Complications in Pregnancy

8/3/2019 Complications in Pregnancy

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INTRODUCTION

Pregnancy is the carrying of one or more embryos or foetuses by female mammals, including humans,inside their bodies. Human pregnancy is the moststudied of all mammalian pregnancies.

A pregnancy complication is any condition or illnessthat threatens the mother and/or fetus during pregnancy. Common pregnancy complications

include pre-eclampsia, premature labour, gestationaldiabetes and depression.

Pregnancy complications may result from a number of possible factors, including pre-existing disorders



or diseases (e.g. diabetes, high blood pressure) or abnormalities of the m or sperm or egg.Complications may also result from sexuallytransmitted diseases, abnormalities in the amniotic

fluid, placental abnormalities and viral, bacterial or parasitic infections.

Most pregnant women only experience minor complications of pregnancy, but for a minority moreserious problems occur for the mother and/or fetus. Inaddition, a number of complications may result in

death of the mother or loss of the fetus. These problems range from failure of the embryo to implantin the womb, leading to miscarriage, to the rupture of the placenta. The fetus can also develop problems inthe womb, including congenital defects.

ECTOPIC PREGNANCY



An ectopic pregnancy is one which occurs when thefertilized egg attaches itself in a place other thaninside the uterus. Almost all ectopic pregnanciesoccur in a fallopian tube, and are thus sometimescalled tubal pregnancies. The fallopian tubes are notdesigned to hold a growing embryo. The fertilizedegg in a tubal pregnancy cannot develop normallyand must be treated. An ectopic pregnancy occurs in1 out of 60 pregnancies.

CAUSES OF ECTOPIC PREGNANCY



Ectopic pregnancies are caused by one or more of thefollowing:• An infection or inflammation of the fallopian

tube can cause it to become partially or entirely

blocked.• Scar tissue left behind from a previous infection

or an operation on the tube may also impede theegg’s movement.

• Previous surgery in the pelvic area or on thetubes can cause adhesions.

• An abnormality in the tube’s shape can be

caused by abnormal growths or a birth defect.

WOMEN AT A RISK OF HAVING

ECTOPIC PREGNANCY



Women who are more at risk for having an ectopic pregnancy include the following:

• Are 35-44 years of age•

Have had a previous ectopic pregnancy• Have had pelvic or abdominal surgery• Have Pelvic Inflammatory Disease(PID)• Have had several induced abortions• Women who get pregnant after having a tubal

ligation or while an IUD is in place

SYMPTOMS OF AN ECTOPIC PREGNANCY

• Sharp or stabbing pain that may come and goand vary in intensity. The pain may be in the pelvis, abdomen or even the shoulder and neck (due to blood from a ruptured ectopic pregnancygathering up under the diaphragm).

• Vaginal bleeding, heavier or lighter than normal period

• Gastrointestinal symptoms• Weakness, dizziness, or fainting• Pain when urinating or defecating.

DIAGNOSIS OF ECTOPIC

PREGNANCY

Ectopic pregnancies are diagnosed first by a pelvicexam to locate pain, tenderness or a mass in the



abdomen. An ultrasound is used to determinewhether the uterus contains a developing fetus.

The measurement of hCG levels is also important. An

h CG level that is lower than what would be expectedis one reason to suspect an ectopic pregnancy. Lowlevels of progesterone may also indicate that a pregnancy is abnormal.A process called Culdocentesis is also done, which isa procedure that involves inserting a needle into thespace at the very top of the vagina, behind the uterus

and in front of the rectum. The presence of blood inthis area may indicate bleeding from a rupturedfallopian tube.

TREATMENT OF ECTOPIC PREGNANC Y



An ectopic pregnancy may be treated in any of thefollowing way:

• Methotrexate may be given, which allows the

body to absorb the pregnancy tissue and maysave the fallopian tube, depending on how far the pregnancy has developed.

• If the tube has become stretched or it hasruptured and started bleeding, all or part of thefallopian tube may have to be removed. Bleedingneeds to be stopped promptly, and emergency

surgery is needed.• Laparoscopic surgery under general anaesthesia

may be performed. This procedure involves asurgeon using a laparoscope to remove theectopic pregnancy and repair or remove theaffected fallopian tube. If the ectopic pregnancycannot be removed by a laparoscope procedure,

then another surgical procedure called alaparotomy may be done.

MISCARRIAGE



Miscarriage is the term used for a pregnancy thatends on its own, within the first 20 weeks of gestation. The medical name for this is spontaneousabortion (SAB). If the baby is lost after 20 weeks of pregnancy, it is called Stillbirth.

