Complications of childbirth
Complications of childbirth — pathological states which arise in the course of patrimonial activity are connected with it, influence the current and the result of childbirth. Are shown by violation of sokratitelny activity a miometriya, a pain syndrome, bleedings, deterioration in the general condition of the woman in labor (dizziness, weakness, consciousness loss, a coma). For diagnostics use methods of external obstetric examination, a vaginal research, a kardiotokografiya, is more rare — ultrasonography, in the posledovy period — audit of patrimonial ways and a uterus. Tactics of conducting childbirth at complications is defined by the nature of the revealed pathology, can assume both a natural, and operational rodorazresheniye.
Complications of childbirth
Today only 37% of childbirth proceed physiologically. In other cases different types of complications are defined, and 23-25% of childbirth come to the end with a surgical way. By results of researches in the sphere of obstetrics and gynecology, the most frequent complications are ruptures of a neck of a uterus (to 27% of cases of childbirth) and crotches (7-15%), premature izlity amniotic waters (12-15%), anomaly of patrimonial forces (about 10%), infectious processes (2-8%), bleedings (2-5%) and a premature otsloyka of a placenta (0,45-1,2%). At the wrong maintaining the complicated childbirth poses a threat to health and life both mother, and a fruit. Despite continuous decrease in indicators of maternal mortality, in Russia dies to 200 women annually while giving birth.
Reasons of complications of childbirth
The pathological course of childbirth can be caused by provocative factors from mother, a fruit and its covers. The main reasons for the violations arising in labor are:
- Pathological pregnancy. At the complicated gestational period the risk of violations increases in labor — a premature otsloyka of a placenta, weakness of patrimonial forces, a decompensation of chronic diseases of mother, bleedings.
- Anatomic features of patrimonial ways. The narrow basin, volume formations of a neck, vagina, bodies of a small pelvis, a high crotch become physical obstacles for passing of a fruit. At infantility, a saddle uterus and other anomalies of development sokratitelny activity a miometriya decreases more often. Age reduction of elasticity of fabrics increases probability of their gap.
- Inflammatory diseases. In the presence of an endometritis, a tservitsit, a colpitis, the horioamnionita increases risk of bleedings, patrimonial traumatism of mother, infection of the child when passing on patrimonial ways.
- Earlier postponed invasive interventions. The cicatricial changed tissues of genitals stretch worse, are less steady against the loadings arising in labor. Therefore at women after gynecologic operations and diagnostic manipulations (abortions, vyskablivaniye, etc.) such complications as injuries of soft fabrics are more often observed.
- Injuries in last labor. The hems created after last ruptures of a crotch, neck and body of a uterus are more subject to damages.
- Ekstragenitalny pathology. The hypertension, diabetes, a renal failure, a miopiya and other chronic diseases can decompensate in labor. Some of them increase probability of bleedings, a long current, DVS-syndrome and other complications.
- Wrong situation and prelying. Childbirth at slanting situation, pelvic, frontal or occipital prelying is followed by patrimonial traumatism, premature izlitiy amniotic waters, loss of an umbilical cord and small parts of a fruit. The natural rodorazresheniye at the cross provision of a fruit is impossible.
- Anatomic features of the child. At the big sizes, hydrocephaly or rough congenital defects it is more difficult to fruit to pass across the patrimonial canal. The probability of female and prenatal traumatism increases in such cases.
- Polycarpous pregnancy. Childbirth more than one child, especially if they the first, is more often characterized by the complicated current with the increased risk of bleedings and traumatism.
- Pathology of fetal covers. Bleedings, a hypoxia of a fruit and other complications of childbirth can be caused by an early rupture of an amniotic bubble, obvitiy or loss of an umbilical cord, small or abundance of water, a dense attachment, an increment, growing, germination or a premature otsloyka normally or low located placenta.
- Medical errors. The wrong tactics of conducting pregnancy and childbirth, the choice of an improper way of a rodorazresheniye or type of surgery, unreasonable stimulation of patrimonial activity are fraught with risk of traumatism, other complications and even death of the woman or the child.
Their nature and time of emergence are the basis for clinical classification of complications the level of the arising violations (pathology of childbirth, damages at mother or a fruit). Kinds of pathological childbirth are:
- Premature birth. At the beginning of patrimonial activity the probability of emergence of complications at a fruit is up to 37 weeks higher. Therefore even at a normal current they are considered as complicated.
- Long childbirth. Increase in a duration of delivery because of the weak or dicoordinated patrimonial activity, clinically or anatomic a narrow basin and other reasons increases risk of injuries, hypoxias, postnatal bleedings.
- Rapid childbirth. At rough reductions of a uterus there are ruptures of soft fabrics of patrimonial ways, a fruit trauma, an otsloyka of a placenta, violation of a placentary blood-groove, hypotonic bleedings more often.
- Operational rodorazresheniye. As at Cesarean section, imposing of a vacuum extractor or nippers, obstetric turn and other interventions the risk of development of complications in the woman and the child increases, such childbirth obviously is considered as complicated.
