of pathology to wait for childbirth, because on the 19th the uterus contracted all day (irregular, from very painful to completely painless) and the doctor said during the examination "the neck is beautiful, the bubble is pouring, now you can start giving birth any day" and recommended to stay in the hospital under supervision. I stayed (in fact, I’m still sitting here), but for some reason I changed my mind about being born. Last week at night there were several times sensitive contractions, but from Saturday they also passed. Now the stomach only periodically painlessly stony (this happened before). On April 24, they looked at me again on the armchair, the doctor said "the opening is 4 cm, the head is in the pelvis. Let's go give birth right now, huh?" I refused, because I really want the baby to get ready to go out on his own - without haste, naturally. the doctor accepted my arguments, promised that on April 25-26 I would probably give birth myself (without her, because she has days off). I was delighted, but nevermind. She did not give birth to the child. Yesterday, April 28, the doctor looked at the cervix again. She said dilation is "up to 5 cm". Again campaigned to go to give birth. I refused again. Then she put the question point-blank: like, decide when we will give birth - on the 29th or 30th. I tried to drag out the old "song about the main thing" - that we have nowhere to rush, we would have to do it naturally .. To which the doctor replied that there are more May holidays, I must understand that she also wants to go to the dacha, she won’t be here because of me May 1-2 in the city to sit. Those. if I am going to give birth on the May holidays, I will have to give birth with the duty team ("there will be no one else here, everyone has the weekend"). In general, I have a birth under a contract (with my husband, with the choice of a doctor and a stay after the birth in a superior room). My doctor is a deputy. the head physician of the maternity hospital (she is just involved in the contract childbirth program, and in general, as I understand it, "what she wants, she turns back"). Before concluding the contract, she explained to me and my husband that if the chosen doctor could not be present at the birth, another doctor would take delivery (also a doctor who conducts "payers" - but not the doctor on duty). Why now they suddenly tell me that there will be only a team on duty - hez .. In my opinion, the doctor is trying to put pressure on me for reasons of personal gain. With such an approach and attitude towards me of my “chosen” doctor, I don’t see how worse it is to give birth with the person on duty (especially since I didn’t particularly choose the “chosen” doctor, she herself volunteered, citing the fact that those doctors whom I I wanted to, either they will be on vacation, or they don’t suit me in terms of character). Out of confusion, I agreed to give birth on the 30th. However, after reflecting in a calm atmosphere, I came to the conclusion that I still do not like the situation. I really want to natural childbirth, and here it turns out that if the contractions themselves do not begin until tomorrow, they will stimulate me. On the other hand, how can it be that there is already such a disclosure, but there are no contractions? Maybe it's really time to stimulate? According to the ultrasound, everything seems to be in order, he is full-term, the degree of development of the lungs last Thursday was 2nd. Saturday CTG - in order, the child is moving as usual. As for the fact that he has a head in the pelvis - so, in my opinion, she has been there since the middle of pregnancy, she did an ultrasound at the 24th week somewhere, so the doctor was exhausted by the sensor under me pubic bone look, but we were looking for a pose for a very long time, in which the head would be visible. My belly either did not drop, or it dropped by 2 centimeters, no more. So it goes. What to do? Go look for a doctor and refuse tomorrow's birth, or what other options are there?

UPD: Thanks to the collective mind. It seems that my head and the brains attached to it fell into place, and I still decided to mow down from stimulation - at least until the moment _medical_ indications appear, other than the doctor's desire not to miss the May barbecue. I went to the doctor, calmly expressed my doubts to her, complained that I was very worried because I agreed to stimulation yesterday, and that I think it would be better if we still wait active action from the side of the child. The doctor did not quarrel with me, she only said that this is my business, I do not want to be stimulated - she is not going to force me. She repeated that in any case she was going to the dacha for May holidays, and I would still have to give birth in her absence with the duty team. I asked to clarify exactly how it will look in the form of a contract. It turns out that this will be the case, as originally promised - just a doctor allocated to payers is part of the duty team. In short, straight from the heart it was relieved :) I, by and large, don’t care which doctor to give birth with, the main thing is to ensure the naturalness of the process, as far as possible. And there was no sabotage on the part of the deputy chief physician, whom, to be honest, I had already begun to fear. And in the end, everything turned out not so scary.

The first stage of labor is the longest. In primiparas, it is from 8 to 10 hours, in multiparous - 6-7 hours. At the same time, the latent phase of labor (from the onset of contractions to the opening of the cervix by 4 cm) accounts for 5-6 hours (an average of 5.4 hours in primiparous and 4.5 hours in multiparous). This phase is painless or painless.