Miscarriage is the most common type of pregnancyloss. 50-75% of all miscarriages occur when a pregnancy is lost shortly after implantation resultingin bleeding that occurs around the time of theexpected period of the mother (first trimester).

CAUSES FOR MISCARRIAGES



The reason for miscarriage is varied, and most oftenthe cause cannot be identified. During the first

trimester, the most common cause of miscarriage ischromosomal abnormality. Most chromosomalabnormalities are the cause of a faulty egg or spermcell, or are due to a problem at the time when thezygote went through the division process. Other causes of miscarriage include:

•Hormonal problems, infections or maternalhealth problems

• Lifestyle (i.e. smoking, drug use, malnutrition,excessive caffeine and exposure to radiation or toxic substances)

• Implantation of the egg into the uterine liningdoes not occur properly

• Maternal age and trauma

WOMEN AT A RISK OF HAVING

MISCARRIAGES



For women in childbearing years, the chances of having a miscarriage can range from 10-25%, and inmost healthy women the average is about 15-20%chance.•

An increase in maternal age increases thechances of a miscarriage• Women under the age of 35 years old have about

15% chances of miscarriage• Women who are 35-45 years old have a 20-35%

chance of miscarriage• Women over the age of 45 can have up to a 50%

chance of miscarriage• A woman who has had a previous miscarriage

has a 25% chance of having another

SYMPTOMS OF A MISCARRIAGE

• Mild to severe back pain (often worse thannormal menstrual cramps)

• Weight loss



• White-pink mucus• True contractions (very painful happening every

5-20 minutes)• Brown or bright red bleeding with or without

cramps (20-30% of all pregnancies canexperience some bleeding in early pregnancy,with about 50% of those resulting in normal pregnancies)

• Tissue with clot like material passing fromvagina

• Sudden decrease in signs of pregnancy

TREATMENT OF MISCARRIAGE

The main goal of treatment during or after amiscarriage is to prevent hemorrhaging and/or infection. The earlier you are in the pregnancy, themore likely that your body will expel all the fetal



tissue by itself and will not require further medical procedures. If the body does not expel all the tissue,the most common procedure formed to stop bleedingand prevent infection is a dilation and curettage,

known as D&C. Drugs may be prescribed to helpcontrol bleeding after the D&C is performed.Bleeding should be monitored closely once you are athome; if you notice an increase in bleeding or theonset of chills or fever, it is best to cal your physicianimmediately.

PREVENTION OF MISCARRIAGE

Since the cause of most miscarriages is due tochromosomal abnormalities, there is not much thatcan be done to prevent them. One vital step is to getas healthy as you can before conceiving to provide ahealthy atmosphere for conception to occur.

• Exercise regularly• Eat healthy• Manage stress• Keep weight within healthy limits• Take folic acid daily• Do not smoke

Once the woman is pregnant, again the goal is to beas healthy as possible, to provide a healthyenvironment for the baby to grow in:



• Keep your abdomen safe• Do not smoke or be around smoke• Do not drink alcohol• Check with your doctor before taking any over-

the-counter medications• Limit of eliminate caffeine• Avoid environmental hazards such as radiation,

infectious disease and x-rays.

PLACENTA PREVIA



Placenta previa is a condition where the placenta lieslow in the uterus and partially or completely coversthe cervix. The placenta may separate from theuterine wall as the cervix begins to dilate (openduring labor.

CAUSES OF PLACENTA PREVIA

The exact cause of placenta previa is unknown.However, the following can increase your risk:

• If over the age of 35 years• Had more than four pregnancies• Have a history of uterine surgery (regardless of

incision type)

RISK OF HAVING PLACENTA PREVIA



Placenta previa affects about 1 in 200 pregnantwomen in the third trimester of pregnancy.

Placenta previa is more common in women who have

had one or more of the following:

• More than one child• A caesarean birth• Surgery on the uterus• Twins or triplets

SYMPTOMS OF PLACENTA PREVIA



Signs and symptoms of placenta previa vary, butmost common symptom is painless bleeding duringthe third trimester. Other reasons to suspect placenta previa would be:

• Premature contractions• Baby is breech, or in transverse position• Uterus measures larger than it should according

to gestational age

TREATMENT OF PLACENTA PREVIA

Once diagnosed, placenta previa will usually require bed rest for the mother and frequent hospital visits.Depending on the gestational age, steroid shots may be given to help mature the baby’s lungs. If the bleeding cannot be controlled, an immediatecaesarean delivery is usually done regardless of the

length of the pregnancy. Some marginal previas can be delivered vaginally, although complete or partial previas would require a caesarean delivery.

