Complication of Late Pregnancy


 COMPLICATION OF LATE PREGNANCY


Pregnancy articles:
22. Birth

Location and position of foetus in the uterus (womb)-

         The head of foetus remains bow normally; his/her chin remains as attached with chest; right hand as on left shoulder and left hand as on right shoulder; both the legs as bend from knees; hip has attached with stomach; both the legs had bended with hiding his/her genitals. All above positions of child are found inside the uterus.

          The shape of the foetus locates inside the womb in such a position so that any part of his/her body does not able to come out. In middle period of pregnancy, foetus remains as free inside the uterus as it moves his/her hands and legs completely (easily), that helps in the proper growth of his/her body and muscles.            

Being the foetus in length-

          The position of foetus in uterus, in which the spines of the foetus is parallel to mother’s spines, is called ‘Being the foetus in length.’ After 7 months, the foetus takes its position. Before it, the foetus goes on moving inside the womb. This is just the position of about 98% of the foetus.   

Being foetus in oblique position-

          When foetus’s spines are not parallel to mother’s spines, but are oblique, this position of foetus is called ‘Being the foetus in oblique position.’

          This position of the foetus is found only 1.5%. This condition is found mainly in those women who have already given a birth to young ones or having additional amniotic fluid in her uterus or whose abdominal muscles have become weak, etc. in many cases, the foetus is come in length by itself during delivery.      

Slanting position of the foetus-

          This type of position is found only in 5% women. In this position, mother’s spines are at slanting position to foetus’s spines. This type of condition occurs in the women who have given birth to young ones many times. Main reasons responsible for this condition are- normal physical weakness in women, muscular weakness, having amniotic fluid in extra volume in uterus due to small path of birth, fault in the structure of uterus, presence of tumors in mother’s stomach, etc. in many cases, this condition persists even at the time of birth, resulting it becomes necessary to do operation.    

Right position of the foetus in uterus-

          The part of the foetus touching above mother’s hips before delivery is called the right position of the foetus. There are two important forms of foetus in uterus- first, holding the head of foetus on mother’s hips i.e. head presentation or holding the hip of foetus on mother’s hips i.e. breech presentation.

          In uterus, when the foetus’s back is toward mother’s stomach whether it is towards left side or right side, this position of the foetus is known as ‘Front form’ and in womb, when foetus’s spine is located towards mother’s spine, it is called ‘Back form’. In this case, it may be possible to have difficulty in giving birth, because in this case, it is very difficult for mother to turn completely for labour.    

Head presentation of foetus-

          In this case, foetus’s head is found in such a condition in the form of mother’s hips that the head is found as bowed inwards and chin stuck on the chest. This position of foetus in uterus is called head presentation.

          At the time of birth, first of all the back part of foetus’s head comes out. This position of birth is called head presentation. It also happens about 1% that foetus’s head is found as up instead of bowed. So, in this situation, the chin also remains up instead of touching the chest. This type of birth is called facial birth. 

Breech presentation-

  • When foetus takes birth by hips, this position of birth is called breech presentation.
  • This position of foetus depends on many things of mother like- having ovule lower in the uterus, tumors in uterus, faults in the structure of uterus, etc. this position is found mainly in case of premature birth or in case of twins with one of them as inverse. In the deliver of this type, many times doctor can have to do operation.    
  • When the foetus is small in size, deliver can be done in this form too, but, in such cases, doctors have to do it immediately so that newly born baby could get adequate amount of oxygen on time. One thing should also be kept in mind that wound may also occur in baby or mother due to having immediate delivery.   
  • In the delivery of this type, foetus’s head is bended inward so that baby could take birth easily. It should also be kept in mind that after coming out hips, the navel and head of baby would not come under the bones of mother’s hips otherwise baby may die due to insufficient supply of oxygen and blood. In this case, it is very important to have birth within 7 minutes. This type of position can be avoided by knowing the form of foetus, length, width, shape and structure of foetus’s head as well as the shape of mother’s hips, etc.     

Moving the foetus to right position from outside-

          This activity is very important for mother and child. Doing right work on time is very necessary otherwise it does not give right result and in the last, even operation may also be needed for child’s birth.   

          During pregnancy, woman must go to doctor at an interval of 2-2 weeks. After 30 weeks, doctors have option to bring the baby in right direction and position. This position can be corrected up to 32 weeks in the case of first child and up to 34 weeks in case of second or other child. This activity to bring the foetus in right position and direction from outside is called E.V.C. it can be done very easily without any trouble.   

