Complications of pregnancy
Encyclopedia
Complications of pregnancy are the symptoms and problems that are associated with pregnancy
. There are both routine problems and serious, even potentially fatal problems. The routine problems are normal complications, and pose no significant danger to either the woman or the fetus
. Serious problems can cause both maternal death
and fetal death if untreated.
A woman experiencing sudden defecation
should report this to her practitioner
.
(DVT) has an incidence of 0.5 to 7 per 1,000 pregnancies, and is the second most common cause of maternal death
in developed countries after bleeding.
, but may have serious consequences on the mother as well.
Multiples may become monochorionic, sharing the same chorion
, with resultant risk of twin-to-twin transfusion syndrome
. Monochorionic multiples may even become monoamniotic, sharing the same amniotic sac
, resulting in risk of umbilical cord compression and entanglement. In very rare cases, there may be conjoined twins
, possibly impairing function of internal organs.
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
. There are both routine problems and serious, even potentially fatal problems. The routine problems are normal complications, and pose no significant danger to either the woman or the fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
. Serious problems can cause both maternal death
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...
and fetal death if untreated.
Back pain
- Common, particularly in the third trimester when the patient's center of gravity has shifted.
- Treatment: mild exercise, gentle massageMassageMassage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
, heating pads, paracetamolParacetamolParacetamol INN , or acetaminophen USAN , is a widely used over-the-counter analgesic and antipyretic . It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies...
(acetaminophen), and (in severe cases) muscle relaxantMuscle relaxantA muscle relaxant is a drug which affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics...
s or narcoticNarcoticThe term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...
s
Carpal tunnel syndrome
- Occurs in between an estimated 21% to 62% of cases, possibly due to edema.
Constipation
- Cause: decreased bowel motility secondary to elevated progesteroneProgesteroneProgesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
(normal in pregnancy), which causes the "smooth muscleSmooth muscleSmooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by...
" along the walls of the intestines to relax. Thus, making sure that the future mother will absorb as much nutrients from her diet as possible in order to nourish the fetusFetusA fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
and herself. As a side effect the feces can get extremely dehydrated and hard to pass. - Treatment: increased PO fluids, stool softeners, bulking agents Drinking plenty of water and eating fruit and fiber enriched foods often help
A woman experiencing sudden defecation
Defecation
Defecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
should report this to her practitioner
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
.
Contractions
- occasional, irregular, painless contractions that occur several times per day are normal and are known as Braxton Hicks contractions
- Caused by: dehydration
- Treatment: fluid intake
- regular contractions (every 10-15 min) are a sign of preterm labor and should be assessed by cervical examColposcopyColposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination...
.
Dehydration
- Caused by: expanded intravascular space and increased Third spacing of fluids
- Treatment: fluid intake
- Complication: uterine contractions, which may occur because dehydration causes body release of ADH, which is similar to oxytocinOxytocinOxytocin is a mammalian hormone that acts primarily as a neuromodulator in the brain.Oxytocin is best known for its roles in sexual reproduction, in particular during and after childbirth...
in structure. Oxytocin itself can cause uterine contractions and thus ADH can cross-react with oxytocin receptors and also cause contractions.
Edema
- Caused by: compression of the inferior vena cavaInferior vena cavaThe inferior vena cava , also known as the posterior vena cava, is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart....
(IVC) and pelvic veins by the uterusUterusThe uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
leads to increased hydrostatic pressure in lower extremities. - Treatment: raising legs above the heart, patient sleeps on her side.
Gastroesophageal Reflux Disease (GERD)
- Caused by: relaxation of the lower esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy)
- Treatment: antacids, multiple small meals a day, avoid lying down within an hour of eating, H2 blockers, proton pump inhibitors
Hemorrhoids
- Caused by: increased venous stasis and IVC compression leading to congestion in venous system along with increased abdominal pressure secondary to constipation.
