As the old saying goes, having a baby is the equivalent of walking through the door of a ghost. Although the level of medical care has improved, maternal death still happens from time to time. Families can’t understand, “We came to have a baby properly, how did it die”; doctors are often very aggrieved, “We are the ones who don’t want anything to happen to you”.
In recent times, the storm between the North Medical College and the Chinese Academy of Sciences, so that people understand the “aortic coarctation”, many people may be the first time to hear this disease. Last year’s Xiangtan maternal “amniotic fluid embolism” death case, so the name amniotic fluid embolism also a fire. These dangerous and rapidly developing comorbidities have a very high mortality rate and are difficult to save with current medical treatment.
However, as obstetricians and gynecologists, we do not want to make these diseases popular only through such painful lessons. We need to recognize that maternity is a special population and that there are a number of maternity-specific illnesses in addition to the everyday illnesses that can occur. Today, I’ll sort out some of the maternal-related illnesses that can cause death.
Obstetric hemorrhage
For many years, obstetric hemorrhage continues to be the leading cause of maternal death, accounting for almost 1 in 4 deaths. Obstetric hemorrhage can occur while still pregnant, such as early ectopic pregnancy rupture bleeding, placenta abruptio and placenta praevia bleeding in middle and late pregnancy; uterine rupture, placenta praevia (especially in the case of dangerous placenta praevia) and other bleeding after delivery; postpartum bleeding after the birth of the fetus, commonly caused by weak contractions, placental factors, birth canal injuries and maternal diseases.
Who should guard against obstetrical bleeding?
People who have had multiple abortions or scrapings are prone to chronic inflammation of the fallopian tubes, leading to ectopic pregnancy, which can cause shock and death if it ruptures and bleeds; it can also cause placenta praevia and placental implantation, leading to hemorrhage in late pregnancy and after delivery. Therefore, it is generally recommended to have an ultrasound during the 6th to 8th week of the last menstrual period to rule out ectopic pregnancy, and to pay attention to the placenta during the subsequent ultrasounds. If problems are found, they should be dealt with in a timely and planned manner to avoid hemorrhage.
If you have had a cesarean section or a large fibroid, because of the trauma to the uterus, the embryo may implant on the scar of the uterus and cause the placenta to implant or even penetrate the myometrium, which may lead to uterine rupture and postpartum hemorrhage in late pregnancy or during delivery. In these cases, the relationship between the embryo or placenta and the scar should be observed during ultrasound during pregnancy, and if necessary, an MRI should be done to clarify. In some cases, the placenta is planted on the cesarean scar, which is called “dangerous placenta praevia”, with the word “dangerous”, it should be able to attract everyone’s attention. The incidence is increasing, and those who have had a cesarean section, or even multiple cesarean sections, must pay attention.
Some pregnant women who have suffered an accidental impact on their stomachs or hypertensive disorders during pregnancy may suffer from placental abruption, massive blood loss, or in severe cases, uterine stroke, which affects coagulation and uterine contractility and aggravates blood loss.
Pregnant women with twins or triplets or quadruplets (are you capable of having more?), excessive amniotic fluid, huge babies, or with significant uterine malformations, are prone to weak uterine contractions after delivery and are also at risk of hemorrhage.
Pregnant women with blood disorders, poor coagulation, during pregnancy to communicate closely with obstetricians and hematologists, collaborate to ensure the safety of pregnancy and childbirth. If a pregnant woman is severely anemic, the same amount of bleeding can be resuscitated without a blood transfusion, but not for you. Some pregnant women with rare blood type “Panda blood type” should actively contact people with the same blood type during pregnancy to help each other.
The shortage of blood banks is even more serious in some remote areas, so if you find any problems during pregnancy that may cause obstetric hemorrhage, it is recommended to refer to a hospital with experience in resuscitation.
Amniotic fluid embolism
This is not much to say, after the case of maternal death in Xiangtan, many people are beginning to realize the menacing, extremely high mortality rate and rapid development of amniotic fluid embolism. For the pregnant women themselves, there is nothing special to pay attention to, most of them happen during the hospital birth. If it does happen, then you can only trust your doctor and make sure that your parents are in the family, for reasons that I won’t go into, there are too many examples, lest you be scolded by your male compatriots.
Pre-eclampsia, eclampsia, HELLP syndrome
I don’t know how many of these three names you have heard of. This is a serious state of pregnancy-specific diseases – hypertensive disorders of pregnancy, one more serious than the other, and damage to almost all organ systems of the whole body, heavy can appear placental abruption, postpartum hemorrhage, cerebral hemorrhage, liver and kidney failure, heart failure, and even hemolysis! If you find that your blood pressure is elevated during pregnancy, or if you have pre-existing hypertension, and you have positive urine protein, then be alert. The key needs to be regular maternity checkups at the obstetrician, so that any problems can be detected and dealt with early.
Infection, sepsis
There are many types of maternal infections, but most of them cause death due to sepsis, which causes multi-organ failure. The most frequent period is after childbirth and the puerperium, when infections occur or worsen due to low resistance and improper care during the “menstrual period”, but most deaths can be avoided by timely consultation with a specialist. Most of the infections that lead to death are found in remote and economically underdeveloped areas, where mothers do not pay enough attention to these cases and delay the diagnosis and treatment of the disease.
Combined heart disease of pregnancy and perinatal cardiomyopathy
Due to changes in blood volume during pregnancy and delivery, the burden on the heart increases, and if the mother with pre-existing heart disease is prone to heart failure, causing death. Examples include congenital heart disease, rheumatic heart disease, heart disease with hypertensive disorders of pregnancy, perinatal cardiomyopathy, and myocarditis. The key to prevention of these is still early detection and early intervention. Known heart disease, cardiology and obstetrics doctors need to jointly assess, heart function suitable for pregnancy, before going to birth; really not suitable for pregnancy, do not try to be strong, so as to avoid similar to the Chinese Academy of Sciences a pregnant woman such tragedies.
Most of the other diseases that can cause human death may occur in pregnant women, but the proportion varies, so I can’t list them all here. In short, there are three points to note.
1, early detection and early treatment, which requires formal card construction and regular maternity checkups, which can avoid many bad outcomes.
2, if the local hospital is not capable of diagnosis and treatment, early transfer to hospital if it is timely.
3, the birth of a child, the mother’s own parents must be in the hospital, must be sure!