Complications of childbirth. Complication after childbirth: ulcer. Birth in breech presentation

During pregnancy, a woman has to deal with various diseases and difficulties. And after the baby is born, the woman thinks that all the troubles are over. But, unfortunately, sometimes there are various complications after childbirth.

Any woman should understand that during pregnancy various changes and disturbances in the functioning of internal organs occur in the body. In order for everything to normalize after childbirth, it takes some time - a month or two. It is at this stage that a young mother may face various complications.

Condition of the uterus after childbirth

Immediately after the birth of the baby, the uterus begins to contract very intensively and becomes like a ball. On the first day after the birth of the baby, the weight of the uterus is about a kilogram. A week later, her weight is halved. And only after a month and a half, it returns to its previous size - approximately 50 grams.

All this time, uterine contractions give the young mother a lot of discomfort: very often there is pain in the lower abdomen. A woman experiences especially severe pain in the first few days. These pains intensify during breastfeeding. The thing is that when a child suckles the breast, a woman begins to actively produce the hormone oxytocin. This hormone is responsible for stimulating uterine contractions, so the pain gets worse when breastfeeding.

The cervix recovers its shape much longer - approximately fourteen weeks after birth. However, no matter how easy the birth is and no matter how much the baby weighs, the cervix will not fully recover to its previous size. But this does not affect the well-being of women.

If the body of a young mother lacks the hormone oxytocin, or if the uterus is too stretched (if the baby weighed too much at birth), then the uterus does not contract properly. So, the uterine cavity is cleaned poorly. Because of this, the risk of developing postpartum acute endometritis is greatly increased. Endometritis is an inflammation of the lining of the uterus. With this disease, a woman develops very strong pain in the lower back and lower abdomen, fever is possible, weakness and abundant vaginal discharge with an unpleasant odor appear.

Injuries of the external genital organs

Many women turn to gynecologists shortly after giving birth with complaints of severe pain in the vagina. Usually such sensations occur after sexual intercourse. This is not surprising, since the vagina is greatly deformed and stretched during childbirth. After some time, it is restored - after about one and a half to two months. By this time, the mucous membrane of the vagina is also restored. Even if the birth went without complications, the vaginal membrane is still injured - microcracks appear on it. And if the birth was difficult, then there may have been tears or incisions in the perineum. In such cases, recovery time will be much longer.

Gynecologists warn that after childbirth, it is necessary to refrain from sexual contact for some time. But not all girls follow these recommendations. But in vain, because the risk of re-injuring the vaginal mucosa with the penis is very high. Moreover, sometimes the injuries are very serious, and doctors have to re-sew them up.

Through unhealed microtraumas on the mucous membranes of the vagina during intercourse, various microorganisms can enter, which will provoke an inflammatory process. In the inflammatory process, pain, deterioration, weakness, and the temperature also increase. If a girl who has recently given birth notices such symptoms in herself, then she needs to contact a gynecologist as soon as possible. If treatment is not provided promptly, the symptoms may worsen, and serious complications may also occur.

Complications from the cardiovascular system

If a woman gave birth to a baby late, after 35 years, then she may have problems with the cardiovascular system. Of course, no one is immune from this, even young mothers. The thing is that during pregnancy, the volume of blood circulation increases. As soon as the baby is born, this volume begins to decrease and after about a week it returns to normal. But such drastic changes often affect the vessels and the heart. Therefore, if a woman has any problems with the cardiovascular system, then she should constantly be examined by a doctor and monitor her health. Very often, various complications begin in the postpartum period: an increase in heart rate, pain in the heart area, and the like.

In the first two weeks after childbirth, a young mother's blood contains a large number of platelets. This is due to the fact that the blood clotting system begins to work actively approximately a day before delivery, as the body prepares itself for bleeding. This natural process helps prevent excessive blood loss. But due to the increased content of platelets, there is a high risk of blood clots that can clog blood vessels. Thromboembolism is a very serious disease that can lead to serious complications and even death.

Bladder complications

It is not uncommon for women to develop bladder problems after childbirth. The tone of the smooth muscles of the bladder decreases, as a result of which the woman may not feel the urge to urinate. Therefore, in the first few days after childbirth, a woman should visit the toilet every two hours. If the bladder is full, it will prevent the uterus from fully contracting. Because of this, the uterus will not remove postpartum discharge, which can lead to inflammatory processes.

Problems with the gastrointestinal tract

After childbirth, the tone of the gastrointestinal tract decreases. As a result, women often experience constipation. Every third woman in labor suffers from this problem. To get rid of this problem, doctors recommend:

physical impact. This method is not only the easiest, but also the most effective. Direct a stream of warm shower to the lower abdomen. The pressure of water stimulates the receptors and enhances intestinal peristalsis. You can massage the abdomen. Just stroke your belly in a clockwise direction in a circular motion. Do this for ten minutes three times a day.
Proper nutrition. It is very important to eat right. Include apples, prunes, zucchini and pumpkin in your diet.

