Childbirth is a natural process in every pregnant woman, although there is no problem a priori, complications may occur during the same. The process of childbirth has three phases: dilation and effacement of the cervix, descent of the fetal cylinder and birth of the newborn and delivery. Medical surveillance avoids problems through instrumental assistance (Forceps, Thierry spatulas or suction cups), or performing a cesarean section. To completely dispense with a medical assistant can turn natural birth into a situation of real risk.
One of the complications is the risk of loss of fetal well-being. The main objective of intrapartum monitoring is to lower fetal and maternal morbidity and mortality rates. Through intrapartum fetal monitoring we are able to detect fetuses at risk to put in place measures that try to improve the perinatal outcome. It is accepted that during delivery the fetus is at risk of hypoxic damage, this damage is reflected by the fetal heart rate, which is why intrapartum surveillance of it is recommended in all pregnant women.
The non-progression of labor is another possible complication. It is defined as prolonged labor that lasts more than 20 hours in multipara and 14 hours in primipara. There may be stagnation of delivery in those cases where the fetus adopts a bad position. The possible solution will be assessed in each case, performing a cesarean section as a final measure.
The detachment of placental normoinserta (DPNI) and early postpartum haemorrhage are other risks of a delivery. The DPNI occurs when it is separated from the placenta not previous, of its decidual insertion, in a gestation of more than 20 weeks and before the third period of labor. The retroplacental hematoma caused by the detachment of the placenta produces separation of the placenta and, therefore, deterioration of feto-maternal exchange leading to fetal distress or fetal death. Blood loss in a vaginal delivery is approximately 500cc. and in conditions of cesarean of 1.000cc. approximately. A higher blood loss would cause early postpartum hemorrhage. This could be due to different situations such as decreased tone of the uterus (Uterine Atonia), retained tissue -retention of placental products or clots-, trauma of delivery - tearing in the birth canal by precipitated or instrumental delivery- and tear by cesarean section due to malposition or fetal fitting. Also the coagulation alterations , the uterine rupture and the uterine inversion , are situations that could cause early postpartum haemorrhage.
Every pregnant woman has a venous stasis due to her pregnant situation, which predisposes her to thrombotic processes, therefore, before any woman with suspected deep vein thrombosis , a Doppler Ultrasound of the lower limbs should be performed and treated with Low Molecular Weight Heparin.. Another important and serious complication, fortunately exceptional, is Pulmonary Thromboembolism , which presents with increased respiration (Tachypnea) and hypoxia.. Given this suspicion, we will request angio-CT or perfusion-ventilation scintigraphy. An exceptional complication, and no less serious, is the Amniotic Fluid Embolism , which occurs at an incidence of one in 80,000 births, is a catastrophic event with high mortality for the mother.
Surveillance and medical assistance does not presuppose the detriment of a natural birth, but the correction of any complication in its early stages, avoiding a progression towards a worsening situation.