Postpartum complications: what they are and how to deal with the problems caused by the birth of a child

The case of Alice Campellofootballer’s wife Álvaro Morata, who after the birth of their daughter Bella – the couple’s fourth child – was hospitalized in intensive care for post-natal complications, draws attention to what may be the problems due to the birth of a child. Alice is fine now, she is no longer in intensive care, and the strong concern of her first moments has been replaced by full happiness, in the heart of her husband and of the whole family.

It is not known what kind of complications Alice Campello had to face, but there are some common criticalities after the birth that she illustrated to us Alessandra Bellasiomidwife and health educator of Unimamma.it.

The most common complication is usuallypostpartum hemorrhage, which can occur in 5 to 15% of pregnancies and is also the leading cause of maternal mortality and morbidity after childbirth,” explains the midwife. “Other complications may then arise from hypertensive problemsin the presence of arterial hypertension linked to pregnancy rather than in cases of eclampsia. Finally there are the coagulopathies, or all the problems concerning coagulation, which can lead to the formation of thrombi or embolisms ». But let’s see all the cases in detail.

Postpartum hemorrhage

“Scientifically, we speak of postpartum hemorrhage when blood loss exceeds 500 ml, or half a liter, within the first 24 hours of birth,” underlines Alessandra Bellasio. «This concerns natural birth, while in the case of cesarean birth, the bleeding is evaluated on a loss that exceeds 1000 ml, or the liter of blood, because it is considered logical to lose more blood during surgery. Not all women who suffer from it face particularly urgent or life-threatening situations, but it is in any case an important situation. As a woman’s body prepares for pregnancy, there is an increase in the volume of circulating blood and also an approximately 20% increase in red blood cells. When certain levels of bleeding are exceeded, it can become difficult to compensate and a lot also depends on the health of the woman. Postpartum hemorrhage is responsible for approximately 25% of all maternal deaths.

“There are already a whole series of techniques that are implemented immediately after the birth of the child to help prevent postpartum hemorrhage”, underlines the specialist. “Such cases are therefore prevented, particularly in women who have risk factors and a predisposition to bleeding, including those who have had other pregnancies. In all these cases, even closer surveillance is implemented, with even more intensive monitoring, although there are also cases in which the woman does not have risk factors. At that point, when significant blood loss is certified, which falls within the definition of postpartum hemorrhage, physical parameters are evaluated such as the degree of compensation for this loss, vital signs, blood pressure, state of consciousness and so on. At this point we will evaluate what to do, which may include various interventions. First of all, keep the woman’s vital parameters monitored and normal, after which verify the cause of the bleeding and intervene to resolve it. In all of this, obviously, blood transfusion can also come into play, where necessary, and hospitalization in intensive care if the situation is really very important, although it is not the practice”.

Hypertensive disorders

The hypertensive disorder is linked to the risk of significant changes in blood pressure, a phenomenon with an incidence of 8-10% of pregnancies. In fact, we speak of gestational hypertension or pregnancy-induced hypertension when we witness the appearance of systolic blood pressure values ​​≥ 140 mmHg or diastolic ≥ 90 mmHg after 20 weeks in a previously normotensive woman.
If hypertension is then associated with proteinuria (presence of protein in the urine) ≥ 300 mg in a 24-hour sample, we speak of preeclampsiaa condition that typically affects 3-4% of pregnancies.

Eclampsia and HELLP syndrome

Eclampsia and HELLP syndrome are complications due to preeclampsiaalso known as gestosis (syndrome characterized by the presence, alone or in combination, of clinical signs such as oedema, proteinuria or hypertension in a pregnant woman). Eclampsia has an incidence of 1 in 2000 deliveries and in its severe form it occurs in less than 1% of all pregnancies (data Aogoi). It is defined by the onset of convulsions and/or loss of consciousness not attributable to pre-existing neurological pathologies, headache, scotomas (black or colored spots in the visual field) and hyperreflexia may precede the eclamptic crisis.

«It is not a very frequent pathology and generally leads to an early terminated pregnancy compared to the regular term, precisely because it requires a cesarean section or an early induction of birth. The eclampsia attack is generally treated pharmacologically», explains Bellasio.

There HELLP syndrome complicates 20% of severe preeclampsias and is defined on the basis of laboratory data: hemolysis, increased levels of liver enzymes, decreased levels of platelets. The most frequent causes of death in preeclamptic patients are: cerebral hemorrhage, the Multiple Organs Failure (MOF) and disseminated intravascular coagulation.

Sepsis

Sepsis, or septicaemia, is a rare complication of an infection, the consequences of which can be very serious and potentially fatal. It consists of an excessive inflammatory response of the body that damages tissues and organs, compromising their functioning. It can occur in the first half of pregnancy, usually related to miscarriage or, very rarely, to diagnostic maneuvers (for example, amniocentesis), at the time of delivery or during the puerperium, both after spontaneous delivery and after a cesarean section . The incidence of sepsis is approximately 1 in 1000 deliveries. In its most serious form, septic shock, it has an incidence of 1 case out of about 8000 deliveries.

Coagulopathies

Cases of coagulopathies, which can lead to thrombi or embolisms, are also infrequent and require the intervention of the entire medical team and ad hoc drugs. The specific case of thromboembolic disease occurs in 13 cases every 10,000 deliveries and represents one of the main causes of direct maternal mortality (15 fatal cases per million pregnancies).

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