COMPLICATIONS OF BIRTH
Most often, pregnancy and birth results in an uncomplicated spontaneous vaginal
delivery. However,
complications of labor and birth may occur, many of which can pose serious problems for the mother or fetus or both.
Premature Labor and Birth
Premature labor is defined as labor that begins before the 37th week of pregnancy. Warning signs of preterm labor include mild menstruallike cramps, low backache, pelvic pressure, increased vaginal discharge or light bleeding, and diarrhea. A prompt exam will determine if preterm labor exists and if it should be treated with medications in an attempt to stop labor. Depending on gestational age, preterm birth frequently leads to respiratory distress, leading to a large proportion of neonatal (newborn) deaths. Because of the danger to the fetus, attempts are made to recognize and stop preterm labor.
Premature Rupture of the Membranes
Rupture of the amniotic fluid sac occurring prior to the onset of labor in a pregnancy of any gestation is described as premature rupture of the membranes. This may pose danger to the mother and baby because of the possibility of infection and preterm birth. Labor is sometimes induced if the pregnancy is far enough along, and at other times the woman is placed at rest in the hospital or home to reduce the risk of infection and prematurity.
Malpresentation
About 96 percent of babies are born head first. Approximately 3 percent are born breech, with the buttocks and legs delivering first, and these babies may be delivered vaginally or by cesarean section. About 1 percent of babies are born in a transverse (sideways) position and must be delivered by cesarean. Whatever method of
delivery is used, malpresentations pose added risk to the mother and fetus.
Disorders of Labor
Deviation from the expected progress of labor may result in abnormal patterns of labor contraction, dilation of the cervix, or descent of the fetus through the pelvic passage. Many disorders are treated by administration of a contraction-inducing drug called oxytocin. Other ways of managing labor disorders include
maternal rest, maternal and fetal position change, and, occasionally, the administration of anesthesia. If treatment is unsuccessful, operative delivery is almost always necessary.
Placenta Previa
The placenta normally implants itself at the top of the uterus. When it implants lower in the uterus, near or over the cervix, it can cause mild to severe bleeding during the last half of the pregnancy or during labor or both. If the placenta covers the entire cervix at the time labor begins, a cesarean delivery is necessary to save the mother and baby.
Multiple Births
Twins occur once in 80 births, triplets once in 10,000, and quadruplets almost once in 1 million. Recent advances in the use of fertility drugs have increased the incidence of multiple births. Multiples are more likely to be born prematurely, and these pregnancies are consequently at higher risk for complications compared to single-infant births.
Chorioamnionitis and Endometritis
Chorioamnionitis is an infection of the placental membranes and the surrounding maternal and fetal tissues. It is characterized by maternal fever, increased maternal and fetal heart rate (tachycardia), and uterine tenderness. Endometritis is an infection of the uterine lining and is the most common cause of postpartum infection. It is common in women with chorioamnionitis and most common in women delivered by cesarean. Both conditions can be effectively treated with antibiotics.
Operative Delivery
In addition to these complications of birth, emergencies can occur during labor, such as placental detachment before birth (abruptio placenta), worrisome changes in the fetal heart rate (fetal distress), and the umbilical cord slipping in front of the fetal head (cord prolapse)Ñany of which often lead to an operative birth.
Close to one-fourth of all babies in the United States are born by cesarean section, the surgical delivery of a baby through the maternal abdomen. A cesarean, when needed, can be a life-saving measure for the mother or the baby. Reasons for a cesarean include: cephalopelvic disproportion (baby is too large for mother's pelvis), transverse lie, abnormal fetal heart rate patterns, prolapsed cord, failure to progress in labor, active genital herpes, and maternal diseases such as preeclampsia, diabetes, or heart disease. The number of U.S. cesarean deliveries has increased in recent years, and there is growing concern that many of these operative deliveries are unnecessary. Recent studies have demonstrated that many women who have had a cesarean may safely give birth vaginally in a subsequent delivery. These vaginal births after cesarean (VBACs) are becoming more popular and should help decrease the cesarean birthrate.
Other operative deliveries can be conducted using forceps or a vacuum extractor. These techniques are used most often to "lift" the baby out of the birth canal during the very last stages of labor. Using proper technique, these procedures can be very safe for mother and baby but should be used only when a reason exists to justify their use.