Obstetrics and Gynecology - A.M. Hromova 2000

Uterine Contractility Disorders
Classification of Labor Abnormalities
Premature Rupture of Membranes

The amniotic sac facilitates the physiological dilation of the cervix, ensures the proper functioning of the Placenta, and protects the maternal and fetal organisms from adverse and traumatic factors. When the sac is absent, the presenting part acts in its place.

In a physiological course of labor, the amniotic sac ruptures at full cervical dilation (10 cm), towards the end of The First stage of labor. If the amniotic sac ruptures before the onset of labor after 28 weeks of gestation, this is termed premature rupture of membranes. If the integrity of the amniotic sac is compromised with the onset of labor but prior to full cervical dilation, it is referred to as early rupture of membranes. If Amniotic Fluid leakage is observed with ОД and a complete amniotic sac is palpated upon examination, this constitutes a high lateral tear of the amniotic sac.

In cases of premature rupture of membranes at 28 to 35 weeks of gestation in the absence of inflammatory processes in the mother (normal Blood count, vaginal discharge showing up to 10-12 leukocytes per high-power field), an expectant management strategy is chosen, along with therapy aimed at maintaining the Pregnancy, preventing inflammatory complications, preventing Fetal Hypoxia, and promoting fetal lung maturation. If inflammatory complications are present, early delivery is performed. In cases of premature rupture of membranes after 35 weeks of gestation with an "immature" cervix, medications for cervical ripening must be prescribed, and labor induction should be carried out using uterotonic agents (oxytocin, Prostaglandins E2, F2a, desaminooxytocin, obsidan, etc.).

During labor, it is necessary to administer spasmolytics, analgesics, and provide prophylaxis against fetal hypoxia and infectious complications.

Postpartum, Hemorrhage prophylaxis is administered (oxytocin - 5 ОД or methylergometrine 1 ml with a 20% glucose solution intravenously).

If labor induction is ineffective, the issue of a Cesarean Section must be addressed in a timely manner.

Control Questions

1. Classification of Uterine Contractile Dysfunction.

2. Causes of Primary and secondary uterine inertia.

3. WHAT IS A pathological preliminary phase?

4. Write out prescriptions for antispasmodic drugs.

5. Name the medications used for the Prevention of fetal hypoxia.

6. What is the physician's management strategy in cases of uterine inertia?

7. What should a physician do in cases of abnormally vigorous labor?

8. What medications are used for postpartum hemorrhage prophylaxis?

9. What is uncoordinated labor?

10. Define premature, early, and high lateral rupture of the amniotic sac.

11. Define the physician's management strategy for untimely rupture of membranes.

12. What medications are used for labor induction?



Last update: 08/08/2026

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