          For this purpose, first of all, mother is allowed to lie down and then make her both feet little up and ask to leave her body loose completely. After that, doctor presses little to foetus’s head for moving downwards with the help of both his hands. In other moment, it is tried to move foetus’s body upwards. After doing like this, woman (mother) should be allowed to remain in lying position for 10 minutes. Now, it is very important to examine her completely. Foetus’s heartbeat should be tried to hear. After that, she should be called next week again for examine. Sometimes, woman can be made unconscious too for proper examination. In many cases, this condition is traced after examining 2-3 times. This condition of foetus should be corrected as soon as possible, because delay causes this work more complicated.       

Twins-

          In Indian, only 1.5% women give birth to twins. It depends on country, caste and family. Twins take birth more in African continent and less in china. It depends on the age of fair sexes. Mostly women in the age between 30 to 40 years give birth to twins with girls in number.       

There are two types of twins-

Similar twins-

          Normally, one sperm (male) fuses with eggs (female) to a foetus (baby), but when it is being divided into two pieces after fusion, twin takes birth. Such both children are same in structure, gender; colors of their hairs, eyes, body’s skin, etc. are also found same. Their body structure is also found similar. Their blocod group is also same. Both the children get blood and oxygen from the same ovule and there is only one amniotic bag inside which foetus grows.            

Dissimilar twins-

          In this case, two sperms fuse with 2 eggs and grown into twin. There are two ovules located in two different sections inside womb. There is only one uterus. In this case, body structure is different to each other. Sometimes, their genders are also different to each other.

          In this present time, it is very difficult to know its main reason. Different people have their own opinions.

Signs of twins-

          There are the following signs of twins- appearing the uterus as big comparison to time-period, coming heartbeats of two fetuses, increasing extra amniotic fluid suddenly in stomach after 24 weeks of pregnancy and becoming the stomach as big, becoming the circumference of mother’s stomach up to 70 to 112 cm, finding many parts of baby while examining the pregnant, knowing heartbeats of two children. This condition can be examined through ultrasound or with the help of x-rays if necessary, because x-ray proves very harmful for both child and mother. Its use should be avoided as far as possible.          

          Birth of twins takes place very soon. In case of birth in between 36 to 38 weeks, baby is not able to grow properly, but they take birth in normal condition.  

Common complaints of twins-

          In case of having twin, many disorders are found in pregnant like- additional vomiting, heart’s fault, deficiency of blood, becoming the womb too big due to having over quantity of amniotic fluid, pain in stomach, feeling of restlessness, swelling on body, attacks of fit, increasing weight, breathing in with motion, presence of varicose arteries, piles, indigestion of food or other disorders, etc.       

Important things considerable in case of twins-

         As soon woman knows about twins in her womb as she should need to start living very carefully. She should be careful especially about her diet and take balanced diet. As a result of it, her body does not suffer from lack of blood. She should need to take salt in less quantity so that her blood pressure would not increase. Her weight should never be increased more than 13 kg comparison to normal otherwise fit can attack too. Swelling should never be appeared on the body. She should need to take enough. She should need to go to a doctor time to time for examination.              

          Due to being two in number, both the babies are light in weight. So any type of incident should be avoided so that delivery would take place before time otherwise the weight of both the babies may be decreased. So, it is very important for her to be careful about herself. Taking proper rest, complete sleep, avoiding sex and any type of medicine should be taken under guidance of doctor only as well as skin should go on caring and medicine for piles should also be taken timely.     

Delivery of twins-

          Having birth of twins in 37th week is considered as very appropriate, but when this birth would be taken place in 35th week, both the babies become very weak. This is the reason why it is very important to remain extra careful in case of twin. First, it should be tried to stop premature birth. But, if it is not possible due to any reason, all types of facilities must have for saving babies. Whether birth would be normal or with the help of operation, all the important facilities must have for both mother and baby. Medicines should never be used for ameliorating labor pain. If operation becomes very essential for delivery, parts below waist can be made insensitive by giving injection in vertebral column (spine).               

  • The delivery of twins takes extra time. It is because of decreasing the pressure of uterus, because uterine muscles remain stretched for longer, resulting these muscles are not able to be contracted soon and delivery takes extra time.    
  • Twins also have their own place inside womb, first child can be allowed to take birth in normal way while for other child, amniotic bag should be operated so that amniotic fluid would come out and labor pain of second child could start. Keep one thing in the mind that what is the position and location of second child inside the womb.     
  • If the child is found as inverse inside the uterus, i.e. breech presentation, the child can be corrected from outside, however if this method fails, foetus can be moved to correct position by inserting finger inside the    vagina. In case of inverse child (breech presentation), baby should be tried to correct by moving its legs. If it also fails due to any reason, it is appropriate to allow the baby to take birth through hip process or operation can be needed for birth.             
  • It is necessary to remove out ovule and give injection for stopping bleeding after birth of both babies.