In addition to constipation, there is another problem -. Approximately 75% of women in labor face this disease. In mild cases, hemorrhoids are small and disappear on their own in about a week. If the hemorrhoids are large, then they cause a lot of discomfort and they have to be removed surgically.

In what cases should you see a doctor?

Let's summarize the above. A young mother very often has to deal with postpartum complications. Some of them do not pose a threat to health, but some can lead to serious complications. And to avoid these complications, it is necessary to consult a doctor in time.

Pain in the abdomen. Moderate pain is a normal physiological phenomenon, but if the pain is too strong and radiates to the lower back, then the woman needs to contact a gynecologist as soon as possible. Perhaps, inflammatory processes began to develop. The doctor will prescribe an examination and identify the cause, after which he will prescribe treatment.
Seam condition. If a woman has had stitches, then they must be constantly monitored. If the stitches begin to bleed, turn red, or blood spots appear, you should immediately consult a doctor.
Vaginal discharge. If vaginal discharge has changed after childbirth: it has become more abundant, has changed its texture, smell or color, then this should be a cause for concern. Therefore, it is necessary to consult a gynecologist.

In this article:

Probably, there is no such woman who would not be afraid of childbirth. After the birth of a child, all the fears that have been tormenting for 9 months are left behind. It seems that a new life stage has begun in life - joyful and serene, because the long-awaited baby has finally been born.

However, no woman is immune from postpartum complications. Any representative of the fair sex can face them. Why complications arise after childbirth, what deviations and health problems can be found in a woman - questions that we have to find answers to.

Causes of postpartum complications

Why complications may arise in women after childbirth is an urgent question. Every woman should know the reasons, because most problems can be prevented. Postpartum complications may occur:

due to the activation of the microflora that inhabits the human body;
due to the ingress of pathogenic microorganisms from the outside;
due to exacerbation of existing diseases;
due to the peculiarities of the course of pregnancy;
due to abnormal childbirth;
due to inaccurate or incorrect actions of the medical staff.

One of the causes of complications that occur after childbirth is the activation of opportunistic microorganisms that live in the body of any person (on the skin, in the internal organs on the mucous membranes). The mother's immune system is weakened.

The body's defenses are further reduced in cases where childbirth is accompanied by the loss of a large volume of blood. With a weakened immune system, conditionally pathogenic microorganisms become more active, begin to multiply faster, leading to inflammatory processes. If hygiene rules are not followed, a woman exposes herself to complications even more. Pathogenic microorganisms can get from the external environment into the internal organs.

In some cases, the cause of inflammatory processes are diseases that were diagnosed in a woman before childbirth. Complications develop 3-5 days after the birth of the child. Fever, pain in the abdomen, bloody discharge from the vagina mixed with pus are typical symptoms of inflammatory processes affecting the internal organs of the small pelvis.

The causes of postpartum complications may lie in the peculiarities of the course of pregnancy. As a rule, problems arise with polyhydramnios, oligohydramnios, multiple pregnancies. The size of the child matters a lot. If the fetus is large, then the likelihood of complications in the postpartum period is very high. In such cases, there is a decrease in uterine contractility. Because of this, heavy bleeding begins after childbirth. Also, in women with a large fetus, deep ruptures of the vagina, ruptures of the perineum most often occur.

Complications after childbirth in women can occur in cases where the process of the birth of a child was difficult and with anomalies. For example, with excessively violent labor activity, characterized by frequent and strong contractions, women in labor experience ruptures of the cervix, perineum, severe bleeding begins. With weak labor activity, the uterus contracts with insufficient force, the intervals between contractions increase. Childbirth is delayed, leading to fatigue of the woman in labor. With weak labor activity, there is a high probability of infection of the birth canal, the development of inflammatory processes, the occurrence of severe bleeding during and after childbirth.

The actions of medical workers and their negligence lead to postpartum complications. For example, if medical instruments are used carelessly, a woman can be seriously injured. In addition, the occurrence of inflammatory processes provokes the use of non-sterile objects by obstetricians and gynecologists. Complications due to these reasons are quite rare. Qualified specialists do not make mistakes, they always try to help their patients.

Common postpartum complications

Every woman who has given birth to a child and is in the postpartum ward is closely monitored by doctors. Specialists monitor body temperature, uterine contractions, and secretions from the genital tract. Observation of the condition of the woman in labor allows you to notice complications in a timely manner, of which the most common are postpartum hemorrhage, endometritis, inflammation of the urethra (urethritis), pyelonephritis, mastitis. Let's consider in more detail all the listed complications.

