Stimulation of labor activity. Weak labor activity - causes, symptoms, what to do What weak labor activity looks like

Along with the exacerbation of the maternal instinct, by the end of pregnancy, many women experience anxiety about the upcoming birth. This is quite understandable, since the birth of a beloved and long-awaited baby is quite an important and responsible event in a woman's life. If the pregnancy proceeded without complications, all that a woman in labor needs to do for a successful birth is to trust nature. Yes, yes, it is nature, and not an obstetrician-gynecologist, whose powers include monitoring normal childbirth and providing medical assistance only if something does not go according to plan. The female body was originally programmed to bear offspring, therefore, everything that happens to the expectant mother during childbirth is quite natural.

Sometimes it happens that childbirth for one reason or another does not begin on time. Well, the expectant mother should not go forever pregnant, so various methods of stimulating childbirth come to the rescue.

Stimulation of labor activity. Salvation or harm?

Undoubtedly, interference in the mysterious and amazing process of childbirth is not to the liking of pregnant women. Most women yearn for their baby to be born without any medications and medical manipulations, but in some cases this cannot be avoided.

In the absence of special indications, stimulation of labor activity is carried out when:

  • gestational age more than 40 weeks;
  • gestational age more than 38 weeks (with multiple pregnancy);
  • there are no signs of the onset of labor activity.

A full-term pregnancy is considered to be a pregnancy that reaches 38 weeks. After 40 weeks of pregnancy, in the absence of self-initiated labor activity, stimulation of labor activity is indicated. Starting from the 41st week of gestation, the function of the placenta decreases, which means that the baby does not receive enough nutrients and oxygen supplied from the bloodstream. Some doctors observe expectant tactics for 10 days, while others give the woman 2 weeks to give birth on her own. In any case, the longer the baby is in the womb after 40 weeks of pregnancy, the more difficult it will be for him in childbirth.

With regard to multiple pregnancy, upon reaching the full 38 weeks, it is advisable to stimulate labor activity, which is carried out in order to prevent complicated and pathological births.

IMPORTANT! After 40 weeks, the bone tissue of the fetus begins to actively store calcium. This leads to the fact that the bones of the child's skull become harder, which prevents the normal configuration of the head during passage through the birth canal.

Stimulation of childbirth. When is it really necessary?

Post-term pregnancy - a period of more than 41 weeks.

On ultrasound, there are signs of a violation of the utero-fetal-placental blood flow, the ossification points are visualized in the fetus.

Premature discharge of amniotic fluid.

The lack of stimulation of labor activity a day after the discharge of amniotic fluid increases the risk of infection of the fetus, as well as the development of septic complications in the mother.

Overdistension of the uterus.

With multiple pregnancy, polyhydramnios, the walls of the uterus become thinner, as a result of which its contractility is significantly reduced.

Diabetes. Stimulation of labor in this case is carried out after 38 weeks of pregnancy, due to the active weight gain of the fetus in the last two weeks of pregnancy.

- insufficient in strength, duration and frequency of contractile activity of the uterus, due to its hypotonic dysfunction. The weakness of labor activity is manifested by rare, short and ineffective contractions, slowing down the opening of the cervix and advancement of the fetus. Pathology is diagnosed through observation, cardiotocography, vaginal examination. In the treatment of weakness of labor activity, rhodostimulation is used; according to indications, a caesarean section is performed.

General information

Weakness of labor is one of the forms of violation of the contractile function of the uterus, characterized by low tone of the myometrium, a rare frequency of contractions, and a weak amplitude of contractions. There is a predominance of diastole of contractions (a period of relaxation) over systole (a period of contraction), which slows down the opening of the cervix and the progress of the fetus through the birth canal.

The weakness of labor activity may be due to the late or young age of the primipara; preeclampsia; premature birth or post-term pregnancy; overstretching of the uterus with multiple pregnancy, large fetus, polyhydramnios; disproportion between the size of the fetus and the pelvis of the woman in labor (narrow pelvis); early discharge of water. Placenta previa, the course of pregnancy in conditions of chronic placental insufficiency, fetal pathology (hypoxia, anencephaly, etc.) can lead to the development of weakness in labor activity.