Bleeding from vagina-

          In case of unbalancing of hormones during pregnancy, bleeding starts in the beginning of pregnancy. For maintaining hormones, it is very important to give injection of projestron resulting bleeding is stopped during pregnancy. In addition to them, pregnant should need to take enough rest.

          In the last period of pregnancy, bleeding from uterus proves harmful for both mother and child. Separating of ovule from uterus is the main reason of it. It is the case of emergency. So, in such case, pregnant should be carried to a doctor immediately. Such types of symptoms appear only when the ovule is located below the uterus at the main opening, called placenta privia. In such symptoms, many times operation can be needed for saving the child.            

R.H.-Negative-

          When female’s blood would be R.H.-negative and her husband’s blood would be R.H.-positive, the blood of newly born baby may be negative or positive. If the baby’s blood is negative, there is no need to be worried, but if the baby’s blood would be R.H.-positive, its blood will react with mother’s blood and form anti-D. In this way, the mother will conceive R.H.-positive next time. In this case, the baby may have to suffer from jaundice, anemia, debility of veins, weakness of brain or even miscarriage may take place too. In such condition, it is very important to test the blood so that injection of N.T.D. could be given to the mother within 48 hours of birth.         

Location of second child inside womb-

          When baby would found as inverse inside the womb, the baby should be tried to correct from out side. If it is not possible to do like this, finger should be inserted inside the mother’s vagina and the baby can be corrected. The baby should be tried to correct by holding baby’s legs. If this way also fails, allowing birth by legs will be appropriate or operation can be done.

          After delivery of both the babies, injection of argometatin or oxitosin is given for coming out ovule and stopping bleeding. 

Amniotic fluid-

          Inside uterus, the foetus goes on moving in a type of fluid, called amniotic fluid. This fluid is filled in a bag like structure, called amniotic sac. As well foetus grows as changes go on coming in this fluid. This fluid is found in as much volume as the baby can move for 16 to 30 weeks properly inside the womb. After 35 weeks, the foetus takes a stable position. In this stage, this fluid starts decreasing gradually however as much its volume is necessary as the baby would go on moving properly.

          Mother’s body has about 1 liter of amniotic fluid. This amniotic fluid is decreased much till the time of birth. When the foetus is become of 40 weeks, amniotic fluid is become only about 800 cc and when it is become of 42 weeks, this fluid is left only 200cc.

          In the beginning of pregnancy, this amniotic fluid is transparent like water. But, as well the foetus grows as its colour is changed into to light and green-yellowish. In the last stage of pregnancy, this fluid is again become transparent. Amniotic fluid is started to form in the eighth week of pregnancy.

Volume of amniotic fluid according to weeks-

Week

Volume of fluid

In 10th week

30 ml

In 20th week

300 ml

In 30th week

600 ml

In 38th week

1000 ml

In 40th week

800 ml

In 43rd week

200 ml

Functions of amniotic fluid-

  • The foetus moves and grows in amniotic fluid during pregnancy period.
  • Due to presence of amniotic fluid in between uterus and foetus, there is no any pressure falls on the uterus.
  • Due to presence of amniotic fluid, there is no any affect of temperature falls on the foetus being nourished inside the uterus.
  • Inside the uterus, the foetus takes this fluid as well as urinates in this fluid too.
  • Amniotic fluid distributes outer hurt or jerk gotten on the stomach during pregnancy period in normal way.
  • This fluid helps the ovule in being attached in the uterus normally.

          It is very difficult to say even in this modern time that how the amniotic fluid forms inside female’s body, but normally it is believed that this fluid secreted from the wall of amniotic sac. During 12 to 24 weeks of pregnancy, this fluid goes on forming and being collected. After that, the volume of this fluid is decreased gradually. If female is suffering from any disease, changes can also take place in the volume of this fluid like- kidney’s disease. In the female who is weak physically may have very little volume of this fluid. Due to having fault in the physically structure of the baby, this fluid can have very large or little volume.     

          Coming out of amniotic fluid from the body during pregnancy period is harmful. When this fluid is come out in additional volume, baby may take birth before time due to starting labour sensation. This is because if this fluid would start coming out in the last stage of pregnancy, mother should need to take enough rest and consult a doctor. The mother can observe by inserting clean cotton or cloth pad in her vagina that in how much volume the amniotic fluid is coming out from the body. One thing is very remarkable that this secretion is of amniotic or urine is coming out from the vagina. For its treatment, she should need medicines and take enough rest.

