Complications During Pregnancy
About Pregnancy
Miscarriage
The name miscarriage is given to a pregnancy that ends before the mother is 20 weeks along. Before 13 weeks of a pregnancy more than half of miscarriages are due to developmental problems in the fetus. Studies have shown that 10-15% of confirmed pregnancies will end in miscarriage. When a miscarriage happens it can be very hard on a family. If you experience any signs or symptoms of a miscarriage, call your doctor right away.
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Ectopic Pregnancy
Normally when an egg is fertilized, it travels through the fallopian tube, implants itself in the wall of the uterus, and begins to grow. Your uterus is the only place that can provide all the space and nourishment that the egg needs to develop into a healthy baby. An ectopic pregnancy occurs when a fertilized egg implants and begins to grow in the wrong place, most commonly in the fallopian tube. An embryo outside of the uterus cannot live, and must be taken out or else it can cause life-threatening complications for the mother.
Symptoms:
- pain in the lower back, pelvis or abdomen
- pain in the shoulder and neck area (if organ has ruptured)
- cramping on one side of the pelvis
- vaginal spotting or bleeding
- low blood pressure
- missed periods
- breast tenderness
- nausea
If you are pregnant and experiencing any of these symptoms you should call your doctor immediately.
Risk Factors:
Women are more likely to have an ectopic pregnancy if they:
- are older than 35 at the time of conception
- have had pelvic inflammatory disease
- have scarring in the fallopian tubes from a previous ectopic pregnancy, surgery or infection
- take hormone pills (birth control) that slow the movement of the egg through the fallopian tubes
Complications:
There is not enough room outside the uterus for your baby to grow, so as it gets bigger it can burst the organ that it implants in. This causes internal bleeding which can lead to shock, or in rare cases, death.
Treatment:
If an ectopic pregnancy is caught early enough, it can be treated with a drug that dissolves the embryo. If caught later, the embryo must be surgically removed. This can cause scarring, which increases the risk of future ectopic pregnancies.
Pregnancy Induced Hypertension (PIH) and Preeclampsia
Pregnancy induced hypertension is a type of high blood pressure that occurs during pregnancy. Preeclampsia is a condition in which a woman has both high blood pressure and protein in her urine. No one is sure why it happens, and no one knows how to prevent it. However by following healthy practices during pregnancy, such as good nutrition, and not smoking, drinking alcohol or using drugs, you increase your chance of having a healthy pregnancy.
Symptoms:
- Swelling
- Weight gain of more than 5 pounds in 1 week
- Protein in the urine
- Blurred vision
- Headaches
- Dizziness
- Stomach pain
- Decreased urination
Risk Factors:
A woman is more likely to develop preeclampsia if she:
- Is older than 40
- Is younger than 20
- Is carrying twins, triplets or more
- Had high blood pressure before pregnancy
- Has had preeclampsia before
- Is carrying the first baby, or first baby with a new partner
- Have a BMI greater than 30 (link to BMI)
Complications:
Food and oxygen are delivered to your baby through your blood. If your blood pressure is high during pregnancy, it is harder for blood to pass through the placenta. Your baby doesn’t get enough nutrients and oxygen. This can result in a low birth weight baby. Preeclampsia also makes it more likely that you will delivery your baby early.
Most of the time preeclampsia can be managed well enough to produce a healthy baby. However mothers who have preeclampsia are at risk for two other potentially life-threatening conditions; HELLP syndrome and eclampsia.
Treatment:
Treatment for preeclampsia will depend on how far along the baby is. If you are close to your due date, the doctor may decide to induce the baby early. If baby is not due for several weeks, there are major risks to delivering early. Your doctor may try to manage the condition as much as possible to give baby more time to develop. You may be asked to rest in bed or in the hospital. If this is not enough, your doctor may prescribe medication to lower your blood pressure. If your doctor thinks that your baby will be delivered early, you may also be given steroids to help the baby develop faster.
Placenta Previa
The placenta is the organ that supplies blood to the baby. It forms at the beginning of pregnancy and normally attaches to the upper wall of the uterus. Placenta previa occurs when the placenta attaches to the lower part of the uterus. It may cover or partially cover the cervix, which is the opening of the uterus. Often the placenta will move to a higher position as the uterus stretches, but if it stays covering the cervix, it can lead to major complications for both mother and baby.