In addition, the weakness of labor activity can be aggravated by the asthenization of a woman (overwork, excessive mental and physical stress, poor nutrition, insufficient sleep); fear of the woman in labor, uncomfortable environment, inattentive or rude service. The weakness of labor activity is often a direct continuation of the pathological preliminary period of childbirth.

Types of weakness of labor activity

According to the time of occurrence, primary weakness of labor activity and secondary are distinguished. The primary weakness is considered a situation in which, from the very beginning of childbirth, insufficiently active (weak in strength, irregular, short) contractions develop. They speak of secondary weakness if there is a weakening of contractions at the end of the 1st or the beginning of the 2nd period of labor after the initially normal or violent nature of labor.

The varieties of weakness of labor activity include segmental and convulsive contractions. Convulsive contractions are characterized by prolonged (more than 2 minutes) uterine contractions. With segmental contractions, not the entire uterus contracts, but its individual segments. Therefore, despite the continuity of segmental contractions, the effect of them is extremely small. Determination of the clinical form of weakness of labor activity allows you to choose differentiated tactics in relation to the treatment of disorders.

Symptoms of weakness in labor

Clinical manifestations of the primary weakness of labor activity are: decreased excitability and tone of the uterus; frequency of contractions - 1-2 within 10 minutes; the duration of contractions is not more than 15-20 seconds; amplitude (strength) of contractions of the myometrium - 20-25 mm Hg. Art. The period of contraction of the uterus is short, the period of relaxation is 1.5-2 times longer. There is no increase in intensity, amplitude, frequency of contractions over time.

Contractions with primary weakness of labor activity can be regular or irregular, painless or slightly painful. The course of structural changes in the cervix (shortening, smoothing and opening of the cervical canal and uterine os) is slowed down. The weakness of the contractile activity of the uterus often accompanies the period of exile, as well as the subsequent and early postpartum period, which leads to hypotonic bleeding. The primary weakness of labor activity leads to a delay in the duration of labor, fatigue of the woman in labor, untimely discharge of amniotic fluid, lengthening of the anhydrous period.

In the case of secondary weakness of labor activity, initially effective contractions weaken, become shorter and less frequent, up to a complete cessation. This is accompanied by a decrease in the tone and excitability of the uterus. The opening of the uterine os can reach 5-6 cm without further progression; the progress of the fetus through the birth canal stops. The danger of weak labor is an increased risk of ascending infection of the uterus, the development of fetal asphyxia or intrauterine death. With prolonged standing of the fetal head in the birth canal, birth injuries of the mother (hematomas, vaginal fistulas) may develop.

Diagnosis of weakness of labor activity

To determine the nature of labor activity, a clinical assessment of the effectiveness of contractions, uterine tone, and labor dynamics is carried out. During childbirth, monitoring of uterine contractions (tocometry, cardiotocography) is carried out; analysis of the frequency, duration, strength of contractions and their comparison with the norm. So, in the active phase of the 1st period, contractions lasting less than 30 seconds are considered weak. and intervals over 5 minutes; for the 2nd period - shorter than 40 sec.

With the weakness of labor activity, the opening of the cervix occurs by less than 1 cm per hour. The degree and speed of opening are assessed during the vaginal examination, as well as indirectly - by the height of the contraction ring and the advancement of the head. Weakness of labor activity is said if the 1st stage of labor lasts more than 12 hours for primiparas, and more than 10 hours for multiparous ones. Weakness of labor forces should be differentiated from discoordinated labor activity, since their treatment will be different.

Treatment of weakness in labor

The choice of treatment regimen is based on the causes, the degree of weakness of labor, the period of labor, the assessment of the condition of the fetus and mother. Sometimes, to stimulate the intensity of contractions, it is enough to catheterize the bladder. If the weakness of labor activity is due to

In the process of pregnancy management by an obstetrician-gynecologist, it is necessary to assess risk factors for the development of weakness in labor, and if such factors are identified, preventive medication and psychophysical training should be carried out. The weakness of labor activity almost always leads to a deterioration in the condition of the fetus (hypoxia, acidosis, cerebral edema), therefore, simultaneously with labor stimulation, prevention of fetal asphyxia is carried out.

One of the most common complications during the birth of a baby is weak labor activity, which, according to statistics, is observed in 7-8% of women in labor. It delays the process and is fraught with the fact that it can provoke hypoxia (oxygen starvation) of the fetus. What is this pathology?

