Complications during childbirth. What can go wrong with childbirth? Getting ready for natural childbirth: possible complications

02.08.2019

Pathological conditions that arise during labor are associated with it, affect the course and outcome of labor. They are manifested by a violation of the contractile activity of the myometrium, pain syndrome, bleeding, deterioration of the general condition of the woman in labor (dizziness, weakness, loss of consciousness, coma). For diagnostics, methods of external obstetric examination, vaginal examination, cardiotocography, less often ultrasound, in the subsequent period - revision of the birth canal and uterus are used. The tactics of labor management in case of complications is determined by the nature of the identified pathology, and may involve both natural and surgical delivery.

General information

Today, only 37% of births are physiological. In other cases, various types of complications are determined, and 23-25% of births are completed surgically. According to the results of studies in the field of obstetrics and gynecology, the most frequent complications are ruptures of the cervix (up to 27% of births) and perineum (7-15%), premature rupture of amniotic fluid (12-15%), abnormalities of labor forces (about 10% ), infectious processes (2-8%), bleeding (2-5%) and premature placental abruption (0.45-1.2%). If not managed properly, obstructed labor is a threat to the health and life of both the mother and the fetus. Despite the constant decline in maternal mortality rates, up to 200 women die each year during childbirth in Russia.

Causes of labor complications

The pathological course of childbirth can be caused by provoking factors from the mother, the fetus and its membranes. The main causes of childbirth disorders are:

Pathological pregnancy... With a complicated gestational period, the risk of abnormalities in childbirth increases - premature placental abruption, weakness of labor forces, decompensation of chronic diseases of the mother, bleeding.
Anatomical features of the birth canal... A narrow pelvis, volumetric formations of the neck, vagina, pelvic organs, high perineum become physical obstacles to the passage of the fetus. With infantilism, saddle uterus and other developmental anomalies, the contractile activity of the myometrium is often reduced. Age-related decrease in tissue elasticity increases the likelihood of rupture.
Inflammatory diseases... In the presence of endometritis, cervicitis, colpitis, chorioamnionitis, the risk of bleeding, birth trauma to the mother, and infection of the child when passing through the birth canal increases.
Previously undergone invasive interventions... Cicatricial tissue of the genital organs is less stretched, less resistant to stress arising in childbirth. Therefore, women after gynecological operations and diagnostic procedures (abortion, curettage, etc.) are more likely to experience complications such as soft tissue injuries.
Past birth trauma... Scars that have formed after past tears in the perineum, cervix, and uterus are more susceptible to damage.
Extragenital pathology... Hypertension, diabetes mellitus, renal failure, myopia and other chronic diseases can decompensate during childbirth. Some of them increase the likelihood of bleeding, protracted course, DIC and other complications.
Incorrect position and presentation... Childbirth in an oblique position, pelvic, frontal or occipital presentation is accompanied by birth trauma, premature rupture of amniotic fluid, prolapse of the umbilical cord and small parts of the fetus. Natural delivery with the transverse position of the fetus is impossible.
Anatomical features of the child... With a large size, hydrocephalus or gross birth defects, it is more difficult for the fetus to pass through the birth canal. In such cases, the likelihood of female and prenatal injury increases.
Multiple pregnancy... Childbirth with more than one child, especially if they are the first, is more often characterized by a complicated course with an increased risk of bleeding and injury.
Pathology of the membranes... Bleeding, fetal hypoxia and other complications of childbirth can be caused by early rupture of the amniotic bladder, entanglement or prolapse of the umbilical cord, little or polyhydramnios, tight attachment, accretion, ingrowth, germination or premature detachment of a normal or low-lying placenta.
Medical errors... Wrong tactics of pregnancy and childbirth management, choice of an inappropriate method of delivery or type of surgery, unjustified stimulation of labor are fraught with the risk of injury, other complications and even death of a woman or child.

Classification

The clinical classification of complications is based on the level of emerging disorders (pathology of childbirth, damage to the mother or fetus), their nature and time of occurrence. The types of pathological childbirth are:

Premature birth... At the onset of labor before 37 weeks, the likelihood of complications in the fetus is higher. Therefore, even with a normal course, they are considered complicated.
Prolonged labor... An increase in the duration of labor due to weak or discoordinated labor, clinically or anatomically narrow pelvis and other reasons increases the risk of injury, hypoxia, postpartum bleeding.
Rapid labor... With rapid contractions of the uterus, ruptures of the soft tissues of the birth canal, fetal trauma, placental abruption, disturbances in placental blood flow, hypotonic bleeding occur more often.
Operative delivery... Since cesarean section, vacuum extractor or forceps, obstetric twist and other interventions increase the risk of complications in a woman and a child, such childbirth is deliberately considered complicated.

