Introduction
As per CDC (Centers for Disease Control) reports, there has been an increase in SMM (severe maternal morbidity) in recent years in the United States due to pre-pregnancy obesity, underlying chronic health conditions, and increased maternal age. Labor complications can lead to extended hospitalizations, more hospital expenses, and, most importantly, a negative maternal and child health impact. And in some cases, the complications can even be life-threatening.
What Is the Reason Behind Labor and Delivery Complications?
Labor and delivery usually do not cause severe problems, as they are normal physiologic processes. Though rare, complications can occur during labor and delivery for various reasons. The risk of developing complications depends on various factors, like maternal medical history, the vigilance of the healthcare team, and the current pregnancy.
The labor type also affects risk:
Cesarean Delivery:
In cesarean delivery, an incision is made in the uterus and abdomen to deliver the baby. It can be a maternal choice or is indicated in case of fetus malpositioning, overly large baby, prolonged labor, maternal complications, placental anomalies, etc.
The complications associated with cesarean sections are:
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Blood clot.
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Infection of the incision.
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Blood loss.
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Endometritis.
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Anesthesia complications.
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Injury to adjacent organs, bladder, and bowel.
Vaginal Delivery:
The natural form of birth in which the baby is pushed through the birth canal is called vaginal delivery.
Complications associated with vaginal delivery include:
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Prolonged labor.
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Postpartum hemorrhage.
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Maternal distress.
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Tearing.
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Injury to the baby.
Who Are at Risk of Developing Labor and Delivery Complications?
Women who are at risk for developing delivery complications are those with the following medical conditions:
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Diabetes.
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Kidney diseases.
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Anemia.
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Sexually transmitted infections.
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Epilepsy.
Other risk factors include:
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Increased maternal age.
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Multiple pregnancies.
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History of preterm birth.
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Smoking and alcohol use during pregnancy.
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Certain medications.
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Eating disorders like anorexia.
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When the placenta covers the cervix (placental previa).
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Overdistended uterus (abnormally large uterus).
What Are the Different Delivery Complications?
Some of the common delivery complications are:
Post-partum Hemorrhage:
Postpartum hemorrhage is a common and serious complication associated with childbirth. An estimated blood loss of greater than 500 mL associated with vaginal birth and blood loss greater than 1000 mL associated with C-section birth is called postpartum hemorrhage.
The symptoms of postpartum hemorrhage are:
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Persistent uncontrolled bleeding.
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Increased heart rate.
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Reduction in red blood cell count.
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Reduction in blood pressure.
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Pain and swelling in the vaginal region.
The management of postpartum hemorrhage involves:
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Uterine atony (inadequate uterine contraction and a common cause of postpartum hemorrhage) is managed by bimanual massage. In this technique, the vaginal hand compresses the anterior aspect of the uterus, and the abdominal hand compresses the posterior aspect of the uterus.
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Medications used for management include uterotonic agents like oxytocin, ergot alkaloids, and prostaglandins.
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Removing placental pieces from the uterus.
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Blood transfusion.
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Repairing cervical, vaginal, and uterine lacerations.
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Using a catheter to put pressure on the uterine wall.
Perineal Tear:
A perineal tear is an injury to the soft tissue that separates the anus and vagina. The pressure exerted during childbirth results in perineal tears. It is a common complication associated with childbirth, and the severity of the condition varies.
Based on the extension and depth of the tear, the different types are:
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Grade 1- Damage does not extend to the muscle and only involves subcutaneous tissue and skin.
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Grade 2- Damage extends to pelvic floor muscles, but anal sphincters are unaffected.
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Grade 3- Damage involves the external anal sphincter and may or may not involve the internal sphincter.
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Grade 4- Damage involves both sphincters and rectal mucosa.
First-degree tears heal on their own, and no management is needed. Second-degree tears are managed with sutures under local anesthetics. Surgical management is required in cases in which the sphincters are involved.
Shoulder Dystocia:
Shoulder dystonia is one of the complications of vaginal delivery, in which the head of the fetus is delivered through the vagina. Still, there is difficulty in delivering the fetal body. Mostly, it occurs in cases where the anterior fetal shoulder gets impacted behind the pubic symphysis of the mother. This may lead to a delivery delay, leading to complications like hypoxia.
Amniotic Fluid Embolism:
It is a complication due to amniotic fluid entry into the maternal bloodstream. When the emboli reach the lungs, fetal cells react with the mother’s blood cells, producing a hyper-immune reaction resulting in cardiovascular collapse and DIC (disseminated intravascular coagulation). The symptoms include profuse bleeding, shortness of breath, cyanosis, hypotension, and loss of consciousness.
Uterine Rupture:
It is one of the most dangerous labor complications for the mother and the fetus. It is an uncommon condition in which the uterine wall ruptures. This can make the fetus oxygen-deprived, further damage the brain, or even cause death. Depending on the severity, the fetus may be delivered via C-section immediately to prevent brain damage.
Umbilical Cord Prolapse:
It is a condition in which the umbilical cord drops into the cervical region before the baby is delivered. Hence, as uterine contractions occur, the cord is compressed, thus restricting the fetal oxygen supply. It is a very rare complication.
Fetal Macrosomia:
In simple terms, fetal macrosomia is a too-big baby that is difficult to deliver safely through vaginal birth. As a baby gets stuck in the vaginal canal during delivery, there are chances for oxygen deprivation, so undiagnosed cases of fetal macrosomia can lead to complications.
Retained Placenta:
It is a condition in which some amount of placenta is retained in the uterus after delivery; that is placenta is not completely moved out of the uterus. The condition can even be life-threatening for the mother. The symptoms may take days or weeks to show up, including fever, heavy bleeding, pain, and abnormal vaginal discharge.
Prolonged Labor:
The labor might be delayed in cases where:
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The uterine contractions are slow or not strong enough.
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Fetal macrosomia.
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Abnormal fetal position.
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Hormonal imbalances.
Conclusion
Prenatal care should be started immediately following pregnancy confirmation. Routine screening tests and scanning help the physician foresee possible complications and take measures to avoid them. Avoiding risk factors like smoking, alcohol, illegal drugs, maintaining weight, taking folic acid tablets daily, and routine physician visits are some steps to reduce the risk of delivery complications.
