Complications just before birth and in the prodromal phase
- Metrorrhagia. It is the loss of blood through the vagina. The cervix may bleed slightly during dilation due to rupture of the small vessels, but a continuous loss of red blood and similar to a menstruation may be a sign of placenta (if accompanied by pain) or placenta. previous (if not accompanied by pain).
- Severe abdominal pain. Usually it is a contraction in which the uterus does not relax; contraction persists and does not subside if no pharmacological methods are applied. It can be caused by a detachment of the placenta or rupture of the uterus, among other reasons.
- Absence of fetal movements throughout the day.
- Intense headache. It may be related to a rise in blood pressure.
- Visual alterations. They consist of blurred vision, double vision or light intolerance; they are also linked to a rise in blood pressure.
- Premature rupture of membranes. Breaking the water bag is one of the ways to start labor. Childbirth usually takes place within 24 hours of breaking the bag; otherwise it should be triggered as it increases the risk of maternal and fetal infection. Vaginal touches should be avoided in women who break the water and have no contractions, as this scan increases the risk of infection.
- Presentation or prolapse of the cord. When the pouch is broken and the fetus is not yet locked in the pelvis, prolapse of the cord may occur; that is to say, the umbilical cord exits before the fetus and, when it encapsulates, the cord is strangulated and the blood circulation between the fetus and the placenta is interrupted. If an urgent cesarean section is not performed, the fetus may die or have severe consequences.
'Complications just before birth and in the prodromal phase', d'Virtual Nurse, content under license CC BY-NC-ND 3.0 ES, with modifications made by the Gynecology and Obstetrics Service of the Hospital de Sabadell
Complications during dilation
- Part parked. It occurs when the birth does not evolve, even if there are contractions.
- Fetal Welfare Loss (PBF). It occurs when the fetus does not receive enough oxygen during contractions. PBF is generally diagnosed with fetal monitoring.
- Severe abdominal pain.
Complications during the expulsion phase
- Loss of fetal well-being. During the expulsion phase, the head experiences pressure which, during contraction, may lower the fetal heart rate but return to normal when the contraction is completed. This condition is not considered a pathological sign, but if fetal bradycardia persists, there may be loss of fetal well-being, and in this case delivery should be completed as soon as possible.
- Part parked. By this stage of labor the dilation has already been completed and the fetus must be fitted into the maternal pelvis. If it does not fit, it may be due to pelvifetal disproportion (DPF) - the fetus is too large for the pelvis and cannot pass. There may be other situations, such as the fetus engaging in the pelvis, making it difficult for the adaptive maneuvers of this phase (rotation and descent); In this case, depending on the place of the pelvis in which the head is located, either a cesarean delivery will have to be completed or instrumental use will have to be performed. To diagnose a birth that is parked in this phase, we must wait a certain amount of time for the individual circumstances of each woman and each child. Thus, it is considered normal for the expulsion phase to be longer if it is the first part or if peridural anesthesia is used; however, if there is a loss of fetal well-being, interventions should be shortened.
- Shoulder dystocia. It refers to a type of disproportion between the fetus and the maternal pelvis that is diagnosed once the head has come out. In normal birth, the fetus fits its head into the pelvis and rotates until it stands facing the mother's back and exits; Once your head is out, make a rotation together with your shoulders, which are placed inside your pelvis. In dystrophy of the shoulders, the head does not rotate or does so with difficulty, so it is encased in the perineum, because the shoulders are too large for the pelvis and do not fit spontaneously. To solve this problem, you can resort to a number of maneuvers, such as squatting (with legs squeezed until buttocks reach heels) or four staples.
Tears. During the expulsion phase, the vagina, vulva, and perineum are elongated in all fibers (skin, mucosa, and muscle) that can cause tearing. First and second degree tears, affecting the skin and mucosa, are easily corrected with simple sutures, but third and fourth degree tears that affect the skin, mucosa, muscle, anal sphincter and rectal mucosa may require follow-up. risk of long-term complications.
Complications during release phase (part of the placenta) and immediate postpartum (24 hours after delivery)
- Retention of placenta or placental remains. Placenta it is released from the womb after the baby is born. Generally, the deliverance occurs during the hour following birth; if this is not the case then maneuvers will need to be made to facilitate detachment. Lastly, manual extraction of the placenta may be required.
- Uterine atony. After delivery, the uterus contracts strongly and forms the so-called security balloon; Thanks to this physiological mechanism, the uterus stops bleeding. When the safety balloon is not formed, uterine atony occurs and the woman suffers from a hemorrhage; In these cases, the bladder of the urine should be emptied with a bladder, a massage of the uterus on the maternal abdomen or administration of drugs to promote contraction of the uterus. If the bleeding does not stop and the uterus does not contract, surgical measures should be taken, such as placing an intrauterine balloon to compress on the placental bed, tying some of the vessels that irrigate the uterus or, ultimately, perform a hysterectomy (removal of the uterus).
- Postpartum hemorrhage. It can be caused by uterine atony or the loss of blood from the vessels of the cervix or vagina due to the trauma of labor.
- Uterine inversion. It is a rare complication and is usually caused by traction of the umbilical cord before the placenta is released which causes invagination of the bottom of the uterus. The uterus should be returned to its place as soon as possible under anesthesia and, if this operation is not possible, a hysterectomy (removal of the uterus) should be performed.
- Perineal hematoma. Perineal trauma such as tears or episiotomy (cut in the perineum to accelerate baby outflow) can be complicated by blood loss from the internal vessels, which result in a hematoma once the tear or episiotomy has been sutured. .