In a woman, due to childbirth, the following types of complications are possible:

Birth trauma... Under the influence of significant tensile loads during childbirth, ruptures of the perineum, vagina, cervix and her body occur. In the most severe cases, there are injuries to the sphincter and rectal wall, and the divergence of the pelvic bones.
Decompensation of extragenital diseases... Significant physical exertion associated with childbirth can provoke a hypertensive crisis, acute cardiac, cerebral, renal or hepatic failure, diabetic coma, retinal detachment and other disorders.
Bleeding... With tissue ruptures, disorders in the blood coagulation system, partial or complete placental accreta, myometrial hypotension, prolonged bleeding often occurs, leading to significant blood loss, hypovolemic shock and disseminated intravascular coagulation.
Amniotic fluid embolism... A terrible complication caused by the ingress of amniotic fluid into the mother's bloodstream. In 70-80% of cases, it ends with the death of a woman, in 60-80% - with the death of the fetus.
Retention of parts of the placenta in the uterus... Even in the absence of bleeding, fragments of the placenta, adherent or ingrown into the wall of the uterus, pose a threat to a woman's health. They can become a nutrient substrate for the development of inflammation or be reborn.
Postpartum inflammatory processes... With severe and prolonged labor, various invasive interventions, the risk of developing endometritis, adnexitis, cervicitis, peritonitis and sepsis increases.

The main complications of childbirth from the fetus are:

Prenatal injury... During childbirth, the child may suffer a spinal injury, a fracture of the clavicle and humerus. Intraorgan hemorrhages are possible in the tissues of the brain, kidneys, liver, adrenal glands, cerebral circulation disorders, and the formation of cephalohematoma.
Acute hypoxia... Decrease or complete cessation of blood flow from mother to child due to placental abruption or cord clamping is accompanied by oxygen starvation. With prolonged hypoxia, irreversible changes in the tissues of the fetus may occur.
Infection during childbirth... With a clinical course or asymptomatic carriage of infections of the birth canal in the mother, it is possible for the child to become infected with conditionally pathogenic flora, pathogens of herpes, gonorrhea, chlamydia and other diseases.

Taking into account the time of occurrence of the consequences associated with childbirth, complications of the period of contractions (premature onset, protracted course, etc.), the labor period (fetal hypoxia, birth traumatism, decompensation of concomitant pathology), the subsequent period (bleeding), the postpartum period (inflammatory diseases ). In addition, the long-term consequences of childbirth associated with their complicated course are distinguished - ectropion and cicatricial deformity of the cervix, prolapse and prolapse of the vagina, uterus, chorionepithelioma in a woman, cerebral palsy, other disabling symptom complexes and diseases in a child.

Symptoms of labor complications

Changes in the strength and nature of contractions, pain syndrome, vaginal discharge, disturbances in the general well-being of a woman, and fetal movement may indicate a complicated course of labor. With a weak labor activity, the woman in labor notes rare short contractions, which are usually less painful. Discoordinated contractions are accompanied by a noticeable increase in the tone of the myometrium, an irregular rhythm of its contraction and relaxation, an uneven force of contractions and pain in labor. Usually, the woman feels a lot of anxiety.

Treatment of labor complications

Obstetric tactics are aimed at choosing the optimal method of delivery with minimizing the consequences for the woman in labor and the fetus. The choice of specific drugs and techniques is determined by the type of complications. In natural complicated childbirth, the following are prescribed:

Stimulants of uterine contractions... Strengthen contractions and speed up the process of childbirth in patients with complications in the form of primary or secondary weakness of labor.
Tocolytics... They allow you to relax the uterine muscles during violent or discoordinated contractions, hypertonicity, and the threat of scar rupture.
Pain relievers... Depending on the intensity of pain and its subjective perception by the woman in labor, a wide range of drugs and methods are used, from prescribing analgesics to epidural or paravertebral anesthesia and general anesthesia.
Sedatives... Reduces emotional stress, potentiates the effect of pain therapy, allows the woman to better control the process of childbirth in response to instructions from midwives and doctors.