It is characterized by the fact that the contractions that have begun do not intensify, but gradually weaken, increasing the duration of labor and depleting the physical strength of the woman in labor. In this case, the cervix either too slowly, or does not open at all.

The occurrence of such a weak labor activity can provoke various deviations regarding both the health of the mother and the development of the fetus:

  • neuroendocrine and somatic diseases of a woman;
  • overstretching of the uterus (often this happens with or multiple pregnancies);
  • complications during pregnancy;
  • pathology of the myometrium (uterine walls);
  • malformations of the fetus itself: disorders of its nervous system, adrenal aplasia, presentation, delayed or accelerated maturation of the placenta;
  • narrow pelvis, tumors, incorrect position of the child, rigidity (inelasticity) of the cervix - all this can become mechanical obstacles that entail weak or insufficient labor activity;
  • the readiness of the mother and baby for childbirth does not coincide, is not synchronous;
  • stress;
  • the age of the expectant mother is less than 17 and older than 30;
  • insufficient physical activity of the woman in labor.

In each individual case, the causes of weak labor activity may be different. Childbirth is also different for everyone.

Symptoms are determined by doctors directly during childbirth:

  • contractions are of short duration and low intensity;
  • the uterine pharynx opens slowly;
  • the movement of the fetus along the birth canal occurs at a very low speed;
  • the intervals between contractions increase;
  • the rhythm of contractions is broken;
  • duration of childbirth;
  • fatigue of the woman in labor;

With primary generic weakness, contractions are mild and ineffective from the very beginning. Secondary differs in that it occurs after a normally begun birth.

What to do with weak labor activity

If weak labor activity is diagnosed, doctors make a decision depending on the causes of the pathology and the condition of the woman in labor. There are various ways to help a woman in such a difficult situation. If prolonged labor becomes dangerous for the mother or child, it is customary to induce labor.

  • 1. Labor induction without medication

Enhances labor activity amniotomy (the procedure for opening the fetal bladder). It allows the expectant mother to cope on her own, without stimulation with drugs.

  • 2. Medical stimulation

In some cases, amniotomy is ineffective, so labor must be stimulated with the help of drugs. This may be drug-induced sleep after the administration of narcotic analgesics and stimulation with uterotonics (oxytocin and prostaglandins). They are administered intravenously, while the condition of the fetus is constantly monitored using a heart monitor.

  • 3. Cesarean section

It happens that even the use of stimulants does not bring results, while the fetus may die from hypoxia. Then an emergency caesarean section is performed.

The use of stimulant drugs is undesirable, since it requires the simultaneous use of analgesics, epidural anesthesia, antispasmodics due to increasing pain in parturient women, which can lead to undesirable. But if the risk of fetal death is too high, this is the only way out of this situation. The weakness of labor activity in the second birth requires exactly the same intervention as in the first.

Preventive measures

If there is a threat of weak labor activity, a whole course of preventive measures is required from the 36th week:

  1. take drugs whose purpose is to increase the energy potential of the uterus: these are vitamin B, ascorbic and folic acids;
  2. observe the correct daily routine with sufficient time for sleep;
  3. prepare mentally for childbirth.

If weak labor activity was detected in a timely manner, with proper treatment, in most cases, childbirth can be carried out naturally, ending with the long-awaited birth of a strong and healthy baby.

Weakness of labor activity is a pathological condition that is characterized by a decrease and weakening of contractions, as well as a slow opening of the cervix. At the same time, the woman in labor gets very tired and loses strength.

Weak labor activity is primary and secondary.

Primary is a decrease in uterine activity that occurs at the very beginning of childbirth. The frequency of occurrence is 5-7% of the number of all births.

Secondary - this is a decrease in the duration, intensity and frequency of contractions after a favorable onset of the course of labor. At the same time, the rate of opening and smoothing of the cervix also decreases, and the movement of the fetus through the birth canal slows down. It occurs in 2-3% of births.

Causes

The risk group includes pregnant women who have a history of:

  • childhood infections (rubella, chickenpox, measles);
  • late onset of the first menstruation (menarche), after 15-16 years;
  • menstrual irregularities;
  • infantilism (small uterus);
  • anomalies in the development of the uterus;
  • inflammatory diseases of the reproductive system;
  • scar on the uterus (after caesarean section, removal of fibroids, ectopic pregnancy, etc.);
  • abortions;
  • large fruit;
  • a large number of births;
  • diseases with metabolic disorders.