- Treatment: topical anesthetics, steroids, treatment of constipation
Pica
- cravings for nonedible items such as dirt or clay. Caused by Iron deficiency which is normal during pregnancy and can be overcome with Iron supplements or prenatal vitaminsPrenatal vitaminsPrenatal vitamins are vitamin supplements intended to be taken before and during pregnancy and during postnatal lactation. Although not intended to replace a healthy diet, prenatal vitamins provide women of child bearing age with nutrients recognized by the various health organizations including...
. Commonly, avoid ice chips; it may worsen anemia
Lower abdominal pain
- Caused by: rapid expansion of the uterus and stretching of ligaments such as the round ligamentRound ligamentIn human anatomy, the term round ligament can refer to several structures:* Round ligament of uterus, also known as the ligamentum teres uteri...
. - Treatment: paracetamolParacetamolParacetamol INN , or acetaminophen USAN , is a widely used over-the-counter analgesic and antipyretic . It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies...
(acetaminophen)
Increased urinary frequency
- Caused by: increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladderUrinary bladderThe urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
by the expanding uterus. Patients are advised to continue fluid intake despite this. UrinalysisUrinalysisA urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
and culture should be ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by dysuriaDysuriaIn medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
(pain when urinating).
Varicose veins
- Caused by: relaxation of the venous smooth muscleSmooth muscleSmooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by...
and increased intravascular pressure. - Treatment: elevation of the legs, pressure stockings
- relieve swelling and pain with warm sitz bath.
- Avoid obesity, lengthy standing or sitting, constrictive clothing and constipation and bearing down with bowel movements
Diastasis recti or abdominal separation
- Caused by: excessive stretching of the abdominal muscles.
- Treatment: paliative care, surgery and/or rehabilitation after childbirth
Pelvic girdle pain (PGP)
- Caused by: PGPPelvic girdle painPregnancy related Pelvic Girdle Pain causes pain, instability and limitation of mobility and functioning in any of the three pelvic joints...
disorder is complex and multi-factorial and likely to be represented by a series of sub-groups with different underlying pain drivers from peripheral or central nervous system, altered laxity/stiffness of muscles, laxity to injury of tendinous/ligamentous structures to ‘mal-adaptive’ body mechanics. Musculo-Skeletal Mechanics involved in gaitGaitGait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency...
and weightbearingWeight bearingIn orthopedics, weight-bearing is the amount of weight a patient puts on the leg on which surgery has been performed. In general, it is described as a percentage of the body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.After...
activities can be mild to grossly impaired. PGP can begin peri or postpartumChildbirthChildbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
. For most women PGP resolves in weeks after delivery but for some it can last for years resulting in a reduced tolerance for weightbearing activities. - Treatment: The degree of treatment is based on the severity. A mild case would require rest, rehabiltation therapy and pain is usually manageable. More severe cases would also include mobility aids, strong analgesics and sometimes surgery. One of the main factors in helping women cope is with education, information and support. Many treatment options are available.
Severe hypertensive states
Potential severe hypertensive states of pregnancy are mainly:- Preeclampsia = gestational hypertension, proteinuriaProteinuriaProteinuria means the presence of anexcess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine , retrograde ejaculation, pneumaturia due to a fistula, or drugs such as pyridium.- Causes...
(>300 mg), and edemaEdemaEdema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
. Severe preeclampsia involves a BP over 160/110 (with additional signs) - EclampsiaEclampsiaEclampsia , an acute and life-threatening complication of pregnancy, is characterized by the appearance of tonic-clonic seizures, usually in a patient who had developed pre-eclampsia...
= seizures in a preeclamptic patient - HELLP syndromeHELLP syndromeHELLP syndrome is a life-threatening obstetric complication usually considered to be a variant of pre-eclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth.HELLP is an abbreviation of the main findings:...
= Hemolytic anemiaHemolytic anemiaHemolytic anemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells , either in the blood vessels or elsewhere in the human body . It has numerous possible causes, ranging from relatively harmless to life-threatening...
