Intrapartum Considerations

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Patients with EDS are high-risk patients and should be followed by a maternal-fetal medicine specialist.   They are at increased risk of having rapid progression of labor and delivery, as well as premature delivery due to cervical insufficiency or premature rupture of membranes.7 Currently, there are no clear recommendations favoring vaginal vs Cesarean delivery. 

Patients with vascular EDS are at higher risk for uterine rupture and postpartum hemorrhage.8

Some further complications of delivery in EDS include abnormal fetal presentations, delayed wound healing, uterus atonia, hemorrhage, pelvic prolapse, deep venous thrombosis, and coccyx dislocation.7

Joints should be kept in neutral positions if a patient receives neuraxial anesthesia for a Cesarean section delivery due to joint hypermobility and the risk of dislocation.

Postpartum Considerations

After delivery, postpartum hemorrhage, extension of episiotomy, and uterine/bladder prolapse can occur. Patients with the vascular type of EDS are at greatest risk for these complications.8

Special precautions may be required for wound healing in patients with hyperelastic skin. Patients with significant skin fragility may decrease their risk of developing skin lacerations by the use of protective bandages or pads over especially exposed areas, such as the knees, shins, and forehead.

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