The reason for the weakness of the birth process can be mechanical obstacles (narrow pelvis, breech presentation of the fetus, inelasticity of the cervix). The age of the pregnant woman also plays a role - women under the age of 17 and over 30 are more prone to anomalies in labor. Obstetric reasons include:

  • prenatal outpouring of water;
  • multiple pregnancy;
  • post-term pregnancy or, conversely, premature birth;
  • large size of the fetus;
  • transverse or oblique position of the fetus;
  • pelvic presentation of the fetus;
  • fear of childbirth, great loss of strength.

The reasons may be from the side of the fetus:

  • intrauterine infection;
  • malformations and anomalies of development;
  • Rhesus conflict;

Most often, for the development of weak labor activity, several reasons or a combination of them are needed.

Signs of weak labor activity

Primary weakness of labor can be manifested by such symptoms:

  • contractions become less sensitive, rare or short;
  • the smoothing of the cervix and the opening of the uterine pharynx slow down or stop (the doctor determines during a vaginal examination);
  • the presenting part of the fetus (head or pelvic end) remains permanently movable or pressed against the entrance to the small pelvis;
  • the long course of the first stage of labor (for primiparous more than 12 hours, for multiparous more than 10 hours) and, as a result, the fatigue of the woman in labor;
  • possible untimely discharge of amniotic fluid.

Norms of disclosure and contractions in the first stage of labor

Normally, in a primiparous woman, the cervix of the uterus opens by 1-1.2 cm per hour, in a multiparous woman - 1.5-2 cm per hour. If the cervix opens more slowly, then this may indicate the development of primary weakness of labor activity.

In the first period, the normal duration of contractions is 20-30 seconds, and the interval between them is 7-10 minutes. With the pathology of labor activity, their duration decreases, and the interval between them increases.

Secondary generic weakness is characterized by a longer period of expulsion of the fetus (more than 1-1.5 hours). This is due to the weakening or cessation of contractions, which at the beginning were intense, rhythmic and prolonged. At this point, the progress of the fetus along the birth canal slows down or stops altogether.

Diagnostics

Primary weakness of labor activity is diagnosed on the basis of:

  • decrease in uterine activity (contractions weaken, become rare);
  • reducing the speed of smoothing the neck and opening the uterine pharynx;
  • prolonged standing of the presenting part of the fetus at the entrance to the small pelvis;
  • increase in delivery time.

The diagnosis is also made on the basis of partogram data, if there is no dynamics of cervical dilatation within two hours.

Partogram - a description of childbirth in a graphical way, which displays data on cervical dilatation, fetal progress, pulse, blood pressure, fetal heartbeat, amniotic fluid, contractions, etc.

Secondary birth weakness is diagnosed on the basis of the clinical picture and partogram data. In addition, it is necessary to monitor the condition of the fetus (listen to the heartbeat, install a CTG sensor), as there is a risk of developing hypoxia. After establishing the diagnosis, obstetricians need to decide on the tactics of childbirth.

Weakness of labor must be distinguished from the following pathologies:

  • pathological preliminary period (chaotic false contractions with an immature cervix);
  • discoordinated labor activity (violation of the contractile activity of the uterus, it is extremely painful; it is very rare);
  • clinically narrow pelvis (mismatch between the size of the pelvis and the head of the fetus).

Treatment and delivery in case of weak labor activity

There are several methods of medical care. The doctor makes a decision depending on the causes of the pathology and the condition of the woman in labor and the fetus. If labor is prolonged and life-threatening, labor is induced or an emergency caesarean section is performed. Methods of medical care:

1. Stimulation of childbirth without medication. Labor activity can be strengthened by the procedure of amniotomy (opening of the fetal bladder), which allows you not to use drugs. Do not be afraid, amniotomy is completely painless.

2. Medicinal stimulation. It is carried out in case of ineffectiveness of the amniotomy. It can be carried out with the help of strong analgesics, which induce drug-induced sleep to relax and rest the woman in labor. Stimulation with oxytocin and prostaglandins is performed intravenously.