, Elevated liver enzymes and low platelet countThrombocytopeniaThrombocytopenia is a relative decrease of platelets in blood.A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. These limits are determined by the 2.5th lower and upper percentile, so values outside this range do not necessarily indicate disease... - Acute fatty liver of pregnancyAcute fatty liver of pregnancyAcute fatty liver of pregnancy is a rare life-threatening complication of pregnancy that occurs in the third trimester or the immediate period after delivery. It is thought to be caused by a disordered metabolism of fatty acids by mitochondria in the mother, caused by deficiency in the LCHAD enzyme...
is sometimes included in the preeclamptic spectrum.
Deep vein thrombosis
Deep vein thrombosisDeep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
(DVT) has an incidence of 0.5 to 7 per 1,000 pregnancies, and is the second most common cause of maternal death
Maternal death
Maternal death, or maternal mortality, also "obstetrical death" is the death of a woman during or shortly after a pregnancy. In 2010, researchers from the University of Washington and the University of Queensland in Brisbane, Australia, estimated global maternal mortality in 2008 at 342,900 , of...
in developed countries after bleeding.
- Caused by: Hypercoagulability as a physiological response to potential massive bleeding at childbirthChildbirthChildbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
. - Treatment: Prophylactic treatment, e.g. with low molecular weight heparinLow molecular weight heparinIn medicine, low-molecular-weight heparin is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis....
may be indicated when there are additional risk factors for deep vein thrombosis.
Serious fetal problems
The following problems occur in the fetus or placentaPlacenta
The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...
, but may have serious consequences on the mother as well.
Ectopic pregnancy (implantation of the embryo outside the uterus)
- Caused by: Unknown, but risk factors include smokingSmokingSmoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
, advanced maternal age, and prior damage to the Fallopian tubeFallopian tubeThe Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
s. - Treatment: If there is no spontaneous resolution, the pregnancy must be abortedAbortionAbortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
either surgically or by the drug methotrexateMethotrexateMethotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...
.
Placental abruption (separation of the placenta from the uterus)
- Caused by: Various causes; risk factors include maternal hypertensionHypertensionHypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, traumaPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, and drug use. - Treatment: Immediate deliveryBirthBirth is the act or process of bearing or bringing forth offspring. The offspring is brought forth from the mother. The time of human birth is defined as the time at which the fetus comes out of the mother's womb into the world...
if the fetus is mature (36 weeks or older), or if a younger fetus or the mother is in distress. In less severe cases with immature fetuses, the situation may be monitored in hospital, with treatment if necessary.
Multiple pregnancies
Main Article: Multiple Birth RisksMultiples may become monochorionic, sharing the same chorion
Chorion
The chorion is one of the membranes that exist during pregnancy between the developing fetus and mother. It is formed by extraembryonic mesoderm and the two layers of trophoblast and surrounds the embryo and other membranes...
, with resultant risk of twin-to-twin transfusion syndrome
Twin-to-twin transfusion syndrome
Twin-to-twin transfusion syndrome is a complication of disproportionate blood supply, resulting in high morbidity and mortality. It can affect monochorionic multiples, that is multiple pregnancies where two or more fetuses share a chorion and hence a single placenta...
. Monochorionic multiples may even become monoamniotic, sharing the same amniotic sac
Amniotic sac
The amniotic sac is the sac in which the fetus develops in amniotes. It is a tough but thin transparent pair of membranes, which hold a developing embryo until shortly before birth. The inner membrane, the amnion, contains the amniotic fluid and the fetus. The outer membrane, the Chorion,...
, resulting in risk of umbilical cord compression and entanglement. In very rare cases, there may be conjoined twins
Conjoined twins
Conjoined twins are identical twins whose bodies are joined in utero. A rare phenomenon, the occurrence is estimated to range from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia and Africa. Approximately half are stillborn, and a smaller fraction of...
, possibly impairing function of internal organs.