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Complications of labour

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Failure to progress

Causes:

y Insufficient contractions

y Small size of pelvis

y Failure of cervical dilatation

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Foetal distress

y Foetal hypoxia

y Causes:

y Pressure on cord

y Premature separation of placenta

y Hypertonia of uterine muscle

y Hypertonia of maternal blood vessels

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MATERNAL DISTRESS

y Prolonged Labour more than 12 hours.

y Increase in pulse rate, temperature, blood pressurewith development or oliguria, ketosis and

dehydration

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MALPRESENTATION

y When presenting is other than the vertex

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BREECH PRESENTION

y Presenting part is the buttocks

y Other dangers are fractures, dislocation, B P lesion,rupture of abdominal

y 3 types of breach

y Fully flexed both legs are flexed and drawn up on theabdomen, most common in multigravidae

y Extended legs are flexed at the hips but extended at theknees, and the feet are in contact with the babys

shoulders, most common in primigravidae.y Footing one or both feet present first (below the

buttocks) with the hips and knees extended.

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MALPOSITION

y Occipitoposterior position

y The occiput is toward the material sacrum ratherthan the maternal symphysis pubis,it is said to be in

the occipitoposterior positon (OP).y Episiotomy is required.

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HAEMORRHAGE

y Because of the hugely enhanced blood supply to theuterus, which has developed through pregnancy,haemorrhage at any stage of labour is extremely

serious and emergency steps to expedite deliverymust be taken possibly by caesarean section.

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CONTRACTED PELVIS

y When one of the diameters of the true pelvis (seep.3) is 1 cm less than the ideal gynaecoid pelvis, it iscalled a contracted pelvis.

y Where apparently the foetal head is physicallyunable to go through there is said to be cephalopelvicdisproportion (CPD).

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PLACENTALABRUPTION

y Occasionally partial or complete separation of theplacenta occurs before the birth of the baby. Bloodmay be retained at the site or drain out through the

vagina. Where it is retained it may seep into themyometrium, causing marked damage (Coulevaireuterus). Any tendency for placental separtion is acritical situation requiring immediate delivery of the

baby by the most expeditious means.

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MULTIPLEBIRTHS

y Twin pregnancy is the most common to come to delivery;in more than 80% of cases the first baby will present bythe vertex, and there is an almost equal chance of thesecond baby being vertex or breech. There is anincreased risk of premature labour owing to the bulk ofthe pregnancy, possibly because uterine muscle has afinite limit of stretch at which labour contractions startand the cervix begins to open.

y Where there are more than two babies it is usual forthem to be delivered preterm by elective caesareansection.

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PERINEALTRAUMA

y Labial laceratinsy Haematomay Perineal tearsy First degree involves the skin only, i.e. the fourchette.

y Second degree is deeper and affects any or all of thesuperficial perineal muscles and the pubococcygeus; thetear may extend up both sides or one side of the vaginal

wall.y Third degree as above, plus anal sphincter

involvement, the tear may extend up the rectal wall.y Fourth degree indicates a very severe third degree tear,

extending into the anal mucosa.

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RETAINED PLACENTAAND ACCRETA

y Where separation appears to be incomplete, or is notoccurring at all, there is an increase in the possibilityof haemorrhage or shock.

y Hysterectomy may be the only safe course to take.

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