Complication of labor with bleeding is an indication for the appointment of infusion therapy using hemostatics, blood-substituting solutions and blood products, oxygen inhalation through a mask. With continued bleeding after the birth of the child, a revision of the birth canal for ruptures with their subsequent suturing and manual examination of the uterine cavity to detect and remove the remnants of the placenta is shown. In rapid labor, at the birth of a large fetus, a child with hydrocephalus or in an unphysiological position / presentation, when using obstetric aids or operations, the threat of damage to the birth canal increases. Therefore, an episiotomy is routinely performed for a woman in labor.

Urgent delivery by cesarean section is indicated in case of an acute threat to the life of the woman in labor and the child (rupture of the uterus, placental abruption, umbilical cord prolapse). In some cases, the abdominal operation ends with the extirpation of the uterus. Hysterectomy is performed with massive ruptures with the formation of intraligamentary hematomas, ongoing bleeding, ingrowth of the placenta, a prolonged anhydrous period with complications of its infectious process.

Forecast and prevention

The prognosis of complicated labor depends on the type of pathology, the timeliness of its diagnosis and the adequacy of obstetric tactics. In the vast majority of cases, the outcome is favorable for the child and the mother. In Russia, the maternal mortality rate has been declining from year to year and in 2016 reached a historic low of 8.3 cases per 100 thousand births. Infant, including intrapartum, mortality is also constantly decreasing. To prevent complications of childbirth, timely registration and follow-up in antenatal clinics, treatment of identified concomitant diseases and complications of pregnancy, planned hospitalization in a maternity hospital if indicated are important. The correct choice of delivery method and the professionalism of medical personnel in the management of childbirth play a key role in preventing intranatal threats.

The fear is completely justified, because quite often during childbirth, a woman has to deal with certain complications. In this article, we'll break down the most common birth complications.

Childbirth tears

Tissue tears during childbirth are the most common complication - here the perineum, the vagina, the cervix, and the uterus itself can be affected. The tears can be mild - small cracks and abrasions that cause slight discomfort but heal quickly without surgery.

Breaks are the result of medical intervention, and there are also spontaneous ones. Spontaneous ruptures most often occur due to too rapid childbirth, when the vagina does not have time to open on its own, and also due to a too narrow vagina. Violent ruptures occur due to medical intervention using obstetric forceps, vacuum extraction, etc. Most often, violent ruptures occur precisely when.

How to prevent?

Only slight tears in the form of cracks and abrasions can be prevented. To do this, it is necessary to prepare the perineum even during pregnancy - to do special gymnastics, for example, to do a light massage using vegetable oils. Nutrition will also help - a large amount of plant products increase tissue elasticity. It is recommended to learn how to breathe and relax correctly - relaxed muscles are less torn from childbirth than tense ones.

During childbirth, the doctor pays attention to the condition of the vagina - if it begins to turn white, it means that the pressure in it increases, in which case the doctor will make an incision in the perineum (episiotomy). The incision will be subsequently stitched and healed much faster than multiple tears and abrasions.

Violent and spontaneous ruptures of a more severe nature cannot be prevented. In this case, doctors apply stitches under local anesthesia.

Whatever the nature of the breaks, in the next few days after giving birth, the woman will not be able to sit, as the stitches may come apart.

Labor activity disorders

There is a weak and violent labor activity, which can lead to certain complications.

Weak labor is most often found in primiparous and is characterized by weak and rare contractions, due to which the cervix cannot fully open, as a result it is possible.

Violent labor, on the contrary, proceeds too rapidly, characterized by strong and frequent contractions. Most often found in multiparous. Rapid childbirth can lead to trauma to the child, fetal hypoxia, perineal rupture in the mother.

What to do?

In the case of weak labor, doctors usually give contraction-stimulating drugs. If the drugs do not help, a caesarean section is prescribed.

In the event of a violent labor, doctors give drugs that reduce the tone of the uterus. Most often, epidural anesthesia is done - the anesthesiologist injects anesthetic into the spinal canal, which brings the contractions of the uterus back to normal.

Bleeding

It can occur both during childbirth and in the subsequent postpartum hours. Bleeding threatens both mother and baby. The causes of bleeding can be uterine fibroids, inflammation in the uterus, hormonal imbalance, placenta, scars after a previous cesarean section, etc.

