Possible Complications During Pregnancy
After childbirth, it often seems to a woman that all the worries and anxieties are over. But, alas, sometimes the first, happiest days or weeks of motherhood can be overshadowed by various complications. In what cases are postpartum changes normal, and when should you see a doctor?
The early postpartum period lasts for 2 hours and during this time the woman is in the maternity ward. Then comes the late postpartum period. This period lasts 6-8 weeks. During this time, there is a reverse development (involution) of all organs and systems that have undergone changes due to pregnancy and childbirth. The exception is the mammary glands – their function reaches its peak precisely in the postpartum period. The most pronounced involutional changes occur in the genital organs, especially in the uterus. In women who have undergone a caesarean section, everything happens more slowly.
Be aware of these postpartum complications
Preeclampsia is a severe complication of pregnancy that occurs after the 20th week of gestation. The main symptoms are an increase in blood pressure in combination with proteinuria (the presence of protein in the urine). A manifestation of severe preeclampsia is visual impairment, the work of the central nervous system, thrombocytopenia, impaired renal function, fetal growth retardation syndrome. As a rule, this complication becomes an indication for emergency delivery, as it poses a real danger to the life of the mother and child. According to statistics, 16% of maternal deaths during pregnancy are due to preeclampsia. Risk factors: women over 35 years of age, as well as those who suffer from chronic arterial hypertension, kidney disease, diabetes mellitus, obesity, have multiple pregnancies and have a family history of preeclampsia.
The task of modern obstetrics is the timely detection of patients with preeclampsia, but not at the stage when critical complications of preeclampsia have arisen that require delivery, but before they appear, which allows saving the life of the mother and baby. But there is also a downside to the coin – this is the existing overdiagnosis of preeclampsia, which entails unjustified unnecessary hospitalization of patients. The fact is that the symptoms that resemble preeclampsia, the so-called “masks of preeclampsia”, may indicate other, less dangerous health problems. The use of a preeclampsia test in this situation helps the patient avoid unnecessary therapy and additional investigations.
The concept of “gestational hypertension” refers to an isolated increase in blood pressure in the second half of pregnancy. Compared with other types, the prognosis for a woman and fetus with gestational hypertension is most favorable.
A number of studies have shown that women with gestational hypertension or preeclampsia have an increased risk of developing hypertension, stroke, and coronary heart disease in the future. These data confirm the need for long-term follow-up of women with gestational hypertension, especially complicated by preeclampsia, for the prevention and early detection of cardiovascular disease.
Excessive vaginal discharge
If the vaginal discharge has increased sharply, profuse blood discharge appears, if the bleeding does not stop for a long time, or you notice large blood clots, you need to contact an obstetrician-gynecologist, preferably at the maternity hospital. If the bleeding is very heavy (several pads are required within an hour), you do not need to go to the hospital yourself, you need to call an ambulance.
Arterial hypertension (hypertension) is the most common chronic disease in adults associated with increased blood pressure. Arterial hypertension (AH) is currently one of the most common forms of pathology in pregnant women. It occurs in 5-30% of pregnant women, and over the past decades there has been a tendency to increase its prevalence. During pregnancy, arterial hypertension significantly affects its course and outcome, and is the main cause of perinatal losses and maternal mortality. According to the World Health Organization (WHO), hypertensive complications take 3rd-4th place after thromboembolism, bleeding, extragenital diseases among the causes of death in pregnant women. During pregnancy, arterial hypertension can lead to premature detachment of a normally located placenta, retinal detachment, eclampsia with cerebrovascular accident, multiple organ failure, severe forms of DIC with massive coagulopathic bleeding, thromboembolism, premature birth. Complications of hypertension are also progressive placental insufficiency and intrauterine growth retardation, the birth of small children, and in severe cases, asphyxia and antenatal death of the fetus and newborn. The long-term prognosis in women who had hypertension during pregnancy is characterized by an increased incidence of obesity, diabetes mellitus, and cardiovascular diseases. Children of these mothers are prone to various metabolic and hormonal disorders, cardiovascular pathology.
Retention of part of the placenta in the uterine cavity
The most common cause of late postpartum hemorrhage (that is, those that occur later than 2 hours after birth) is the retention of part of the placenta in the uterine cavity. The diagnosis in this case is confirmed by ultrasound. To remove the remnants of the placenta, curettage of the walls of the uterus is performed under general intravenous anesthesia with mandatory subsequent antibiotic therapy to prevent infectious complications.
Changes in the blood clotting system
In rare cases, the causes of bleeding may be changes in the blood coagulation system of a hereditary or acquired nature, blood diseases. In these cases, complex drug therapy is required.
Violated muscular contraction of the uterus
A woman may suffer from bleeding associated with impaired contraction of the muscles of the uterus. This is the so-called hypotonic bleeding. In the subsequent period, the hypotonic state of the uterus can be caused by its overstretching due to polyhydramnios, multiple pregnancies, large fetuses, and underdevelopment of the uterus. A decrease in the contractility of the uterus is also caused by changes in its very wall (fibroids, the consequences of inflammatory processes, frequent abortions). This bleeding most often occur in the first hours after childbirth and require active treatment with medications, and in severe cases, surgery.
