Posted on: Wed 09-03-2016

Most often, the labor and birth process is uncomplicated. However, there are times in which complications arise that may require immediate attention. Complications can occur during any part of the labor process.

Common complications of labor include:1-3

1. Failure to progress
2. Fetal distress
3. Perinatal asphyxia
4. Shoulder dystocia
5. Excessive bleeding
6. Malposition
7. Placenta previa
8. Cephalopelvic disproportion (CPD)
9. Uterine rupture
10. Rapid labor.

In this Medical News Today Knowledge Center article, we examine each of the above 10 complications of labor, including some information on how they can be caused, treated or prevented.

1. Failure to progress

Labor may be described as prolonged or having failed to progress when it lasts for an abnormally long period of time. For first time mothers, failure to progress is described as labor lasting over 20 hours, whereas in mothers who have previously given birth, it is described as labor lasting more than 14 hours.4 Prolonged labor can occur in any phase of labor; however, it is most concerning during the active phase.4

Causes of prolonged labor include:1,4

• Slow cervical dilation
• Slow effacement
• A large baby
• A small birth canal or pelvis
• Delivery of multiple babies
• Emotional factors, such as worry, stress and fear.
• Pain medications can also be a contributing factor by slowing or weakening uterine contractions.4

In cases of labors that fail to progress, women may be given labor-inducing medications or require a cesarean section (C-section).1

Depending on the stage of labor, it may be recommended that a woman tries relaxation techniques, walking, sleeping, bathing or positional changes, such as side lying, standing or squatting.4

2. Fetal distress

Fetal distress, now referred to as non-reassuring fetal status, is a term that is used to describe when a fetus does not appear to be doing well.

Causes of fetal distress include:5,6

• The baby not receiving enough oxygen
• Anemia
• Low levels of amniotic fluid (oligohydramnios)
• Pregnancy-induced hypertension (PIH)
• Post-date pregnancies of 42 or more weeks gestation
• Intrauterine growth retardation (IUGR)
• Meconium-stained amniotic fluid.

During episodes of non-reassuring fetal status, it may be recommended that women change position, increase their hydration, maintain oxygenation, undergo amnioinfusion (the instillation of fluid into the amniotic cavity) or tocolysis (temporary stoppage of contractions) and receive intravenous hypertonic dextrose.5 To confirm the presence of fetal distress, a fetal blood acid base study may be performed; at times, delivery via C-section may be warranted.5

3. Perinatal asphyxia

Perinatal asphyxia (birth asphyxia) is a condition which can occur before, during or immediately following birth and is caused from inadequate oxygenation.1,7 This condition can result in blood abnormalities in the baby including hypoxemia (low oxygen levels) and acidosis (excessive acid in the blood).7 Babies who are not yet born may show symptoms of perinatal asphyxia by way of a low heart rate and lower than normal pH levels; babies affected by the condition at birth may present signs such as poor skin color, low heart rate, weak muscle tone, gasping, weak breathing or meconium-stained amniotic fluid.7

Treatment of perinatal asphyxia can include maternal oxygenation, C-section, mechanical breathing or medication.7

4. Shoulder dystocia

Shoulder dystocia is an unpredictable condition in which the baby's head is delivered vaginally, only for their shoulders to remain stuck within the mother.8 In the presence of shoulder dystocia, health care providers may employ several maneuvers to release the shoulders:8

• Pressure to the abdomen
• Manually turning the baby's shoulders
• Performing an episiotomy to make room for the shoulders
• Pressing the mother's thighs against her belly.

Complications from shoulder dystocia are typically treatable and temporary. However, there are cases of significant injury. Risks to the infant include nerve injury to the shoulder, arms and hand that typically resolve within 6-12 months, and decreased brain oxygenation which can lead to brain damage and death.8 Maternal complications include uterine, vaginal, cervical or rectal tearing and heavy postpartum bleeding.8

5. Excessive bleeding

On average, women lose 500 ml during the vaginal delivery of a single baby. During a C-section for a single baby, the average amount of blood lost is 1,000 ml.9 Approximately 4% of women will experience postpartum hemorrhage - excessive bleeding following the delivery of a baby.9

The most common cause of postpartum hemorrhage is uterine atony, in which the uterine contractions are too weak to provide adequate compression to the blood vessels at the site of where the now-expelled placenta was attached to the uterus.9 Maternal blood pressure, shock and death can result from postpartum hemorrhage.9 Certain medical conditions can increase a woman's risk for developing postpartum hemorrhage:9

• Placental abruption
• Placenta previa
• Uterine overdistention
• Multiple gestation pregnancy
• Pregnancy-induced hypertension
• Several prior births
• Prolonged labor
• Infection
• Obesity
• Labor-inducing medications or medications to stop labor
• Forceps or vacuum-assisted delivery
• Use of general anesthesia.

Additional medical conditions increasing the risk of postpartum hemorrhage include cervical, vaginal or uterine blood vessel tears, hematoma of the vulva, vagina or pelvis, blood clotting disorders, placenta accreta, increta or percreta and uterine rupture.9 Treatment for postpartum hemorrhage includes the use of medication, uterine massage, removal of retained placenta, uterine packing, tying off bleeding blood vessels and surgery - a laparotomy or hysterectomy.9

On the next page, we look at another five complications of labor, including fetal malposition, placenta previa and rapid labor.

By: Smith BSN MSN CRNP

Medical News today

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