Disorders During Pregnancy, Childbirth, Postpartum and Neonatal Periods...Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female human. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Obstetrics is the medical field that studies and treats pregnant patients. Childbirth usually occurs about 38 weeks from fertilization, i.e., approximately 40 weeks from the start of the last menstruation. Thus, pregnancy lasts about nine months. The term embryo is used to describe the developing human during the initial weeks, and the term fetus is used from about two months of development until birth. In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of the fetus has the ability to survive, with or without medical help, outside of the uterus. Complications can occur during childbirth. Infant deaths (neonatal deaths from birth to 28 days, or perinatal deaths if including fetal deaths at 28 weeks gestation and later) are around 1% in modernized countries. The maternal mortality (MMR ) rate varies from 9/100,000 live births in the US and Europe, to 900/100,000 live births in Sub-Saharan Africa. The "natural" mortality rate of childbirth—where nothing is done to avert maternal death—has been estimated as being between 1,000 and 1,500 deaths per 100,000 births. The most important factors affecting mortality in childbirth are adequate nutrition and access to quality medical care ("access" is affected both by the cost of available care, and distance from health services). "Medical care" in this context does not refer specifically to treatment in hospitals, but simply routine prenatal care and the presence, at the birth, of an attendant with birthing skills. Factors that may make a birth high risk include prematurity, high blood pressure, gestational diabetes and a previous cesarean section. Birthing complication may be maternal or fetal, and long term or short term. Maternal risks: Hemorrhage is still the biggest killer of birthing mothers in the world today especially in the developing world. Heavy blood loss leads to hypovolemic shock, insufficient perfusion of vital organs and death if not rapidly treated. Blood transfusion may be life saving. Rare sequelae include Hypopituitarism Sheehan's syndrome. Infection remains a major cause of mortality and morbidity in the developing world today. The work of Ignaz Semmelweis was seminal in the pathophysiology and treatment of puerperal fever and saved many lives. Vaginal birth injury with visible tears or episiotomies are common. Internal tissue tearing as well as nerve damage to the pelvic structures lead in a proportion of women to problems with prolapse, incontinence of stool or urine and sexual dysfunction. Fifteen percent of women become incontinent, to some degree, of stool or urine after normal delivery, this number rising considerably after these women reach menopause. Vaginal birth injury is a necessary, but not sufficient, cause of all non hysterectomy related prolapse in later life. Risk factors for significant vaginal birth injury include:
Pelvic girdle pain. Hormones and enzymes work together to produce ligamentous relaxation and widening of the symphysis pubis during the last trimester of pregnancy. Most girdle pain occurs before birthing, and is know as diastasis of the pubic symphysis. Predisposing factors for girdle pain include maternal obesity. Fetal complications: Intrapartum asphyxia: The term Fetal distress is emotive and misleading. True intrapartum asphyxia is the impairment of oxygen to the brain and vital tissues during the progress of labour. This may exist in a pregnancy already impaired by maternal or fetal disease, or may rarely arise de novo in labour. True intrapartum asphyxia is not as common as previously believed, and is usually accompanied by multiple other symptoms during the immediate period after delivery. Monitoring might show up problems during birthing, but the interpretation and use of monitoring devices is complex and prone to misinterpretation. Mechanical fetal injury Risk factors for fetal birth injury include fetal macrosomia (big baby), maternal obesity, the need for instrumental delivery, and an inexperienced attendant. Specific situations that can contribute to birth injury include breech presentation and shoulder dystocia. Most fetal birth injuries resolve without long term harm, but brachial plexus injury may lead to Erb's palsy. Neonatal infection Neonates are prone to infection in the first month of life. Some organisms such as S. agalactiae (Group B Streptococcus) or (GBS) are more prone to cause these occasionally fatal infections. Risk factors for GBS infection include:
A woman in the Western world who is delivering in a hospital may leave the hospital as soon as she is medically stable and chooses to leave, which can be as early as a few hours postpartum, though the average for spontaneous vaginal delivery (SVD) is 1-2 days, and the average caesarean section postnatal stay is 3-4 days. During this time bleeding, bowel and bladder function, and baby care are monitored. The mother is assessed for tears, and is sutured if necessary. Also, she may suffer from constipation or hemorrhoids, both of which would be managed. The bladder is also assessed for infection, retention and any problems in the muscles. The major focus of postpartum care is ensuring that the woman is healthy and capable of taking care of her newborn, equipped with all the information she needs about breastfeeding, reproductive health and contraception, and the imminent life adjustment. Some medical conditions may occur postnatally, such as Sheehan Syndrome. In some cases, this adjustment is not made easily, and hormonal disturbances may lead to postnatal depression or even puerperal psychosis. Postnatal depression ("Baby blues") is very common, with approximately 50% of women suffering from it, potentially as early as 24 hours postpartum. It is usually limited in duration, lasting 36 to 48 hours. Apart from empathy and support from caregivers and family, treatment is not required. Approximately 10-20% of women will suffer the symptoms of major depression, and should be treated accordingly. Postpartum depression may be the response to the hormonal changes and life adjustment the woman goes through immediately after childbirth. Postnatal Psychosis (also known as puerperal psychosis), is a more severe form of mental illness than postpartum depression. Care provided by a Postpartum Doula will support the mother, assist with breastfeeding and baby care which enhances her confidence, helping to lessen her chances of developing postpartum depression or other postpartum mood disorders. Perinatal defines the period occurring around the time of birth (5 months before and 1 month after). The perinatal period commences at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g), and ends seven completed days after birth. In relation to perinatal period breastfeeding is one of the most important thing to remember. Breastfeeding is the feeding of an infant or young child with milk from a woman's breasts. Babies have a sucking reflex that enables them to suck and swallow milk. Experimental evidence suggests that, with few exceptions, human breast milk is the best source of nourishment for human infants. Experts still disagree about how long breastfeeding should continue to gain the most benefit, and how much extra risk is involved in using breast milk substitutes. An infant may be breastfed by its own mother or by another lactating female, a wet nurse. Breast milk may be expressed and fed to a baby through a bottle, and pasteurized donor human milk may also be used. Breast milk substitutes are available for mothers or families who cannot or prefer not to breastfeed their children. While there are conflicting studies about the relative value of breast milk substitutes, the use of commercial infant formulas is acknowledged to be inferior to breastfeeding for both full term and premature infants. In many countries, artificial feeding is associated with a greater mortality from diarrhea in infants but where there is clean water, many consider artificial feeding to be acceptable. The following is a list of common disorders pregnancy, childbirth, postpartum, and neonatal period.
As always, the articles in this category, along with the comments thereon and other elements, are intended to inform as well as generate interest in and interaction between individuals, their family, and/or support team. Additional Reference sites may be found in our own Link Directory.
A comprehensive list of diseases related to pregnancy, childbirth, the puerperium, and perinatal period, may be found at ICD-10 Chapter 15 & 16 Block O00-O99 and P00-P96. |
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Pregnancy, Childbirth, Post-Partum & New Born