Bleeding

The most common postpartum complications in women are uterine bleeding. The reasons for their occurrence are:

benign tumors in the uterus (myomas, fibromas);
violation of the contractile function of the myometrium (the muscular membrane of the uterus);
excessive stretching of the uterus, which is observed in multiple pregnancies, polyhydramnios;
long and difficult delivery;
the use of drugs that help reduce the tone of the uterus;
mechanical damage to the uterus during childbirth;
poor blood clotting.

Blood loss of up to 0.5% of a woman's body weight is considered normal. If the woman in labor loses more blood, then experts regard this as pathological postpartum hemorrhage. Symptoms such as pallor of the skin, tachycardia, arterial hypotension are observed.

Previously, postpartum hemorrhage was the cause of death. Now this complication is not so dangerous. Thanks to modern medical devices, techniques, you can very quickly find out and eliminate the cause of postpartum hemorrhage.

endometritis

After the birth of a child, a woman may become inflamed endometrium - the mucous membrane lining the uterine cavity. This complication is called postpartum endometritis. The main cause of the disease is the entry of microorganisms into the uterine cavity. The inflammatory process can begin both after natural childbirth and after a caesarean section.

With postpartum endometritis, the following main symptoms occur:

persistent aching pain in the lower abdomen;
mucopurulent vaginal discharge from scanty to profuse;
uterine bleeding.

The general condition is deteriorating. Body temperature is kept within 37.2–37.5 degrees. There is rapid fatigue, weakness. When diagnosing the disease, doctors prescribe broad-spectrum antibiotics.

Postpartum endometritis is a very serious complication. If untreated, the inflammation will spread to the deeper layers of the uterus, penetrate the fallopian tubes and lead to infertility or sepsis.

Inflammation of the urethra (urethritis)

Another complication that can occur after the birth of a child is inflammation of the urethra. The cause of the disease may be microorganisms that have entered the urinary system, or injuries due to the use of obstetric forceps. Sometimes irritation occurs due to the catheter, which is placed after childbirth.

Symptoms of postpartum inflammation are:

redness and adhesion of the edges of the opening of the urethra;
pain that occurs during urination;
discharge of pus from the urethra.

To relieve inflammation, doctors prescribe antibiotics that kill the microorganisms that provoked the inflammatory process. If treatment is not carried out, then a progressive complication will lead to the defeat of the entire genitourinary system.

Pyelonephritis

In the first days after childbirth, a woman who has given birth to a baby may experience postpartum pyelonephritis, which refers to inflammation of the kidneys, which began due to the ingestion of microorganisms (for example, Escherichia coli, staphylococci, enterococci, Pseudomonas aeruginosa). With this complication, the renal pelvis, parenchyma and calyx are affected. If a woman was diagnosed with a chronic form of the disease even before childbirth, then after the birth of a child, pyelonephritis will certainly make itself felt. To prevent complications during childbirth and after them, it is necessary to treat all diseases in a timely manner.

With this complication, the following symptoms are observed:

a strong increase in body temperature (up to 38–40 degrees);
pain felt in the lumbar region;
malaise, weakness;
loss of appetite;
sometimes nausea and vomiting.

When diagnosing postpartum pyelonephritis, doctors prescribe antibacterial and anti-inflammatory drugs. Also, a woman suffering from this disease is sent for physiotherapy, undergoes infusion-detoxification therapy. With severe changes in the kidneys, surgical intervention is required.

Mastitis

Approximately 2–11% of women are diagnosed with mastitis after childbirth. Under this medical term, specialists understand the inflammation of the mammary gland, which began during the period of feeding the child. Most often, the disease is diagnosed in primiparous women 2-3 weeks after the birth of the baby.

The causative agents of postpartum mastitis are staphylococci, streptococci and other microorganisms. They penetrate through cracks in the nipples into the mammary gland from the baby's mouth, from contaminated linen. The likelihood of mastitis increases if a woman does not follow the rules for caring for the mammary glands, milk stagnation, poor emptying of the gland during breastfeeding.

Signs of postpartum mastitis include:

bursting pain in the chest;
high body temperature;
compaction of the mammary glands;
redness of the skin;
abscess formation under the skin.

At the initial stage of the disease, experts recommend applying cold to the sore spot, completely emptying the mammary glands, applying the baby to the chest as often as possible. Sometimes antibiotics are required. If suppuration is found, then the abscess is opened. Feeding the affected mammary gland is temporarily stopped.

If left untreated, the disease progresses. In very advanced cases, gangrene of the mammary glands begins. If treatment is started in a timely manner, then irreversible consequences can be avoided.

When to see a doctor urgently

Complications do not always occur immediately after childbirth, when medical personnel monitor the condition of the woman. Suspicious symptoms may also occur after discharge from the hospital. Some signs serve as a signal of serious complications that threaten the health and life of a woman. If you notice them, you should immediately consult a doctor.

