17.1. ACTUALITY, EPIDEMIOLOGY
Abnormalities of uterine contractility constitute the most common complication of labor diagnosed in 10-15% of parturient women; in about every third case it is an indication for intrapartum cesarean delivery. Up to the present moment there are no effective methods for prevention and treatment of various disturbances of uterine contractility. Abnormalities of uterine contractility in labor can lead to dangerous complications both for the mother and fetus: premature detachment of normally situated placenta, lacerations of soft tissues in the birth canal, uterine rupture, fetal hypoxia and injury, etc.
17.2. HISTORICAL ASPECT
The first mention of commonly noted painful or protracted but inefficient labor dates back to classical literature. Thus, Hippocrates in his work mentions the procedure of instrumental and manual dilation of the cervix when labor is ineffective.
In the 12th and 13th centuries a sponge drenched in opium solution was used to relieve labor pain. The method was proposed by Hugh of Lucca and Theodoric.
In the 19th century famous obstetricians J. Simpson and A.J. Krassovsky (1889) suggested administration of chloroform as obstetric anesthesia to treat precipitous labor.
The Russian obstetrician N.N. Fenomenov (1907) proposed instrumental dissection of a rigid cervix if pharmaceutical therapy failed.
In his textbook on obstetrics A. Bumm pointed out in 1908 that therapy of spasmodic pain requires administration of narcotic agents in large doses.
Oxytocin began to be administered in maternity departments for treatment of hypotonic contractions in labor while β-adrenomimetics were administered in case of hypertonic contractions.
The second half of the 20th century witnessed a new era in treatment of labor abnormalities. The rise of a new discipline, Anesthesiology and Critical Care, promoted the development and introduction of methods for labor analgesia, management of dystocia and precipitous labor, introduction of methods of regional anesthesia (epi-dural nerve block).