Complications of pregnancy

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.

Maternal routine problems

Back pain

Common, particularly in the third trimester when the patient's center of gravity has shifted.

Treatment: mild exercise, gentle massage, heating pads, paracetamol (acetaminophen), and (in severe cases) muscle relaxants or narcotics

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 progesterone (normal in pregnancy), which can lead to greater absorption of water.

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 should report this to her practitioner.

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 exam.

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 oxytocin 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 cava (IVC) and pelvic veins by the uterus 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. Commonly, patients will be placed on ice chips to chew on instead of these nonedible items.

Lower abdominal pain

Caused by: rapid expansion of the uterus and stretching of ligaments such as the round ligament.

Treatment: paracetamol (acetaminophen)

Increased urinary frequency

Caused by: increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus. Patients are advised to continue fluid intake despite this. Urinalysis and culture should be ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by dysuria (pain when urinating).

Varicose veins

Caused by: relaxation of the venous smooth muscle 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

Serious maternal problems

The following problems originate mainly in the mother.

Pelvic girdle pain (PGP)

Caused by: PGP 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 gait and weightbearing activities can be mild to grossly impaired. PGP can begin peri or postpartum. 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

Further information: Gestational hypertension

Potential severe hypertensive states of pregnancy are mainly:

Preeclampsia = gestational hypertension, proteinuria (>300 mg), and edema. Severe preeclampsia involves a BP over 160/110 (with additional signs)

Eclampsia = seizures in a preeclamptic patient

HELLP syndrome = Hemolytic anemia, Elevated liver enzymes and low platelet count

Acute fatty liver of pregnancy is sometimes included in the preeclamptic spectrum.

Deep vein thrombosis

For more info on DVT and pregnancy, see Deep vein thrombosis.

Deep vein thrombosis (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.

Caused by: Hypercoagulability as a physiological response to potential massive bleeding at childbirth.

Treatment: Prophylactic treatment, e.g. with low molecular weight heparin may be indicated when there are additional risk factors for deep vein thrombosis.

Serious fetal problems

The following problems occur in the fetus or placenta, but may have serious consequences on the mother as well.

Ectopic pregnancy (implantation of the embryo outside the uterus)

Main article: Ectopic pregnancy

Caused by: Unknown, but risk factors include smoking, advanced maternal age, and prior damage to the Fallopian tubes.

Treatment: If there is no spontaneous resolution, the pregnancy must be aborted either surgically or by the drug methotrexate.

Placental abruption (separation of the placenta from the uterus)

Main article: Placental abruption

Caused by: Various causes; risk factors include maternal hypertension, trauma, and drug use.

Treatment: Immediate delivery 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#Risks

Multiples may become monochorionic, sharing the same chorion, with resultant risk of twin-to-twin transfusion syndrome. Monochorionic multiples may evenbecome 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.

(source:wikipedia)