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When Delivery Is Fast and Furious: Precipitous Labour

S,30, would like to forget the harrowing experience of her first delivery two years ago. She was at 39 weeks of gestation then. Early in the morning, she was woken up with labour pain which occurred every 10 minutes. While on her way to the hospital in the car, the pain became so frequent and intense that she felt there was no break in between the contractions. As soon as she reached the hospital, she had the sensation of bearing down with an urge to push. She was attended by the midwife immediately and a girl weighing 2.5 kg was delivered on the trolley during the transfer from the car. As she sustained multiple tears at her perineum and required many stitches, she had a more prolonged recovery than usual.

S was a case of precipitous labour in which the baby was delivered within a very short period of time.

What is precipitous labour?

Precipitous labour is a condition in which labour and delivery occur within 3 hours after regular contractions. It is not a common occurrence and is estimated to happen in 1 to 3 per cent of deliveries.

By comparison, a regular labour for mums who’ve never given birth before would last between 6 and 12 hours after regular contractions start and between 4 and 10 hours in those who have delivered a baby previously.

What are the cause and risk factors for precipitous labour?

The exact cause is not well understood. Risk factors include:

  • History of precipitous labour

  • Small baby with low birth weights e.g., prematurity or intrauterine growth restriction (IUGR)

  • Mums who have delivered more than 5 babies before.

  • Teenage pregnancy

  • ·Hypertensive disorders of pregnancy (pre-eclampsia) or chronic hypertension

  • Placenta abruption in which the placenta detaches too early from the uterus before the baby is delivered

What are the signs of precipitous labour?

  • Sudden onset of intense contractions

  • Strong uterine contractions and pain

  • Feeling of continuous uterine contractions with no break in between.

  • Intense sensation of bearing down and the urge to defecate

What are the complications of precipitous labor?

There are no serious complications with precipitous labour most of the time.

Occasionally, complications may develop. They include:

Maternal complications:

  • Retained placenta

  • Lacerations of the cervix, vagina and perineum with heavy bleeding

  • Postpartum hemorrhage from the vaginal tears or the failure of the uterus to contract (uterine atony)

  • Shock from postpartum hemorrhage requiring blood transfusion

Neonatal complications:

  • Increased risk for infection if delivery happens in an unsterile environment

  • Breathing difficulties from aspiration of amniotic fluid.

  • Hemorrhage in the brain from a sudden change in pressure on the baby’s head during rapid expulsion

During her subsequent pregnancy, S was seen at 8 weeks of gestion. Her antenatal course was uneventful. The length of her cervix was monitored regularly. It started to soften up around 36 weeks of gestation and began to dilate one week later. I suggested that she should have a planned delivery at 38 weeks when her cervix was open at 2 cm. She had an easy and normal delivery of her second daughter who weighed 3.2 kg.

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