Pregnancy & Delivery

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Care In Normal Birth (BACK COVER) Complications arising during pregnancy and childbirth cause the deaths of hall a million women every year, the vast majority in the developing world. Over 4 million newborn babies die each year, most of them as a result of poorly managed pregnancies and deliveries. Millions more women and babies suffer debilitating and life-long consequences of ill-health. The World Health Organization seeks to alleviate the burden of suffering borne by women, children and families, through its Maternal Health and Safe Motherhood Program which seeks to reduce levels of maternal and neonatal mortality and ill-health significantly...

Infant Feeding Emergencies This booklet is designed to help you if you are a mother, soon-to-be a mother, or want to help one of your friends or relatives to breastfeed their baby. The concept for this booklet was born during the last war in Europe, in Bosnia and Herzegovina in 1994, when it was clear many mothers had become so accustomed to bottle-feeding that most women had lost their knowledge on how to breastfeed. Although originally developed for mothers during emergency situations, this booklet can be of use to all mothers everywhere.

Considering A Home Birth Have you considered giving birth at home? For some women, this idea might sound a bit strange. Isn't a hospital the only place you can give birth? Actually, no. Giving birth at home is something that women have been doing since, well, since they started giving birth. Lots more on this site - look to the frame on the left.

Danger Signs During Pregnancy Call your physician if you experience any of these symptoms during your pregnancy

Sudden gush of fluid from the vagina
Vaginal bleeding
Abdominal or epigastric pain
Hard, rigid abdomen with severe pain Fever over
101° and chills
Dizziness, blurred or double vision and spots before your eyes
Persistent vomiting
Severe headaches Swelling around the eyes with accompanying swelling of the hands (some swelling in the legs and feet can be normal)
Convulsions
Noticeable decline in fetal movement
Painful, difficult or scanty urination

Common Pregnancy Complaints and Questions Author: Suzanne R Trupin, MD, Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign

Dystocia is defined as abnormal or difficult labor. The opposite of dystocia is eutocia, which is normal labor. Dystocia is often an indication for operative delivery, with its associated complications. Therefore, a diagnosis of dystocia has a significant impact on the health care system. Dystocia entails a vast number of influencing factors that include both maternal and fetal entities. Accurately diagnosing dystocia is crucial. [Link Recovered 6/22/11]

Diagnosis of Abnormal Labor In order to define abnormal labor, a definition of normal labor must be understood and accepted. Normal labor is defined as uterine contractions that result in progressive dilation and effacement of the cervix. By following thousands of labors resulting in uncomplicated vaginal deliveries, certain time limits and progress milestones have been identified. Failure to meet these milestones defines abnormal labor, which suggests an increased risk of an unfavorable outcome. Thus, abnormal labor alerts the obstetrician to consider alternative methods for a successful delivery that minimize risks to both the mother and infant.

Labor and Delivery Complications Usually, labor and delivery occur without any problems. Serious problems are relatively rare, and most can be anticipated and treated effectively. However, problems sometimes develop suddenly and unexpectedly. Regular visits to a doctor or certified midwife during pregnancy make anticipation of problems possible and improve the chances of having a healthy baby and safe delivery.

Abruptio Placentae Shad H Deering, MD, Chief, Division of Obstetrics, Department of Obstetrics and Gynecology, Madigan Army Medical Center: Abruptio placentae is defined as the premature separation of the placenta from the uterus. Patients with abruptio placentae typically present with bleeding, uterine contractions, and fetal distress. A significant cause of third-trimester bleeding associated with both fetal and maternal morbidity and mortality, abruptio placentae must be entertained as a diagnosis whenever third-trimester bleeding is encountered.

Amniotic Fluid Embolism (AFE) is a rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, causing cardio respiratory collapse.

Autoimmune Thyroid Disease and Pregnancy Thyroid disorders are the second most common endocrinopathies found in pregnancy. Thyroid disorders are estimated to affect 0.2% of all pregnancies.

Breech Presentation occurs in 3-4% of all deliveries. The occurrence of breech presentation decreases with advancing gestational age. Breech presentation occurs in 25% of births that occur before 28 weeks' gestation, in 7% of births that occur at 32 weeks, and in 1-3% of births that occur at term.