3. Cesarean section. An emergency operation is performed in case of ineffective stimulation and in case of a threat to life for the woman in labor or the fetus.

drug sleep

For therapeutic sleep, sodium oxybutyrate and glucose are administered, performed by an anesthesiologist. In his absence, the obstetrician introduces promedol, relanium, atropine and diphenhydramine. Medication sleep allows a woman in labor to rest for 2-3 hours and gain strength, and also helps to intensify contractions. If there is an indication for an emergency caesarean section, then there is no need for therapeutic sleep.

After the woman has a rest, the doctor needs to assess her condition and the fetus, as well as the degree of opening of the uterine pharynx. After that, a hormonal-energy background is created with the help of:

  • ATP, riboxin, cocarboxylase;
  • 40% glucose solution;
  • calcium preparations (to enhance uterine contraction);
  • vitamins: B1, B6, E, ascorbic acid;
  • piracetam (to improve uterine circulation).

Amniotomy

Opening the fetal bladder promotes the production of prostaglandins, which stimulate contractions. It is performed when the cervix is ​​dilated by 3-4 cm. 2-3 hours after the procedure, the doctor needs to assess the state of the dynamics of cervical dilatation, and also decide on the use of reducing drugs.

Medical stimulation

When stimulated with drugs, oxytocin and prostaglandins are used.

Oxytocin is administered intravenously through a drip. It provokes increased contractions and the production of prostaglandins. Oxytocin is administered when the uterine os opens by 5-6 cm or more, only after amniotomy or spontaneous discharge of amniotic fluid.

Prostaglandin E2 contributes to the development of normal contractions. The drug also accelerates the maturation of the cervix and its opening, while not disturbing the uteroplacental circulation. The drug is administered similarly to oxytocin. It is used until the opening of the uterine os by 2-3 cm with an insufficiently mature cervix.

Prostaglandin F2a (enzaprost or dinoprost) is used when opening the uterine os by 5 cm or more. Effects of the drug: stimulation of contractions, narrowing of blood vessels, increased blood clotting. Therefore, it is contraindicated in preeclampsia and blood diseases. Prostaglandin F2a is administered intravenously using a drip system.

With drug stimulation, it is mandatory to prevent fetal hypoxia every 3 hours. For this, a 40% glucose solution + ascorbic acid + eufillin, sigetin or cocarboxylase is injected intravenously. It also shows the inhalation of humidified air.

C-section

If all of the above methods were ineffective or there are additional indications, then a caesarean section is performed.

Contraindications for labor stimulation

  • narrow pelvis (anatomical and clinical);
  • the presence of a scar on the uterus;
  • women with a history of more than 5-6 births;
  • incorrect position and presentation of the fetus;
  • life threatening for the mother and fetus.

Possible Complications

In the case of an incorrect choice of a delivery strategy with weak labor activity, the following complications are possible:

  • abuse of stimulant drugs can lead to discoordinated labor and fetal hypoxia.
  • prolonged standing of the presenting part of the fetus in one plane of the small pelvis can lead to compression of the soft tissues, in which there is a risk of urogenital fistulas. On the part of the fetus, this can lead to impaired cerebral circulation and cerebral hemorrhage.
  • in women with weakness of labor in the postpartum period, there is a risk of hypo- and atonic bleeding, infectious diseases.

Forecast

With adequate medical care, the prognosis for the woman and the fetus is favorable. Much depends on the psychological state of the woman, there is no need to panic and be afraid, it is better to listen to the recommendations of the obstetrician. Serious complications are rare.

Some research on pregnancy

The dilatation was small, but it is said that this is always the case with primiparas. The contractions intensified, and then the attempts came ... Before giving birth, I read that they last nothing at all, that is, in 2-3 attempts, the baby should already be born. But lying in the delivery room, I understood that something was going wrong ... and the contractions seemed to have stopped ... Then I still didn’t know that this was called weak labor, the reasons for which could be very different ...

Why are we weak before childbirth

The doctors fussed, brought a dropper and began to drip something on me, from which the contractions resumed. My baby was wrapped around the umbilical cord twice, and the minutes were counting. Thank God, everything worked out, and my son was born healthy, screamed, and I cried with happiness. There were still minor consequences of the fact that the baby was clamped in the birth canal for a long time ... The pediatrician advised us to wear a special cervical collar for a month. So we got away with a little blood.

