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Maternal-complications-after-labor-and-vaginal-delivery

Maternal complications of labour and vaginal delivery Author: Yan Yu Reviewers: Kayla Nelson, Radhmila Parmar, Jemimah Raffe-Devine, Alina Constantin* * MD at time of publication Labour and vaginal delivery Detachment of placenta disrupts uterine blood vessels Intense pressure on vaginal walls during fetal passage and/or use of forceps or vacuumà physical damage vagina and perineum Urinary tract catheterization during labour Foreign tube inserted into bladder allows easier colonization of bladder & urinary tract by bacteria Urinary Tract Infections Passage of fetus distends pubo-vesicular and pubo- rectalis sling muscles Urethra /rectum no longer kinked enough to prevent high intra-abdominal pressures from forcing out urine or feces Stress incontinence (of bladder & bowel; usually temporary) Scar tissue forms at site of placental detachment After complete hemostasis (cessation of bleeding) and vessel healing, scar tissue is shed from uterus Lochia (vaginal discharge/ bleeding) & eschar (scar tissue) shedding Placental tissue may be retained in the uterus Uterus fails to contract fully to seal off uterine blood vessels Post-partum hemorrhage (See relevant slide) Foreign substances trigger systemic inflammatory response in mother Disseminated Intravascular Coagulation, DIC (see relevant slide) Rarely, torn blood vessels let amniotic fluid (with fetal cells & meconium) enter maternal circulation Amniotic fluid embolism (clumps of foreign fetal cells and meconium in maternal circulation) Viscous amniotic fluid can block maternal blood vessels Obstructing blood flow out of lungs Blood backs up before lungsàless preload for heart Damaged tissue & blood in the uterus Ample nutrients for bacteria to infect uterus Endometritis Uterine pain, radiating throughout the abdomen Pulmonary edema Hypotension Perineal tears (1st-4th degree); Hemorrhoids Perineal Pain Unilateral leg pain & swelling Dyspnea, Cough If profound Cardiac arrest Tissue damage activates blood coagulation factors ­ Coagulation in areas of hemostasis (e.g. veins) Deep Vein Thrombosis Post-partum fever (see relevant slide) Cardiovascular collapse Lack of perfusion to heart Note: Post-partum depression is commonly seen in at least 10% of newly-delivered mothers. Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Initially published September 5, 2013 on www.thecalgaryguide.com Updated and re-published January 23, 2021