What are the signs of childbirth before delivery?

Pregnant women are a very common group, and childbirth is something that many people worry about. You must know that the childbirth process is very dangerous for pregnant women, and their lives may be in danger at any time. There are many things to pay attention to during childbirth.

1. Uterine fundus descent

About two weeks before delivery, the fundus of the uterus will drop for a first-time mother. At this time, she will feel relaxed in the upper abdomen, and her breathing will become smoother than before. The uncomfortable feeling of stomach pressure will be relieved a lot, and her appetite will also increase accordingly.

2. Feeling of oppression in the lower abdomen

Due to the descent, the part that will be exposed first during childbirth has already descended to the entrance of the pelvis, so the lower abdomen is swollen and the bladder is compressed. At this time, you will feel back pain and leg pain, inconvenience in walking, and frequent urination.

3. Seeing red

In the last few weeks of pregnancy, cervical secretions increase and the woman will notice an increase in vaginal discharge. Normal cervical secretions are a viscous liquid, which usually forms a mucus plug in the cervix to prevent bacteria from invading the uterine cavity. This secretion is more abundant and more viscous during pregnancy. As the uterus contracts regularly, this mucus plug is discharged with the contractions that begin with delivery; and due to the separation of the fetal membranes at the endometrium and the uterine wall, there is a small amount of bleeding. This bleeding is mixed with the uterine mucus plug and discharged from the vagina, which is called spotting. Spotting is a relatively reliable sign that delivery is about to begin. If the amount of bleeding is greater than usual, you should consider whether there is an abnormality. It may be placental abruption, and you need to go to the hospital for examination immediately.

4. Water breaking

The leakage of amniotic fluid from the vagina is commonly known as "broken water". Because of the strong contraction of the uterus, the pressure in the uterine cavity gradually increases, the cervix opens wider, the head drops, causing the fetal membrane to rupture and the amniotic fluid to flow out of the vagina. At this time, birth is not far away.

5. Labor pains

Generally, the pain lasts for 30 seconds, with an interval of 10 minutes. Later, the pain duration gradually increases and the interval shortens, which is called regular labor pain.

Although modern medical technology is advancing by leaps and bounds, there are still many uncertainties in the process of childbirth. Some complications may occur, and in serious cases, they may endanger the lives of mothers and babies. Let's take a look at the six major risks of childbirth: fetal distress, postpartum hemorrhage, umbilical cord prolapse, uterine rupture, amniotic fluid embolism, and premature rupture of membranes!

Delivery risk 1: Fetal distress

Fetal distress is when the fetus shows signs of hypoxia in the uterus, endangering the health and life of the fetus. Fetal distress is a complex symptom and is currently one of the main indications for cesarean section. The incidence rate is 2.7% to 38.5%. Fetal distress is more common in the prenatal period, mainly manifested by placental insufficiency. Pathophysiologically high-risk pregnancy prevents the fetus from getting enough oxygen, causing fetal growth retardation, decreased fetal movement, polycythemia, and even severe fetal distress, leading to fetal death.

Clinical phenomena: Meconium-stained amniotic fluid, changes in fetal movement and fetal heart rate are common clinical manifestations, but they are not unique to fetal distress.

1. Meconium staining of amniotic fluid

When the fetus is hypoxic, it often reflexively causes relaxation of the anal sphincter, increased intestinal motility, and the discharge of meconium, which leads to fecal staining of the amniotic fluid. Fecal staining of the amniotic fluid is not a specific manifestation of fetal distress in the uterus. If it is discovered during labor, it requires a comprehensive analysis.

2. Changes in fetal movement

Many factors can affect fetal movement, but about half of decreased fetal movement is due to fetal distress.

3. Fetal heart rate changes

Tachycardia of 160 to 180 beats per minute is the initial sign of fetal distress, and this stage lasts only a short time.

Delivery risk 2: premature rupture of membranes

Premature rupture of membranes, commonly known as water breaking, refers to the rupture of the membranes before the fetus is full-term. It is a common complication during pregnancy. Premature rupture of membranes can occur at any gestational age during pregnancy, but it is more common in the second and third trimesters of pregnancy. The incidence of premature rupture of membranes before 37 weeks of pregnancy is about 2.0% to 3.5%. The adverse effects of premature rupture of membranes on pregnancy and delivery are increased premature birth rates, increased perinatal mortality, and increased intrauterine infection and puerperal infection rates.

