The journey of pregnancy right from conception to delivery is a delicate one. While all may be smooth in most cases, there always lurks danger of unforeseen life-threatening complications that require immediate specialised attention to deal with.
Severe bleeding during pregnancy or delivery is the leading cause of maternal death in both developed and developing countries, mostly preventable with adequate management. Other causes include; high blood pressure, infections, difficult deliveries, birth injuries and foetal distress.
Dr Joseph Musana, an Assistant Professor and Head of Obstetrics Section at the Aga Khan University Hospital in Nairobi, explained, "20 to 25 per cent of labour and delivery complications are unpredictable hence it is advisable for expectant women to select a hospital well equipped with a trained team including a consultant obstetrician gynaecologist round the clock to attend to these emergencies.
However approximately 80 percent of women will have uncomplicated labour and delivery and will not require highly specialised care. The care of these low risk women during labour and delivery can be led by midwives linked to a functional referral system in case of complications".
"Excessive bleeding during pregnancy or delivery could be as a result of injuries in the birth canal, some of which are easily detected while injuries in the uterus may require a specialist’s urgent attention."
"After delivery of the baby, if the uterus does not contract strongly, the blood vessels where the placenta detached continue bleeding. This is the most common cause of postpartum haemorrhage. Other causes maybe a tear in the uterus, cervix or vagina."
High blood pressure is another leading cause of death during pregnancy. The condition could be pre-existing, or develop after 20 weeks of gestation also called pre-eclampsia. The cause is still unknown as to why some mothers develop hypertension during pregnancy. Women suffering from pre-existing hypertension and are planning for a pregnancy should consult a specialist for evaluation and possible changes in medications that suit pregnancy.
"In the course of pregnancy, hypertension can progressively damage the mother’s liver, kidney and brain. If left untreated, it could lead to fatal complications for both the mother and baby, including development of seizures hence the ultimate solution is delivery in order to save life", observes Dr Musana.
"During induced labour or augmentation, the baby could get distress. It is therefore vital to keep track of the labour process and how both the mother and baby are coping. The mother’s health history is also important in determining the cause of distress. In such cases, a cardiotocograph, acid-base check or ultrasound can be done to determine the level of distress."
"Emergency pregnancy complications require timely decisions to be made and therefore, a 24 hour care systems should be implemented in all county health facilities with nurses and midwives as the primary care attendant, with emergency back up by a medical doctor or an obstetrician available within 10-15 minutes to improve quality of care and reduce maternal death, newborn mortality and stillbirth, currently still too high in Kenya." Dr. Musana further notes.
"At Aga Khan University Hospital, Nairobi, we have opted for a midwifery-obstetrician team model of care whereby a consultant obstetrician gynaecologist is available on campus at any given time of day and night, assisted by a team of other professionals to attend to these emergency pregnancy conditions in order to save lives and assure safe deliveries."