Brow Presentation In a brow presentation, the fetal head is midway between full flexion (vertex) and hyperextension (face) along a longitudinal axis. The presenting portion of the fetal head is between the orbital ridge, and the anterior fontanel presents at the pelvic inlet. The frontal bones are the point of designation and can present (as with the occiput during a vertex delivery) in any position relative to the maternal pelvis. When the sagittal suture is transverse to the pelvic axis and the anterior fontanel is on the right maternal side, the fetus would be in the right frontotransverse position (RFT).

Compound Presentations are rare obstetric events and often engender much anxiety in the care team. Such concerns are usually unjustified, but considering the unlikely possibility of a problem delivery is valuable. Although in an average delivery service of 2500 births annually such an event might be expected to occur only about once a year, providers should know strategies for managing this situation if intervention becomes necessary.

Eclampsia is defined as seizure activity or coma unrelated to other cerebral conditions in an obstetrical patient with preeclampsia. While most cases present in the third trimester of pregnancy or within the first 48 hours following delivery, rare cases have been reported prior to 20 weeks' gestation or as late as 23 days postpartum. Eclampsia has also been described without prior development of preeclampsia.

Ectopic Pregnancy presents a major health problem for women of childbearing age. It is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity, which ultimately ends in death of the fetus. Without timely diagnosis and treatment, ectopic pregnancy can become a life-threatening situation.

Face Presentation In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact against the upper back of the fetus while lying in a longitudinal axis. The presenting portion of the fetus is the fetal face between the orbital ridges and the chin. The fetal chin (mentum) is the point designated for reference during a vaginal examination.

Forceps Delivery Michael G Ross, MD, MPH, Chair, Professor, Department of Obstetrics and Gynecology, University of California at Los Angeles-Harbor Medical Center: Forceps are instruments designed to aid in the delivery of the fetus by applying traction to the fetal head. Many different types of forceps have been described and developed throughout time. Generally, forceps consist of 2 mirror image metal instruments that are maneuvered to cradle the fetal head and are articulated, after which traction is applied to effect delivery.

Hyperemesis Gravidarum The most severe form of nausea and vomiting in pregnancy is called hyperemesis gravidarum (HEG). A continuous spectrum of the severity of nausea and vomiting ranges from the nausea and vomiting that occurs in most pregnancies to the severe disorder of HEG.

Hypertension and Pregnancy Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy: chronic hypertension, preeclampsia-eclampsia, preeclampsia superimposed on chronic hypertension, and gestational hypertension (transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy). This terminology is preferred over the older but widely used term PIH (pregnancy-induced hypertension) because it is more precise.

Placenta Previa literally means afterbirth first and defines a condition wherein the placenta implants over the cervical os.

Postpartum Hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks' gestation are at risk for PPH and its sequelae. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere.

Preeclampsia (Toxemia of Pregnancy) , a disorder associated with pregnancy that consists of hypertension and proteinuria, manifests most often after the 20th week of pregnancy. In the past, edema was considered a diagnostic criterion; recently, however, it has been eliminated as a requirement for diagnosis. Eclampsia is defined as seizure activity in a patient with the presentation described above.

Seizure Disorders in Pregnancy Approximately 1 million women of childbearing age in the United States have seizure disorders. Of these women, approximately 20,000 give birth each year. Concerns during these pregnancies include the risk of fetal malformation, miscarriage, perinatal death, and increased seizure frequency.

Umbilical Cord Complications in pregnancy are numerous, ranging from false knots, which have no clinical significance, to vasa previa, which often leads to fetal death. As prenatal ultrasound becomes increasingly sophisticated, many of these conditions are being diagnosed in utero. However, many are not apparent before delivery, and the only forewarning is related to their association with certain conditions such as monochorionic twins and placental abruption. This article outlines the risk factors for known umbilical cord complications and the available courses of action to avert their associated morbidity and mortality.

Giving Birth "In Place" Article from Midwife.org explains what is happening during an "emergency birth" and how to help. Removed from public display, but we have it saved in PDF format

Childbirth - emergency delivery Directions for an attendant to help when labor goes faster than expected.

Pregnancy Complications - Learn how to detect complications and what can be done to help prevent problems, what to do if they arise and more.

Labor & Birth Complications - Things aren't always a smooth ride, learn what to do when the road gets bumpy!

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