by McCollum Consultants
Our expert witnesses in obstetrics specialise in pregnancy and labour. They are experts in both the surgical and medical care of women’s fertility, pregnancy, and labour.
Our experts in obstetrics have a profound knowledge of managing complications during pregnancy and labour, including ectopic pregnancy, pre-eclampsia, miscarriage, placental problems, and obstetric haemorrhage.
With a strong understanding of appropriate standards of care and NICE Guidelines, in addition to a thorough knowledge of treatment pathways, our expert witnesses in obstetrics can advise on causation, breach of duty, current condition, and prognosis in individuals with obstetric conditions and injury.
See below for a brief overview on obstetrics. Alternatively, contact an expert witness in obstetrics to see how they can help.
What is Obstetric Medicine?
The specialty of obstetrics covers the care of women during pregnancy, childbirth, and the postpartum period.
The normal pregnancy duration is between 37 and 42 weeks. Delivery of a baby before 37 weeks is classed as a premature birth. Pregnancy which continues past 42 weeks is defined as a prolonged pregnancy and is associated with foetal, neonatal, and maternal complications. When the woman begins to deliver the baby, it is known as labour.
Premature Birth
Premature birth can be managed through educating at risk women, prophylactic vaginal progesterone, cervical cerclage (reinforcement of the cervix), and tocolysis (specific contraction-inhibiting medicines). Babies born prematurely are at risk of significant morbidities including immaturely developed lungs (respiratory distress syndrome), feeding difficulties, hypothermia, hypoglycaemia, seizures, neonatal jaundice, infection, hearing impairment, visual difficulties, brain haemorrhage, and cerebral palsy.
Prolonged Pregnancy
Prolonged pregnancy gives an increased risk of stillbirth and neonatal death, in addition to putting the mother at risk of perineal damage, obstructed labour, postpartum haemorrhage, infection, and requiring a caesarean section or use of forceps in vaginal delivery.
Complications of Pregnancy
Complications during pregnancy include gestational diabetes, pre-eclampsia (high blood pressure and protein in the urine), eclampsia (high blood pressure leading to seizures), anaemia, deep vein thrombosis (DVT), obstetric cholestasis, and hyperemesis gravidarum (excessive vomiting).
Complications of Labour
Complications during labour include labour that does not progress, perineal tears, umbilical cord problems (wrapping around the baby’s neck, becoming compressed), abnormal heart rate of the baby, shoulder dystocia (the baby’s shoulder becomes stuck in the birth canal), and post-partum haemorrhage.
Interventions During Labour
Procedures performed to aid labour include:
- Induction – vaginal prostaglandins, membrane sweep;
- Caesarean section – surgical procedure to remove the baby from the womb through the abdomen;
- Forceps – an instrument is placed around the baby’s head to gently pull it through the birth canal;
- Episiotomy – incision to the perineum to enlarge the vaginal opening;
- Amniotomy – manually breaking the amniotic membranes to release the amniotic fluid; and
- Vacuum extraction – a small suction cup is put on the baby’s head to gently pull it through the birth canal.
Postpartum Complications
Postpartum complications relate to the action of labour itself, the after care of wounds, and the effect that giving birth has on the body systemically. There may be excessive uterine bleeding or a retained placenta. Individuals may develop infections leading to postpartum endometriosis and salpingitis, pelvic abscess, or peritonitis. Breast complications may develop, including cracked nipples, breast engorgement, lymphangitis, breast abscess, or mastitis. Further, the trauma of labour can sometimes lead to pelvic floor dysfunction or vesicovaginal fistulas, presenting as leakage of urine or urinary incontinence. Finally, giving birth can affect the brain and mental health of individuals, presenting as postpartum depression and postpartum psychosis.