Concerns during labourCConcerns during labourConcerns during labourEnglishPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC12.000000000000045.00000000000001800.00000000000Flat ContentHealth A-Z<p>Read about various concerns that may arise during labour and delivery. In-depth information on issues such as prolonged labour is included.</p><p>Although labour and delivery are natural processes that usually proceed without complication, there are a few conditions of concern that can arise, such as prelabour rupture of the fetal membranes, meconium staining of the amniotic fluid, prolonged labour, cephalopelvic disproportion, umbilical cord complications, uterine complications, and shoulder dystocia.</p><h2>Key points</h2> <ul><li>Concerns during labour include pre labour rupture of membranes, meconium, prolonged labour, cephalopelvic disproportion, shoulder dystocia, umbilical cord complications and uterine complications.</li></ul>
Préoccupations au cours du travailPPréoccupations au cours du travailConcerns during labourFrenchPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC12.000000000000045.00000000000001800.00000000000Flat ContentHealth A-Z<p>Apprenez-en davantage sur les diverses complications qui peuvent survenir durant le travail et l'accouchement. Vous y retrouverez des renseignements sur des problèmes tels que le travail prolongé.</p><p>Bien que le travail et l'accouchement soient des processus naturels qui se déroulent habituellement sans complication, certaines situations préoccupantes peuvent survenir, comme la rupture des membranes fœtales avant le travail, du méconium dans le fluide amniotique, un travail prolongé, la disproportion céphalopelvique, des complications liées au cordon ombilical, des complications utérines et une dystocie des épaules. </p><h2>À retenir</h2> <ul><li>Les préoccupations au cours du travail comprennent une rupture des membranes avant le travail, la présence de méconium, un travail prolongé, une disproportion céphalopelvienne, la dystocie des épaules, des complications associées au cordon ombilical et des complications utérines.</li></ul>

 

 

Concerns during labour409.000000000000Concerns during labourConcerns during labourCEnglishPregnancyAdult (19+)Body;UterusReproductive systemNAPrenatal Adult (19+)NA2009-09-11T04:00:00ZNicolette Caccia, MEd, MD, FRCSCRory Windrim, MB, MSc, FRCSC12.000000000000045.00000000000001800.00000000000Flat ContentHealth A-Z<p>Read about various concerns that may arise during labour and delivery. In-depth information on issues such as prolonged labour is included.</p><p>Although labour and delivery are natural processes that usually proceed without complication, there are a few conditions of concern that can arise, such as prelabour rupture of the fetal membranes, meconium staining of the amniotic fluid, prolonged labour, cephalopelvic disproportion, umbilical cord complications, uterine complications, and shoulder dystocia.</p><h2>Key points</h2> <ul><li>Concerns during labour include pre labour rupture of membranes, meconium, prolonged labour, cephalopelvic disproportion, shoulder dystocia, umbilical cord complications and uterine complications.</li></ul><h2>Prelabour rupture of membranes</h2><p>Prelabour rupture of membranes (PROM) is when the fetal membranes rupture or break before contractions have begun. After the membranes rupture, amniotic fluid starts to leak through the cervix and vagina. In most full-term pregnancies, labour begins within 24 hours after the membranes have ruptured. If labour does not begin by then, the level of amniotic fluid in the womb may become too low or infection may set in and put the baby at risk. </p><p>PROM occurs in 5% to 10% of full-term pregnancies, and is thought to be the cause of 30% of premature deliveries. Certain infections and placental complications may lead to PROM. </p><p>The management of PROM depends on how far along the pregnancy is and how mature the unborn baby’s lungs are. If the mother is at or near her due date, many doctors will induce labour right away with either oxytocin or prostaglandin gel, sometimes followed by oxytocin. Other doctors will observe the woman for up to 72 hours and induce after that time if necessary. If there is an infection but the mother and baby can tolerate a vaginal birth, labour may be induced and antibiotics given. If the baby is breech or if their heart rate shows that they are not tolerating labour well, the mother may need a caesarean section. </p><p>If PROM occurs earlier in pregnancy, the baby’s lungs might not yet be mature enough to survive outside the womb. Therefore, the doctor might monitor the pregnancy and