Complications of childbirth – myths, delusions and the most popular “horror stories”
It would seem that could be happier for future moms and dads than meeting with the long-awaited baby. However, even in the 21st century, childbirth for some continues to be a risk factor or a kind of “Russian roulette” – as you are lucky. On what health complications can occur during childbirth and what are the main causes of maternal mortality – in the material Passion.ru and obstetrician-gynecologist Irina Fedyunina.Sad statistics
At first glance, even the term “maternal mortality” itself is strange to hear in our time, the era of modern medical technologies, the wide development of the possibilities of reproductive medicine. At the same time, physicians define maternal mortality as the death of a woman that occurred during pregnancy or within 42 days after its termination. Despite a clear downward trend, over the past 20 years, the maternal mortality rate in Russia and in the world as a whole remains quite high.
Refer to the data of the World Health Organization. Every day, about 830 women die from preventable causes related to pregnancy and childbirth. And 99% of all maternal deaths occur in developing countries. Every year around 350,000 maternal deaths are recorded in the world, and this figure, by the way, is equal to the population of the city of Sochi. Moreover, residents of large cities and regional centers have better chances for successful delivery – the highest rates of maternal mortality are observed among women living in rural areas and among poorer communities. In 2015, an estimated 303,000 women died during and after pregnancy and childbirth. Therefore, today the efforts of the medical community are focused on significantly reducing the global maternal mortality rate to less than 70 per 100,000 live births.
In Russia, according to the Ministry of Health of the Russian Federation, year after year there is a systematic decrease in maternal and infant mortality rates. For example, in 2017, maternal mortality decreased by 27%, compared with the previous year. In numerical terms, this is 7.3 cases per 100 thousand births. For comparison, in 1990 this indicator was 6.5 times higher – 47.7 cases per 100 thousand births. But, as doctors say, it is too early to celebrate victory, if at least one such case per year has a place to be. In 2018, 149 Russian women died from the effects of childbirth. If someone thinks that it is not enough, imagine that each of them could have been someone of your relatives, acquaintances, colleagues, friends. Each such death is a great sorrow for a family, a born child who remains an orphan for life. But it should also be noted that the maternal mortality rate in our country is also decreasing and approaching that in developed countries.
The main causes of maternal mortality
There can be several causes of maternal mortality. Let’s call the main ones. First of all, the adverse outcome of childbirth can be due to the fact that there are still such diseases in obstetrics, the causes and mechanism of development of which are not fully understood, and therefore it is impossible to prevent them in 100% of cases. First of all, it is extragenital pathology – this includes chronic diseases of the mother that existed before pregnancy and complicating it, or diseases that were first exacerbated during pregnancy.
There are extragenital diseases that are not significant for pregnancy, which have a small effect on the course of gestation (the number of full weeks of gestation that have passed since the date of the first day of the last menstruation until the birth of a child) and do not pose a threat to life for the mother and fetus: chronic gastritis, chronic cystitis osteochondrosis, etc.
There is also a more formidable group of somatic (extragenital) pathology, which can significantly complicate the course of gestation, childbirth and the postpartum period and increase the risk of adverse outcomes, even lethal (cardiovascular failure, and in particular heart attacks, brain diseases – strokes, brain cysts brain disease, liver, kidney, leading to a decrease in their function, etc.).
Blood circulation due to various reasons can also provoke an adverse outcome of labor: premature placental abruption (during pregnancy and childbirth), impaired uterine contractility in the early postpartum period (atony and hypotension), traumatic injuries during childbirth (uterine rupture and soft birth canal ), as well as congenital or acquired pathology of the blood coagulation system (genetic thrombophilia, von Willebrand disease, etc.).
It is worth noting that obstetric hemorrhages are characterized by massiveness and lightning speed of increasing blood loss, so if in a matter of minutes in this situation do not provide expert help, the woman will die.