According to the Centers for Disease Control and Prevention (CDC), about 700 women die each year in the United States because of pregnancy or delivery complications. The most recent U.S. maternal mortality rate (2018) was about 17.4 per 100,000 pregnancies.
Labor or childbirth is a physiologic process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus. The most important trigger of labor is a surge of hormones released by the fetus. In response to this hormone surge, the muscles in the mother's uterus change to allow her cervix (at the lower end of her uterus) to open. The hormones, namely the oxytocin and chemicals called the prostaglandins, help make the smooth muscles in the uterus work together to create synchronized contractions. The hormones also cause the cervix to dilate to make room for the baby to pass through and prepare the mother's body for nursing. Delivery can occur in two ways: vaginally (through the birth canal) or by a Cesarean (surgical) delivery. Most deliveries occur without complications if performed by a doctor in a hospital with good emergency care facilities. However, the risks associated with a Cesarean delivery are slightly higher than for vaginal deliveries.
Complications during vaginal delivery
The following are the most common complications women experience during pregnancy:
- Preeclampsia: Preeclampsia is also called toxemia. It occurs after the first 20 weeks of pregnancy and causes high blood pressure and possible problems with the mother’s kidneys. The recommended treatment for preeclampsia is delivery of the baby and placenta to prevent the disease from progressing.
- Eclampsia: High blood pressure may precipitate convulsions during labor. This is called eclampsia. It puts the woman at a higher risk of having a baby well before the due date, which is called preterm delivery.
- Gestational diabetes: Gestational diabetes occurs when the mother’s body cannot process sugars effectively. This leads to higher than normal levels of sugar in the bloodstream. Some women will need to modify their meal plans to help control blood sugar levels. Gestational diabetes can give rise to complications, such as obstructed labor and prolonged labor.
- Preterm labor: Preterm labor occurs when the women go into labor before the 37th week of pregnancy. This is before the baby’s organs, such as the lungs and the brain, have finished developing.
- Uterine atony: This is a life-threatening condition that occurs after childbirth. In this condition, the uterus fails to contract after delivery, leading to postpartum hemorrhage.
- Infections: Various bacterial, viral and parasitic infections may complicate a pregnancy. Infections can be harmful to both the mother and the baby. Some examples include
- A urinary tract infection
- Bacterial vaginosis
- Group B Streptococcus
- Hepatitis B virus, which can infect the baby during birth
- A yeast infection
Complications of Cesarean delivery
Cesarean delivery or Cesarean section is a type of surgery used to deliver a baby. The baby is surgically removed through an incision over the mother's abdomen and then a second incision in the uterus is made to remove the placenta. The rates of Cesarean deliveries have increased exponentially and have been linked with a variety of different factors, such as rising rates of maternal obesity and diabetes, multiple births and increased maternal age. Once the delivery and afterbirth are completed, the incisions made in the mother's uterus are sutured, which will eventually dissolve under the skin. The abdominal skin is closed with stitches or with staples, which will be removed before a woman leaves the hospital.
Complications of Cesarean delivery include
- Infection. After a Cesarean delivery, the mother might be at risk of developing an infection of the endometritis (lining of the uterus).
- Postpartum hemorrhage. Uncontrolled bleeding due to the inability of the uterus to contract after the labor. This may be due to prolonged labor, maternal exhaustion, the baby lying in an abnormal position, the placenta being in an abnormal position, etc.
- Reactions to anesthesia
- Blood clots
- Wound infection
- Surgical injury to nearby structures, such as urinary bladder and intestine
- Increased risks during future pregnancies
Purpureal sepsis or postpartum sepsis is another complication that may be seen after vaginal or Cesarean delivery.
The complications that increase the risk of purpureal sepsis are
- Post-term labor
- Prolonged rupture of membranes
- Multiple internal exams during labor
- Thick meconium staining
- Internal fetal monitoring
- Operative vaginal delivery
- Manual removal of the placenta
- Retained products of conception
- Use of a foley catheter
- Postpartum hemorrhage
The symptoms are fever with chills, foul-smelling discharge and pain in the area between the anus and genitals (perineum). The severe cases may present as toxic shock, disorientation, high fever and can progress to death if untreated.
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Medscape: "Normal Labor and Delivery." https://emedicine.medscape.com/article/260036-overview%20
StatPearls Publishing: "Stages of Labor." https://www.ncbi.nlm.nih.gov/books/NBK544290/
Kaiser Permanente: "The Four Stages of Labor." https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=%2Fcommon%2FhealthAndWellness%2Fpregnancy%2Fbirth%2FlaborStages.html
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