A sharp, unexpected cessation of spotting should also alert the woman and requires urgent medical attention. In this case, the outflow of blood from the uterus may be disturbed, that is, lochia accumulate in the cavity and the so-called lochiometer develops. Blood clots are a good breeding ground for bacteria, so if the lochiometer is not treated in time, bacteria enter the uterine cavity and endometritis develops – inflammation of the uterine mucosa. After a caesarean section, a lochiometer occurs more often than after a vaginal birth. Treatment consists in prescribing drugs that reduce the uterus, while using antispasmodics to relax the cervix and restore the outflow of lochia. In some cases, it is necessary to resort to vacuum aspiration of the contents of the uterus under general intravenous anesthesia and mandatory follow-up antibiotic therapy.
Inflammatory process in the vagina or in the uterus
Vaginal discharge may acquire an unpleasant odor. This may indicate the development of an inflammatory process in the vagina or in the uterus. In the postpartum period, there is a significant increase in the composition of most groups of bacteria, including bacteroids, Escherichia coli, streptococci, staphylococci. Potentially, all of these species can be the cause of postpartum infections. A common problem for women after childbirth is bacterial vaginosis. Bacterial vaginosis is a pathology of the vaginal ecosystem caused by the increased growth of predominantly anaerobic bacteria (that is, those that grow in an oxygen-free environment) that actively proliferate in the postpartum period in the woman’s vagina and can be pathogens in postpartum endometritis or suppuration of the sutures of the vagina and cervix. Diagnosis of bacterial vaginosis is based on measuring the acidity of the vagina and detecting in a smear on the flora specific for this disease “key cells” (these are cells of the vaginal mucosa covered with anaerobic bacteria). Bacterial vaginosis in the postpartum period are treated with local preparations.
Vaginal candidiasis (thrush)
If you expereince curdled discharge, itching, burning in the genital area, redness, this indicates the development of vaginal candidiasis (thrush). The risk of this complication increases with antibiotics. Diagnosis is based on the detection of a large number of yeast-like fungi in a smear on the flora. For treatment, local preparations are used in the form of vaginal suppositories or tablets.
A woman may suffer from purulent discharge, pain in the lower abdomen, fever. These symptoms may indicate the development of a serious complication – postpartum endometritis (inflammation of the inner lining of the uterus). Most often, endometritis occurs in patients after cesarean section, manual examination of the postpartum uterus, manual separation of the placenta and separation of the placenta (if independent separation of the placenta is difficult due to a violation of the contractile function of the uterus), with a long anhydrous interval (more than 12 hours from the moment of amniotic fluid outflow to the birth of a baby), in women admitted to childbirth with inflammatory diseases of the genital tract (for example, against the background of sexually transmitted infections), in patients with a large number of abortions in the past. The classic form of endometritis occurs on the 1-5th day. Body temperature rises, heart rate increases to 80-100 beats per minute. They note depression of the general condition, chills, dryness and hyperemia of the skin, soreness of the body of the uterus, purulent discharge with a smell. The erased form appears on the 5-7th day. The temperature does not exceed 100°F degrees, there is no chill. Endometritis after caesarean section is always severe.
When making a diagnosis, the doctor is helped by an ultrasound examination of the uterus and a complete blood count, which reveals signs of inflammation. Treatment of endometritis should be started as early as possible. It is carried out in a hospital. Postpartum endomeritis is necessarily treated with antibiotics and agents that reduce the uterus. Currently, in many clinics and maternity hospitals, the uterine cavity is washed with cooled solutions of antiseptics. In severe cases, an intravenous infusion of saline solutions is required to improve blood circulation and relieve symptoms of intoxication.
With untimely treatment, there is a very high risk of spreading the inflammatory process to the entire uterus, small pelvis, the development of sepsis (infectious agents in the blood)..
Laktostasis and mastitis
In the postpartum period, pain in the mammary glands, a feeling of fullness, and an increase in body temperature may occur. If these symptoms appear, you should definitely consult a doctor – an obstetrician-gynecologist or a surgeon.
Possible causes of pain in the mammary glands and the accompanying increase in temperature are lactostasis and mastitis.
Laktostasis (stagnation of milk in the gland) develops due to blockage of the excretory ducts. Most often, this condition develops when the baby is not properly attached to the chest, or when the feeding regimen is violated. Laktostasis often affects primiparous women. With the stagnation of milk, the mammary gland increases in volume, its dense enlarged lobules are determined. Body temperature can rise to 100-104°F degrees. There is no redness of the skin and swelling of the gland tissue, which usually appear with inflammation. After decanting the mammary gland with lactostasis, the pain disappears, painless lobules with clear contours are small in size, and the body temperature decreases. If lactostasis is not eliminated within 3–4 days, mastitis (inflammation of the mammary gland) occurs. With the development of mastitis, the body temperature constantly remains high, accompanied by chills. Symptoms of intoxication appear (general weakness, fatigue, headache). The patient is disturbed first by a feeling of heaviness and pain in the mammary gland, which is accompanied by stagnation of milk. The mammary gland increases in volume, areas of redness appear on the skin. In severe cases, pus impurities can be determined in milk.