So, with the following symptoms, a specialist should be visited as soon as possible:

very profuse bleeding began;
in the lower abdomen there was a strong, undying pain;
the seam from the caesarean section turned red and began to fester;
the body temperature has risen;
vaginal discharge has an unpleasant odor.

Severe bleeding can lead to death if the woman does not seek help in time. The rest of the symptoms will also not pass without a trace. They may indicate an infection in the body. Inflammatory processes localized in the uterus are fraught with the appearance of adhesions. Because of them, the conception of the next child can be difficult.

In conclusion, it is worth noting that complications during and after childbirth are an exciting topic for women, because it concerns their condition and health. The first days and weeks after the baby is born may not be as happy and cloudless as it seems. There is a possibility that the postpartum period will be overshadowed by various complications. Their occurrence depends on many factors:

woman health,
woman's personality,
lifestyle,
course of pregnancy,
actions of the medical staff.

Do not worry and despair if any complication occurs after childbirth. A positive attitude will help overcome temporary difficulties and defeat any ailment.

Useful video about what complications in childbirth can be

The birth of a baby is such a long-awaited stage in the life of every mother, but not everything in it always goes smoothly. Sometimes this process has complications after childbirth in women. Much depends on the body and the state of health of the woman in labor.

The postpartum period usually lasts six to ten weeks. During this time, the female body is restored and the work of some individual organs and functions returns to normal. But it happens during this period of time that pathologies appear and serious problems arise. What are the complications after childbirth? In this article, we will consider this issue in more detail.

Very often at this stage inflammation occurs:

mammary glands (mastitis);
membranes of the fetus and uterus (chorioamnionitis);
urethra;
kidneys (pyelonephritis);
abdominal region (peritonitis);
pelvic veins (thrombophlebitis).

Quite often, prolapse of the uterus (prolapse) also occurs. The prolapse of the uterus occurs due to stretching and injury of the muscles of the pelvic region. As a result, it leaves its place (between the bladder and the rectum).

Factors in the development of this disease:

injuries and ruptures;
physical labor immediately after the birth of children;
weak muscles of the abdominal wall;
stretching of the uterine ligaments;
multiple, heavy delivery;
large fetus during pregnancy.

Signs of prolapse:

discomfort, pain in the lower abdomen;
swelling and puffiness;
chronic constipation;
pain in the region of the sacrum, lower back;
bloody, painful discharge.

Postpartum endometritis

Endometritis is the most common disease of the mucous membranes of the uterine cavity, which most women experience. According to statistics, 7% of puerperas develop this disease, mainly after a caesarean section. After birth, the uterus is a continuous wound. There are two stages of its healing: inflammation and restoration of the mucosa. At these stages, it is cleaned inside. But if it contains pathogenic microbes, inflammation can become chronic.

There is severe endometritis, which manifests itself on the second or fourth day. Endometritis in a mild form usually overtakes a little later. At the same time, the temperature rises to 38 ° C, the pulse quickens, the body aches and shivering, weakness and pain appear in the lower abdomen and in the lumbar region, which sometimes intensifies when breastfeeding. A purulent-brown discharge comes out of the vagina. The uterine muscles begin to contract slowly.

Prevention and therapy lies in the fact that before conception, during the planning period of pregnancy, it is necessary to be examined and cured (if any) of infectious diseases. You need to take this seriously!

In some situations, experts prescribe antibiotic therapy.

Bleeding

After the birth of a baby, blood is released from the vagina. It is similar to a profuse menstruation. Provided there are no pathologies, the discharge for the first seven days is abundant, thick, bright red. After a while, they change color, their number decreases and after a month or two they completely stop.

If the fair sex is breastfeeding, then these discharges stop earlier. After a caesarean, they last longer. But it happens that the discharge turns into pathology.

How to diagnose?

If, after two weeks after the appearance of the crumbs, the bleeding is very profuse, has a bright red color, an unpleasant odor, or has a purulent character, you should immediately contact a gynecologist. After all, these can be symptoms of a complication in which urgent medical care is needed.

Dangerous to health and delayed postpartum hemorrhage. This may be due to a bend or a slow contraction of the uterine muscles. In such a situation, the woman in labor has an elevated temperature, heaviness in the abdomen, chills are felt, a significant decrease in discharge is observed.

Prevention

It is imperative to follow the rules of hygiene of the genital organs: during the period of bleeding and when there are stitches on the perineum, it is advised to wash with clean water with each urination and defecation process (use soap once or twice a day).

It is necessary to change sanitary pads every two to three hours and avoid tight clothing for the first week.