Clinical phenomenon: Generally speaking, premature rupture of membranes is manifested by vaginal discharge without pain. It often occurs when abdominal pressure increases, such as after coughing, urination or defecation. When premature rupture of membranes occurs, a large amount of water suddenly flows out of the vagina, which can soak the underwear and is intermittent. The amniotic fluid that flows out during premature rupture of membranes is colorless and non-sticky, which is different from the sticky leucorrhea. This vaginal discharge usually increases when standing up and decreases or even stops when lying down. In addition, the amniotic fluid will be slightly turbid, and sometimes vernix caseosa can be seen mixed in it, which is different from urination.

Delivery risk three: postpartum hemorrhage

Vaginal bleeding of more than 500 ml within 24 hours after the birth of the fetus is called postpartum hemorrhage. It usually occurs within 2 hours after delivery. Postpartum hemorrhage is a serious complication of delivery and one of the important causes of maternal death. It ranks first among the causes of maternal death in my country, and its incidence accounts for about 2%-3% of the total number of deliveries.

Clinical phenomena: Vaginal bleeding and hemorrhagic shock after fetal delivery are the main clinical manifestations of postpartum hemorrhage.

1. Symptoms of shock

If the mother continues to be irritable, has pale and cold skin, a weak and rapid pulse, and a short and tight pulse, she may be in the early stages of shock.

2. Heavy vaginal bleeding

If vaginal bleeding occurs immediately after the fetus is delivered and the color is bright red, soft birth canal laceration should be considered; if vaginal bleeding occurs a few minutes after the fetus is delivered and the color is dark red, placental factors should be considered; if vaginal bleeding is heavy after the placenta is delivered, uterine atony or residual placenta or fetal membranes should be considered; if vaginal bleeding continues after the fetus is delivered and the blood does not coagulate, which coagulation dysfunctions should be considered; if the blood loss is obvious, accompanied by vaginal pain but not much vaginal bleeding, occult soft birth canal injury, such as vaginal hematoma, should be considered.

Delivery risk 4: Umbilical cord prolapse

Umbilical cord prolapse refers to the rupture of the fetal membranes of pregnant women, and the umbilical cord falls out of the cervix. If the fetal membranes have been broken, the umbilical cord will further fall out from under the fetal presenting part, enter the vagina through the cervix, and even appear in the vulva through the vagina. Umbilical cord prolapse is a rare complication, with an incidence of about 1‰ in the total number of births. Umbilical cord prolapse is extremely harmful to the fetus, because during uterine contractions, the umbilical cord is squeezed between the presenting part and the pelvic wall, resulting in obstruction of umbilical cord blood circulation, fetal hypoxia, and severe intrauterine distress. If the blood flow is completely blocked for more than 7 to 8 minutes, the fetus will quickly suffocate and die.

Clinical phenomena:

1. If the membranes have not been ruptured, a vaginal or anal examination may be performed, and a pulsating cord-like object may be felt; if the membranes have been ruptured, a vaginal examination may be performed, and part of the umbilical cord may be felt or seen.

2. The fetal heart rate changes faster, slower or irregularly, which can be relieved by changing body position or raising the hips.

3. Variable decelerations in the fetal heart rate electronic monitoring indicate that the umbilical cord is compressed.

Delivery risk 5: uterine rupture

Uterine rupture refers to the rupture of the uterine body or lower uterine segment in late pregnancy or during delivery. It is a serious obstetric complication that directly threatens the life of the mother and fetus. Uterine rupture often occurs in women with dystocia, elderly women with multiple births, and women who have undergone surgery or uterine damage. The vast majority of uterine ruptures occur after 28 weeks of pregnancy, most commonly during delivery. The current incidence is controlled below 1‰, with a maternal mortality rate of 5% and an infant mortality rate of 50% to 75% or even higher.

Clinical phenomena:

1. Threatened uterine rupture

The parturient has unbearable abdominal pain, restlessness, shortness of breath, and dysuria and hematuria due to prolonged bladder pressure. There is obvious tenderness in the lower uterine segment and changes in the fetal heart rate.

2. Incomplete uterine rupture

Symptoms and signs may be atypical. Incomplete uterine rupture can only be discovered under close observation. In some cases of late pregnancy rupture, the diagnosis can only be made when symptoms and signs of uterine rupture appear.