To eliminate lactostasis, it is recommended to use pumping, local anti-inflammatory ointments, and physiotherapy. Mastitis is treated with antibiotics. In some cases, lactation suppression and surgical treatment are required.
Fever, pain in the back or side, painful urination… These symptoms may indicate the development of postpartum pyelonephritis, that is, kidney inflammation. Critical periods for the development of postpartum pyelonephritis are 4-6 and 12-14 days of the postpartum period. The development of the disease is associated with infection in the urinary tract from the genital tract. Most often, the disease develops in puerperas who had a small amount of bacteria in the urine during pregnancy. An ultrasound examination of the kidneys and bladder and a urine test help the doctor make the diagnosis.
Pyelonephritis is treated with antibiotics.
Pain in the legs, swelling, redness on the legs along the vein, increased pain when walking – these are symptoms of a serious pathology – venous thrombosis (formation of blood clots in the veins) and require an urgent visit to a surgeon or phlebologist. The most dangerous periods for the occurrence of thrombosis are considered 5-6 days after childbirth or cesarean section, less often thrombosis occurs 2-3 weeks after childbirth. The causes of thrombosis are changes in the blood coagulation system that occur during pregnancy and after childbirth. Physiologically, in the postpartum period, the activation of the coagulation system occurs as the body tries to stop bleeding. At the same time, the tone of the vessels of the small pelvis and lower extremities is reduced, the veins have not yet had time to adapt to work in the new conditions. These conditions trigger the mechanisms of thrombus formation. An important role in the development of postpartum venous thrombosis is also played by the hormonal background, which changes dramatically after the end of pregnancy.
The risk of developing venous thrombosis is especially high in women with various pathologies of the blood coagulation system, which are detected even before pregnancy or during childbearing. There is a high probability of thromboembolic complications in the presence of cardiovascular diseases, overweight. The risk of thrombosis also increases in women in the age group after 40 years, in the presence of varicose veins of the lower extremities. The risk of thrombus formation is increased in women who have undergone a caesarean section. Venous thrombosis is treated with medications, it is also recommeded to wear compression stockings.
A severe complication of venous thrombosis is the detachment of a part of the thrombus and its movement along the vascular bed. In this case, blood clots enter the vessels of the lung or brain and cause strokes (impaired cerebral circulation) or pulmonary embolism (blockage of the pulmonary arteries by a thrombus). This serious complication appears sharp cough, shortness of breath, pain in the chest, hemoptysis may occur. In severe cases, the work of the heart is disrupted and death can occur.
Discomfort in the area of postoperative sutures
Unpleasant sensations in the area of postoperative sutures after cesarean section or in the area of sutures on the perineum may be disturbing. Normally, after suturing vaginal tears, there may be slight pain for 1-2 days, but it quickly passes. Pain in the postoperative wound after cesarean section may be disturbing for 2 weeks, gradually decreasing. Feeling of heaviness, fullness, pain in the area of the postoperative wound may indicate the accumulation of hematoma (blood) in the area of the sutures. This usually happens in the first three days after childbirth and requires surgical treatment – removal of accumulated blood. Pain, burning, bleeding of the sutures, discharge with an unpleasant odor, swelling in the area of the sutures, an increase in body temperature indicates the attachment of an infection and suppuration of the sutures. In these cases, you should also consult a doctor to treat the wound and select a further method of treatment.
Urinary incontinence, feces, uterine prolapse
A woman may experience violations of the pelvic organ function, which may appear as in the postpartum period – urinary incontinence, feces, uterine prolapse. The problem of genital prolapse occurs when the pelvic floor muscles have lost the ability to contract so much that individual organs or parts of them do not fall into the projection of the supporting apparatus. The most common cause of pelvic organ prolapse is trauma to the pelvic floor muscles during childbirth.
Quite often, women after childbirth suffer from hemorrhoids – varicose veins of the rectum. The predisposing factor in this case is a significant increase in intra-abdominal pressure during pregnancy and during childbirth. In the case of hemorrhoids, formations appear in the anus, which can be painless, but most often – painful, bleeding and itchy. The appearance of intense pain in the anus, bloody discharge from the rectum are a reason to consult a doctor. Most often, uncomplicated forms of hemorrhoids are treated with local medications – creams and suppositories, in case of complications (nodule pinching, bleeding), surgical treatment is required.
In any case, if you experience any symptoms that cause concern, it is recommended to consult a doctor because any complication is best prevented or treated at the initial stage.