Inflammatory diseases are caused by microorganisms from the vagina or from the site of a chronic infection inside the body.

time to cure all possible infections, including gynecological;
do not use tampons;
go to the toilet on time;
start moving as soon as possible if the birth was successful, without complications.

Inflammation of the membranes of the fetus and uterus

This ailment appears with premature rupture of the membranes of the fetus. And the longer the anhydrous period lasts, the greater the chance of infection of the fetus in the womb.

How to recognize? Symptoms of chorioamnionitis with a long anhydrous period (from six to twelve hours) in a woman:

fever,
cardiopalmus,
body aches and chills,
purulent discharge from the vagina.

In every fifth woman in labor, chorioamnionitis turns into endometritis. Be careful.

When diagnosing this disease, the birth process is urgently stimulated, in case of impossibility of natural childbirth, a caesarean section is prescribed with the help of antibacterial and infusion therapy.

Mastitis and lactostasis

These diseases can only overtake mothers who are breastfeeding. The reason is Staphylococcus aureus, which can be infected if there are cracks in the nipples. Those who give birth for the first time are most often at risk, the incidence rate in this case reaches 2-5%.

Postpartum mastitis is characterized by fever (up to 38.5 ° C, but sometimes higher), headache, general weakness, chills, characteristic pain and swelling in the chest, redness. If you conduct a manual examination, then painful seals are noticeable. Feeding a baby and pumping is very painful. With lactostasis, on the contrary: relief is felt.

Laktostasis must be able to distinguish from mastitis.

Lactostasis progresses without the presence of cracks. If this is lactostasis, then the process of expressing milk is free and after it comes relief (body temperature returns to normal, there are no redness and swelling, the pain disappears).

Preventive actions include:

pumping breast milk to empty after each feeding, be sure to avoid stagnation;
correct attachment of the child to the breast (the nipple and areola must be completely captured);
treatment of cracks in the nipples, lactostasis;
compliance with the rules of personal hygiene;
wearing a loose bra;
air baths for breasts (10-15 minutes after feeding).

Inflammation of the urinary tract

The first days after the appearance of a newborn, the fair sex feel burning sensations and pain during urination. If this lasts for the first few days, then this is normal. But if a woman feels these painful sensations even after all the tears and incisions have healed, then this may indicate the presence of some kind of infection or an inflammatory process.

How to understand that you have this deviation?

Symptoms:

painful and difficult urination;
increased body temperature;
cloudy urine;
the presence of pain in the lumbar region.

Causes of occurrence:

use of a catheter during childbirth;
bladder injury during childbirth;
the presence of low tone of the bladder ();
wounds after the use of obstetric forceps.

Preventive procedures

With this problem, experts recommend drinking plenty of fluids. For example, not very sweet cranberry juice. It contains tannin in its composition, which prevents the development of microorganisms in the bladder. It is strictly forbidden to consume black coffee and sweet carbonated drinks. Empty your bladder completely and regularly. Washing more often is good for cleanliness and will stimulate urination.

Inflammation in the pelvic area

infections of the genitourinary system (if not cured during pregnancy);
weak immunity;
non-compliance with the rules of intimate hygiene;
blood loss during childbirth,
blood incoagulability;
avitaminosis;
remnants of the placenta in the uterus;
pathologies during pregnancy and with the appearance of crumbs;
a long time without amniotic fluid during delivery;
abnormal bleeding or blood poisoning (sepsis).

Other

Sometimes "young" mothers notice other failures and violations:

From the gastrointestinal tract: decrease, lack of appetite, loose stools, bloating.
From the side of the nervous system. Sleep disturbance, anxiety, nervousness, worries, or, conversely, euphoria, when an exhausted patient assures that everything is fine with her and you should not worry about her.

Any woman after such "hard work" can feel weakness and poor health, drowsiness. After all, this is a very serious burden on the entire body and its organs.

But if you notice a fever, deterioration of health, severe pain, then be sure to contact the health workers, do not joke with it!

Be healthy! Take care of your health, take care of it! Your baby needs a healthy mom!

Almost all postpartum diseases are accompanied by a pronounced inflammatory process in the uterus itself. In most cases, the uterus is affected primarily, but sometimes its defeat is secondary. The defeat of the uterus can be either more or less pronounced; the inflammatory process can either be localized only on its inner surface, or affect all layers of the uterine wall, so the clinic of metroendometritis is very diverse.
One of the characteristic signs of metroendometritis is the slow regression (subinvolution) of the uterus and its sensitivity or tenderness to palpation. The nature of the secretions and their quantity are changing. Occasionally, due to spasm of the internal os of the uterus or blockage of the cervical canal with fragments of shells, pieces of a falling shell, blood clots, etc., the discharge stops altogether. In such cases, lochia lingers in the uterine cavity and decomposes under the influence of microbial flora. The temperature rises to 38-39°, but the general condition of the patient remains quite satisfactory. This condition is called a lochiometer. Lochiometer, with rare exceptions, is not an independent disease, it is only one of the manifestations (symptoms) of metroendometritis, moreover, non-permanent.

