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Complications of pregnancy

  (Redirected from Pregnancy complication)

Complications of pregnancy are health problems that are caused by pregnancy. In the immediate postpartum period, 87% to 94% of women report at least one health problem.[1][2] Long term health problems (persisting after 6 months postpartum) are reported by 31% of women.[3] Severe complications of pregnancy are present in 1.6% of mothers in the US[4] and in 1.5% of mothers in Canada.[5] The relationship between age and complications of pregnancy are now being researched with greater impetus.[6]

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

In 2013, complications of pregnancy resulted globally in 293,000 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.[7]

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.[8][9]

Pelvic girdle painEdit

  • Caused by: Pelvic girdle pain (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 weight bearing 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 weight bearing activities. PGP affects around 45% of women during pregnancy: 25% report serious pain and 8% are severely disabled.[10]
  • Treatment: The degree of treatment 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.[16]

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.[17] 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.[18] Pregnant women are more severely affected by, for example, influenza, hepatitis E, herpes simplex and malaria.[18] The evidence is more limited for coccidioidomycosis, measles, smallpox, and varicella.[18] Mastitis, or inflammation of the breast occurs in 20% of lactating women.[19]

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 6 months post-pregnancy. It increases the risk of congestive heart failure, heart arrhythmias, thromboembolism, and cardiac arrest.[20]

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.[21][22][23]

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 damage 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.[24]

MiscarriageEdit

Miscarriage is the loss of a pregnancy prior to 20 weeks.[25] In the UK miscarriage is defined as the loss of a pregnancy during the first 23 weeks.[26]

Placental abruptionEdit

Placental abruption is 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.

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 intra-uterine bleeding caused by injury inflicted by the fetus with its fingernails or toenails.[27]

Complications following childbirthEdit

HaemorrhageEdit

Primary postpartum haemorrhage is blood loss following childbirth of more that 500ml (minor) or 1000ml (major) [28] Secondary postpartum haemorrhage is abnormal or excessive bleeding after 24 hours and before 12 weeks postnatally.[29]

Perineal tearingEdit

Perineal tearing is the spontaneous (unintended) tearing of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tearing occurs in 85% of vaginal deliveries.[30] At 6 months postpartum, 21% of women still report perineal pain[3] and 11-49% report sexual problems or painful intercourse.[3]

IncontinenceEdit

Urinary incontinence and fecal incontinence have been linked to all methods of childbirth, with the incidence of urinary incontinence at 6 months postpartum being 3-7% and fecal incontinence 1-3%.[3]

Psychological traumaEdit

Postpartum depressionEdit

Postpartum depression is a moderate to severe depressive episode starting anytime during pregnancy or within the four weeks following delivery. It occurs in 4-20% of pregnancies, depending on its definition.[3] In 38% of the cases of postpartum depression, women are still depressed 3 years postpartum.[31] In 0.2% of pregnancies, postpartum depression leads to postpartum psychosis.[32]

Posttraumatic stress disorder (PTSD)Edit

Research shows that symptoms of Posttraumatic stress disorder are common following childbirth, with prevalence of 24-30.1%[33] at 6 weeks, dropping to 13.6% at 6 months.[34] PTSD is rarer; a review found that following normal childbirth (excluding stillbirth and some other complications) rates of PTSD ranged from 2.8-5.6% after 6 weeks, dropping to 1.5% at 6 months.[33]

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.[35] These pre-existing factors may relate to physical and/or mental health, and/or to social issues, or a combination.[36]

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 showed that "low-risk" pregnancy in the Netherlands may actually carry a higher risk of perinatal death than a "high-risk" pregnancy.[44]

See alsoEdit

ReferencesEdit

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