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why do women die in childbirth..............3 possible dangerous scenarios on the birth table | MOMSANDCHILD


1- The length of labor:

     Prolonged labor, or failure to progress when labor is longer than expected. Studies show that this affects about 8 percent of those who give birth. It can happen for a number of reasons.
The American Pregnancy Association defines prolonged labor as lasting more than 20 hours if it is the first birth. For those who have given birth before, failure is progression when labor lasts more than 14 hours.
       If labor occurs for a long time, it can be stressful, but it usually does not lead to complications.
However, if this occurs during the active phase, a medical evaluation and intervention may be required.

Reasons for prolonged labor:

  • Slow cervical neck
  • big child
  • The tub is small
  • The mother gave birth to many children
  •  Anxiety, tension and fear
  • Taking painkillers slows or weakens the uterus.
So the first thing to do as a first tip is to relax and wait. The American Pregnancy Association recommends walking, sleeping, or running in a warm bath
 Health professionals may give employment-stimulating drugs or advise a cesarean delivery.

2-Non-reassuring fetal statusm:

Nonreassuring fetal status (NRFS) is a term that may be used to describe a baby's health late in the pregnancy or during labor. It is used when test results suggest that the baby may not be getting enough oxygen.

How it happens:

The baby gets oxygen from the mother's blood as the baby’s blood passes through the placenta. NRFS may happen if:
  • There is a problem with the blood flow to the placenta.
  • Not enough oxygen is crossing from the placenta to the baby.
  • Blood flow from the placenta to the mother is blocked.
For example, NRFS may occur when:
  • There is too much or too little amniotic fluid.
  • The umbilical cord is pinched, flattened, or twisted.
  • Labor contractions are too strong, too long, or too frequent. Sometimes this may result from the use of medicines to help labor, such as oxytocin.
  • The mother has been given anesthetic medicine to relieve pain. The medicine may lower the mother's blood pressure. This may reduce the supply of blood and oxygen to the placenta, which means that the baby gets less blood and oxygen.
  • The mother is lying on her back, putting pressure on the major blood vessels, which can change blood flow to the uterus.
  • The mother has medical problems, such as heart, lung, or kidney problems.
  • The mother has pregnancy complications, like high blood pressure or placental abruption (early separation of the placenta).
The baby has a genetic problem or has not developed normally.

WHAT ARE THE SYMPTOMS?

  • The mother may not have any symptoms, but it will appear on the BABY
  • The baby is moving less.
  • The baby has an abnormal heart rate.
  • Bowel movement from the baby (called meconium) is found in the amniotic fluid when the membranes (bag of waters) rupture.
  • A heart rate that is too slow, too fast, or irregular doesn’t always mean there is a problem. The baby is usually OK. For example, sometimes when the baby's head is squeezed during a contraction or delivery, the baby will have a reflex that causes the heart rate to change. 

HOW IS IT DIAGNOSED?


NRFS may be discovered from tests of the baby late in pregnancy or during labor and delivery.

The following tests of the baby's health might be done 

An ultrasound test called a biophysical profile checks the baby's breathing movements, body movements, heart rate, and muscle tone. 
A nonstress test checks the baby for a short time to see if his or her heart rate changes when the baby moves.
A contraction stress test :you are given medicine to cause contractions and the baby's heart rate is checked during contractions of the uterus.
During labor and delivery The baby's heart rate is usually watched with an electronic external or internal fetal monitor.
A sample of blood from the baby's scalp may be tested during labor if there is concern about how the baby is doing during labor.