Clinical picture and symptomatology depend on many reasons, the main of which are the following.

The reactivity of the patient and her general condition at the time of the disease and during it. An increase in temperature, pain, leukocytosis and other phenomena observed during illness with a good general condition of the patient indicate its good reactivity and its ability to fight infection. An areactive state, expressed in subfebrile, normal or even below normal temperature, in the absence of pain and in its other manifestations with a poor general condition of the patient, indicates a weakening of the body's defenses.
The degree of damage to the uterus. In this regard, three stages in the development of the disease can be distinguished. The first stage - only the falling off membrane and islets of the endometrium are infected. In the part of the myometrium, which is directly adjacent to the lesion, there are phenomena of reactive inflammation (tissue edema, vasodilation, small cell infiltration, etc.). There are either no pathogenic microbes in the myometrium, or very few. The second stage - along with the falling off membrane and islets of the endometrium, the deeper, muscular layers of the uterus are also affected, where pathogenic microbes are found in large numbers. In accordance with this, small cell infiltration covers the deep muscle layers up to the adjacent tissues directly to them, that is, to the perimetry in the upper part of the uterus and to the parauterine tissue in its lower part. The third stage - the focus of infection covered, in addition to the endometrium and myometrium, also the perimetry or parameters, or both together. If the infection spreads to the serous membrane of the uterus, perimetritis occurs. The latter is usually accompanied by reactive inflammation and serous membranes covering the abdominal organs adjacent to the uterus (omentum, intestines, bladder). In this case, pelvioperitonitis occurs, accompanying metroendometritis. In other cases, the focus of infection spreads to the periuterine tissue - parametritis occurs. Quite often pelvioperitonitis and parametritis develop simultaneously.
The nature of the pathogen microbe, its biological properties, virulence and toxicity. Some of the microbes (for example, hemolytic streptococci and staphylococci) have the ability to quickly penetrate through damaged tissues deep into the latter, spread along each of the above routes and cause intoxication in the patient. Others (for example, gonococci) do not need tissue damage to spread. They spread almost exclusively along the surfaces of the internal membranes of organs (intracanalicular). Possessing mild toxicity, compared to streptococci, staphylococci, Escherichia coli and other microbes, they do little to disturb the general condition of the patient.
The state of the inner surface of the postpartum uterus. The clinical picture depends on the presence of fragments of dead tissue on this surface, especially particles of the placenta, on the contractility of the uterus (with its insufficiency, thrombus formation increases, which favors the multiplication of microbes and the development of infection), on the degree of crushing of the tissues of the uterus.

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Due to these circumstances, the clinical picture and symptomatology of postpartum metroendometritis are very diverse and are determined by one or another combination of these circumstances. Depending on the latter, sometimes a milder, sometimes more severe, sometimes a very severe course of the disease is observed. With a mild course of the disease, the clinical picture is characterized by the following features.
On the 3-4th day after childbirth, with a good general condition of the puerperal, the body temperature rises to 38 °, sometimes with remissions of 1E or more. The patient complains of minor headaches, feeling of general fatigue, loss of appetite. The pulse is slightly quickened, but corresponds to the temperature. Postpartum discharge is bloody, turning into bloody-purulent on the 8-9th day. The uterus, when it is probed through the wall of the abdomen, is flabby, sensitive; its reverse development lags behind the usual, as a result of which it is larger in size than could be expected on the day of the postpartum period corresponding to the study. With a vaginal examination, one can detect swelling of the cervix, its insufficient formation, an increase in the body of the uterus, its swelling, uneven contraction and soreness. In the case of a delay in secretions (lochiometer), metroendometritis occurs at a higher temperature, the presence of general intoxication and painful contractions.
In more severe cases, on the 3-4th day of the postpartum period, the temperature rises rapidly and reaches 39-40 °; the pulse quickens, but not sharply (up to 100 beats per minute), the general condition of the patient suffers little. The involution of the uterus is slowed down. Palpation of the uterus is painful, but not to the same extent in its individual parts. Painful and percussion of the abdomen in the uterus, indicating a reactive inflammation of the perimetry. In the future, headaches, insomnia, often chills appear, appetite worsens. A vaginal examination reveals the same phenomena as with mild metroendometritis, but they are more pronounced, especially the pastosity of the uterus and its soreness, which is often diffuse. Often, edema of the periuterine tissue is detected - a reactive inflammation of the latter. Lochia, depending on the biological characteristics of the microbe-causative agent, have a different smell up to fetid, sometimes there is no smell at all.
In especially severe cases of metroendometritis, all the described phenomena are expressed very sharply. The temperature begins to rise and by the 6-7th day of the postpartum period gives a sharp jump upwards, chills and sweating are sometimes observed. The pulse quickens to 100-120 beats per minute. The tongue is coated, dryish. Headache and insomnia increase, appetite disappears, constipation appears. Palpation and percussion of the abdomen in the area of the uterus and in the areas adjacent to the uterus are painful; the Blumberg-Shchetkin symptom is more or less pronounced (reactive inflammation of the peritoneum covering the uterus and adjacent abdominal organs). Vaginal examination reveals a painful, soft uterus, almost devoid of the ability to contract under the examiner's hands, as well as edematous and painful periuterine tissue. Allocations, at first bloody, later are replaced by purulent and acquire an ichorous smell. Improvement begins by the end of the 2nd week of the disease with a lytic decrease in temperature. Recovery usually occurs by the end of the month.