Symptoms:
- Spotting in the early months of pregnancy
- Profuse bleeding in the second half of pregnancy
- Early contractions
Risk Factors:
Women are more likely to have placenta previa if they:
- Have had a c-section or surgery that causes scarring in the lower part of the uterus
- Have had an abortion
- Are having twins, triplets or more
- Have had several other pregnancies
- Are older than 35
- Smoke
- Use cocaine
Complications:
If the placenta is covering all or part of the cervix, it can pull away from the wall of the uterus during labor. This can lead to massive bleeding, which may cause the mother to go into shock. It can also cause death if too much blood is lost. Placenta previa also increases the chances of having a premature baby. If bleeding becomes too severe, the doctor may need to perform an emergency c-section before the 37th week of pregnancy.
Treatment:
Treatment of placenta previa depends on many factors including how far along the woman is and how serious the symptoms are. She may be put on bed rest for the rest of the pregnancy and advised not to have sex. If bleeding is severe, she may need a blood transfusion. If premature delivery seems likely, steroids may be given to help the baby’s lungs develop faster. In some cases, vaginal delivery may be attempted, however most women will require a c-section. With proper treatment, most moms deliver healthy babies.
Chorioamnionitis:
Chorioamnionitis is an infection of the amniotic fluid and membranes that protect the baby. There are many kinds of healthy bacteria that live in the vagina. Infection occurs when these bacteria move upward and grow colonies in the membranes and fluid surrounding the baby.
Symptoms:
- Fever
- Fast heart rate (mom and baby)
- Tender uterus
- Foul-smelling vaginal discharge
- High number of white blood cells
Risk Factors:
- Torn membranes
- Labor lasting more than 24 hours
Complications:
This type of infection can cause the woman’s water to break before the baby is fully developed. Most doctors believe that infection is the cause of many premature deliveries. If the mom has an infection at delivery, it is also more likely that the baby will have an infection. Infections during the pregnancy can also damage the baby’s brain and cause cerebral palsy.
Treatment:
Treatment involves antibiotics, which are given to the mother during pregnancy and sometimes to the baby after delivery. If the baby needs to be delivered early, the mom will often be given steroids to help the baby’s lungs develop.
Deep Vein Thrombosis:
During pregnancy, blood changes so that it clots more easily. Blood flow through the veins slows down. Because of these changes, pregnant women are more likely to develop blood clots in their legs and pelvis. This is called deep vein thrombosis (DVT). A blood clot created in the legs or pelvis can break away and lodge itself in the lungs, called a pulmonary embolism (PE). Once there, it cuts of the blood supply and causes lung failure. DVT continues to be a risk for 6 weeks after delivery.
Symptoms:
Symptoms of DVT:
- Swelling in one or both legs
- Red skin and warmth on one leg
- Tenderness or pain in one leg
- If you experience these symptoms, contact your doctor immediately
Symptoms of PE:
- Chest pain, especially when breathing in
- Coughing up blood
- Rapid breathing
- Rapid heart rate
- Lightheadedness or fainting
- If you experience any of the symptoms of pulmonary embolism, go to the emergency room immediately
Risk Factors:
Women are more likely to have DVT if they:
- Smoke
- Have a family history of blood clotting disorders
- Have varicose veins
- Have had multiple previous pregnancies
- Are inactive or on bed rest for a long period of time
- Are overweight
- Are anemic
- Have had previous clots
Complications:
The most common place that blood clots from the legs and pelvis lodge is the lungs. Pulmonary embolism resulting in lung damage is the most common serious complication of DVT.
Treatment:
Pregnant women with DVT are usually treated with a medication called Heparin. This medication thins the blood and makes it less likely to clot. Heparin does not break down a clot that has already formed, but it keeps it from getting bigger while the body breaks it down. Heparin treatments are stopped before delivery to reduce the risk of excessive bleeding. Warfarin is another blood thinner which is often given after delivery. It is safe to take either of these medications while nursing.
Gestational Diabetes
Diabetes is a disease in which the body can’t process sugar in the blood properly. There are three main types of diabetes: Type 1, Type 2, and gestational diabetes. Gestational diabetes is a form of diabetes that begins during pregnancy, and generally goes away after pregnancy. If you have been diagnosed with gestational diabetes, it means that your body doesn’t use the hormone insulin as well as it did before pregnancy. No one knows what causes it, but a common theory is that your placenta produces hormones that block the action of insulin.
