Complications under birth

introduction

There can be a variety of complications for the mother and / or child during childbirth. These are partly treatable, but can also be acute emergencies. They affect both the birth process until delivery of the child and the postnatal phase.

Complications for mother and child can also occur during pregnancy or shortly before birth. Reasons for this are, for example, gestational diabetes, hypertension of the mother or pregnancy poisoning.

Overall, birth complications are rare, with most births occurring without any problems. Deaths of mothers in connection with childbirth are extremely rare in this country.

Complications for the mother

Complications for the mother can occur especially during the postpartum period, ie when the child is already delivered and the afterbirth (mother cake, remains of the umbilical cord and membranes) still has to be born. In this case, the placenta should be discharged about 10 to 30 minutes after childbirth. Incomplete rejection of afterbirth can lead to severe blood loss and, in the worst case, to circulatory failure (see below).

High blood losses can also occur if the uterine muscles do not contract or contract sufficiently after birth (so-called uterine atony ). This can be caused by overexpansion of the uterine wall (eg by very large children or multiple births) or malformations of the uterus.

A very rare but serious complication for the mother is the so-called uterine rupture, which can occur during pregnancy and childbirth. This leads to cracks in the uterine wall, which are accompanied by sudden severe pain and a large loss of blood.

Other complications for the mother are birth injuries. These include injuries to the vagina, the labia, the vagina, the cervix, the cervix and very rarely the pubic symphysis (so-called symphysis ). A common birth injury is the so-called dam rupture, ie an injury to the skin and possibly the muscles between the vagina and the intestine. These are divided into different degrees depending on size and depth and occur in about 20 to 30 percent of all births.

In the foreground of the treatment of birth injuries are haemostasis, wound cleansing and suturing the wound.

A very rare complication of childbirth is the amniotic fluid embolism. In the process, amniotic fluid (usually due to birth defects) enters the mother's blood and sudden blood clotting can lead to respiratory distress and circulatory failure.

Complications for the child

Complications for the child occur especially during labor. Causes for this can be on the one hand the size, position or attitude of the child or on the other due to the labor activity and the physique of the mother.

An important complication of these causes is birth-arrest, in which childbirth does not progress in the course of good labor (

In addition to the pelvic end position (see below), the so-called positional anomalies of the child include the transverse or oblique position when the child lies transversely or obliquely with respect to the birth canal. Attitude anomalies describe, among other things, the forehead or face position when the child's head is stretched backwards. In most cases, then a caesarean section is performed.

Problems during childbirth can occur even if the child's head does not turn properly into the mother's pelvis. If the head does not set properly despite various aids, the delivery must be stopped by external intervention (suction cup, forceps or cesarean section). A so-called shoulder dystocia occurs in 0.5 to 1 percent of births and describes the condition when the child's head is already born but due to a lack of rotation of the child, the shoulders still hang in the mother's pelvis, so that the rest of the body is not born can. The risk of developing shoulder dystocia is increased in large children (over 4000 g) and is an emergency for both mother and child.

A disorder of labor means stress for both mother and child, and may cause, inter alia, a child's deficiency in oxygen, a delay in the birth process, or an obstetric cessation. In this case, the contractions may be either too weak or too strong: A too low contracting activity describes too weak labor, too short labor or too long breaks between the individual contractions. Too much labor describes too much or too frequent contractions to a so-called labor storm.

In addition, stress for the child during the birth can lead to the premature departure of the so-called child smasher (meconium). Child's Spech is the first newborn's chair, usually delivered within the first 48 hours after birth. Due to birth complications such as an oxygen deficiency of the child, it may come during the birth process for discontinuation of the meconium in the amniotic fluid. This poses an acute threat to the child, since the meconium-containing amniotic fluid can be inhaled and lead to lung damage ( meconium aspiration syndrome ).

Also, a mismatch between the child's head and the mother's pelvis (shape and / or size do not match), too tight a pelvis or too tight pelvic floor can cause complications during childbirth and, among other things, lead to a birth loss.

Further complications for the child at birth are problems with the umbilical cord. These can be, for example umbilical cord wrap and umbilical cord knot - an acute emergency is the umbilical cord prolapse (see below).

Complications with the umbilical cord

Umbilical cord complications include umbilical cord, umbilical cord and umbilical cord prolapse. In part, these umbilical cord complications can be detected before birth or fall during birth through changes in the so-called CTGs (cardiotocography, recording of children's heart sounds and contractions) on.

The umbilical cord wrap occurs in about 20 percent of all children and describes a single or multiple wrapping of the neck through the umbilical cord. Causes include, among other things, an increased physical activity of the child or a long umbilical cord. Umbilical cord knots occur in about one percent of all births. They, too, can come about through an increased movement of the child. Rarely, contracting the nodules during childbirth causes the child to become undersupplied with oxygen. However, umbilical cord entanglements or nodules do not lead to major complications at birth.

An emergency, however, is the umbilical cord episode. It occurs in 0.5 percent of all births and describes an entrapment of the umbilical cord between the pelvis and the head after the rupture of the bladder. As a result, there may be a lack of oxygen in the child, which is why fast action and an emergency Caesarean section must be performed.

Complications from a breech presentation

A pelvic end position describes a child situation in which not the child's head, but the pelvic end (rump, foot or knee position) precedes. It occurs in five percent of all births, in premature births it is about ten to 15 percent. The causes of pelvic endings are often unclear.

A normal, vaginal birth at pelvic endings involves many risks, especially at the first birth. On the one hand, the birth of the head is made more difficult because the birth canal was insufficiently widened due to the previous passage of the rump or buttocks. On the other hand there are more often umbilical cord incidents and entrapments with the following oxygen deficiency of the child.

Vaginal delivery is possible under certain conditions - but the decision to do so should be carefully weighed, requires some pre-admission examinations, and should take place at specific specialized centers. Most children are born in pelvic end position, however, either after successful external turn vaginal or there is a planned caesarean section. An external twist can be made from the 37th week of pregnancy. It tries to turn the child from the outside into the right position. It is carried out under strict supervision of mother and child.

Complications of the placenta

The placenta (mother cake) represents a direct link between mother and child, through which, inter alia, oxygen and nutrients are exchanged. Misplacement of the placenta or problems with placental detachment can cause complications before, during and after childbirth.

Placenta praevia is a placental misplacement and occurs in 0.4 percent of all pregnancies. The cake is deeper in the uterus and can cover the cervix partially or completely. During delivery, severe bleeding may occur and a caesarean section must be performed.

Premature placental ablation, ie detachment of the placenta before the child is abled, can also cause complications before or during labor. It occurs in about 0.8 percent of all pregnancies and can put both mother and child at risk. Symptoms include a hard uterus, pain, dizziness, loss of consciousness and bleeding, and can cause circulatory and renal failure.

Disruption of the placental abrupt solution occurs when the placenta has not yet resolved after more than 30 minutes after being broken off, the mother has lost more than 300 ml of blood, or the afterbirth has not been born or only incompletely. There may be different causes, for example, that the uterine muscles do not contract enough to repel the placenta or that the placenta is fused to the uterine wall.

Furthermore, a spasm of the cervix can lead to the fact that the afterbirth can not be born. Complications are mainly heavy bleeding. Therapeutic drugs or various hand grips are used, in the worst case, the uterus must be surgically removed.


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