Modern medicine allows you to identify and prevent possible causes of complications long before the day of "X". Therefore, difficult births in our time is a rare phenomenon. The doctor, as a rule, immediately sees what needs to be done. Perhaps he will inject a woman with drugs that enhance the ancestral activity, perhaps he will decide to apply one of the known methods of anesthesia, etc. Let's look at some complications that may arise during childbirth.
There are, however, circumstances in which labor does last longer than usual, and in this case prolonged births are usually observed when there is a delayed course of labor, estimated by the way the head of the child goes down and the cervix dilates.
There are three main reasons for the delay in childbirth. It can be:
- Complications related to labor activity. For example, a woman does not have periodic bouts. They can be too short, weak or rare. Can be, on the contrary, very strong and frequent. And in the first and second cases, contractions are ineffective and do not lead to full-fledged labor. If the contractions are too lethargic and rare, stimulation of the uterus can be used. For this, a woman is put on a dropper. If on the contrary, try to calm the activity of the uterus, using painkillers or epidural anesthesia.
- Complications related to the child. It is possible that a woman is difficult to give birth, because the child is very large or is located incorrectly. It is known, that for some time before childbirth the baby is installed head down. At the same time his head is lowered, and his chin is pressed to his chest. This is a successful, well-thought out nature, a pose that is most conducive to birth. But it happens that the baby has not lowered the head, and at birth the first "wants to go out" is the chin. In this case, the diameter facing the pelvic opening increases, and although the head of the child can be of quite normal size and shape, its position artificially increases the dimensions that must pass through the birth canal, leading to a certain delay in delivery. If in the second phase of childbirth the child has not turned the head correctly (and this usually happens), the doctor will make a decision and turn his head with the help of obstetric forceps or a vacuum extractor. If this does not help, they perform urgent cesarean. Very rarely, but still it happens, when the baby's head faces the pelvic opening with its lateral side, and in some cases the face or even the forehead of the child may be the presenting part. Based on each specific situation, a decision is made on the method of delivery. The same applies to situations with regard to pelvic (breech) presentation of the fetus. Natural childbirth with breech presentation is more dangerous, because when the child passes through the birth canal, all the "work" is performed by his buttocks, and the head of the child simply does not have time to adapt to the pressure exerted on it, modifying its form properly. Since the head during natural births with breech presentation is more vulnerable, from the side of obstetrician-gynecologists requires extreme care. The most frequent method of delivery in this case is a cesarean section. Special, if the woman is primiparous. If the fetus is very large and there is a threat of rupture of the perineum, or if acute fetal hypoxia is observed, it is possible to conduct an episiotomy (cut the perineum from its center to the side) or perineotomy (incision towards the anus). These manipulations are also carried out with pelvic presentation, premature birth or when establishing that the water is green.
- Complications associated with the birth canal. To this type of complication is a narrow pelvis. This implies that the birth canal, formed by the pelvic bones, as well as the soft tissues of the cervix and vagina, may be much narrower than usual. In this case, the birth is performed by caesarean section. If the pelvis is narrowed slightly, natural childbirth can be allowed. A situation is possible in which pelvic dimensions are normal, and complications are the result of other abnormalities of the birth canal (tumor formations, such as uterine fibroids or ovarian cysts, tight crotch).
Premature birth can be attributed to complications to some extent, since a baby born between 28 and 37weeks of pregnancy, very weak and suffering during the birth process. At such kid bodies and systems are insufficiently developed, weight makes 0, 5-2, 5 kg. Premature babies are easier to receive birth trauma in childbirth, because their bones are very soft. Many children born before the term require observation in the department of children's intensive care.
Distress is said if the fetus lacks oxygen. There are several reasons for this condition: clamping of the umbilical cord, wrapping it around the child's neck or body, bleeding caused by premature detachment of the placenta. Often, distress occurs as a result of excessive pressure on the baby's head during short, intensive or prolonged childbirth. In such a state, the heart rate and heart rate of the child change (it can be above 160 or below 100 beats per minute at the rate of 120).
If the amniotic fluid has a yellow or brown color, it is said that it contains meconium. This is a consequence of stress. In this case, especially if there is a violation of the heart rate, carry out a thorough electronic monitoring of the fetus. Perhaps, it will be decided to take a small sample of the child's blood through a puncture in the scalp. With the help of an electronic machine, the acidity level is measured, which will allow to determine the degree of severity of the fetal condition. Based on the results obtained, a decision is made on the mode of delivery.