If bleeding occurs during childbirth, a catheter with blood-substituting drugs is inserted into the pregnant woman, and an emergency caesarean section is performed.

Oxygen starvation (hypoxia)

During childbirth, the umbilical cord can twine around the baby's neck, the umbilical cord can be pinched, and it can also occur - all this can lead to fetal hypoxia, i.e. oxygen starvation. Also, too fast and too long childbirth can cause hypoxia. In this case, the only way out is operative delivery.

Summing up

Childbirth is an ordeal for the mother, both physically and psychologically. But you must understand that a lot also depends on you - the ability to breathe correctly, relax, and moral readiness can help you endure childbirth quickly and easily. Try to prepare yourself for this significant event in advance and do not forget to do gymnastics, strengthen your internal muscles, so that there are fewer complications, and the recovery process goes quickly.

This is a very exciting topic for both women and her family. Especially if the woman in labor is an impressionable nature, then the expectation of childbirth becomes a real test. However, is it boring to be so worried? After all, it is not known how your childbirth will take place, whether it is favorable or not. Especially if the gestation proceeded favorably, and physically you are in full normalcy. You should forget about the scary stories from the lips of the "experienced". Some people are capable of exaggerating and embellishing what they were feeling or telling them. However, there are also real situations when labor is complicated by some phenomena. It is boring to know about this in order to react at the right time and take the necessary measures. Do not worry, experienced doctors and modern technology will solve all the problems they face.

Today medicine gives a chance to identify and prevent the causes of complications even before the birth process. Therefore, difficult childbirth in our time is very rare. A specialist usually sees immediately what needs to be done. Probably, he will introduce medications to the woman in labor that enhance the birth process or decide to apply some known method. Let's take a look at a few complications that can occur during labor.

Prolonged labor

There are circumstances in which the labor process lasts longer than usual, and as a result, prolonged labor is usually stated when there is a delayed course of labor. They are judged by how the baby's head descends and the cervix expands.

There are three reasons for delayed labor. It:

complications associated with the birth process. Since, the woman in labor is not observed periodic. They can be too sparse, weak and short. They can be, and vice versa, frequent and strong. Both contractions are ineffective and lead to unfavorable childbirth. If the contractions are too infrequent and sluggish, uterine stimulation may be given. For this, the expectant mother is given a dropper. And if on the contrary, they try to calm the work of the uterus using epidural anesthesia or pain relievers.
complications associated with the baby. It may be that it is difficult for a woman in labor to give birth, because the baby is not located correctly and is very large. Everyone knows that some time before the birth process, the baby is head down. At the same time, his chin is pressed to his chest, and his head is lowered. This is the most favorable posture for birth.
However, it happens that the child does not lower his head, and when he is born, the chin “wants to come out”. In this situation, the diameter facing the pelvic canal increases significantly, and although the baby's head can be of normal shape and size, its position increases the size of the birth canal, leading to a delay in labor. If, nevertheless, the baby in the second phase did not turn the head correctly, then the specialist will turn the baby's head using a vacuum extractor or special forceps.
If this procedure does not help, an urgent cesarean is done. Not often, but still it happens that the head of the baby is turned to the pelvic passage with its lateral side, face or even the forehead of the baby. As a result, depending on the situation, a decision is made and the method of delivery management. First of all, it sways the cases of the baby's breech presentation. Vaginal birth process with breech presentation is very dangerous, since when the baby passes through the birth canal, all the "work" is performed by his buttocks. Therefore, the baby's head does not have time to adapt to the pressure.
Since the head of the crumbs is very vulnerable during the period, then on the part of specialists, maximum care is required. In this case, the birth is carried out using a caesarean section. Especially if the woman in labor gives birth for the first time. If the baby is large and there is a possibility, or hypoxia is observed, it is possible to perform a perineotomy or episiotomy. This procedure is carried out, usually with premature birth.
complications associated with the birth canal. It may be a narrow pelvis. This says that the birth canal is formed by elastic pelvic bones, soft and delicate tissues of the vagina and uterus. As a result, childbirth will proceed through surgery. If the pelvis is not very narrowed, vaginal labor may be enlarged. There may be a case in which the pelvic dimensions are ideal, and complications arise from abnormalities of the birth canal.

