Birth Complications and Perinatal Mortality - A Comprehensive Guide

Introduction

Pregnancy is a complex and long journey during which the female body undergoes drastic transformations to sustain the developing baby within the womb. About 37 weeks is estimated as the duration of a full-term pregnancy, required for the baby's necessary growth. Pregnancy is a miraculous stage where a new life starts to develop and grows into a baby, which eventually gets delivered, marking the end of the pregnancy. Though it is an exciting phase in every woman's life, it carries potential risks and complications. Certain complications can be effectively tackled with prompt medical assistance, while some complications threaten the life of the baby and the expectant mother. Hence, pregnancy is a crucial period that entails proper care and attention to keep the baby and mother healthy and safe. Technological evolution and advances have dramatically brought down the incidence of birth-related complications over the last few years.

What Are Birth Complications?

Complications encountered during childbirth, which can endanger the life of the mother, child, or both, are generally categorized as birth complications. Whenever birth complications are anticipated, medical assistance is made available to tackle the situation without fail. Prompt medical intervention often safeguards the child’s life. Some of the birth complications that critically threaten the child’s life include the following:

• Perinatal Asphyxia: Asphyxia, as the name suggests, indicates a remarkable compromise in oxygen delivery to the baby in the womb (fetus). In perinatal asphyxia, oxygen exhaustion or draining can develop in the baby, either within the womb or immediately after birth.

• Uterine Rupture: It is recognized as the most devastating form of birth complication, where the uterus develops a tear or break, allowing the amniotic fluid that supports a baby inside the womb to seep. In most severe cases, the baby will be transpositioned outside the womb. Uterine rupture reduces the oxygen flow to the baby to the extent that it requires an immediate caesarian to save the baby’s life. The baby’s life would be in grave danger from the moment of the uterine tear. Cessation in the oxygen supply instantly precipitates brain cell damage, which could lead to the baby's death.

• Umbilical Cord Prolapse: The umbilical cord is a tube-like structure that connects the baby to the placenta so that the baby can receive nutrients and oxygen through it. Prolapse of this cord through the cervix, even before the baby approaches the cervical part, can potentially threaten the baby’s life. Once the baby’s head approaches the birth canal, the umbilical cord gets squeezed against the cervix. This squeezing checks the nutrients and oxygen flow through the umbilical cord, eventually resulting in perinatal death. It is reported to have a very high perinatal death rate of about 50 percent.

• Fetal Macrosomia: Fetal macrosomia is a specific condition where the baby’s size will be appreciably more significant than what is supposed to be the normal size. Seven pounds is considered the ideal birth weight required for a baby, but when it overshoots eight pounds and 13 ounces, it could pose difficulties for the mother during vaginal birth. If fetal macrosomia is left undetected before delivery, it can bring in complications. Larger babies are more likely to get trapped within the birth canal. Once they get stuck over there, it could impair the oxygen supply to the baby and can even bring in permanent brain damage or the baby’s death.

• Shoulder Dystocia: It is another potent birth complication requiring immediate resolution to save the baby’s life. As the name suggests, it develops due to the wedging of the baby’s shoulder into the birth canal in the delivery process. Once the shoulder gets jammed, it can challenge the baby’s life by impairing oxygen delivery. Doctors initiate special maneuvers or techniques to unseat the baby when shoulder dystocia is detected. These techniques risk inflicting physical trauma on the child’s baby, potentially bringing permanent disability.

• Maternal Infections: A baby growing in the womb can acquire certain infections from the expectant mother. Bacterial infections, particularly from the genital area of the mother, have easy access to the baby in the womb. These bacteria or infectious agents creep into the fluid-filled protective sac (amniotic sac) that envelops the baby inside the womb, exposing it to the fetus (baby). It hinders the fetal nutrients and oxygen flow and can threaten the baby’s life. Maternal nutritional deficits are also reported to have close correction with certain pregnancy complications. Maternal anemia (collapsed hemoglobin level) is identified to be a triggering factor for early delivery (preterm birth), where the baby will be delivered prematurely.

What Is Perinatal Mortality?

The death of the baby that occurs past the 28th week of pregnancy till the baby turns one week of age is denoted by the term perinatal mortality. It encompasses all the cases of stillbirth where the baby will be delivered lifeless. Death can occur within the womb, in the delivery process, or immediately post-delivery due to events during childbirth. Birth complications are the critical ground that can lead to the baby's death. Hence, it is conclusive that both perinatal mortality and birth complications share an imperative association.

Proper tackling of birth complications is the key to gearing down the perinatal mortality rate. Technological and diagnostic innovations have facilitated the detection of possibilities of birth complications, which in turn helps doctors to analyze those complications and their resolution much before the actual encounter happens. Doctors may also structure the treatment plan if birth complications are anticipated. They may advise the caesarian section to bypass the complication, as in the case of fetal macrosomia.

What Are the Factors That Influence Perinatal Mortality?

Numerous studies have been conducted to expose the factors that enhance the risk of perinatal mortality.

• Maternal Age: Maternal age significantly influences the probability of perinatal mortality. If the expectant mother is too young or old, there are higher chances of developing birth complications and perinatal death.

• Maternal Pelvic Anatomy: The narrow and constricted pelvic structure of the maternal pose enhances the risk for certain birth complications like shoulder dystocia.

• Fetal Size: Babies with enhanced birth weight often pose challenges during childbirth and often demand cesarean section.

• Final Position of the Baby: During childbirth, the baby is supposed to approach the birth canal in a head-down position. The abnormal position of the baby can make the baby jammed within the birth canal, which can be fatal to the child.

• Preterm Birth: Babies give birth prematurely, way before the actual delivery rate, predisposing the child to perinatal complications and even death. Such babies are often marked with low birth weight, further enhancing the perinatal mortality risk.

Conclusion

Perinatal mortality is consistently recognized as a matter of concern. Birth complications enhance and intensify the risk of perinatal death. With the invention of more advanced and sophisticated fetal monitoring techniques, many birth complications can be anticipated, and appropriate measures can be taken beforehand to deal with them. Proper management of birth complications at the right time reinforces and strengthens the survivability of the baby. Periodic check-ups with the concerned doctors are often advised to keep track of fetal development and foresee any birth complications.