The woman in connection with childbirth has possible following types of complications:
- Patrimonial traumatism. Under the influence of the considerable stretching loadings during childbirth there are ruptures of a crotch, vagina, neck of a uterus and its body. In the most hard cases injuries of a sphincter and a wall of a rectum, a divergence of pelvic bones are observed.
- Decompensation of ekstragenitalny diseases. The considerable physical activities interfaced to childbirth are capable to provoke hypertensive crisis, a sharp heart, brain, renal or liver failure, a diabetic coma, an otsloyka of a retina and other violations.
- Bleedings. At ruptures of fabrics, violations in the curtailing system of blood, a partial or full increment of a placenta, hypotonia a miometriya quite often there are long bleedings leading to considerable blood losses, gipovolemichesky shock and the DVS-syndrome.
- Embolism amniotic waters. The terrible complication caused by hit of amniotic liquid in mother's blood-groove. In 70-80% of cases comes to an end with death of the woman, in 60-80% — fruit death.
- Delay of parts of an afterbirth in a uterus. Even in the absence of bleeding the placenta fragments which grew or grew into a uterus wall pose a threat for health of the woman. They can become a nutritious substratum for development of an inflammation or regenerate.
- Postnatal inflammatory processes. At difficult and long delivery, various invasive interventions the risk of development of endometritises, adneksit, tservitsit, peritonitis and sepsis increases.
As the main complications of childbirth from a fruit are considered:
- Prenatal traumatism. At childbirth the child can get a spine injury, a fracture of a clavicle and humeral bone. Intra organ hemorrhages in tissue of a brain, kidneys, a liver, adrenal glands, violations of brain blood circulation, formation of a kefalogematoma are possible.
- Sharp hypoxia. Reduction or complete cessation of intake of blood from mother to the child because of an otsloyka of a placenta or a perezhatiya of an umbilical cord is followed by oxygen starvation. At a long hypoxia there can be irreversible changes in fruit fabrics.
- Infection in labor. At a clinical current or an asymptomatic carriage at mother of infections of patrimonial ways infection of the child with opportunistic flora, causative agents of herpes, gonorrhea, clamidiosis and other diseases is possible.
Taking into account time of emergence of the consequences connected with childbirth distinguish complications of the period of fights (the premature beginning, a long current, etc.), the potuzhny period (a fruit hypoxia, patrimonial traumatism, a decompensation of the accompanying pathology), the posledovy period (bleeding), the postnatal period (inflammatory diseases). Besides, allocate the remote consequences of childbirth connected with their complicated current — and cicatricial deformation of a neck of a uterus, omission and loss of a vagina, uterus, horionepiteliy at the woman, a cerebral palsy, other invalidiziruyushchy simptomokompleks and diseases at the child.
Symptoms of complications of childbirth
Changes in force and character of fights, a pain syndrome, vaginal allocations, violations of the general health of the woman, stir of a fruit can testify to the complicated course of childbirth. At weak patrimonial activity the woman in labor celebrates rare short fights which usually differ in smaller morbidity. The dicoordinated fights are followed by notable increase in a tone a miometriya, the wrong rhythm of its reduction and relaxation, uneven force of fights and morbidity of patrimonial activity. Usually at the same time the woman feels the expressed concern.
Though in the absence of anesthesia pain is always present at labor, change of its intensity can demonstrate development of complications. More often the expressed pain syndrome arises at the menacing and begun gap to a uterus. Directly at the time of a gap pain decreases, and reductions a miometriya stop. If in labor or right after them the woman complains of the sharp ("shooting") pain in the field of a lonny joint, it is possible to suspect a divergence or a rupture of a pelvic ring.
Emergence of plentiful watery allocations from a vagina testifies to an izlitiya of amniotic waters. Unlike timely opening of a fetal bubble in normal labor, its premature gap is considered a complication, often provokes weakening of patrimonial activity, loss in a vagina of parts of a fruit or umbilical cord. Bloody allocations in the first period of childbirth usually are a consequence of premature flaking of a placenta. In the second period they most often accompany ruptures of patrimonial ways, and in the third the miometriya or delays of parts of a placenta in a uterine cavity result from hypotonia.
At development of ekstragenitalny complications of childbirth the general changes in health of the woman are observed. She can feel sudden weakness, dizziness, loss of clearness of sight, "front sight" or a veil before eyes, strong heartbeat, perspiration, feeling of cold, a shiver. In the mezhskhvatochny period and, especially, during the fights of stir of a fruit usually are not felt, but when developing a hypoxia the discomfort felt by the child forces it to move actively. Therefore the increased activity of a fruit in the period between fights has to become a reason for vigilance of the obstetrician-gynecologist.