Long pregnancy-

         passing two more weeks than estimated completion of pregnancy is called long pregnancy. Long pregnancy can prove harmful for both mother and baby, which are as follow-

  • In case of long pregnancy, the volume of amniotic fluid starts decreasing; resulting dry birth may take place.
  • In case of long pregnancy, it may create troubles for both mother and baby due to becoming the head of baby as too strong.
  • Supply of blood full of oxygen from the ovule to the baby is decreased and sterility is come in the ovule.
  • In many cases, heartbeats of baby are stopped too due to getting insufficient blood.

Weakness according to pregnancy period-

          When the foetus is not able to getting sufficient blood full of oxygen from ovule, the growth of the foetus is stopped. Due to delay, the baby takes birth as weak and in light weight comparison to birth on time. In this condition, doctors gives right diet and medicines and check that the foetus’s growth is proper or not. However, if the growth of the foetus has not recovered, it is called I.U.G.R. how much volume of blood the foetus is getting from the ovule, is checked through color Doppler. In case of female weakness, immediate delivery is very useful.

          In this condition, it should be kept in mind that healthy diet and proper rest prove beneficial for the baby. Mother should need to sleep on left side so that the baby could get sufficient blood. The surroundings of mother should be neat and clean. Smoke and pollution are very harmful for both mother and baby. 

Blood pressure-

          In the last 3 months of pregnancy, if the blood pressure of mother is high, then also baby’s growth is affected. So, blood pressure should go on checking time to time. When blood pressure would be noted as 140/90, mother should need to take enough rest, use less salt, take medicine for blood pressure according to the advice of doctor, keep her body weight as balanced, avoid fatty food and live free from mental troubles as well as social and family worries. Otherwise, it will be better to encourage for delivery or operation may also be needed.

Poisoning of pregnancy-

          High blood pressure, coming protein in urine, swelling in arms, fingers, feet and ankles, facial heaviness, over weight, insufficient blood to the foetus, lack of balanced diet, becoming the foetus as weak with passing time, etc. in mother during pregnancy period is called poisoning of pregnancy. In this condition, encouraging for birth or doing operation is better otherwise it may prove dangerous for both mother and baby.  

Diabetes-

          It is very necessary to check the diabetes of pregnant women because it may occur before or during pregnancy period. As a result of it, the bay may be big in shape and heavy. In this condition, normal delivery is not possible and safe. Operation is only an option for birth. In this condition, mother should need to avoid sweet eatables like- potato, rice, sweets, sweet beverages, etc. few gynecologists encourage for delivery before time so that the baby would not be grown bigger. If any family member of pregnant is suffering from diabetes, doctor must be informed about that. 

          Normally, child born in our country is of about 2.6 kg. If the weight of newly born baby is 4 kg, mother should need to check her diabetes, because in this case, she may be suffered from diabetes any time.  

Bursting of amniotic sac-

          When labor pain would not start even after bursting of amniotic sac, you may wait for 12 hours for birth otherwise encouraging for birth immediately or doing operation is the better options.

          After bursting of amniotic sac, there is a possibility of entering bacteria inside the body or the navel or hand of baby would not come out. Coming out of baby’s navel may be dangerous for his/her life. 

X-ray-

          X-rays are harmful for mother during pregnancy. So, it should be avoided as far as possible.

Navel vein-

          The vein of navel is found from the navel to the ovule of mother. It acts as supplying blood from the ovule to baby’s navel through a special blood vessels and supplying of blood from baby to the ovule through two arteries (blood vessels). In this way, it has two arteries (blood vessels) and one vein. This vein is made up of thin wall. It is identified by its color. All the three blood vessels are wrapped with a thick fluid substance, called varants jelly. The navel appears as coiled, bended and wrapped about 50 cm in length. The navel of fully grown baby is equal to the little finger of an adult.    

          In many cases, nodes are fallen on them due to its movement inside womb, but it does not harm the womb. At the time of birth, this node may be more complicated and operation can be needed due to insufficient supply of blood and oxygen. Sometimes, the navel is wrapped in the hand or neck of the foetus. It may be wrapped in the neck 6-7 times, but it does prove any type of harmful effect inside womb. As the baby takes birth, the baby is not able to get blood and oxygen due to stretching the navel which is harmful for the baby. Sometimes, it is being wrapped around the baby’s neck in such a way that it becomes very difficult to get blood from the ovule. In the first phase of birth, ovule is left due to wrapping the navel and due to stretch; the ovule is left from the uterus before time. As a result of it, it is possible to have additional bleeding and the limp of baby (in this case, the baby does not cry after birth)     In this condition, if the ovule is found above in the uterus, stretch comes on baby’s neck at the time of birth, but when ovule would come lower, this stretch is decreased. This type of complicated situation can be identified only in the second phase of delivery, because baby’s heartbeat may become fast or slow. It is very difficult to find this condition. In this modern time, this condition can be identified with the help of color Doppler only.