INCOMPETENT CERVIX



During pregnancy, as the baby grows and gets

heavier, it presses on the cervix. This pressure maycause the cervix to start to open before the baby isready to be born. This condition is called incompetentcervix or weakened cervix, and it may lead tomiscarriage or premature delivery. However, anincompetent cervix happens in only about 1 out of 100 pregnancies.

An incompetent or weakened cervix happens in about1-2% of pregnancies. Almost 25% of babiesmiscarried in the second trimester are due toincompetent cervix.

CAUSES OF INCOMPETENT CERVIX

A weakened can be caused by one or more of thefollowing conditions:



• Previous surgery on the cervix• Damage during a difficult birth• Malformed cervix or uterus from a birth defect•

Previous trauma to the cervix, such as a D&C(dilation and curettage) from a termination or amiscarriage

• DES (Diethylstilbestrol) exposure

SYMPTOMS OF INCOMPETENT CERVIX

• Change in the amount or type of vaginal discharge, particularly a mucosy or watery discharge

• Vaginal spotting or bleeding• Menstrual- like cramping



• Pelvic pressure or “heaviness”

TREATMENT OF INCOMPETENT CERVIX

The treatment for an incompetent or weakened cervix isa procedure that sews the cervix closed to reinforce thatcervix. This procedure is called a cerclage and is usually performed between week 14-16 of pregnancy. Thesesutures will be removed between 36-38 weeks to prevent any problems when you go into labor. Removalof the cerclage does not result in spontaneous deliveryof the baby. A woman would not be eligible for a

cerclage if:

• There is increased irritation of the cervix• The cervix has dilated 4 cm• Membranes have ruptured

Possible complications of cervical cercalge include

uterine rupture, maternal hemorrhage, bladder rupture,cervical laceration, preterm labor and premature ruptureof the membranes. The likelihood of these risks is veryminimal, and most health care providers feel thatcerclage is a life saving procedure that is worth the possible risks involved.

POLYHYDRAMNIOS



Polyhydramnios is the condition of having too muchamniotic fluid. Doctors can measure the amount of fluid through a few different methods, mostcommonly through amniotic fluid index (AFI)

evaluation or deep pocket measurements. If an AFIshows a fluid level of more than 25 centimetres (or above the 95th percentile), a single deep pocketmeasurement of <8, or a fluid level of 2000 ml or more, then a diagnosis of polyhydramnios would bemade. About 1-2% of pregnant women have toomuch amniotic fluid. Most of these cases are mild,with only slightly elevated levels.

CAUSES OF POLYHYDRAMNIOS



Congenital defects- The higher the fluid level, theincreased chance of a congenital defect. These birthdefects hinder swallowing, which can prohibitingestion of the amniotic fluid, resulting in buildup of

fluid. Other birth defects could also include intestinaltract blockage or neurological abnormalities.

Rh factor- As screening for the Rh factor hasincreased, this is no longer a common cause of elevated fluid levels.

Maternal diabetes- Experts have found somecorrelation between diabetes and too much amnioticfluid.

Twin-to-twin transfusion syndrome- This acomplication that can affect identical twin pregnancies. This syndrome is when one baby gets

too much blood flow and the other too little due toconnections between blood vessels in their shared placenta.Unknown Reasons- According to the Center for Maternal Fetal Medicine, about 65% of cases of polyhydramnios are due to unknown causes.

RISK OF HAVING POLYHYDRAMNIOS

Most cases of polyhydramnios are mild and result infew, if any, complications. Those with higher levels



of fluid could experience one or more of thefollowing risks:

• Premature rupture of the membranes (PROM)•

Placental abruption• Preterm labor and delivery (approximately 26%)• Growth restriction (IUGR) resulting in skeletal

malformations• Stillbirth occurs in about 4 in 1000 pregnancies

that suffer from polyhydramnios vs. about 2 in1000 pregnancies with normal fluid levels

•Caesarean delivery

• Postpartum hemorrhage

SYMPTOMS OF POLYHYDRAMNIOS

The woman may feel that her stomach is gettingtoo large too quickly and that her skin is stretched

and shiny. She might also feel breathless that it becomes hard to climb a flight of stairs. Other symptoms include abdominal pain, severeheartburn and constipation, swollen legs andvaricose veins. Ultrasound scanning can confirmthe diagnosis of polyhydramnios.

