most patients have an uneventful post partum course, but unfortunately many develop complications and issues which can create substantial impacts and in some cases can be life threatening.
General complications not specific to delivery modality
rarely, fatal air embolism may occur following manual repositioning of uterine inversion in 3rd stage of labour as well as during the 2nd stage of labour (especially with forceps delivery), and rarely, following drainage of a LUSCS wound abscess.
fatal air embolism is a rare cause of death in the puerperium and presumably occurs when there is delay in the usual thrombotic occlusion of the placental bed vasculature which becomes exposed to air within the uterus
it is mainly associated with coitus or oral sex, and a significant number also were associated with amphetamine use as well as coitus
a 1936 case report of a patient on day 8 when she was in knee chest exercise posture for 5 minutes and noted to have a moderate subinvoluted uterus with small amount of RPOC, and another case report of similar position causing death in 1938 on day 7 and again associated with some RPOC
Complications primarily following vaginal delivery
episiotomy wound or perinear tear repair complications
massive haematomas can be life threatening
traumatic delivery issues:
fractured coccyx
vaginal bleeding from vaginal tears, cervical tears
psoas muscle haematoma
vulval haematoma
supravaginal haematoma
this may be life threatening as they are usually arterial bleeds similar to ruptured ectopics and cause shock
located above the levator ani muscle and are due to damage to the uterine artery branches in the broad ligament and can dissect retroperitoneally or develop within the broad ligament
difficult to diagnose and thus often present as shock
paravaginal haematoma
this may be life threatening as they are usually arterial bleeds similar to ruptured ectopics and cause shock
caused by damage to the descending branch of the uterine artery
some 1 in 1000 to 1 in 4000 deliveries, most occur within 1st few days of delivery, but some present 2-4 wks post partum 1)
mass often occludes the vaginal canal and extends into the ischiorectal fossa
difficult to diagnose early as often non-specific symptoms with pelvic or rectal pain
later may develop urinary retention due to mass effect, bruising buttocks/perineum, obvious paravaginal mass on bimanual PV exam and then shock