Premature birth

They can be classified as complications because a baby born between 29-36 weeks is very lethargic and suffers during childbirth. In such a child, the systems and organs are poorly developed, the weight becomes from 0.5 to 2 kilograms. Premature babies are more likely to be injured because their bones are so soft. Some crumbs born before the prescribed time require monitoring in the children's intensive care unit.

Baby's distress

If the baby is experiencing a lack of oxygen, they talk about distress. There are many reasons for this phenomenon: premature detachment of the placenta, around the baby's body or neck. Distress often results from strong pressure on the baby's head during short, long or intense labor. In this state, the baby's heart rate and heart rate change.

If the amniotic fluid is brown or yellow, it contains meconium. This is a consequence of stress. In this situation, especially if there is a violation of the heart rhythm, electronic monitoring of the baby is done. They will probably take a sample of the baby's blood through parts of the scalp. Thanks to the electronic machine, you can find out the degree of acidity. It will help determine the level of severity of the baby's condition. After the results, they decide how the childbirth will take place.

Prolapse of the umbilical cord

This is a very dangerous case, because the clamped umbilical cord does not deliver the necessary oxygen to the child, which threatens with hypoxia or even death. In this situation, immediate labor is required. This situation occurs when the umbilical cord loop is below the presenting part of the baby and falls out.

Discharge during labor

It can develop during childbirth or after childbirth, posing a threat to the health of the woman and the unborn baby. It is not uncommon for the cause of bleeding to be problems, which are primarily associated with the state of the placenta. This is very important if there is chronic inflammatory diseases of the uterus, some diseases of the liver and kidneys, severe heart disease, endocrine diseases, hormonal disorders, diseases of the genital organs, and others. Also, the cause of bleeding during childbirth can be trauma during gestation or a large number of miscarriages, abortions.

If bleeding has opened, the specialist will work simultaneously in several directions. As a result, blood products and blood-substituting solutions will be injected into the woman in labor through large veins. Also - erythrocyte mass, frozen plasma. Often a special mask with humidified oxygen is applied to a woman's face. Blood pressure, oxygen saturation and heart rate are monitored during this period. Women in labor are injected into narcotics, so that surgical treatment can be done.

This is the most common complication of childbirth. They usually can have different consequences and origins. These can be ruptures of the perineum, cervix, vagina.

Perineal tears are superficial in the form of abrasions and cracks, do not bleed and heal very quickly after the baby is born. For the prevention of perineal ruptures, it is recommended that the perineum be specially prepared for the birth process during gestation. A woman in labor needs to know what is the ideal procedure for a perineal tear. Indeed, when the muscles are very tense, the likelihood of rupture increases several times.

Vaginal tears can be violent or spontaneous. The reasons for spontaneous ruptures include rapid labor, if the expectant mother has a narrow pelvis or an underdeveloped short vagina. As a rule, spontaneous vaginal ruptures are a continuation of the tears in the birth canal. Violent tears are formed due to vacuum extraction of the baby, obstetric forceps. When treating tears, the specialist sutures them with special sutures. Very deep and severe tears are sutured under general anesthesia. This operation should only be performed by a professional.

Unfortunately, tissue tears can be dire. This is especially true of the cervix. Such breaks often lead to the death of the fetus or the woman herself. A rupture in the uterus may be if the woman in labor has undergone surgery before. In cases of uterine rupture, the birth procedure is stopped by introducing the woman in labor into deep anesthesia and performing the necessary manipulation. If a rupture does not arise, but there is a chance of its occurrence, an emergency caesarean section is performed, because in such cases the child can be saved.

Postpartum bleeding

Of course, blood loss during the birth process is indispensable. Blood always flows from any wound. During childbirth, the area of \u200b\u200bthe wound is very large, so the bleeding continues for several days. But sometimes the bleeding can be quite copious. It is likely that the reason for this is a perineal tear or episiotomy. If there are no injuries and ruptures, then the specialist determines whether the uterus is relaxed or the placenta does not remain.

It also happens that the bleeding lasts for several days or even a month. The main reason for this is hormonal change. As well as infectious inflammation. If there is a fragment of the placenta in the uterus, the specialist will prescribe medication. If it doesn't work, you can try scraping the uterus.