Diagnosis and solutions:

     .The goal of treatment is to get more oxygen to the baby. If there are signs that the baby may not be getting enough oxygen, your healthcare provider will try to find the cause and fix it.
       The following may be done to try to increase your oxygen level and improve blood flow to the uterus and the baby
  • Your healthcare provider may ask you to lie on your left side. The large blood vessels near the spine are less likely to be pressed by the uterus in this position.
  • You may be given intravenous (IV) fluids or blood if your blood pressure drops during labor or if you are bleeding a lot.
  •  You may be given extra oxygen so  can get to the baby.
  •  You may be given medicine to relax the uterus and stop contractions.
  • If the baby's heart rate shows that the umbilical cord may be pinched, your healthcare provider may ask you to change your position. Raising the foot of the bed or getting on your hands and knees may help get the baby off the umbilical cord.
  • If there is not enough fluid in the baby's sac, a salt solution may be put into the sac to cushion the umbilical cord.
  • If your blood pressure drops because of the anesthetic you were given, you may get more fluids in the IV and possibly medicine for your blood pressure.
If these treatments don't correct the problem, the baby may need to be delivered right away. If the cerv
When oxygen does not reach the BABY It leads to what is known as Birth Asphyxia

  • A breech presentation in which the baby’s legs or buttocks present first
  • A face presentation in which the baby’s face is in position to exit the birth canal first
  • A deflexed position of the head in which the neck of the baby is less flexed, straight or extended
  • The position of a baby in the uterus is such that the head of the baby is presenting first and is tilted to the shoulder, causing the baby’s head to no longer be in line with the birth canal (asynclitism).
  • At birth, symptoms may include:
  • Bluish or pale skin color
  • Low heart rate
  • Weak muscle tone and reflexes
  • Weak cry
  • Gasping or weak breathing


3- Excessive Uterine Bleeding at Delivery


       After the baby is born, excessive bleeding from the uterus becomes a major concern.
Usually, a woman loses about a pint of blood during and after a vaginal delivery. Blood is lost because some blood vessels open when the placenta separates from the uterus. Uterine contractions help close these vessels so that they can heal. Usually, a cesarean delivery causes almost twice as much blood as a vaginal delivery, partly because birth requires an incision in the womb, and much blood is pumped into the womb during pregnancy.
Blood loss is considered excessive if one of the following occurs within 24 hours of birth:
More than two pints of blood are lost.
Women experience symptoms of significant blood loss, such as low blood pressure, fast heartbeat, dizziness, light head, fatigue, and weakness.
Excessive blood loss usually occurs shortly after birth but may occur later after one month.

Its causes:

The uterus that does not start contracting after birth but instead remains loose and extended (a condition called a uterine attack)
When the uterus does not begin to contract after birth, the blood vessels that opened when the placenta separates continue to bleed and contractions may weaken in the following cases
 Tighten the uterus a lot
 A very large fetus
 Labor is long, abnormal, or rapid
When a woman has more than five children
When an anesthetic has been used, it relaxes the muscles during labor and delivery
When membranes surrounding the fetus become infected (called intra-amniotic infection)

Excessive bleeding can also result when:

When the vagina or cervix is ​​torn or cut during childbirth (as it occurs during episiotomy)
When a woman suffers from a bleeding disorder that interferes with clotting
When an intra-amniotic infection leads to a uterus injury (called endometriosis)
When a piece of the placenta remains inside the uterus after birth
Rarely, when the uterus tears or turns inward (upside down)
Excessive bleeding after one birth may increase the risk of excessive bleeding after subsequent deliveries. Fibroids in the womb may also increase your risk.

For prevention:

Before a woman enters labor, doctors take steps to prevent or prepare for excessive bleeding after childbirth. Such as:
Determine if the woman has any conditions that increase the risk of bleeding (much like amniotic fluid or bleeding disorder).
If a woman has an unusual blood type, doctors make sure that her blood type is available.
Delivery should be as slow and gentle as possible. Doctors usually give women oxytocin through a vein or a muscle injection, which helps oxytocin reduce blood loss.
When the placenta is attached, doctors examine it to determine if it is complete. If incomplete, the remaining fragments in the womb are removed.
After the placenta is born, the woman is monitored for at least one hour to confirm the uterus contraction and assess the bleeding.

What happens after losing blood

In the event of excessive bleeding, the uterus is massaged by applying pressure to its abdomen, and oxytocin is constantly given intravenously. These procedures help the uterus contract. The woman is also given intravenous fluids to help restore fluid in the bloodstream. If the bleeding continues, another medication that helps contract the uterus is also given. These medications can be injected into a muscle, placed as a tablet in the rectum, or during a cesarean delivery, to be injected into the uterus.





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