Every time you eat carbohydrate, your body breaks it down or converts it to glucose. Glucose is the kind of sugar that your body uses for energy. Glucose from your food is absorbed into your bloodstream. When the glucose level in your blood increases after a meal, your body produces insulin. Insulin is a hormone that carries glucose out of the blood and into the cells where it is used for energy. If you have gestational diabetes, you produce insulin, but your cells are resistant to it. The glucose can’t enter your cells as fast. If gestational diabetes is not treated, glucose builds up in your blood to such high levels that it is dangerous for you and your baby. However if treated early by following a special diet, and in some cases taking insulin shots, you can avoid complications.
Symptoms:
- Blurred vision
- Excessive thirst
- Fatigue
- Frequent infections
- Increased urination
- Nausea, vomiting
- Weight loss
Many women experience no symptoms until later in the pregnancy. All women are tested for diabetes between the 24th and 28th week of pregnancy, regardless of whether or not they have had symptoms. If you have any of the above symptoms, report them to your doctor immediately.
Risk Factors:
You are more likely to develop gestational diabetes if you:
- Have a past history of gestational diabetes
- Have a family history of Type 2 diabetes
- Are older than 25
- Were overweight before pregnancy
- Have had a baby that weighed more than 9 pounds
- Are Black, Hispanic or American Indian
Complications:
Risks to the baby:
One of the major risks of gestational diabetes is having a very large baby. Since you share your blood with your baby, when you have a lot of sugar in your blood, so does your he. He produces a large amount of insulin to match the high sugar level. The insulin brings more and more sugar into his cells. Any extra sugar that baby can’t use for growth and development becomes stored in his body as fat. Having a large baby makes it more likely that you will need a c-section or that baby will have shoulder damage from squeezing through the birth canal. Baby’s born to mothers with gestational diabetes are also at higher risk for breathing problems, jaundice and low blood sugar levels at birth. The good news is that by closely monitoring and controlling your blood sugar levels, you can reduce or eliminate the risks to baby.
Risks to the mother:
Gestational diabetes increases your risk of preeclampsia and cesarean delivery. If you have other children, the chance of you having gestational diabetes again is very high. You are also at higher risk of developing type 2 diabetes later in life.
Treatment:
There are two main forms of treatment: Diet therapy and insulin therapy. All women with gestational diabetes are put on diet therapy. For many women, changing diet alone is enough to control blood sugar. Women who still have high blood sugar even after following a special diet may need insulin therapy.
Diet therapy:
If you have been diagnosed with diabetes, your doctor may recommend that you talk to a registered dietitian about a special diet. The diet is different for everyone. Your dietitian will be able to make a meal plan specific to you.
Any carbohydrate food will increase your blood sugar, and the more you eat of it, the more your blood sugar will increase. The point of following your meal plan is to regulate your carbohydrate intake so that your blood sugar stays in a normal range. Many women mistakenly believe this means that all carbohydrate foods are bad, and stop eating them altogether. Your body needs carbohydrate for energy, and your baby needs it to grow and develop properly. The trick is getting just the right amount at the right time so your blood sugar level doesn’t get too high and baby can grow well.
What are carbohydrate foods?
When we think of carbohydrate foods, we usually think of bread, pasta, rice, and sugar. People are often surprised to find out that carbohydrate is in almost every food, including fruits, vegetables, and milk. Did you know that ½ cup of peas has the same amount of carbohydrate as 1 slice of bread? And that a cup of milk has as much carbohydrate as a small bowl of unsweetened cereal?
How much carbohydrate can I eat?
Your dietitian will tell you exactly how much carbohydrate you can eat. The amount depends on how severe your diabetes is and how much you need to weight gain you need during your pregnancy. A typical meal plan is divided into 3 meals and 3 snacks, spaced every 2-3 hours throughout the day. If you have concerns about following this schedule, make sure you talk about it with your dietitian. Skipping meals or not eating at regular intervals can be dangerous.
Your meal plan will tell you exactly how many grams of carbohydrate you should eat at each meal. Your dietitian can teach you how to count the grams of carbohydrate in a food. One easy way to figure out how much you can eat is to use the diabetic exchange lists. In the exchange lists, foods are put into groups based on the amount of carbohydrate, protein, and fat in them. Your dietitian will tell you how many exchanges you should eat from each group at each meal. Foods that are grouped together have the same amount of carbohydrate, fat, and protein and can be used interchangeably.
