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Complications of pregnancy

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Complications of pregnancy are health problems that are caused by pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. Severe complications of pregnancy, childbirth, and the puerperium are present in 1.6% of mothers in the US[1] and in 1.5% of mothers in Canada.[2] In the immediate postpartum period (puerperium), 87% to 94% of women report at least one health problem.[3][4] Long-term health problems (persisting after six months postpartum) are reported by 31% of women.[5]

Complications of pregnancy
Classification and external resources
Specialty obstetrics
ICD-10 O00-O48
ICD-9-CM 630-648
MeSH D011248

In 2016, complications of pregnancy, childbirth, and the puerperium resulted globally in 230,600 deaths, down from 377,000 deaths in 1990. The most common causes of maternal mortality are maternal bleeding, maternal sepsis and other infections, hypertensive diseases of pregnancy, obstructed labor, and pregnancy with abortive outcome, which includes miscarriage, ectopic pregnancy, and elective abortion.[6]

There is no clear distinction between complications of pregnancy and symptoms and discomforts of pregnancy. However, the latter do not significantly interfere with activities of daily living or pose any significant threat to the health of the mother or baby. Still, in some cases the same basic feature can manifest as either a discomfort or a complication depending on the severity. For example, mild nausea may merely be a discomfort (morning sickness), but if severe and with vomiting causing water-electrolyte imbalance it can be classified as a pregnancy complication (hyperemesis gravidarum).

Contents

Maternal problemsEdit

The following problems originate mainly in the mother.

Gestational diabetesEdit

Gestational diabetes is when a woman without diabetes develops high blood sugar levels during pregnancy.

Hyperemesis gravidarumEdit

Hyperemesis gravidarum is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common morning sickness and is estimated to affect 0.5–2.0% of pregnant women.[7][8]

Pelvic girdle painEdit

  • Caused by: Pelvic girdle pain (PGP) disorder is pain caused by instability and limitation of mobility and functioning in any of the three pelvic joints. PGP can begin peri or postpartum. For most women, PGP resolves in the weeks after delivery, but for some it can last for years, resulting in a reduced tolerance for weight bearing activities. PGP affects around 45% of women during pregnancy: 25% report serious pain and 8% are severely disabled.[9]
  • Treatment: The treatment modality is based on the severity. A mild case would require rest, rehabilitation 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.

High blood pressureEdit

Potential severe hypertensive states of pregnancy are mainly:

Deep vein thrombosisEdit

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.[15]

AnemiaEdit

Levels of hemoglobin are lower in the third trimesters. According to the United Nations (UN) estimates, approximately half of pregnant women suffer from anemia worldwide. Anemia prevalences during pregnancy differed from 18% in developed countries to 75% in South Asia.[16]

Treatment varies due to the severity of the anaemia, and can be used by increasing iron containing foods, oral iron tablets or by the use of parenteral iron.

InfectionEdit

A pregnant woman is more susceptible to certain infections. This increased risk is caused by an increased immune tolerance in pregnancy to prevent an immune reaction against the fetus, as well as secondary to maternal physiological changes including a decrease in respiratory volumes and urinary stasis due to an enlarging uterus.[17] Pregnant women are more severely affected by, for example, influenza, hepatitis E, herpes simplex and malaria.[17] The evidence is more limited for coccidioidomycosis, measles, smallpox, and varicella.[17] Mastitis, or inflammation of the breast occurs in 20% of lactating women.[18]

Some infections are vertically transmissible, meaning that they can affect the child as well.

Peripartum cardiomyopathyEdit

Peripartum cardiomyopathy is decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy. It increases the risk of congestive heart failure, heart arrhythmias, thromboembolism, and cardiac arrest.[19]

HypothyroidismEdit

Hypothyroidism (also called Hashimoto's disease) is an autoimmune disease that affects the thyroid in women. This condition can have a profound effect during pregnancy and on the child. The infant may be seriously affected and have a variety of birth defects. Many women with Hashimoto's disease develop an underactive thyroid. The clinician will do an exam and order one or more tests.[20][21][22]

Fetal and placental problemsEdit

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

Ectopic pregnancyEdit

Ectopic pregnancy is implantation of the embryo outside the uterus

  • Caused by: Unknown, but risk factors include smoking, advanced maternal age, and prior surgery or trauma to the fallopian tubes.
  • Treatment: In most cases, keyhole surgery must be carried out to remove the fetus, along with the fallopian tube. If the pregnancy is very early, it may resolve on its own, or it can be treated with methotrexate, an abortifacient.[23]

MiscarriageEdit

Miscarriage is the loss of a pregnancy prior to 20 weeks.[24] In the UK, miscarriage is defined as the loss of a pregnancy during the first 23 weeks.[25]

Placental abruptionEdit

Placental abruption is the separation of the placenta from the uterus.

  • 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.

Placenta praeviaEdit

Placenta praevia is when the placenta fully or partially covers the cervix.

Placenta accretaEdit

Placenta accreta is an abnormal adherence of the placenta to the uterine wall.[26]

Multiple pregnanciesEdit

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.

Vertically transmitted infectionEdit

The embryo and fetus have little or no immune function. They depend on the immune function of their mother. Several pathogens can cross the placenta and cause (perinatal) infection. Often microorganisms that produce minor illness in the mother are very dangerous for the developing embryo or fetus. This can result in spontaneous abortion or major developmental disorders. For many infections, the baby is more at risk at particular stages of pregnancy. Problems related to perinatal infection are not always directly noticeable.

The term TORCH complex refers to a set of several different infections that may be caused by transplacental infection.

Babies can also become infected by their mother during birth. During birth, babies are exposed to maternal blood and body fluids without the placental barrier intervening and to the maternal genital tract. Because of this, blood-borne microorganisms (hepatitis B, HIV), organisms associated with sexually transmitted disease (e.g., gonorrhoea and chlamydia), and normal fauna of the genito-urinary tract (e.g., Candida) are among those commonly seen in infection of newborns.

Intrauterine bleedingEdit

There have been rare but known cases of intrauterine bleeding caused by injury inflicted by the fetus with its fingernails or toenails.[27]

General risk factorsEdit

Factors increasing the risk (to either the woman, the fetus/es, or both) of pregnancy complications beyond the normal level of risk may be present in a woman's medical profile either before she becomes pregnant or during the pregnancy.[28] These pre-existing factors may relate to physical or mental health, or to social issues, or a combination of those.[29]

Some common risk factors include:

High-risk pregnancyEdit

Some disorders and conditions can mean that pregnancy is considered high-risk (about 6-8% of pregnancies in the USA) and in extreme cases may be contraindicated. High-risk pregnancies are the main focus of doctors specialising in maternal-fetal medicine.

Serious pre-existing disorders which can reduce a woman's physical ability to survive pregnancy include a range of congenital defects (that is, conditions with which the woman herself was born, for example, those of the heart or reproductive organs, some of which are listed above) and diseases acquired at any time during the woman's life.

Low-risk pregnancyEdit

A Dutch 2010 research paper showed that "low-risk" pregnancy in the Netherlands may actually carry a higher risk of perinatal death than a "high-risk" pregnancy.[37]

See alsoEdit

ReferencesEdit

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