Recognition presents no difficulty. It is necessary to clarify the question of whether the detected uterine lesion is an independent disease or a symptom of some other, more severe postpartum disease.

Treatment. Indispensable prerequisites for proper treatment are the placement of the patient in a well-ventilated room, good care for her - keeping the skin, oral cavity, external genitalia clean, monitoring the function of all organs and systems, in particular the intestines and bladder (and regulating them) , rational nutrition and other activities. Ice is prescribed for the lower abdomen, antibiotics, sulfonamides. In case of mild metroendometritis, 1 ml of pituitrin is injected under the skin 2-3 times a day and autohemotherapy is carried out in 3-5 ml once every 2-3 days.
In severe forms of metroendometritis, uterine and cardiac agents are prescribed, blood transfusions of 75-100 ml 2-3 times, intravenous infusions of 10 ml of 10% calcium chloride solution, cans, subcutaneous injection of 200-400 ml of 5% glucose solution or physiological saline.
With a delay in secretions, it is advisable to put the patient on her stomach, which ensures a free outflow of secretions, and prescribe 1 ml of pituitrin 2-3 times a day for 2-3 days.

Almost every pregnant woman, with the approach of childbirth, worries that this important event passes without complications. In fairness, we note that in most cases, fears are in vain. If the expectant mother is in excellent physical shape and psychologically ready to meet the baby, then everything will go fine. And yet, today we want to talk about possible complications during natural childbirth and caesarean section. Every pregnant woman needs to know about this. At least in order to understand how to act in this or that case, so as not to harm either yourself or the baby.

Complications in natural childbirth

Unfortunately, having a baby doesn't always go smoothly. The birth process consists of three periods, and during each of them, a woman may experience complications. Let's look at each of the stages of childbirth in detail.

Period one - "disclosure"

At this stage, the woman in labor begins contractions, which ensure the opening of the cervix and may be accompanied by the following complications:

Premature placental abruption is a complication in which the placenta separates from the walls of the uterus even before the birth of the fetus. This pathology can occur in mild or severe form. Most often observed in primiparous women. It can pose a threat to both the life of the fetus and the mother.
Weakness of labor activity - often occurs not only in the first, but also in subsequent periods of the labor process. It is characterized not by the intensification of contractions, but by their weakening. As a result, the process of cervical opening slows down and the baby's head does not move along the birth canal. This pathology is characterized by protracted labor and leads to fatigue of the expectant mother, who does not have enough strength to complete the birth on her own. Complication is fraught with the development of acute hypoxia in the fetus.
Too active generic activity is the exact opposite of weak. It is characterized by rapid delivery, which can result in premature detachment of the placenta, injury or even death of the fetus, as well as serious injuries and deep ruptures of the birth canal in a woman in labor.
Iron deficiency anemia also has an adverse effect on the development of contractile activity of the uterus, provoking prolonged, protracted labor or fast and rapid. True anemia of pregnant women can be accompanied by a violation of the properties of the blood, which is the cause of severe blood loss.
Complications during labor induction. The hormone oxytocin, which is used to stimulate labor, is synthetic and, unlike the natural hormone, does not cause the production of its own endorphins. Contractions become more painful, exhausting, and can cause fetal hypoxia. There is a high probability that the stimulation of labor will end with an emergency caesarean section.

Period two - "exile"

This stage begins with the first attempts and ends with the birth of the baby. During the second stage of labor, the following complications may occur:

Fetal hypoxia is a complication in which the child does not receive enough oxygen while passing through the birth canal. This pathology occurs in every tenth woman in labor.
Soft tissue ruptures are the most common complication that occurs during the baby's progress through the birth canal. It most often occurs at the birth of a premature or large fetus, as well as during rapid childbirth. In such a situation, a woman in labor can receive not only injuries to the vagina and perineum, but also a rupture of the uterus, her neck, and the pubic joint. Quite often, the uterine wall (perforated) injured during the abortion process is torn.

