Can we stop birth and death

Life-threatening emergencies during childbirth and in the puerperium

03.12.2013

Birth emergencies can affect not only the baby, but its mother as well. Birth emergencies are an important topic at the 26th German Congress for Perinatal Medicine.

Heart failure and seizures, heavy bleeding and infection - emergencies during childbirth can affect not only the baby but its mother as well. "Especially when several risk factors come together during the birth, this can lead to an escalation that threatens the mother's life", says Prof. Dr. med. Wolfgang Henrich from the Charité Berlin others the emergency develops unexpectedly. In any case, only immediate medical intervention, often in cooperation with different disciplines, can avert the danger. Emergencies during childbirth are an important topic at the 26th German Congress for Perinatal Medicine.

Thrombosis and embolism

The most common life-threatening complications during childbirth and in the puerperium include thromboses and embolisms: They occur with a frequency of 1: 1,000, more frequently after caesarean sections. Pregnant women who have had fertility treatment, have an increased tendency to clot or have thrombosis in the family are particularly at risk, as well as overweight high blood pressure patients, bedridden pregnant women with premature labor, multiple pregnancies and patients with placenta previa (a placenta that lies in front of the cervix) or premature one Placenta detachment. If a thrombosis is discovered early, a life-threatening embolism, a wash-up of blood clots in the lungs, can usually be prevented: A pulmonary embolism can lead to heart failure and be fatal. The alarm signal for thrombosis is the swollen, painful leg; The alarm signal for the embolism is the shortness of breath with and without blue coloring of the lips after the birth or in the puerperium.

Bleeding

The most common life-threatening situations include heavy bleeding: the placenta usually detaches easily from the wall of the uterus as an afterbirth within 30 minutes of the baby's birth. The uterus contracts in the aftermath and the blood vessels close. In some cases, however, significant bleeding occurs after the placenta has been detached if the overstretched uterine muscle does not contract properly after a long birth (uterine atony). The risk of such bleeding is increased by twin births, by a very large child, by a lot of amniotic fluid or by congenital coagulation disorders or myomas. Even if the uterus has had previous operations and the placenta in the uterine cavity has stuck to the old scar, the delayed or incomplete placental detachment and placental birth can lead to massive bleeding. Previous caesarean sections also increase the risk.

If the bleeding continues for a long time, the blood can lose its ability to clot, so that a dreaded vicious circle develops with ever greater blood losses. The bleeding can often be stopped mechanically with fluid-filled pressure balloons that are placed in the uterine cavity and sutures that shrink the uterine muscle. Highly effective drugs to contract the uterus and the consistent replacement of blood, plasma and coagulation factors support the measures. This complex treatment can only succeed in an interdisciplinary manner in trained cooperation with anesthetists and coagulation specialists. "Sometimes, despite all measures being taken, there is only one possibility to save the mother's life," says Henrich, "namely to remove the uterus."

Blood pressure crises and gestures

Pregnancy-related seizures with and without high blood pressure crises, strokes and, very rarely, heart attacks and tearing of the main artery are the particular dangers for women with a gestosis. These complications are particularly threatening if it has not been possible to treat the disease effectively during pregnancy or to end the pregnancy at the right time by induction of labor or a planned caesarean section. Fortunately, the life-threatening symptoms usually go away once the birth has occurred.

sepsis

If bacteria enter the mother's bloodstream during or after the birth, this can lead to the dreaded puerperium fever. If it is an infection with the highly dangerous type A streptococci, such an infection via sepsis or the so-called "toxic shock syndrome" still leads to death in every second case despite the best intensive medical treatment. Therefore every temperature increase in the puerperium must be The question of whether there was or is a streptococcal infection in the family, e.g. tonsillitis or scarlet fever. The first signs of the disease are body aches and fatigue; high infection parameters in the serum are noticeable. C-reactive protein) and low blood pressure.

Amniotic fluid embolism

The penetration of amniotic fluid into the mother's bloodstream, which can suddenly trigger a so-called amniotic fluid embolism, is also feared. Sudden blood clotting and the closure of the smallest blood vessels in the lungs lead to high blood pressure in the lungs, heart failure and circulatory collapse. Due to the consumption of the coagulation factors, massive bleeding sets in quickly. Amniotic fluid embolism occurs in about 1 in 15,000 births. The risk is increased after obstetric surgery such as caesarean sections, curettages or vaginal surgery.

Heart disease

Women with congenital or acquired heart defects or diseases or who have had previous heart operations are particularly at risk during childbirth. You should only plan your delivery in clinics with attached cardiology and intensive care medicine. In close cooperation with the cardiologist, the right time and the appropriate delivery mode must be determined individually. Anesthetists are involved in interdisciplinary care. Regional anesthesia that reduces pain and stress is the recommended form of anesthesia for natural births or a possibly medically justified caesarean section.

“Even if we have a very good level of training and very good equipment in many clinics in Germany, the number of maternal deaths during childbirth and during childbirth can only be achieved through centralization of obstetrics and sustained intensive medical and midwifery training To further reduce the puerperium. Some life-threatening emergencies are rare, unpredictable and only manageable with great interdisciplinary effort with the appropriate experience and a sufficiently large team ", says Henrich Therefore also to the gynecologists and pregnant women to be attentive during pregnancy to the particularities of the previous history and to current findings and risks and to present themselves to the maternity clinic in good time. "

Prof. Dr. med. Wolfgang Henrich
Director of the Obstetrics Clinics - CCM and CVK Charité Berlin

Source: © DGPM 2013

Author (s): äin-red