Conducting childbirth in the period of dilatation of the cervix

Contractions are established initially with a frequency of 1-2 in 10 minutes, the tone of the uterus is 10 mm Hg. Art. The duration of contraction of the uterus (systole of contractions) is 30-40 s, relaxation (diastole of contractions) is 2-3 times longer (80-120 s). Intrauterine pressure during contractions rises to 25-30 mm Hg. Art.

This phase is characterized by prolonged relaxation of the uterus after each contraction, especially the isthmus (lower segment and cervix), since each contraction causes the cervical tissue to move into the structure of the lower segment, as a result of which the length of the cervix decreases (the cervix shortens), and the lower segment of the uterus stretches , lengthens.

The presenting part is tightly fixed in the entrance of the small pelvis. The fetal bladder gradually, like a hydraulic wedge, is introduced into the area of ​​\u200b\u200bthe internal os, contributing to the opening of the cervix.

Cervical dilation period - latent phase

The latent phase in primiparas is always longer than in multiparas, which basically increases the total duration of labor. By the end of the latent phase, the neck is completely or almost completely smoothed out. The rate of cervical dilatation in the latent phase of labor is 0.35 cm/h.

Any medical correction in the latent phase of childbirth is not required. But in women of late or young age, in the presence of a burdened obstetric and gynecological history, any complicating factors, it is advisable to promote the processes of cervical dilatation and relaxation of the lower segment. For this purpose, appoint rectal suppositories co antispasmodic drugs(papaverine, no-shpa, baralgin) 1 every hour No. 3.

Cervical dilation period - active phase

In the active phase (opening of the cervix from 4 to 8 cm), there is a gradual increase in the tone of the uterus (up to 11-12 mm Hg). The frequency of contractions increases to 3-5 in 10 minutes, the duration of systole and diastole equalizes to 60-90 s. Intrauterine pressure during contractions rises to 40-50 mm Hg. Art. The duration of the active phase is almost the same in primiparous and multiparous women and is 3-4 hours. The active phase is characterized by intense labor and rapid opening of the uterine os. The opening rate is 1.5-2 cm / h in the primiparous and 2.5-3.0 cm / h in the multiparous. At the same time, the fetal head moves along the birth canal. At the end of the active phase, there is a complete or almost complete opening of the uterine os. The cervix completely merges with the lower segment of the uterus, the edges of the uterine os are at the level of the spinal plane.

The fetal head moves along the birth canal synchronously with the opening of the uterine os. Thus, at 6 cm of opening of the uterine os, the head is located in a small segment at the entrance of the small pelvis or is +1 cm away from the spinal plane. At 8 cm of opening, the fetal head descends as a segment into the entrance of the small pelvis (+2 cm). When fully opened, it is located in the pelvic cavity, most often already on the pelvic floor. With coordinated labor activity in the active phase of labor, reciprocity (conjugation) of the activity of the upper and lower segments of the uterus takes place. Contraction of the fundus and body of the uterus is accompanied by active relaxation of the lower segment of the uterus. The curve of the external hysterography, reflecting the state of the lower segment, has a curve opposite to the upper segment (mirror reflection).

The intensity of labor activity in this phase increases, the tone and frequency of contractions also increase, the rate of cervical dilatation is maximum, contractions most often become painful. In the active phase of labor, it is especially important to maintain the normal basal tone of the uterus, since with hypertonicity of the myometrium (13 mm Hg or more), the frequency of contractions increases above normal values ​​(over 5 per 10 minutes), and the amplitude (strength) of the contraction decreases. This leads to ruptures of the cervix, disruption of the uterine, uteroplacental and fetal-placental blood flow, fetal hypoxia. There may also be a decrease in basal tone (less than 10 mm Hg), leading to a decrease in the frequency of contractions and a decrease in intrauterine pressure. Childbirth with both options is delayed.

The outflow of amniotic fluid with uterine hypertonicity helps to reduce intramyometrial pressure and can normalize uterine contractions. In order to determine the nature of the violations of contractions that have arisen, one should first of all evaluate the tone of the myometrium (decreased, increased, normal), as well as the rhythm, frequency, duration and strength of the contraction. Labor activity is the work of the uterus (of course, and the whole body of the woman in labor), aimed at opening the birth canal, promoting and expelling the fetus, separating and isolating the placenta.