Diagnostic actions are at the time of delivery directed to assessment of a condition of the woman in labor and child, timely identification of complications and definition of their weight. At suspicion are recommended for the complicated course of childbirth:
- External obstetric research. Allows to define a form and the sizes of a uterus, height of standing of its bottom, extent of disclosure of a neck (approximately), compliance of the sizes of a basin and the child's head, to estimate the frequency, force and rhythm of fights, to reveal sites of local morbidity.
- Vaginal survey. It is applied to definition of a condition of a neck of a uterus, extent of its disclosure, integrity of an amniotic bubble, the prelying part of a fruit and features of its advance on patrimonial ways. During inspection in a vagina blood, an umbilical cord, parts of a fruit can come to light.
- Kardiotokografiya. Allows to carry out monitoring of sokratitelny activity of a uterus and heartbeat of a fruit, in time to find symptoms of a hypoxia and other threats to the child which are followed by increase or delay of warm activity.
- Gynecologic ultrasonography. Because of bystry dynamics of childbirth at their maintaining ultrasonographies are appointed much more less than at pregnancy. In certain cases with their help specify the provision of a fruit, umbilical cord, a condition of a placenta and a hem on a uterus.
- Survey of patrimonial ways after the delivery. Audit of a neck of a uterus by means of special spoon-shaped mirrors gives the chance in time to reveal and take in its gaps. Then regarding gaps examine a vagina and a crotch.
- Manual inspection of a uterus. Is the medical and diagnostic procedure. It is carried out in case of suspicion on a delay to cavities of a uterus of fragments of a placenta.
If necessary to the woman appoint the general blood test, the ECG, monitoring of pulse and HELL. As pathological states are directly connected with process of childbirth, differential diagnostics is carried out between different types of complications. According to indications involve the intensivist, the therapist, the neuropathologist, a neonatolog in conducting childbirth.
Treatment of complications of childbirth
Obstetric tactics is directed to the choice of an optimum way of a rodorazresheniye with minimization of consequences for the woman in labor and a fruit. The choice of concrete medicines and the technician is defined by a type of complications. In the natural complicated labor are appointed:
- Stimulators of reductions of a uterus. Strengthen fights and accelerate process of childbirth at patients with complications in the form of primary or secondary weakness of patrimonial activity.
- Tokolitiki. Allow to relax uterine muscles at the rough or dicoordinated fights, a hyper tone, threat of a rupture of a hem.
- Anesthetics. Depending on intensity of pain and its subjective perception by the woman in labor the wide range of medicines and ways, from purpose of analgetics to epiduralny or paravertebralny anesthesia and the general anesthesia is applied.
- Sedative medicines. Reduce emotional pressure, exponentiate effect of the anesthetizing therapy, allow the woman to control better process of childbirth in response to instructions of midwifes and doctors.
The complication of childbirth by bleeding serves as the indication for purpose of infusional therapy with use of gemostatik, krovozameshchayushchy solutions and medicines of blood, inhalations of oxygen through a mask. At the remaining bleeding after the birth of the child audit of patrimonial ways on gaps with their subsequent ushivaniye and manual survey of a cavity of a uterus for detection and extraction of the remains of a placenta is shown. In rapid labor, at the birth of a large fruit, the child with hydrocephaly or in not physiologic situation / prelying, when using obstetric grants or operations the threat of damage of patrimonial ways increases. Therefore to the woman in labor in a planned order make an epiziotomiya.
The wrong prelying and the provision of a fruit is the indication for use of one of obstetric grants — turn of a fruit on a head (on Arkhangelsk) or a leg, classical manual or grants across Tsovyanov at pelvic prelying. If the provision of a fruit interferes with natural childbirth, Cesarean section is recommended. At threat of mother and to the child obstetric operations — a fruit vacuum extirpation, its extraction for the pelvic end or imposing of obstetric nippers can be applied to more bystry completion of childbirth. At death of the child and impossibility of completion of childbirth in the natural way or Caesarian section carry out plodorazrushayushchy operations.
The urgent rodorazresheniye Caesarian is shown by section at sharp emergence of threat of life of the woman in labor and child (a rupture of a uterus, an otsloyka of a placenta, loss of an umbilical cord). In some cases band operation comes to the end with a uterus extirpation. The hysterectomy is carried out at massive gaps with formation of intraligamentarny hematomas, the proceeding bleeding, growing of a placenta, the long waterless period with a complication its infectious process.
Forecast and prevention
The forecast of the complicated childbirth depends on a type of pathology, timeliness of its diagnostics and adequacy of obstetric tactics. In most cases the outcome is favorable for the child and for mother. In Russia the indicator of maternal mortality decreased from year to year and in 2016 reached a historical minimum — 8,3 cases on 100 thousand childbirth. Infantile, including intranatalny mortality is also constantly reduced. Timely registration and dynamic observation in antenatal clinic, treatment of the revealed associated diseases and complications of pregnancy, planned hospitalization in maternity hospital in the presence of indications is important for prevention of complications of childbirth. A key role for the prevention of intranatalny threats is played by a right choice of a way of a rodorazresheniye and professionalism of medical personnel when conducting childbirth.