Complications of labour

Failure to progress
Causes:
Insufficient contractions
Small size of pelvis
Failure of cervical dilatation
 Foetal distress

Foetal hypoxia
Causes:
Pressure on cord
Premature separation of placenta
Hypertonia of uterine muscle
Hypertonia of maternal blood vessels
 MATERNAL DISTRESS

Prolonged Labour more than 12 hours.

Increase in pulse rate, temperature, blood pressure
with development or oliguria, ketosis and
dehydration
 MALPRESENTATION

When presenting is other than the vertex

 BREECH PRESENTION

Presenting part is the buttocks

Other dangers are fractures, dislocation, B P lesion,
rupture of abdominal
3 types of breach
Fully flexed – both legs are flexed and drawn up on the
abdomen, most common in multigravidae
Extended – legs are flexed at the hips but extended at the
knees, and the feet are in contact with the baby’s
shoulders, most common in primigravidae.
Footing – one or both feet present first (below the
buttocks) with the hips and knees extended.
 MALPOSITION

Occipitoposterior position
The occiput is toward the material sacrum rather
than the maternal symphysis pubis,it is said to be in
the occipitoposterior positon (OP).
Episiotomy is required.
 HAEMORRHAGE

Because of the hugely enhanced blood supply to the

uterus, which has developed through pregnancy,
haemorrhage at any stage of labour is extremely
serious and emergency steps to expedite delivery
must be taken possibly by caesarean section.
 CONTRACTED PELVIS

When one of the diameters of the true pelvis (see

p.3) is 1 cm less than the ideal gynaecoid pelvis, it is
called a ‘contracted pelvis’.
Where apparently the foetal head is physically
unable to go through there is said to be cephalopelvic
disproportion (CPD).
 PLACENTAL ABRUPTION

Occasionally partial or complete separation of the

placenta occurs before the birth of the baby. Blood
may be retained at the site or drain out through the
vagina. Where it is retained it may seep into the
myometrium, causing marked damage (Coulevaire
uterus). Any tendency for placental separtion is a
critical situation requiring immediate delivery of the
baby by the most expeditious means.
 MULTIPLE BIRTHS

Twin pregnancy is the most common to come to

delivery; in more than 80% of cases the first baby will
present by the vertex, and there is an almost equal
chance of the second baby being vertex or breech.
There is an increased risk of premature labour owing to
the bulk of the pregnancy, possibly because uterine
muscle has a finite limit of stretch at which labour
contractions start and the cervix begins to open.
Where there are more than two babies it is usual for
them to be delivered preterm by elective caesarean
section.
 PERINEAL TRAUMA

Labial laceratins
Haematoma
Perineal tears
First degree – involves the skin only, i.e. the fourchette.
Second degree – is deeper and affects any or all of the
superficial perineal muscles and the pubococcygeus; the tear
may extend up both sides or one side of the vaginal wall.
Third degree – as above, plus anal sphincter involvement,
the tear may extend up the rectal wall.
Fourth degree – indicates a very severe third degree tear,
extending into the anal mucosa.
 RETAINED PLACENTA AND ACCRETA

Where separation appears to be incomplete, or is not

occurring at all, there is an increase in the possibility
of haemorrhage or shock.
Hysterectomy may be the only safe course to take.