This work is carried out mainly due to the mechanical contractile function of the uterus and is provided with the necessary energy of biochemical, metabolic, oxidative processes, intensification of the activity of the cardiovascular, respiratory, neuroendocrine and autonomic processes. nervous systems. With an average amplitude of contraction of the upper segment of the uterus, which is 50 mm Hg. Art., normal basal tone of the uterus in 10-12 mm Hg. Art., the number of contractions in childbirth ranges from 240 to 300 (24-30 contractions per hour). This work often causes fatigue, fatigue in a woman in labor, especially since the contractions are almost always painful, they begin at night, which the woman spends in anxiety and excitement.

In the active phase of childbirth, it is necessary to apply drug anesthesia(nitrous-oxygen analgesia or a single injection of promedol 20 mg) in combination with antispasmodic drugs. The latter are especially useful for the prevention of cervical rupture, smoother opening of the cervix and stretching of the vaginal walls. Antispasmodics (no-shpa 4 ml or baralgin 5 ml) are administered either intravenously by drip or intravenously simultaneously (2 ml with glucose solution).

Amniotic fluid - outpouring

The fetal bladder bursts at the height of one of the contractions when opening 6-8 cm. 150-200 ml of light (transparent) amniotic fluid is poured out.

If there was no spontaneous outflow of amniotic fluid, then when the uterine os is opened by 6-8 cm, an artificial amniotomy is performed. However, in this case, it is advisable to pre-administer antispasmodic drugs so that too rapid a decrease in the volume of the uterus does not provoke hypertonic contraction dysfunction.

Amniotomy is accompanied by a short-term decline in uteroplacental blood flow and a change in the heart rate of the fetus (often bradycardia). Therefore, in addition to antispasmodics, 40.0 ml of a 40% glucose solution and 5 ml of a 5% solution are prescribed before amniotomy. ascorbic acid, 150 mg of cocarboxylase, supporting the energy level and oxygenation of the fetus.

Cervical dilation period - third phase

The third phase of the first stage of labor (not expressed in all women in labor) is called the deceleration phase. It is determined from the moment of opening the cervix by 8 cm and continues until the full (10-12 cm) opening of the uterine os. Its duration is from 20 to 60 minutes.

In this short phase of slowing down labor activity, the tone of the uterus changes (increases by another 2-3 mm), the strength (amplitude) of contractions weakens somewhat, the frequency remains the same (from 4.4 to 5 contractions in 10 minutes).

The physiological essence of this phase is that the contractile activity of the uterus is rebuilt to the function of fetal expulsion. The entire uterus acts in the same direction. Uterine contractions occur synchronously from the bottom to the uterine os. The task is one - to expel the fetus from the birth canal. At the same time, all departments and layers of the uterus contract and relax.

The deceleration phase is considered transitional from the first stage of labor to the second. The delayed phase of labor is based on two factors of biological expediency: one is the need for a slower (careful) advancement of the fetal head through the spinal plane - the narrowest part of the closed bone ring of the pelvis, and the second - in the accumulation energy potential uterus for the most intense work in a relatively short period of time.

The delayed phase of the first stage of labor is isolated so that the doctor does not rush to diagnose the secondary weakness of labor and does not apply unindicated labor stimulation.

During the entire first stage of labor, the condition of the mother and her fetus is constantly monitored. They monitor the intensity and effectiveness of labor activity (the number of contractions in 10 minutes, the duration of contraction and relaxation of the uterus, its tone), the condition of the woman in labor (health, pulse rate, respiration, arterial pressure, temperature, discharge from the genital tract).

Cervical dilatation period - condition Bladder and intestines

In childbirth, it is necessary to monitor the function of the bladder and intestines. Overflow of the bladder and rectum prevents the normal course of the period of disclosure and expulsion, the release of the placenta. Overflow of the bladder can occur due to its atony, in which the woman does not feel the urge to urinate, as well as due to pressing urethra to the pubic symphysis with the fetal head. In order to prevent overflow of the bladder, the woman in labor is offered to urinate every 2-3 hours. In the absence of independent urination, catheterization is used. Timely emptying is important lower section intestines (enema before childbirth and during their protracted course). In the history of childbirth, the presence or absence of spontaneous urination every 2 hours is noted. Difficulty or lack of urination is a sign of pathology.

Vaginal examination during childbirth

A vaginal examination during childbirth is performed to maintain a partogram (WHO, 1993), orientation in the insertion and advancement of the head, assessment of the location of the sutures and fontanelles, i.e., to clarify the obstetric situation.

