Hospitals take aim at pregnancy complications

Giving birth is a part of life for many women. A string of recent reports though have drawn the public's attention to deadly complications women can face during and after labor.

Last month, news broke of a young woman in Hunan Province who died tragically soon after giving birth to her child. Autopsy reports later revealed that the woman died from an amniotic fluid embolism, a life threatening condition where fetal material enters the mother's bloodstream. One week later, another woman nearly lost her life due to the same complications. Thanks to prompt treatment by hospital staff in Shanghai, this woman fortunately pulled through.

According to Michelle Lu-Ferguson, Chief Medical Officer at Shanghai Redleaf International Women's Hospital, amniotic fluid embolisms are extremely rare. In fact, she hasn't personally encountered a single case during the roughly 1,000 deliveries she has performed in Shanghai over the past nine years.

"Some people believe I've been lucky. I insist it's because I pay special attention in preventing things from going wrong. I don't neglect any sign," she told the Global Times.

Cheng Yanhua, a gynecologist and obstetrician at Shanghai International Medical Center, echoed Dr Lu and cautioned against getting overly worried about statistically improbable complications. What's more, Shanghai's thorough pregnancy health evaluation system has helped push the city's maternal mortality rate down to a level seen in many developed countries, Dr Cheng explained.

Back in 2009, municipal health officials recorded an average of 12.23 maternal deaths per 100,000 live births. In 2013, figures from the World Health Organization indicated that this ratio was 16 deaths per 100,000 live births in developed countries and 230 deaths per 100,000 live births in developing countries.

Risk factors

Dr Cheng explained that women facing high-risk pregnancies receive special attention and hospitals take more stringent precautions to guard against possible delivery complications. She mentioned a few factors which can increase the likelihood of birth difficulties.

"If a woman is over 35 years of age and obese, the evaluation system will send out a yellow warning. If a woman has a chronic illness like diabetes, heart disease or asthma, the system will send an orange warning. The highest warning is a red warning, which will be issued if a pregnant woman is found to have serious heart or respiratory system problems."

Doctors typically recommend hospitals for prenatal treatment and deliveries based on a woman's specific health conditions and risk factors. Women who receive orange or red warnings are often directed toward one of the city's Tier-Three comprehensive hospitals, which are better equipped to handle emergency health situations.

As Dr Lu explained, children born to mothers over the age of 35 are at a higher risk of being born with Down's syndrome.

"After the age of 37, women will see a significant drop in the quality of their eggs," she said, which could cause fetal chromosome problems.

The doctor suggested that older women receive regular gynecological examinations prior to pregnancy. Such examinations are crucial when it comes to ensuring a baby's health.

Family genetic problems present another risk source. Even though a pregnant woman might not have a heritable disease herself, she may nevertheless pass on the genes for this particular disease to her offspring. Dr Lu explained one case of this involving a woman who was an asymptomatic carrier of hemophilia. Because the gene for this disease is on the X chromosome, she said, if the woman gave birth to a son, he would definitely manifest this disorder since men have one X chromosome; while if she gave birth to a daughter, the baby will not be caught by the disease if the father does not have the hemophilia gene.

"Therefore communications with hospital doctors prior to pregnancy or at least during the early period of pregnancy are very important to help one figure out the possible risks," Dr Lu stated.

Fatal consequences

Dr Lu warned that high blood pressure is among the most serious commonly seen factors that can complicate pregnancy and delivery.

"High blood pressure is the second leading cause of death for pregnant women, right behind postpartum hemorrhages," she said.

The doctor went on to say that a pregnant woman with hypertension can suffer malfunctions of the liver, kidneys and other organs. "A decline in one's liver function can lead to blood coagulation problems. If a woman suffers from serious dropsy and is found with high levels of protein in her urine, it means that her kidneys are in disarray."

Although there are many clear indicators of high-risk pregnancy, both Cheng and Lu told the Global Times that even outwardly healthy women have been struck by tragedy. "Many not flagged as being at high risk have unfortunately passed away as a result of postpartum hemorrhages, which remain the biggest killer of pregnant women in China," said Dr Cheng.

Dr Lu said that postpartum hemorrhages can occur for many reasons, such as prolonged uterine contractions or uterine inertia after a baby is delivered. "This doesn't necessarily have any connection with a pregnant woman's everyday bodily functions."

Lu said her hospital has a checklist that staff can refer to during postpartum hemorrhage cases. She suggested that all hospitals develop such protocols.

To make women and their families better aware of the risks that come with pregnancy, Dr Lu recommended that health authorities in China do more to educate the public. "In the US, Canada and Australia, there are official patient education websites, where people can find basic information concerning pregnancy… But here we don't have any authoritative platform. I believe the government should have the vision to create such things."