Normally, childbirth begins exactly when all the developmental processes of the fetus are completed and it is ready for independent life. As with all natural processes, normal childbirth does not require any additional intervention. The main task of medical personnel during childbirth is to monitor the condition of the expectant mother and baby. But if something goes wrong, doctors will be able to provide the necessary assistance in time. Let's try to understand the causes of labor disorders and labor complications.

1. Incorrect position of the fetus

Usually, at the time of birth, the baby is located in the womb of the mother longitudinally with its head down. If the child lies across, his movement along the birth canal becomes impossible. In this case, there is no presenting part of the fetus (head), which normally should press on the cervix during labor, and in this case, the cervix practically does not open, and the walls of the contracting uterus put pressure on the transversely located spine of the baby, which is fraught with severe birth injuries ... There is also an unstable, or oblique, incorrect position of the fetus - in this case, as the contractions intensify, it can also go transverse, which is dangerous for the baby, or into longitudinal - then everything will go according to the usual scenario, without complications in childbirth.

Another option for the incorrect location of the fetus is when not the head is located below, but the buttocks or legs of the crumbs. In this case, childbirth through the natural birth canal may well pass safely and without any complications in childbirth. However, the breech process is certainly longer and more complicated. The risk of complications in childbirth with breech presentation increases the large weight of the fetus (more than 3600 g) or the mother's narrow pelvis. The gender of the baby is of great importance. Since in boys the genitals protrude significantly between the buttocks, with a "pelvic" birth for them, the risk of injury and development of genital disorders in the future significantly increases.

2. Anatomical features of the pelvis

Most often, in practice, there is a uniform narrowing of the pelvis, characterized by a symmetrical decrease in all sizes. In this case, four degrees of constriction are distinguished. In the first degree - a decrease in all sizes of the pelvis within 2 cm - in most cases, childbirth takes place naturally without any complications. The second degree is characterized by a decrease in all sizes by 2-4.5 cm. In this case, childbirth in a natural way is possible, however, the course of the birth process is more often complicated. The third degree involves a decrease in the size of the pelvis by 4.5-6 cm, and the fourth - by more than 6 cm (this is extremely rare). These degrees of narrowing of the pelvis are otherwise called an absolutely narrow pelvis, and in this case, birth through a natural birth canal is impossible.

3. Clinically narrow pelvis

The pelvis is called, which complicates childbirth or prevents their flow, regardless of its size. A clinically narrow pelvis is a concept that denotes a discrepancy between the actual dimensions of the walls of the birth canal and the head of the fetus. Such a discrepancy can develop with the correct shape and normal size of the pelvis, in the following cases:

large fruit or large fetal head;
post-term fetus (the head bones are denser and lack the ability to configure, that is, to adapt to the size of the pelvis);
incorrect insertion of the fetal head, in which the transverse size of the head increases, for example, with the frontal and facial location in the birth canal (correct insertion of the head is occipital, this is its smallest size).

4. Large fetus and childbirth

Using the term "large fetus", we mean that the estimated weight of the baby at birth exceeds 3600 g. Of course, the larger the fetus, the more difficult it is for him and for the expectant mother during the second stage of labor associated with the movement through the birth canal. Weighing more than 4500 g, even a normal pelvis may be too narrow for a large fetus, and a natural childbirth may be too risky for health. However, it is not the estimated weight of the fetus that is decisive for predicting childbirth, but the estimated size of its head - the hardest and largest part of the baby's body. It often happens that with a large weight, a full-term fetus has a relatively small head. In this case, in the absence of other contraindications, natural childbirth is possible and not necessarily associated with the risk of complications. Despite his bone structures are commensurate with the size of the mother's pelvis and the risk of injury during childbirth is low. On the contrary, if, at a normal weight, the fetus determines too large (relative to the size of the mother's pelvis) head sizes, the prognosis for natural childbirth may be unfavorable.

Preparing for childbirth in advance. In order to learn how to relax, control emotions and be able to behave correctly during childbirth, you can read popular literature on preparation for childbirth (books, magazines for pregnant women) and enroll in special maternity schools that are organized at antenatal clinics, maternity hospitals or family clubs for parents and kids. Communication with specialists and other mothers, the opportunity to ask all the questions that bother you and master the technique of self-pain relief during childbirth will help to cope with unaccountable fear and insure against most violations of labor and other complications of childbirth.