Mandatory vaginal examinations are indicated in the following situations:

• when a woman enters the maternity hospital;
• with the discharge of amniotic fluid;
• with the onset of labor (assessment of the condition and disclosure of the cervix);
• with anomalies of labor activity (weakening or excessively strong, painful contractions, as well as early onset attempts);
• before anesthesia (find out the cause of painful contractions);
• with the appearance of bloody discharge from the birth canal.

The results of the vaginal examination reflect the effectiveness of labor activity (the degree of opening of the uterine os, the advancement of the fetal head), the biomechanism of childbirth.

You should not be afraid of frequent vaginal examinations, it is much more important to ensure their complete safety in terms of asepsis, antisepsis and atraumaticity (carry out with cleanly washed hands, in sterile gloves using disinfectant solutions, sterile liquid vaseline oil). Research must be carried out gently, carefully and painlessly.

During vaginal examination during childbirth, attention should be paid not only to the degree of cervical dilatation, the position of the sutures and fontanelles of the fetus, the pelvic bones and its capacity, but also to the condition of the edges of the cervix.

During normal labor, the edges of the cervix are thin, soft, easily extensible. In a fight, the edges of the neck do not tighten, which indicates a good relaxation of the tissues; the fetal bladder is well expressed. In the pause between contractions, the tension of the fetal bladder weakens, and through membranes it is possible to determine identification points on the head: sagittal suture, posterior (small) fontanelle, wire point.

The position of the woman in childbirth

Particular attention deserves the position of the woman in childbirth. Historical evidence shows that the supine position has been predominantly common in France since the 17th century, when Marie de Medici, the daughter-in-law of Countess Duchesse Monpezier, Marie de Medici, gave birth in this position in the presence of the royal court midwife, Louise Burgois, and the barber-obstetrician, Julien Clémont. Childbirth in the presence of a man led to the spread in the higher spheres of the position of the woman in labor on her back. This custom was widely promoted by such famous obstetricians as Pare and Morisot. Childbirth on the back has become a tradition for a number of centuries. Obstetric practice readily accepted this method as beneficial and convenient, first of all, for the obstetrician (it is more convenient to conduct a vaginal examination, listen to the fetal heartbeat, carry out cardiac monitoring, etc.).

However, a comprehensive assessment of the various positions of the woman in labor, carried out independently in 3 centers (Germany, Spain and the USA), showed that the position of the woman in labor on her back is not the most beneficial for the contractile activity of the uterus (contractions weaken), for the fetus (uteroplacental blood flow decreases ) and for the woman herself (danger of compression of the inferior vena cava). In this regard, most obstetricians recommend that women in labor in the first stage of labor sit, walk (for short periods of time), stand or lie on their side. In the future, apparently, it will be possible for a woman in labor to stay in a warm pool in the first stage of labor.

You can get up and walk with whole or outflowing waters, but with a tightly fixed fetal head in the pelvic inlet.

If the localization of the placenta is known (according to ultrasound data), then the position of the woman in labor on the side where the back of the fetus is located is optimal. In this position, the frequency and intensity of contractions do not decrease, the basal tone of the uterus retains normal values. In addition, studies have shown that this position improves the blood supply to the uterus, uterine and uteroplacental blood flow. The fetus is always located facing the placenta.

A woman in labor in the first stage of labor

In the first stage of labor, active phase dilatation of the cervix, a woman in labor can perform psychoprophylactic analgesia techniques. Feeding a woman in labor during childbirth is not recommended for a number of reasons: the food reflex during childbirth is suppressed. During childbirth, a situation may arise in which anesthesia is required. The latter creates a risk of regurgitation (aspiration of the contents of the stomach) and the development of Mendelssohn's syndrome.

During childbirth, the position and advancement of the head in relation to the plane of the entrance of the small pelvis and in relation to the spinal plane (the most narrow plane small pelvis). They listen to the fetal heartbeat (the results are recorded in the history of childbirth), but most often they carry out constant cardiomonitoring. Coordinated contractions of the uterus during childbirth provide a normal biomechanism of labor.

Identification points at different positions of the fetal head

Recall the identification points at different positions of the fetal head in relation to the main planes of the pelvis.

1. Head above the entrance of the small pelvis. The entire head is located above the entrance of the small pelvis, movable or pressed against the entrance of the small pelvis. During vaginal examination: the pelvis is free, the head is high, does not interfere with the palpation of the border (nameless) lines of the pelvis, the cape (if it is achievable), the inner surface of the sacrum and the pubic symphysis. Sagittal suture in transverse size at the same distance from the pubic symphysis and promontory, anterior and posterior fontanelles at the same level (with occiput presentation). In relation to the spinal plane, the head is in position -3 or -2 cm.