This is a dangerous situation, because the clamped umbilical cord does not supply the baby with oxygen, which threatens hypoxia, and, with prolonged squeezing, death. In this case, urgent deliveries are required. There is such a situation, when the umbilical cord is lower than the presenting part of the child and is released into the vagina inside the fetal bladder or falls out, if the membranes of the fetal bladder have already ruptured.
Bleeding during labor
Bleeding can develop during labor or in the early postpartum period, creating a serious danger to the health (and sometimes to life) of the mother and the unborn child. The most common cause of bleeding are problems associated with the placenta condition. This is especially true if there are chronic inflammatory diseases of the uterine mucosa (especially untreated or untreated), occurred & ldquo; old & rdquo; trauma of the pelvic organs and scars on the uterus, a woman diagnosed with uterine myomas and other diseases of the internal genital organs, hormonal disorders, endocrine diseases, severe cardiovascular diseases, and certain diseases of the kidneys and liver. Moreover, the cause of bleeding during childbirth can be traumas borne during pregnancy or a large number of abortions, miscarriages and / or births in a woman's life.
If the bleeding does open, the doctor will act in several directions at the same time. In this case, a woman through large veins will be poured special blood-substituting solutions and blood products. Also (to improve blood coagulability) - fresh frozen plasma, erythrocyte mass. Often a mask with moistened oxygen is applied to a woman's face. At this time, carefully monitored blood pressure, heart rate, oxygenation of the mother's blood. The woman is put in a state of anesthesia in order to conduct further surgical treatment.
Gaps during labor
Tearing of the tissues during labor is one of the most common complications of the birth process. They can have different origins and consequences. These can be ruptures of the perineum, vagina, cervix or uterus itself.
The perineal ruptures, as a rule, are superficial in the form of cracks and abrasions, do not bleed and heal for several days after the baby was born. As prevention of tearing of perineal tissues, it is recommended to prepare the perineum for childbirth even during pregnancy (limiting the use of meat products and increasing the consumption of vegetable oil, the implementation of special exercises for pregnant women, etc.). A woman should know that relaxation during labor is an excellent prevention of perineal ruptures, because with strained muscles the probability of tissue rupture is significantly increased.
Vaginal tears, just like perineal ruptures, can be spontaneous or violent (as a result of the activities of doctors). The causes of spontaneous vaginal ruptures are rapid delivery if a woman has an underdeveloped short (or narrow) vagina, or a narrow pelvis. Usually, spontaneous vaginal ruptures are a continuation of the ruptures of other parts of the birth canal, most often the perineum. Violent vaginal ruptures are caused by the use of obstetric forceps, vacuum extraction of the fetus and others. Carrying out the treatment of vaginal ruptures, the doctor sutures them with separate catgut sutures. Deep vaginal ruptures are sutured under general anesthesia. It is very important that this operation is performed by a professional.
Sometimes it happens that soft tissue ruptures can be quite significant and lead to serious consequences. Especially it concerns the rupture of the uterus or its neck. Unfortunately, such ruptures often lead to the death of the baby and / or the woman in childbirth. A rupture on the uterus is possible if the woman previously had a cesarean or, if for any other reason, there is a scar on her uterus. In the case of a rupture of the uterus, the labor activity is immediately stopped, introducing the woman into a general deep anesthesia and performing the necessary manipulations. If the gap itself did not occur, but there is a threat of its occurrence, or if the gap is only just beginning, an emergency cesarean section is carried out, since in that case there is a chance to save the baby.
Of course, without loss of blood during delivery and some time after it - it is impossible. Blood flows from any wound. During the birth, the area of ??the wound formed is large enough, so bleeding continues for several days. However, sometimes bleeding after childbirth can be quite abundant. Probably, that the reason of it or this - the spent episiotomy or a break of a perineum (sometimes a cervix of a uterus). If there is no rupture or damage, then the doctor determines whether the uterus is not too relaxed or if a fragment of the placenta remains in it.
Sometimes bleeding can occur after a few days or even three to four weeks after childbirth. One of the reasons for this phenomenon is hormonal changes. Also, the cause is infectious inflammation. If a small fragment of the placenta remains in the uterus, the doctor will prescribe medication. If it proves ineffective, you may need to scrape the uterus.