The third period - "postpartum"

As a rule, this stage passes without complications, and only in rare cases the following pathologies may occur:

Incomplete separation of the placenta - occurs when part of it lingers in the uterus of the woman in labor. In such a situation, an inflammatory process may develop, accompanied by the loss of a large amount of blood.
Postpartum hemorrhage - occurs when large blood vessels are not completely blocked, caused by insufficient contraction of the uterus. This situation is most often provoked by infectious inflammation or hormonal changes in the body of a woman.

Complications in caesarean section

Despite the fact that today the operation of caesarean section is used quite often, it is by no means a simple procedure. During and after surgery, some complications may occur:

Severe blood loss, especially in emergency childbirth. A caesarean section involves cutting several layers of tissue to remove the baby. Therefore, blood loss during surgical intervention is stronger than during vaginal delivery. Sometimes a woman in labor needs a blood transfusion.
Damage to internal organs when cutting the uterus in the lower third after opening the abdominal cavity. Neighboring organs may be affected - the bladder, intestines. These injuries are rarely life-threatening, but can lead to prolonged pain and subsequent adhesions.
Child injury. With a caesarean section, the baby may receive minor abrasions and cuts. They usually heal on their own.

Complications after surgery

After the birth of a baby by caesarean section, a large number of women in labor are faced with consequences that are extremely rare during natural childbirth:

Long rehabilitation period. Usually, after a caesarean section, young mothers stay in the hospital for about seven days, with natural childbirth without complications, the woman returns home after a few days. Walking after a caesarean, carrying and caring for a baby is usually more difficult because the wound will still hurt for a while.
Wound infection. Even in a sterile operating room, such a situation can occur, provoking pain and difficulty in healing the sutures.
The postpartum discharge is also longer because the tissue inside the uterus regenerates more slowly than after a vaginal delivery.
Adhesions that occur between internal organs and tissues. The consequences of adhesions are chronic pain in the upper and lower abdomen, intestinal obstruction or infertility caused by blockage of the fallopian tubes.
Problems in subsequent births: increased risk of uterine rupture, placenta previa.

Complications in out-of-hospital childbirth

Community-acquired or home births are divided into two groups. The first group, as a rule, is associated with medical reasons - quick and rapid childbirth in multiparous women; remoteness from the hospital or lack of means of communication. This also includes childbirth on the way (train, plane).

The second group of home births is characterized by unauthorized rejection of hospital conditions. Most often this is caused by the desire for an unconventional method of delivery, national or religious traditions.

In the first group of home births, birth trauma can occur - both on the part of the mother and on the part of the fetus, caused by the rapid birth of a child.

A feature of the birth of the second group is a high percentage of complications:

infection in unsanitary conditions;
postpartum septic pathologies;
birth trauma, difficult obstetric situations.

That is why doctors insist on inpatient childbirth.

Childbirth with diabetes

Patients with diabetes mellitus rarely endure pregnancy. Their optimal delivery time is 36-37 weeks. During childbirth, doctors monitor the nature of labor, the condition of the mother and fetus, and blood sugar levels. Childbirth is carried out through the natural birth canal. Indications for a caesarean section in a woman in labor with diabetes mellitus are the following pathologies: complications from the vessels, vision, kidneys.

Birth in breech presentation

The baby should be head down in the uterus as it is the widest part of the fetus. In a normal birth, the baby's head should appear first, followed by the rest of the body. However, some women have births with a breech presentation of the fetus, which are fraught with complications.

The location of the child in the uterine cavity is classified as follows:

leg - both hips are unbent or only one of them, and one leg is located at the exit from the uterus;
gluteal - the legs of the fetus in the hip joints are bent, and the knees are pressed to the tummy and straightened;
mixed (gluteal-leg) - the knees and hips of the fetus are bent.

A child can be born in a breech presentation naturally or as a result of a caesarean section. Complications that can occur during childbirth with a breech or breech presentation are often associated with weak labor activity. This is because the pelvic end of the fetus is smaller than the head. It slightly presses on the uterus, as a result of which it contracts worse, its neck opens more slowly.

During childbirth, the baby's head may tilt back. There is a risk that the baby will be injured. Also, often with a breech presentation, the umbilical cord is clamped between the wall of the birth canal and the head of the baby. In such a situation, hypoxia develops. In most cases, with such pathological conditions, an emergency caesarean section is prescribed.

Summing up our conversation, it can be noted that natural childbirth or surgical always have a certain degree of risk and may be accompanied by complications. To avoid trouble, it is better to give preference to good maternity hospitals and experienced specialists.

Especially for - Nadezhda Vitvitskaya