2. The head at the entrance of the small pelvis with a small segment. The head is motionless. Most of it is above the entrance to the pelvis, a small segment of the head is below the plane of the entrance to the pelvis. During vaginal examination: the sacral cavity is free, you can approach the promontory with a bent finger. The inner surface of the pubic symphysis is accessible for examination, the posterior fontanelle is lower than the anterior one (flexion). The sagittal suture is transverse or slightly oblique. In relation to the spinal plane, the head is -1 cm apart.

3. Head at the entrance of the small pelvis with a large segment. With an external examination, it is determined that the head with its largest circumference (large segment) has descended into the cavity of the small pelvis.

The smaller segment of the head is palpated from above. During vaginal examination, the head covers the upper third of the pubic symphysis and sacrum, the cape is not achievable, the ischial spines are easily palpable. The head is bent, the posterior fontanel is lower than the anterior, the sagittal suture is in one of the oblique dimensions. In relation to the spinal plane - "O".

4. Head in a wide part of the pelvic cavity. With an external examination, only a small part of the head is probed. During vaginal examination - the head of the largest circumference passed the plane of the wide part of the pelvic cavity; 2/3 of the inner surface of the pubic symphysis and the upper half of the sacral cavity are occupied by the head. The vertebrae SIV and Sv and the ischial spines are freely palpable. The sagittal suture is located in one of the oblique dimensions. In relation to the spinal plane, the head is +1 cm apart.

5. Head in the narrow part of the pelvic cavity. During vaginal examination, it is determined that the two upper thirds of the sacral cavity and the entire inner surface pubic symphysis are occupied by the head. Only vertebrae SIV and SV are palpated. The sagittal suture is in an oblique size, closer to a straight one. The head with the lower pole is in the +2 cm position.

6. Head in the outlet of the pelvis. On external examination, the head is not palpable. The sacral cavity is completely filled with the head, the ischial spines are not defined, the sagittal suture is located in direct size the exit of the small pelvis (in relation to the "0" plane +3 cm).

The process of resolving the burden is interesting for every expectant mother. Most multiparous women already imagine what they will have to face. Newly-made expectant mothers before childbirth are in a state of excitement and uncertainty. In order for the baby to appear in accordance with all the rules and in a natural way, a woman must have a complete It is about this process and will be discussed in the article. You will learn the main stages and terms of the transformation of the cervical canal. You can also find out what it means when the cervix dilates by 1 finger.

reproductive organ

The woman's uterus is unique and very interesting body. Inside it is lined with a mucous membrane, which in the process menstrual cycle constantly changing. With the onset of conception, this so-called sac becomes the place where the fetus grows and develops.

The uterus consists of several parts. At the very beginning, it has an entrance, which is called the internal pharynx. A tube comes out of it. This segment ends with another pharynx, only this time external. This hole is the cervix. It is already in the woman's vagina. It is there that the unborn baby passes during childbirth.

Cervix during pregnancy

During the bearing of the baby, this mucous pharynx is tightly sealed. A cork is collected in its internal space, which will come out only shortly before the onset of labor. In this way, the baby is reliably protected from infection entering his body.

The cervix during the second and subsequent pregnancies may be slightly open. However, the internal pharynx is still securely and tightly sealed. This prevents the fetus from developing premature birth. When the time comes for the baby to be born, the cervical canal begins to gradually expand. This can happen normally after. However, most expectant mothers feel signs of cervical dilatation only a few days before childbirth.

Opening of the cervix

Immediately before the birth of the baby, there is an increased expansion of the cervical canal. Most often, this process is carried out in the period from the 36th to the 42nd week of pregnancy. However, in some cases, premature opening of the cervix occurs. You will learn more about it below.

A slight expansion of the cervical canal is facilitated by training contractions. During them, the woman feels the tension of the anterior wall of the abdomen. The uterus becomes very hard and presses down. In most cases, such sensations do not pose any threat to the life of the child and the condition of the expectant mother. However, if training contractions appear more than four times in an hour, then it is worth notifying your doctor about this.

How is the opening of the cervix before childbirth? going on this process maybe in several stages. Consider how the expansion of the cervical canal is carried out (stages and terms).

Stage one: slow

At this point, the woman's contractions are already quite regular. There is a contraction of the uterus with an interval of 7-10 minutes. The duration of one contraction is 30-50 seconds. The woman notes that the sensations are painless, but there is some discomfort.