But there are so many cases when all the efforts of mothers and doctors are in vain, and the baby dies before he has time to be born.

Weakness of labor activity is a serious problem that occurs in about 8% of women in labor and manifests itself in shortening contractions, weakening attempts and slow passage of crumbs through the birth canal.

Because of what modern women, so strong and decisive in life, cannot fulfill their main task - to give birth to their baby without complications?
The reasons can be very different, both physiological and psychological. Often the process of childbirth slows down with various diseases of the genital area (chronic endometritis, fibroids), with underdevelopment of the uterus (hypoplasia).

Diabetes and obesity can also slow down labor. If you have a second birth, and the first ones went with complications or you had a cesarean, and besides, the doctor says that the pelvis is anatomically narrow - know that you are also at risk. Often a woman in labor is mentally unprepared for childbirth and strong emotional stress slows down childbirth.
The baby, for its part, can also slow down its own birth. The large weight and circumference of the fetal head will make the mother not only sweat and try hard, but can also lead to physical exhaustion. It is also difficult for women in labor with multiple pregnancies.

Weak labor activity

Labor activity can weaken at any time during the birth process:
Primary weakness of labor activity. Occurs at the beginning of labor, contractions are very weak, the opening of the cervix is ​​slow. Usually, in primiparas, the opening of at least 2-3 cm lasts up to 6 hours, with the second birth - twice as fast. The protracted first stage of labor is very exhausting, the energy and muscles of the uterus weaken, and the crumbs inside have a hard time, it begins. If the doctor does not take action, the child may die.

Secondary weakness of labor activity. It is found at the beginning of the 2nd birth period. The contractions completely subside, the opening of the neck stops. Due to the fact that the baby's head is squeezed by the birth canal, both mother and child suffer. Often this leads to the fact that the cervix swells and urinary or rectovaginal fistulas occur.

Weakness of attempts. Occurs in the final stage of childbirth. Weak abdominal muscles are to blame, because during attempts the main load falls on them. Usually these muscles are weakened in women who have had many births, who are obese. At the finish line and moral exhaustion reaches its climax. So much effort and no results! But in no case should you give up, the baby is already halfway there, he is also trying and suffering.

Sleep is the best medicine

Modern medicine has a mass of effective drugs, due to which it is possible to treat weak labor activity. Everything is individual.

The doctor decides what exactly can be applied based on several factors. Affects the choice of medicines and the phase of childbirth, and the patient's condition and possible contraindications. For example, if a gynecologist sees that a woman is exhausted already at the beginning of labor, he can inject her with a drug sleep. It does not harm at all and allows mommy to rest for an hour or two and recuperate before the strongest contractions and attempts.
Often, doctors resort to opening the water bladder (amniotomy) if the water does not break on its own. This usually activates labor activity. The same is done with polyhydramnios and a flat bladder.
In the final stage of labor, if the contractions suddenly stop, the woman in labor is injected with oxytocin or prostaglandins through a dropper. They increase uterine contractions. By the way, oxytocin can also drip at 41 weeks of gestation if the birth has not come on time.

It happens that all measures do not bring results, and doctors make a cardinal decision - to caesarean the patient. Sometimes this is the only way to save a child.

On the prevention of weak labor activity

How to protect yourself from weak labor activity? After all, I really want the birth to go well and without force majeure. Many mothers are interested in whether there is an effective prevention in this situation. There is no medical prophylaxis and cannot be. Unless, during pregnancy, one should not forget to drink the vitamins prescribed by the gynecologist and eat them in a “pure” form (fresh vegetables and fruits).

Do not forget about physical activity. Hiking is very useful for strengthening the abdominal muscles. If you are about to give birth for the first time, be sure to attend courses for expectant mothers. This will relieve you of unnecessary anxiety, relieve tension and give you confidence before childbirth. And, of course, do not break the regime of sleep and rest. Pregnant women must discipline themselves in this regard.

Watching movies at night and daytime sleep will eventually lead to, and the lack of a normal, full-fledged night's sleep takes a lot of strength and energy. You need to accumulate and save all your internal physical and moral resources. During childbirth, they will be very useful to you.

Have a good labor activity, my dears! Well, I'll go to other activities, home-household. As always, a lot of things have accumulated. I won't say goodbye to you, because I'll be back very soon! I look forward to your comments, stories and feedback.

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