Labor complications

An **obstetric labor complication** is a difficulty or abnormality that arises during the process of labor or delivery.

The Trust for America's Health reports that as of 2011, about one third of American births have some complications; many are directly related to the mother's health including increasing rates of obesity, type 2 diabetes, and
physical inactivity. The U.S. Centers for Disease Control and Prevention (CDC) has led an initiative to improve woman's health previous to conception in an effort to improve both neonatal and maternal death rates.

## Types

### Perineal tear

A **perineal tear** is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most common form of obstetric injury. Tears vary widely in severity. The majority are superficial and may require no treatment, but severe tears can cause significant bleeding, long-term pain or dysfunction. A perineal tear is distinct from an episiotomy, in which the perineum is intentionally incised to facilitate delivery. Episiotomy, a very rapid birth, or large fetal size can lead to more severe tears which may require surgical intervention.

### Amniotic fluid embolism

An amniotic fluid embolism (AFE) is a rare childbirth (obstetric) emergency in which amniotic fluid, enters the blood stream of the mother to trigger a serious reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and massive bleeding (coagulopathy).

### Bleeding

**Obstetrical bleeding** or hemorrhage, or heavy blood loss, is still the leading cause of death 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. Causes of heavy bleeding during labour include placental abruption and uterine rupture.

### Cord prolapse

Umbilical cord prolapse occurs when the umbilical cord comes out of the uterus with or before the presenting part of the fetus. Umbilical cord prolapse should always be considered a possibility when there is a sudden decrease in fetal heart rate or variable decelerations, particularly after the rupture of membranes. With overt prolapses, the diagnosis can be confirmed if the cord can be palpated on vaginal examination. Without overt prolapse, the diagnosis can only be confirmed after a cesarean section, though even then it will not always be evident at time of procedure.

### Obstructed labour

Main articles: Obstructed labour
The second stage of labour may be delayed or lengthy due to poor or uncoordinated uterine action, an abnormal uterine position such as breech or shoulder dystocia, and cephalopelvic disproportion (a small pelvis or large infant). Prolonged labour may result in maternal exhaustion, fetal distress, and other complications including obstetric fistula.

### Placental abruption

Placental abruption is separation of the placenta from the uterus. Treatment of placental abruption during labour is immediate delivery if the fetus is mature (36 weeks or older), or if a younger fetus or the mother is in distress.

### Premature labour

Main articles: Preterm birth
Premature labour is labour that spontaneously occurs earlier than 37 weeks gestational age.

### Nuchal cord

A nuchal cord is a complication that occurs when the umbilical cord becomes wrapped around the fetal neck. If present during labour, treatment is delivery by C-section.

### Perinatal asphyxia

Main articles: Perinatal asphyxia
Perinatal asphyxia is the medical condition resulting from deprivation of oxygen to during labour. Hypoxic damage can occur to most of the infant's organs (heart, lungs, liver, gut, kidneys), but brain damage is of most concern and perhaps the least likely to quickly or completely heal. Treatment is immediate delivery (C-section). Causes of perinatal asphyxia include umbilical cord prolapse, nuchal cord, and obstructed labour.

### 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, conduplicato corpore and shoulder dystocia. Most fetal birth injuries resolve without long term harm, but brachial plexus injury may lead to Erb's palsy or Klumpke's paralysis.

### Uterine rupture

Uterine rupture is a serious event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament. A uterine rupture is a life-threatening event for mother and baby as it typically results in severe hemorrhage and can cause perinatal asphyxia.