It is usually noted at the first stage of childbirth the opening of the cervix by 1 finger. In this case, in primiparas, the internal os first expands. Only after that the outer hole is transformed. Women who have already given birth undergo simultaneous opening of the cervical canal along its entire length.

The first stage of cervical dilatation can last from 4 to 12 hours. In the end this period are joining drawing pains in the waist. Many representatives of the weaker sex compare these sensations with menstrual pain.

Stage two: fast

During this period, the woman should already be in the hospital. Only in medical institution specialists can sensibly assess the condition of the woman in labor and, if necessary, provide her with timely assistance. Contractions during the rapid opening of the cervix are already quite painful. They are marked with an interval of one or two minutes. In this case, the duration of the contraction of the genital organ can be approximately 3-5 minutes.

The speed at this stage is one centimeter per hour. However, these data can be considered conditional. The body of each woman is individual, and the process can proceed in completely different ways.

Stage three: full disclosure

When the complete expansion of the cervical canal occurs, the expectant mother is already in the hospital. During this period, the baby's head has already entered the pelvis and the baby is ready to be born. Doctors lay the woman in labor on a special chair called a table and ask her to push.

Full dilatation of the cervix always ends in childbirth. After this, the reverse transformation of the cervical canal and the reproductive organ of the woman occurs.

Fourth stage: narrowing of the cervix

The opening of the cervix by 1 finger remains after childbirth for about one month. In the first days after the process, the cervical canal can be expanded up to five centimeters. The uterus remains enlarged and gradually shrinks in size.

Around the end of the fourth week reproductive organ returns to normal, and the cervix becomes the same as before childbirth. It is worth noting that in women who have given birth, the entrance to the cervical canal has an oblong shape. Whereas for the fairer sex, who have not yet become mothers, it is round.

Opening the cervix for 1 finger: when to give birth?

Many women who are preparing to become mothers hear a similar diagnosis. What does it mean?

Gynecologists and obstetricians always measure the dilation of the cervical canal in the fingers. The full opening of the reproductive organ forms a hole of 10 centimeters. One finger is about two centimeters long. If you have found the position of the cervix described above, then you can assume that the opening in the cervical canal has reached about 2 cm. When can you expect the onset of labor? It all depends on the woman's body. Let's look at a few popular situations.

Labor will start in a few hours

If the expectant mother has a cervical canal opening of one centimeter, then childbirth may well begin within a few hours. In this case, the position of the cervix must also be taken into account. It must be straight. It is also necessary to determine the length of the cervical canal. This distance does not exceed one centimeter. If these indicators are distinctive, then, most likely, the woman is not yet quite ready for the birth of a baby.

Few weeks left before delivery

How to determine the dilatation of the cervix? Very simple. This can be done by an obstetrician or gynecologist during a routine examination. With the expansion of the cervical canal to one finger, a woman may well go a few more months before giving birth. Often, in multiparous women, such indicators are found already at the 32nd week of pregnancy. However, the representatives of the weaker sex safely carry the baby to the prescribed 40 weeks.

If there are no contractions, pains or bloody issues from the vagina, the woman is usually allowed to go home. However, if the due date has already come, and the cervix is ​​still not ready, then the doctors perform stimulation. It consists in the introduction of certain drugs that contribute to the speedy expansion of the cervical canal and the onset of contractions.

Can the cervix dilate prematurely?

It also happens that a woman has a cervical canal opening of one centimeter, but the gestational age is still quite short. In this case we are talking about premature dilation of the cervix. In this case, there is a threat of interruption of the course of pregnancy. Treatment is most often carried out urgently. This necessarily takes into account the state of health of the woman and the position of the fetal bladder.

If a 3 cm dilatation of the cervix is ​​detected, then it is still quite possible to save the pregnancy. Usually, the expectant mother is sutured to the external pharynx or a pessary is placed. These devices allow you to carry the baby to the due date and prevent further expansion of the mucous membranes.

When the opening of the cervix is ​​quite large and the fetal bladder has already descended into the pharynx, there is practically no chance of carrying a child before the due date. In this case, the expectant mother is prescribed complete rest and At the same time, drugs are administered that contribute to rapid development the fetus and the beginning of its respiratory system.

Cervical opening: sensations

Can you feel that the cervical canal has expanded to one finger? The opinions of experts on this matter are very controversial. In most cases, a woman does not feel this process. It is asymptomatic and painless. However, many expectant mothers note the presence of training contractions. So the reproductive organ prepares for the expulsion of the fetus from its cavity.