TREATMENT OF POLYHYDRAMNIOS

Many cases of polyhydramnios are easily treated anddo not result in complications if the pregnancy ismonitored closely. Monitoring would include



frequent sonograms measuring growth, biophysical profile and fetal assessment. Other treatments couldinclude:

•

Medication that can reduce fluid production andare as much as 90% effective. This treatment isnot used after 32 weeks gestation because of possible complications.

• Amnioreduction is a procedure that can be usedto drain excess fluids. This is done throughamniocentesis, which may carry certain risks.

There is, however, the chance that fluid could build back up even after draining.• Delivery of the baby

OLIGOHYDRAMNIOS



Oligohydramnios is the condition of having too littleamniotic fluid. Doctors can measure the amount of fluidthrough a few different methods, most commonly throughamniotic fluid index (AFI) evaluation or deep pocketmeasurements. If an AFI shows a fluid level of less than 5centimetres (or less than the 5th percentile), the absence of

a fluid pocket 2-3 cm in depth, or a fluid fluid volumeless than 500ml at 32-36 weeks gestation, then adiagnosis of oligohydramnios would be suspected. About8% of pregnant women can have low levels of amnioticfluid, with about 4% being diagnosed witholigohydramnios. It can occur at any time during pregnancy, but it is most common during the lasttrimester. If a woman is past her due date by two weeks

or more, she may be at a risk for low amniotic fluid levelssince fluids can decrease by half once she reaches 42weeks gestation. Oligohydramnios can causecomplications in about 12% of pregnancies that go past41 weeks.

CAUSES OF OLIGOHYDRAMNIOS

Birth defects- They refer to problems with thedevelopment of the kidneys or urinary tract whichcould cause little urine production, leading to lowlevels of amniotic fluid.



Placental problems- If the placenta is not providingenough blood and nutrients to the baby, then the babymay stop recycling fluid.

Leaking or rupture of membranes- This may be agush of fluid or a slow constant trickle of fluid. Thisis due to a tear in the membrane. Premature ruptureof membranes (PROM) can also result in lowamniotic fluid levels.

Post Date Pregnancy- A post date pregnancy (onethat goes over 42 weeks) can have low levels of amniotic fluid, which could be a result of declining placental function.

Maternal Complications- Factors such as maternaldehydration, hypertension, preeclampsia, diabetes

and chronic hypoxia can have an effect on amnioticfluid levels.

RISK OF HAVING OLIGOHYDRAMNIOS

The risks associated with oligohydramnios often depend

on the gestation of the pregnancy. The amniotic fluid isessential for the development of muscles, limbs, lungsand the digestive system. In the second trimester, the baby begins to mature. The amniotic fluid also helps the baby develop muscles and limbs by providing plenty of



room to move around. If oligohydramnios is detected inthe first half of pregnancy, the complications can bemore serious and include:

• Compression of fetal organs resulting in birthdefects

• Increased chance of miscarriage or stillbirth

SYMPTOMS OF OLIGOHYDRAMNIOS

The doctor may suspect this problem if the followingtakes place:

• The woman is leaking fluid• The baby is smaller than normal at that period of

pregnancy• On examination the outline of the baby is easily felt• The woman has had a previous baby whose growth

was restricted• The woman has chronic high blood pressure• The woman has diabetes• The woman has lupus

TREATMENT OF OLIGOHYDRAMNIOS

The treatment for low levels of amniotic fluid is basedon gestational age. Tests such as non-stress and

contraction stress tests may be done to monitor your baby’s activity. Other treatments that may be usedinclude:



• Amnio-infusion during labor through anintrauterine catheter. This added fluid helps with padding around the umbilical cord during deliveryand is reported to help lower the chances of acaesarean delivery.

• Injection of fluid prior to delivery throughamniocentesis. The condition of oligohydramnios isreported to often return within one week of this procedure, but it can aid in helping visualize fetalanamtomy and make a diagnosis.

• Maternal re-hydration with oral fluids or IV fluidshas shown to help increase amniotic fluid levels.

LISTERIA



Listeria monocytogenes is a type of bacteria that isfound in water and soil. Vegetables can becomecontaminated from the soil and animals can also becarriers. Listeria has been found in uncooked meats,uncooked vegetables, unpasteurized milk, foods fromunpasteurized milk and processed foods. Listeria iskilled by pasteurization and cooking. There is achance that contamination may occur in ready-to-eatfoods such as hot dogs and deli meats becausecontamination may occur after cooking and before packing.

RISK OF HAVING LISTERIA

According to research, pregnant women account for 27% of these cases. The Centers for Disease Control



and Prevention (CDC) claims that pregnant womenare 20 times more likely to become infected thannon-pregnant healthy adults.

