©Pregnancy bliss 2008

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Placental detaching in labor before delivery

This can happen but is a very unusual occurrence.

Placental detachment will cause fetal distress, the gravity of which will depend on the extent of the separation. It could lead to a cesarean section unless labor is in the second stage, when instrumental vaginal delivery may be the quicker and preferred option.

 

Rupture of the uterus

This is a very serious complication that is fortunately rare.

Rupture is serious for the mother because the blood loss that ensues can be life-threatening. For the fetus, this occurrence causes very severe acute fetal distress, where the only hope of saving the baby is delivery within minutes of the event. Delivery following uterine rupture is almost always abdominal (cesarean).

 

The uterus could rupture as a result of over-stimulation of an already weakened womb. Mothers who have had many babies are at particular risk of this complication. Over­-stimulation may be spontaneous, probably combined with another factor such as a big baby. It could also result from administration of an oxytocin infusion.

 

Rupture of the uterus may occur in the presence of normal contractions in cases where there is an abnormally weak scar on the uterus following previous surgery.

 

When a uterus ruptures, the baby is likely to be lost. Even the few that survive are at high risk of ending up with brain damage, because of prolonged oxygen starvation lasting several minutes.

 

Unfavourable positions for the mother in labor

Lying on your back in labor is regarded as unwise. The heavy uterus will be lying on top of the major blood vessels in the mother's abdomen. This may be severe enough to reduce the amount of blood flowing through these vessels. This will result in inadequate oxygen delivery to the uterus itself and hence to the baby. It could lead to fetal distress. Propped-up, sitting up and left side positions are considered more ideal, as far the baby's welfare is concerned.

 

 

Recognizing fetal distress

If fetal distress occurs before the onset of labor, the mother may get a warning in the form of suddenly reduced or complete disappearance of fetal movements. In cord accidents, the fetus may react by suddenly increasing movements. The mother may therefore experience uncharacteristic vigorous fetal activity.

 

In many cases, pre­-labor fetal distress may go unsuspected and unrecognised, sometimes with catastrophic results. Pre-labor fetal distress is not common.  

 

Potential fetal distress in labor is the whole essence of fetal surveillance during labor. Many cases of fetal distress will have no warning whatsoever and it is only the fetal monitoring which will give a clue that something may be wrong.

 

Electronic fetal monitoring in the form of cardiotocography (CTG) is now the standard form of fetal surveillance in labor in most countries.

 

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A propped-up position (above) or lying on your side is recommended during labor to prevent inadvertent fetal distress. Avoid lying flat on your back.