5. Multiple pregnancy

If a woman bears two or more babies, then such a load often turns out to be a serious test for her health, doubling (or tripling - in proportion to the number of fetuses) and risks in childbirth. Natural childbirth is possible, but any, even the most insignificant "nuances" associated with the condition of mothers and babies, much more often provoke the development of complications in childbirth. The most common complications of childbirth in this case are premature labor, premature effusion of water, weakness of labor, placental abruption.

6. Features of the structure of the uterus

These, first of all, include unusual forms of the uterus: saddle-shaped, two-horned, one-horned, infantile. The irregular shape of the uterus often causes the development of weak labor, oblique or transverse position of the fetus in childbirth, bleeding. Other unfavorable features of the structure of the uterus that affect the development of labor complications are septa (connective tissue cords) and septa in the uterine cavity, fibroids (globular growths of the uterine muscle) and postoperative. These formations impair the conduction of a nerve impulse in the muscles of the uterus, which can cause various disorders, mainly weakness or discoordination of labor. In the presence of septa and septa, the risk of birth trauma to the fetus increases significantly, and the main danger associated with the presence of a scar on the uterus is its rupture against the background of contractions or attempts.

7. Multiple entanglement with the umbilical cord

Multiple entanglement with the umbilical cord leads to a significant shortening of its length and deterioration of the blood supply to the fetus. In addition, numerous (more than three) loops of the umbilical cord interfere with the normal position of the fetus in the uterus and impede its movement, which disrupts the normal course of labor. If the baby is not able to make the necessary movements - for example, bend, unbend and turn the head, then birth trauma is inevitable even with the normal size of the pelvis and the fetus itself.

8. Change in the amount of water

Normally, by the end of pregnancy, the fetal bladder contains about 800-1500 ml of amniotic fluid. However, with some common diseases of the expectant mother, pathologies of pregnancy, the amount of water can change significantly. There is both pronounced low water and significant high water. Both conditions are deviations from the norm and can adversely affect the growth, development and the very process of giving birth to a baby.

Very often, with polyhydramnios (the amount of water exceeds 2 liters), premature rupture of amniotic fluid occurs. Due to the overstretching of the uterine wall with a large volume of water, weakness and discoordination (dysregulation) of labor forces often develop. The moment of rupture of the fetal bladder is dangerous: the amniotic fluid, poured out with polyhydramnios in a large and strong stream, often carries along the umbilical cord and small parts of the fetus - the fetus can be established in a transverse or oblique position.

9. Childbirth with lack of water

Childbirth with low water (the amount of water is less than 800 ml) also have their own flow characteristics. The period of cervical dilatation is usually delayed, since there is no proper pressure of the fetal bladder. Primary and secondary weakness of the labor force often develops. At the same time, the contractions are painful from the very beginning, but unproductive. In the subsequent and early postpartum period (the first two hours after childbirth), bleeding develops more often.

10. Complications of pregnancy

In principle, any deviations from the normal course of pregnancy are fraught with the development of complications during childbirth, however, most often they are caused by three main pathologies of pregnancy: preeclampsia, placental insufficiency and impaired hemostasis.

Gestosis is called late pregnancy toxicosis, in which kidney function is impaired. This pathology of pregnancy is characterized by an increase in blood pressure - a symptom that is extremely dangerous for childbirth. Against the background of preeclampsia, premature placental abruption, bleeding during childbirth or the early postpartum period, and even eclampsia (convulsive syndrome, extremely dangerous for the life of a woman in labor) can develop.

With fetoplacental insufficiency, blood circulation in the vessels of the placenta is disturbed and, as a result, the supply of oxygen to the fetus. During childbirth, this can lead to oxygen starvation of the baby.

Violation of hemostasis, that is, a stable state of the blood, during childbirth can provoke multiple bleeding or thrombosis - both types of clotting disorders, unfortunately, pose a threat to the life of the mother and baby.

11. Premature and late birth

There are two options for an untimely start - premature birth (before the 36th week of pregnancy), which occurred significantly earlier than the natural term of the baby's maturity, and delayed labor with prolonged pregnancy, starting later than expected.

In case of premature birth, the development of the process often becomes too intense and labor proceeds in an "accelerated" mode. Such a high rate of the birth process is provided by excessively strong and frequent contractions of the uterus, significantly exceeding the natural resistance of the tissues of the birth canal. As a result of this "birth pressure", the fetus is literally pushed out of the mother's body, not having time to adapt to the abruptly changing environmental conditions (the pressure in the uterus, in the vagina and at the exit from the birth canal differs tenfold) and leaving significant destruction in the mother's birth canal ...

