Labour complications in global settings Flashcards
context specific labour complications
Place of birth
Skilled birth attendance
Fetal monitoring in labour
Maternal monitoring in labour (e.g. labour progress, observations)
Access to medical care in labour (e.g. long transfer in extremis)
Access to caesarean section (e.g. in a tertiary hospital only)
Access to assisted vaginal birth (e.g. where medical staff work)
Access to medical care in context of birth after caesarean section
Prevalence and severity of female genital mutilation
Top maternal mortality causes in low income settings
Postpartum haemorrhage
Infection post-birth
High blood pressure complications
Context-specific risk factors for adverse outcomes
Education level
Socioeconomic status
Intimate partner violence
Cultural practices e.g. female genital mutilation
Long-distance travel to facility
Antenatal care attendance/follow-up
Multiparity
Twin pregnancy
Lack of women’s involvement in decision-making
Uterine rupture risk factors
Prolonged labour
Previous uterine surgery (could be previous caesarean or myomectomy)
Obstetric Fistula
Fistula management
Repair – complex and may only be provided by charity organisations
e.g. fistula foundation – enormous benefit to one repair (from the individual woman to the wider community), aim to eradicate fistula within a generation (treated 65,000 in 13 years)
Requires extensive experience and surgical skills
placenta accreta
placenta attaches firmly to uterine wall lining
placenta percreta
invasion through uterine wall sometimes into nearby tissues like the bladder
normal placenta
separated from uterine wall by fine fibrinous layer
placenta increta
placenta invades at least halfway through uterine wall
Prevention of labour complications
Oxytocin injections
Good hygiene
Early treatment of infection
Blood pressure control and magnesium sulphate in severe pre-eclampsia
Education
Access to health facilities
Tackling poverty, cultural practices, low quality health services