try to wait for the baby to become more mature. The mother will be given non-stress tests every day, and other tests as necessary, to make sure that the baby is doing well. Antibiotics may be given to prevent or treat infection. However, if the mother already has a serious infection, immediate delivery may be necessary. </p><h2>Meconium staining of amniotic fluid</h2><p>After the fetal membranes rupture, some women may notice a green-brown colour to the amniotic fluid that seeps through the vagina. This is an indication of meconium staining of the amniotic fluid, and needs to be brought to the attention of a physician right away. </p><p>Meconium is the baby’s first bowel movement, and it is normally passed some time after the baby is born, not when the membranes rupture. Meconium staining of the amniotic fluid may indicate that the baby is stressed, or has been stressed. Also, the newborn baby may breathe in the meconium-stained amniotic fluid, which may irritate the lungs and cause respiratory problems. To reduce the chance of this, the baby’s mouth and nose will be suctioned before they take their first breath. Despite this suctioning, sometimes the meconium has already got into the lungs before the baby is born, and they may need to be put on a ventilator to help them breathe. </p><h2>Prolonged labour</h2><p>Normal labour is divided into three stages. Stage one is labour, where the uterus contracts and the cervix dilates to 10 cm (4 inches). This stage consists of three phases: the early phase where the contractions begin and the cervix starts to open, the active phase where the cervix dilates from 3 to 8 cm (1 to 3 inches) and the contractions are strong and frequent, and the transition phase where the contractions are even more intense and frequent and the cervix dilates to 10 cm. Stage two is the exciting pushing phase, where the baby is delivered. Stage three is the delivery of the placenta. </p><p>Prolonged labour, also called failure to progress in labour, is when labour lasts longer than it is expected to. A prolonged early phase is when strong, regular contractions occur for more than 20 hours but the cervix does not dilate sufficiently. As a result, labour does not enter into the active phase. If this happens, some doctors will give labour a "kick" with oxytocin. Others will avoid oxytocin and provide the mother with supportive pain relief instead. Neither option has proven to be a superior choice, and the aggressive use of oxytocin can lead to a higher risk of caesarean section. </p><p>Sometimes the dilation of the cervix can stop or slow during the active phase, even if the contractions have been strong and frequent. If the dilation of the cervix stops for over two hours during this phase or slows over four hours, and the contractions lose their rhythmic pattern and become uncoordinated or spaced out, oxytocin can be helpful to correct the problem. </p><p>In stage two, the pushing stage, the baby is expected to descend through the mother’s pelvis. If descent is slow, some physicians may want to consider using forceps, vacuum extraction, or caesarean section. Other doctors feel that if the baby is tolerating labour well, and has not stopped descending through the pelvis altogether, there is no need to interfere with the vaginal delivery. </p><h2>Cephalopelvic disproportion</h2><p>Cephalopelvic disproportion (CPD) is when the baby’s head is too large to pass through the mother’s pelvis. The term CPD has been overused to describe almost any unsuccessful attempt at vaginal delivery. However, although many women worry that their pelvis is too small, this actually occurs very rarely in labour. Often when labour does not progress properly, it has nothing to do with an inadequately sized pelvis. In many cases, the diagnosis of CPD can only be made during labour. </p><p>Large babies of over 4500 g (9 lbs 14 oz) birth weight are more likely to have larger heads and therefore result in CPD. Unfortunately, it is difficult to predict the weight of the baby while they are still in the womb. Sometimes, if there is a setback during labour, the dimensions of the woman’s pelvis can be measured to determine if CPD is causing the problem. </p><p>A previous history of true CPD is important if a woman is considering VBAC in a subsequent pregnancy. These women need to be managed differently during labour, and their chances of having a successful VBAC range from 30% to 50%. </p><h2>Shoulder dystocia</h2><p>Shoulder dystocia is when the baby is in a head-down position, and their head passes through the birth canal but their shoulders get stuck behind the pubic bone. Shoulder dystocia affects 