3. Uterine rupture

The parturient suddenly feels a tearing pain in the abdomen, followed by the disappearance of uterine contractions. The pain is temporarily relieved, but she soon enters a state of shock. At the same time, the fetal movement stops, the fetal heart sounds disappear, and the cervix retracts. Due to the stimulation of blood, amniotic fluid, and the fetus, the whole abdomen is tender, rebound, and tense, with shifting dullness.

Delivery risk six: amniotic fluid embolism

Amniotic fluid embolism refers to the blockage of the mother's pulmonary artery by amniotic fluid. During delivery, amniotic fluid suddenly enters the mother's blood circulation and causes acute pulmonary embolism, anaphylactic shock, disseminated intravascular coagulation, renal failure or sudden death. This is a rare complication during delivery. Amniotic fluid embolism is the most dangerous complication in obstetrics, with an incidence of 4/100,000 to 6/100,000 and a mortality rate of 70-80%. Although the probability is low, once it occurs, it is easy to cause maternal death even if it is treated. Amniotic fluid embolism often occurs during delivery or rupture of membranes, and can also occur after delivery. It is more common in full-term delivery, but it can also be seen in mid-term induction of labor or forceps curettage. Most of the onset is sudden and the condition is dangerous. Since this situation is often unpredictable before delivery, the mother should be closely observed during delivery and be extra careful.

Clinical phenomena: After rupture of membranes during childbirth, the mother suddenly develops symptoms such as irritability, chest tightness, difficulty breathing, cyanosis, rapid heart rate, decreased blood pressure, moist rales in the lungs, shock and coma.

As the gestational age increases, the fetus also continues to grow. The mother's uterine muscles are in a state of high tension for a long time. If there is a lack of adequate preparation and the delivery period suddenly begins, it is easy to have high-risk complications of delivery. Pregnant mothers should pay attention to adequate rest, maintain a good mental state, and be prepared for delivery. When the due date is approaching, if there is any abnormality in the body, you should communicate with the doctor at any time. In the late pregnancy, you should prepare a delivery bag for admission to the hospital to avoid being in a hurry. Although delivery is accompanied by danger, pregnant mothers do not need to be too anxious. The probability of some delivery complications is extremely low. Just be aware of it. Also, don't be lazy and don't skip the prenatal check-up!

In fact, too much pain during childbirth not only brings pain to the mother, but also has adverse effects on the fetus. According to data, when the human body feels severe pain, it releases a substance called catecholamine (mainly composed of adrenaline and norepinephrine), which has adverse effects on both the mother and the fetus. The increase in catecholamine can weaken the coordination of uterine contractions. Uncoordinated uterine contractions can slow down the expansion of the cervix, and the blood and oxygen supply of the newborn may be affected.

1. Directionality of force during childbirth

The force applied during childbirth has a strict direction. The abdominal pressure created by the force must be in the direction of the birth canal to be useful, otherwise it is meaningless. It is easy to determine whether the force is applied in the correct direction. Place your palm near the anus and then apply force. If the direction is correct, the palm will be pushed forward. If the direction is wrong, the palm will not feel anything. The correct force application method will have a very balanced force. If you only feel the front or back half of your palm being pushed, it means that the method is wrong and needs to be readjusted.

2. Effectiveness of force during childbirth

During childbirth, the force is applied as the uterus contracts. One contraction lasts for one minute. In this one minute, you must apply force at least three times to be effective. The longer the labor process, the greater the effort, and effective force is of great significance. The secret to force is to take a full breath and pause for a few seconds before applying force. The mother can first take a full breath, stop breathing while exhaling from the nose, and then slowly apply force as if she is going to defecate or open her anus after a few seconds. At this time, keep your lips tightly closed and do not let any air leak out until the end. It takes about 25 seconds from inhaling, applying force to exhaling. When practicing, check whether there are the following shortcomings. If there are, it means that the method is incorrect and needs to be improved in time.

3. Cooperate with the doctor

The parturient should follow the doctor's instructions and actively cooperate with the contractions by taking deep breaths, holding the breath, and exerting force. During this period, you can first take a gentle breath, then take a deep breath. After the air enters the chest cavity, exhale a small amount first and then hold it. When the contraction reaches its peak, push hard towards the anus like defecating, and repeat this many times until the head is exposed. Next, because the vaginal opening expands to the maximum, it is not advisable to hold the breath at this time. According to the doctor's request, you can open your mouth and breathe gently and quickly. Finally, with the help of the doctor, use the pressure generated by the contraction to smoothly deliver the fetus.