Tolerance is not just a pregnancy lasting over 40 weeks, as many mistakenly believe. With prolongation, the placenta and membranes "age" and gradually lose their ability to protect the baby and maintain his life in the mother's body. Aging of the placenta and membranes gradually leads to oxygen starvation of the fetus, a decrease in nutrition and metabolism, and a decrease in the amount of amniotic fluid. In such cases, incorrect insertion of the fetal head develops more often due to the high density of the bones of the skull, weakness of labor against the background of oligohydramnios, lack of oxygen to the fetus during labor due to circulatory disorders in the placenta.

12. Biological immaturity of the birth canal

This term denotes the discrepancy between the state of the cervix and the walls of the vagina and the period of pregnancy. Normally, before childbirth, the cervix gradually shortens and begins to open slightly, the tissues of the vagina and cervix become soft and elastic. If during a full-term pregnancy and a mature fetus, the cervix remains tight and long, as in the middle of pregnancy, and the cervical canal is closed, even training contractions can feel extremely painful, and the opening of the cervix during childbirth takes much longer and more difficult, often accompanied by ruptures.

13. Physical fatigue of a woman in labor

This is the main and most common reason for the development of such complications in childbirth as weakness in labor. Childbirth is a significant burden and a serious test for the body of the expectant mother, and in order for them to pass safely, strength is needed. If, at the beginning of the process, a woman is physically exhausted (most often this is due to sleep disturbance at the end of pregnancy due to anxiety before childbirth, night "harbinger" contractions or other physiological and everyday reasons), the body does not have enough energy to regulate and develop labor. In this case, the weakness of the labor forces develops - a complication in childbirth, in which the contractions practically do not increase, and the opening occurs extremely slowly or does not increase at all. At the same time, childbirth becomes protracted, which threatens the development of fetal hypoxia and postpartum hemorrhage.

14. Chronic diseases of the mother

The presence of serious diseases in a woman in labor significantly increases the risk of complications during childbirth, since the body, weakened by a chronic illness, is less resistant to stress. Doctors pay the most close attention to diseases of the kidneys and cardiovascular system, since if these organs are disrupted, the most dangerous complications of childbirth can develop, leading to bleeding in the mother and impaired respiration of the fetus. With endocrine diseases, characterized by a violation of the hormonal background, weakness of labor forces often develops or, on the contrary, a rapid and rapid course of labor.

15. Age of the expectant mother

Doctors pay more attention to older pregnant women, especially when a woman is preparing to become a mother for the first time. Obstetricians attribute such expectant mothers to the risk group for the development of various complications of childbirth - both from the woman herself and from the fetus. After all, unfortunately, the past years add to us not only knowledge, but also various health problems. There is another reason for the higher risk of complications in childbirth after 30 years - gradual changes in hormonal levels, characteristic of this age, often provoke. But, of course, the age of a woman in labor in itself is neither an indication of the inevitable development of complications in childbirth, nor a reason for any additional interventions in the childbirth process.

16. Psychological unpreparedness for childbirth

Naturally, on the eve of childbirth and during them, every woman experiences strong anxiety, fear for herself and the child. However, if at the same time the expectant mother has no idea what exactly will happen to her during childbirth, fear of the unknown joins the above worries.

He can do a disservice to the expectant mother. After all, it is the state of panic, overexcitation of the nervous system of a woman in labor that leads to the development of various complications during childbirth, first of all - discoordination of contractions. As a result of "nervous breakdowns", the signals that coordinate labor activity arrive unevenly, may weaken or, on the contrary, sharply increase. Due to a violation of the nervous regulation of labor, contractions become painful and unproductive. Unfortunately, such contractions often negatively affect not only the well-being of the expectant mother, but also the health of the baby: frequent intense contractions of the uterus interfere with the normal blood flow in the placenta, which is necessary for the baby to breathe, and he begins to suffer from a lack of oxygen. Therefore, along with a thorough medical examination during planning and during the course of pregnancy, doctors recommend that all expectant mothers, without exception, take care of psychological and practical preparation for childbirth in advance.

It is the psychological unreadiness of the expectant mother for childbirth that is considered the most common cause of the development of complications during childbirth.