0.6% to 1.4% of vaginal deliveries when the baby weighs between 2500 and 4000 g (5 lbs 8 oz to 8 lbs 13 oz). The rate of shoulder dystocia jumps to 5% to 9% for larger babies weighing 4000 to 4500 g (8 lbs 13 oz to 9 lbs 14 oz) at birth. </p><p>Risk factors for shoulder dystocia may include a large baby, a problem with the mother’s pelvis, gestational diabetes, post-term pregnancy, prolonged labour, and a history of shoulder dystocia in previous pregnancies. The use of vacuum extraction or forceps can also result in shoulder dystocia. However, most cases of shoulder dystocia in normal weight babies cannot be anticipated, and an evaluation of risk factors is not always helpful. </p><p>When shoulder dystocia occurs, the umbilical cord can become compressed between the baby’s body and the mother’s pelvis. Compression of the umbilical cord is life-threatening because it can cut off the baby’s oxygen supply. Shoulder dystocia also puts the baby at risk for developing nerve injuries in their upper body. The mother is at risk of developing postpartum hemorrhage and lacerations. Because of these risks, shoulder dystocia may be one of the most frightening conditions that can occur during labour and delivery. </p><p>Shoulder dystocia becomes obvious when the baby’s head emerges and then retracts back into the birth canal. The doctor will not use force to pull the baby’s head and neck out, because this could injure both baby and mother. The doctor may perform some maneuvers to rotate and move the baby into a better position. An episiotomy may be performed but, because shoulder dystocia is an impaction of the baby in the bones of the pelvis, episiotomy alone will not release the baby’s shoulder. An episiotomy may be useful if the doctor has to do maneuvers internally. Sometimes if the mother is rolled from her existing position to all fours, the simple act of rolling may dislodge the baby’s shoulder. </p><p>As a last resort, a caesarean section may be required. Caesarean section for shoulder dystocia is more complicated than regular caesarean section because it involves rotating and guiding the baby out from the position where they are stuck in their mother’s pelvic bones and back into the uterus. </p><h2>Umbilical cord complications</h2><p>Cord prolapse is when the umbilical cord slides into the birth canal ahead of the baby’s head or body. About half of cord prolapses occur during the pushing stage of labour. If cord prolapse occurs and the cord is compressed, the baby will develop heart rate abnormalities that show up on fetal monitoring. When cord prolapse is diagnosed, every effort is made to make sure that the cord does not become compressed by the baby’s head or body, so a caregiver will often hold the head or body away from the cord through the vagina. The treatment of choice for cord prolapse is caesarean section. Studies have shown that if caesarean section can be done within 10 minutes of the diagnosis of cord prolapse, the baby has a 95% chance of survival. </p><p>Nuchal cord is a condition where the cord wraps around the baby’s neck. This occurs in about one-quarter of all births. Nuchal cord is not known to cause significant fetal distress or death. These babies have excellent outcomes, and no special measures need to be taken unless the baby develops distress during labour. </p><h2>Uterine complications</h2><p>Uterine inversion occurs when the placenta remains attached to the uterus after childbirth; as the placenta leaves the birth canal, it pulls the uterus inside out. Uterine inversion can be caused by a number of conditions such as a short umbilical cord or placenta accreta, where the placenta has grown too deeply into the uterus. In most cases, the doctor can remove the placenta from the uterus and push the uterus back into position. Sometimes surgery is needed to reposition the uterus. </p><p>Uterine rupture is a serious concern that can occur in any labour, but most cases occur when a woman attempts vaginal birth after a previous caesarean section. The uterus can rupture at the area where the incision was made in the caesarean section. Uterine rupture is more common when the incision is done in the "classic" up and down direction, as opposed to the more popular side to side "bikini cut" incision. The main sign of uterine rupture during childbirth is a problem with the baby’s heart rate. Other signs include a stopping of contractions, abdominal pain, vaginal bleeding, blood in the urine, or cardiac instability in the mother. </p>https://assets.aboutkidshealth.ca/AKHAssets/concerns_during_labour.jpgConcerns during labour

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