Birth through medical apparatuses-

          Sometimes in normal delivery too, birth is done with the help of medical apparatuses due to abnormal structure of hips bones or having small birth opening of child. In this method, baby can be pulled out by holding both the temples of the baby through apparatus. In this method, perineum is made insensitive and birth opening is made wider by cutting for the completion of baby’s birth so that the head and body of the baby could come out easily at the time of birth. One thing should also be very important that the front and rear part of baby’s head, there is no any bone and this part is very soft, but the bones on the both side of baby’s head are very flexible resulting the birth of baby takes place very easily.  

Birth through apparatus without giving any pressure-

          This bowl shaped apparatus made up of silicon or rubber, is fixed on the baby’s head present inside the womb, which is connected with a pump on other end. By removing out air in between the head and bowl through this apparatus, vacuum pressure originates. As a result of it, baby’s head can be pulled out very easily. 

Birth through operation-

  • Birth through operation is known as C.S. (caesarian section). There may be many reasons for birth through operation. In this operation, the baby is pulled out after cutting the lower end of mother’s navel.   
  • Before doing operation at the time of birth, doctor has to check blood pressure, hemoglobin in blood, blood group, R.H.Factor, E.C.G., urine and sugar, HIV., etc. in many cases, heartbeats of baby is become as bad as it is not checked on time. So, mother should need to check it earlier. After setting the arrangement of glucose, doctor makes the lower section or entire body of mother as insensitive. Making insensitive of the lower section of mother’s body is called spinal anesthesia. For making mother’s waist as insensitive, doctor use injection.
  • During operation for delivery, gynecologists cut about 12 to 15 cm below mother’s navel. Few gynecologists cut as slanting but not as vertically so that mark would not appear on the body and it would remain hidden under garments. Mother feels little dryness in her throat after operation. When the lower part of mother is made insensitive, she is not allowed to take pillow under her head for minimum 24 hours. By lifting the head, she may feel pain in it. As well as, mother’s legs are also made little up. During operation, inner stitches are done in such a way that they are being disappeared by their selves, but upper stitches are done of silk. These stitches are opened on seventh or eighth day. All these stitches can be opened at once or after leaving one after next can be opened. After that, all the remaining stitches are opened at once.  
  • After one day of operation, woman can move her body little; can stand on the floor. Liquid diet should be started to give her from second or third of operation. Before it, glucose is enough. As well as, a rubber tube is fixed at her urinary opening that is connected with a urinary sac in which urine goes on collecting. 
  • If she has history of operation, it is not necessary that operation is done again. But, if the shape of her hips’ bones is small, operation may be needed at second and every time of birth. Other reasons of doing operation are- heartbeats of baby, failure of encouraging for delivery and having the slanting position of baby inside the womb. Uterus is become weak by the marks of earlier operation and there is a chance of bursting that section. As a result of it, operation may be needed at the time of second delivery. This is the reason why doing delivery at home may be harmful.  
  • Blood and then brownish yellow fluid go on coming up to 40 days after birth and it is stopped after 40 days. If woman is feeding her baby through her breasts, menstruation does not take place during feeding. In few cases, menstruation does not start up to 6-9 months, but it is started soon in few women. After delivery, first menstruation runs for 7 days and in profuse volume. After that, it is started as regular way.
  • She should need to involve in sexual intercourse only after 40 days of birth or take advice of an expert doctor for this purpose. If she does not want to conceive again, she should adopt means of family planning.
  • Changes are come suddenly in the hormones of female body after birth. As well as, woman start thinking about birth, family condition, her body, etc. this type of thinking is very harmful for her. In this case, co-operation of her husband, satisfaction of her family, doctor’s advice and treatment are beneficial.   

Possible problems of pregnancy -

Problems

Percentage

Becoming the uterine muscles as more complicated.

27%

Normal heartbeats of foetus.

17%

Infection in the amniotic fluid of womb.

7%

Coming out of baby’s navel.

5%

Bursting of uterus.

4%

Problems of female are heart and lungs disease.

3%

Separating of ovule from the wall of uterus       before time.

2%

Death of female.

2%