SYMPTOMS OF LISTERIA

Symptoms of Listeriosis may show up 2-30 daysafter exposure. Symptoms in pregnant womeninclude mild flu like symptoms, headaches, muscleaches, fever, nausea and vomiting. If the infectionspreads to the nervous system it can cause stiff neck,

disorientation or convulsions. Infection can occur atany time during pregnancy, but it is most commonduring the third trimester when your immune systemis somewhat suppressed.

You could also experience:

• Miscarriage• Premature delivery• Infection to the new born

TREATMENT OF LISTERIA



Listeriosis is treated with antibiotics during the pregnancy. These antibiotics, in most cases, will prevent infection to the fetus. These same antibioticsare also given to newborns with Listeriosis.

Following these guidelines can greatly reducechances of contracting Listeriosis:

• Eat hard cheeses instead of soft cheeses• Do not eat refrigerated pates or meat spreads• Do not eat hot dogs, luncheon meats or deli

meats unless they are cooked properly

• Do not eat refrigerated smoked seafood unless itis contained in a cooked dish, such as acasserole

• Practise safe handling of food:

a. Wash all fruits and vegetables b. Keep everything clean, including your hands

and preparation surfacesc. Keep your refrigerator thermometer at 40˚

degrees or belowd. Clean your refrigerator oftene. Avoid cross contamination between raw and

uncooked foodsf. Cook foods at proper temperatures and reheat all

foods until they are steaming hot.

MOLAR PREGNANCY



A molar pregnancy is the result of genetic error during the fertilization process that leads to growth of abnormal tissue within the uterus. Molar pregnanciesrarely involve a developing embryo, and the growth

of this material is rapid compared to normal fetalgrowth. It has the appearance of a large and randomcollection of grape-like cell clusters. Molar pregnancies are also called gestational trophoblasticdisease (GTD), hydatidiform mole or simply referredto as “mole”.

There are two types of molar pregnancies:

Complete molar pregnancies: They have only placental parts (there is no baby), and form when the



sperm fertilizes an empty egg. Since the egg isempty, no baby is formed. The placenta grows and produces the pregnancy hormone, hCG. Anultrasound will show that there is no fetus, only a

placenta.

Partial mole: It occurs when the mass contains both,the abnormal cells and an embryo that has severedefects. In this case the fetus will be overcome by thegrowing abnormal mass rather quickly. An extremelyrare version of a partial mole is when twins are

conceived but one embryo begins to developnormally while the other is a mole.

RISK OF HAVING A MOLAR PREGNANCY

• White women in the US are at a higher risk than black women

• Women over the age of 40 years• Women who have had a prior molar pregnancy• Women with a history of miscarriage

SYMPTOMS OF MOLAR PREGNANCY

• Vaginal spotting or bleeding• Nausea and vomiting• Develop rare complications like thyroid disease



• Early preeclampsia (high blood pressure)• Increased hCG levels• No fetal movement or heart tone detected

TREATMENT OF MOLAR PREGNANCY

• Most molar pregnancies will spontaneously endand the expelled tissue will appear grape-like.

• Molar pregnancies are removed by suctionevacuation, dilation and curettage (D&C), or

sometimes through medication. Generalanesthetic is normally used during these procedures.

• Approximately 90% women who have a moleremoved require no further treatment.

• Follow-up procedures that monitor the hCGlevels can occur monthly for 6 months or as

your physician prescribes.• Follow-up is done to ensure that the mole has

been removed completely. Traces of the molecan begin to grow again and may possess acancerous-type threat to other parts of the body.

• Pregnancy should be avoided for one year after a molar pregnancy.

• Any birth control method is acceptable with theexception of an intrauterine device.



Conclusion

Despite all its possible complications, difficulties anddiscomforts, pregnancy is a boon. It is the birth of anew life and along with it, the birth of the mostcherished experience of a woman- motherhood.

A mother’s joy begins when a new life is stirringinside, when a tiny heartbeat is heard for the veryfirst time, and a playful kick reminds her that she isnever alone.

Great care, a healthy diet and exercise help to ensurea healthy pregnancy. So, despite the risk of complications, pregnancy is one of the most

wonderful phases of a woman’s life because as theysay: “Being fat lasts nine months, but the joy of motherhood lasts forever.”



BIBLIOGRAPHY

• WEB: www.google.co.in, www.wikipedia.org

• BOOKS: Cherry and Merkatz’s Complication of Pregnancy

http://www.google.co.in/

http://www.wikipedia.org/

http://www.wikipedia.org/

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