You can feel the opening of the cervix on one finger quite clearly when the woman's water has broken. In this case, the baby's head descends into the small pelvis and strongly presses on the internal pharynx, causing it to expand. The woman begins to feel regular cramping pains in the lower abdomen, which subsequently spread to the entire abdominal cavity.

Another sign that the cervix has opened to one finger is the discharge of the mucous plug. However, it may not come out completely, but only partially. With a stronger expansion of the cervical canal, the lump departs completely.

What to do if the cervical dilatation is set to one finger?

Everything will whistle on how long your pregnancy is. If the expectant mother is already ready for childbirth and the fetus is full-term, then nothing needs to be done. Most likely, contractions will begin in the near future, which will end in natural childbirth.

If, however, there are still a few months left before the expected day of resolution of the burden, then it is necessary to reasonably assess the condition of the expectant mother. In some cases, correction is required medications and compliance bed rest. Other situations do not cause concern, and a woman may well lead a normal life.

At the beginning of the process of opening the cervix, it is necessary to carry out especially careful monitoring. future mother must be examined on the chair at least at each appointment. In some cases, additional visits to the gynecologist are scheduled for diagnostics. It may also be recommended ultrasound procedure for exact definition state of the internal os.

Summarizing

You now know how the cervix opens during childbirth. You also found out the features of the situation when the cervical canal is expanded to one finger. Remember that if the opening of the cervix has begun, infection of the fetus may occur. That is why it is worth avoiding unprotected sexual intercourse, bathing in the bath and public reservoirs. Visit the doctor more often and follow all appointments. Successful childbirth!

Normal births never happen spontaneously. A few weeks before this event, changes in the cervix begin to occur. These changes will help the baby to be born. The fact that the baby will soon see the world is evidenced by some signs: the appearance of contractions, the discharge of water. During contractions, the cervix begins to open before childbirth, and this process determines how well the birth will go.

Childbirth: stages

Childbirth is the process of expulsion of the fetus and placenta from the uterus, during their normal course, the process is carried out naturally. In cases where you have to resort to various delivery methods surgical methods, childbirth is called operational.

To that important event in her life, a woman should approach in full readiness - if a woman has a good idea of ​​what will happen to her and how, it will be much easier for her to give birth.

Childbirth consists of periods:

Opening of the cervix;
expulsion of the fetus;
the birth of the afterbirth.

The longest in time is the first period, during which, as a result of uterine contractions, a fetal bladder is formed, the fetus moves along birth canal, resulting in full disclosure of the cervix during childbirth and the baby is born. In primiparous childbirth lasts up to twelve hours, for multiparous this period of time is much less - up to eight hours. Knowing how many cm is the opening of the cervix during childbirth, you can accurately name which phase of the contractions passes, how long this process will continue.

The uterus is responsible for carrying the fetus, which is a hollow muscular organ, consisting of three parts:

bottom;
body;
necks.

The processes of gestation and childbirth depend on the state of the cervix.

Opening of the cervix

Preparation of the cervix for childbirth begins at about the 32nd week. The density of the tissue area near the cervical canal still remains, but in other places the cervix softens, this process is completed by the 38th week of pregnancy. Now the fetus descends into the small pelvis and with its weight presses on the neck, which contributes to its even greater opening.

If the doctor announced to the woman that the disclosure of 1 finger, she begins to wonder how long to wait for childbirth. But this so far suggests that the pregnant woman is only physiologically prepared for childbirth. And they will begin when regular contractions appear. Therefore, opening by 1 finger will not tell you how much time is left before the birth, but will indicate that you are ready for labor. This readiness can be judged by several other parameters.

In addition to opening to the finger and softening, the neck should be shortened to a length within one centimeter. At the same time, it begins to settle down in the center of the small pelvis, although more recently it has been somewhat deviated to the side. There should also be a discharge of the mucous plug that protected the uterus throughout the pregnancy. The discharge of the cork indicates that the cervix is ​​​​ripe, and contractions may soon begin. First, the internal pharynx of the cervix opens, as the fetus moves along the birth canal, the external pharynx also stretches. In women who have given birth, this disclosure occurs simultaneously, so the whole process takes a much shorter period of time than in a primipara. And if, for example, the disclosure is 3 cm, then how long will the birth begin?

By the way, obstetricians and gynecologists often call the size of the neck opening not in centimeters, but focusing on the size of their fingers. Therefore, it is much more common for a doctor to hear - how many fingers should be open during childbirth?

