User:Hschmidt2/Emergency childbirth

Complications: Gestational Parent
Complications of emergency childbirth include the complications that occur during normal childbirth. Potential complications for the gestational parent include perineal tearing (tearing of the vagina or surrounding tissue) during delivery, excessive bleeding (postpartum hemorrhage), hypertension (high blood pressure), and seizures.

Vaginal bleeding and shock
Bleeding during pregnancy is fairly common (experienced by up to 25% of pregnant people ) and may not always indicate a problem. However, bleeding can be a sign of a serious complication, including miscarriage or another condition that threatens the health of the gestational parent or fetus. It is important to get medical attention for any of the following:


 * Vaginal bleeding early or late in pregnancy
 * Severe abdominal pain
 * Trauma (such as a fall or car accident) while pregnant
 * Uncontrolled vaginal bleeding after the baby is delivered (postpartum hemorrhage)
 * Inability to remove the entire placenta after the baby is delivered (retained products of conception)

First trimester bleeding
Causes of vaginal bleeding early in pregnancy include miscarriage (including inevitable, incomplete, or complete abortion), embryo implantation and growth outside the uterus (ectopic pregnancy), and placenta attachment at the bottom of the uterus over the cervix (placenta previa), all of which can cause significant bleeding.

Vaginal bleeding early in pregnancy may also be a sign of a threatened abortion, which is when there is light to moderate vaginal bleeding but the cervix is still closed. Threatened abortion does not mean that miscarriage is inevitable; about 50% of people with bleeding before the third trimester will progress to a live birth.

Bleeding after the first trimester and during delivery
Prior to and during delivery, bleeding can occur from tears in the cervix, vagina, or perineum, sudden placental detachment (placental abruption) and placental attachment over the cervix (placenta previa), and uterine rupture.

Bleeding after delivery (postpartum hemorrhage)
After delivery of the baby and placenta, the uterus should contract to close off blood vessels in the uterine wall that were attached to the placenta. If the uterus is not contracting (atonic uterus) or ruptures during delivery, severe bleeding can occur. Massaging the lower abdomen (fundal massage) increases contraction of the uterus and can be used preventatively to manage postpartum bleeding. Uterine bleeding can also occur if parts of the placenta or fetal tissue remain stuck in the uterus after delivery. When the placenta is delivered, steady traction is applied to the cord as it is pulled out to prevent trauma, cord avulsion (tearing of the umbilical cord), uterine inversion, and retained placental products, all of which can increase blood loss and/or the risk of infection.

Postpartum hemorrhage is defined by “cumulative blood loss ≥1000 mL, or bleeding associated with signs/symptoms of hypovolemia within 24 hours of the birth process”. It is difficult to predict with few known risk factors and occurs in 3% of women, leading to ~150,000 annual deaths worldwide. Once uncontrolled bleeding occurs, management can be manual (fundal massage from the outside, packing the uterus, tamponading bleeding from the inside with balloon or condom catheter), and pharmacological (with oxytocin, ergotamine, misoprostol). Alongside these treatments, shock should be addressed with IV fluids or blood transfusions as discussed below.

Severe blood loss leading to shock
When a person is in shock they may have cold clammy skin, pale skin (especially around eyes, mouth, and hands), sweating, anxiousness, and loss of consciousness. They may have a fast heartbeat (110 beats per minute or more), low blood pressure (90mmHg systolic or less), and decreased urine output. The person should be laid on their left side, with legs and buttocks elevated to encourage blood flow back to the heart with gravity. Most importantly, seek medical attention.

Seizures
Seizures related to pregnancy may be caused by eclampsia, which typically progresses from preeclampsia, a condition in pregnant people that is characterized by new-onset high blood pressure and protein in urine from kidney failure. Associated symptoms include headaches, blurry vision, trouble breathing from fluid in lungs, elevated liver enzymes from liver dysfunction, and possibly coagulation defects from platelet dysfunction.

If a pregnant person begins to have seizures, additional help and assistance should be sought. One should not restrain the patient, but lie them down on their left side and check the airway (mouth, nose, throat). Turning the patient on their side decreases risk of breathing in vomit and spit. In a medical setting, magnesium sulfate is the preferred treatment for seizures in pregnant people.