Sometimes it happens that labor is already beginning, and the cervix is ​​not ready at all and is not going to open. In this case, the doctor will apply stimulation, otherwise the fetus will experience a lack of oxygen, because the placenta begins to age rapidly and lose the ability to perform its main functions.

Contraction period

Contractions refer to the first, longest, period of labor, which lasts until the cervix opens, allowing the fetus to pass. Many women are interested in the question - how many fingers should be disclosed in order for labor to begin? It can be said that before the onset of labor, the cervix is ​​​​flattened and open for at least two fingers. To answer the question - if a woman in labor has two fingers opened, then after how long she will give birth, then first you need to consider how the opening goes during contractions. But first things first.

The period of contractions is divided into a slow period, called latent, and fast (the so-called active phase of contractions). Contractions last 10-12 hours in nulliparous women and 6-8 hours in women who have given birth.

The latent phase begins from the moment when the rhythm of contractions is established, they occur with a frequency of one or two contractions in 10 minutes, this phase lasts about six hours and usually passes without severe pain. In primiparas, this phase always lasts longer. The use of medicines is not yet required, but for too young or, conversely, more late age women, may need to be applied antispasmodics. At this time, a disclosure of 3 cm is already observed, however, it will not be possible to say exactly how long the birth will begin. IN this moment there is still an alternating contraction of the muscles of the uterus and their relaxation, as a result of which the length of the neck is shortened, the head of the fetus is located at the entrance to the small pelvis, the fetal bladder begins to put pressure on the internal pharynx, causing it to open.

If there was a disclosure of 3-4 cm, then after how much the birth will begin, the doctor already sees. Complete smoothing of the neck and a dilatation of 4 cm indicates that the active phase of contractions begins. This phase for both primiparous and women who have already given birth lasts up to four hours. During this period, the subsequent disclosure is already very fast. For every hour, the cervix opens 2 cm in primiparas, and 2.5 cm in recurrent births.

If the disclosure is 5 cm, then after how much labor will begin - the doctor knows for sure. In order for the fetal head and torso to be able to pass through the birth canal, the cervix must open up to 10, sometimes up to 12 cm. Therefore, in the active phase, an experienced doctor can accurately determine both the time of birth and their course. For example, if the opening is already 6 cm, it is quite simple to answer the question - after how long the birth will begin, you just need to calculate how many centimeters are left before the cervix is ​​fully opened. At this time, the baby's head is already moving through the birth canal and the cervix opens faster and faster. The most painful contractions become after five centimeters of opening. This pain is natural, but not every woman can withstand this pain. To maintain the state of the pregnant woman at this time, apply various methods anesthesia. These can be non-drug methods:

Massage;
Adoption warm baths;
listening to soothing music;
various exercises.

If these methods are not enough, the obstetrician-gynecologist will prescribe a medication pain reliever, based on the characteristics of the woman, the complexity of the course of childbirth, and the pain threshold.

With a 3-finger opening, after how much labor will begin - you can answer quite accurately - after about two hours, the contractions should end, after which attempts will begin. By the end of the active period of contractions, the neck is already completely open, or almost completely. Usually at this time the waters break, it is believed that this is a timely process. However, if the water does not drain on its own when the cervix is ​​fully opened, the doctor has to perform a procedure for opening the fetal bladder, called an amniotomy.

Full disclosure of the cervix will occur with sufficient labor activity. With weak labor activity or its absence, the cervix does not open. In this case, it comes to stimulate labor activity.

What does the opening of the cervix look like during childbirth - we examined. Let's try to consider whether it is possible to influence this process with the help of posture.

Poses

It turns out that the horizontal position we are accustomed to slows down the process of childbirth, prevents the uterus from contracting normally, slows down the opening, and at the same time increases the pain. With the right posture, you can relieve pain, stimulate tribal activity. What postures during childbirth are favorable for opening the cervix:

Vertical, in which, due to the force of gravity, the weight of the child is directed downward. At the same time, the child presses harder on the cervix, causing it to open faster, with attempts, it is also easier for the child to pass in this position.

Sitting position. In this case, care must be taken that the surface should be elastic, but in no case hard. For this, large inflatable balls are well suited, which will contribute to a faster opening of the neck. The legs should not be closed, it is better to spread them as much as possible to the sides.

True, in some cases, the horizontal pose will still remain necessary option, for example, when rapid labor, at breech presentation fetus and in some other serious violations of the process of childbirth.