The specific exchange groups are: (link to http://www.mayoclinic.com/health/diabetes-diet/DA00077)
- Fruits
- Meats and meat substitutes
- Milk and milk products
- Non-starchy vegetables
- Starches
- Sweets, desserts and other carbohydrates
- Fats
- Free foods
As an example, let’s say your meal plan states that for breakfast you can have 1 starch, 1 meat, 1and 1 milk exchange. You can choose whichever foods from these groups that you want.
Exchange |
Option 1 |
Option 2 |
| 1 starch | 1 slice whole wheat toast | ½ cup sugar frosted cereal |
| 1 meat | 1 tbsp peanut butter | 1 hard boiled egg |
| 1 milk | 6 oz. Fat-free, sugar-free yogurt | 1 cup skim milk |
| 1 fruit | 1 small apple | ½ banana |
You will need to measure your blood sugar at least 4 times each day. The first measurement should be taken right when you wake up in the morning before eating breakfast. You should also measure about 1-2 hours after each meal, as your doctor directs. It is a good idea to keep a thorough record for at least 3 days to show your dietitian. You should record everything you eat and the amount and also your blood sugar measurements. Also note if you feel like your meal plan gives you too much or not enough food. This will help your dietitian know if your meal plan needs to be changed.
Insulin therapy:
You may find that your blood sugar is still high even when following your meal plan exactly. If this is the case, your doctor will probably prescribe insulin therapy. This means that you will have to give yourself insulin shots in addition to following your meal plan. Many women are nervous at first to give themselves insulin shots, however over time this fear goes away. Just remember that it is temporary and will help you have a healthy baby.
Premature/Preterm Delivery
Any baby that is born 3 or more weeks early is considered premature or preterm. Delivering a baby early is one of the most serious complications of pregnancy. Babies who are born early are not fully developed, so they are not as prepared to survive in the outside world as full-term babies. Premature babies are more likely to die. Many suffer from long-term health problems. Even babies who are not considered premature, but are born 1 to 2 weeks early are at higher risk for health problems. Currently about 1 in 8 babies are born prematurely, and the number has increased over the past 20 years. All women are at risk of premature delivery, though some are at higher risk than others.
Symptoms:
All pregnant women should know the signs of preterm labor. You should contact your doctor immediately, or go to the hospital if you experience even one of the following symptoms:
- Contractions (your abdomen feels tight like a fist) every 10 minutes or more often
- Change in vaginal discharge (leaking fluid or bleeding from your vagina)
- Pelvic pressure—the feeling that your baby is pushing down
- Low, dull backache
- Cramps that feel like your period
- Abdominal cramps with or without diarrhea
Risk Factors:
Any woman is at risk for preterm labor, however a woman is more likely to experience preterm labor if she:
- Has had a premature baby before
- Is having twins, triplets or more
- Has cervix or uterine abnormalities
- Receives late or no prenatal care
- Smokes during pregnancy
- Drinks alcohol during pregnancy
- Uses illegal drugs during pregnancy
- Is a victim of physical, sexual or emotional abuse
- Is exposed to the medications DES
- Has little social support
- Experiences a lot of stress during the pregnancy
- Has long working hours with long periods of standing
- Has uterine tracts, vaginal, sexually transmitted or other infections
- Has diabetes
- Has high blood pressure
- Has a clotting disorder
- Experiences bleeding from the vagina
- Is carrying a baby with certain birth defects
- Is pregnant as a result of in vitro fertilization
- Was underweight before pregnancy
- Is obese
- Is pregnant 6 to 9 months after the birth of the previous baby
- Has poor nutrition
- Is under 18 years old
Complications:
Many of the baby’s organs, like the brain, lungs, and kidneys, do not fully develop until the very last weeks of pregnancy. Most complications of premature delivery happen because the baby’s organ systems are not developed. Common complications include:
- Breathing problems and lung failure
- Bleeding in the brain
- Vision problems
- Heart disease
- Digestive problems
- Jaundice
- Infection
- Anemia
- Low blood sugar at birth
- Slow growth and development
- Mental retardation
Treatment:
If you go into preterm labor, call your doctor immediately. You may be given medications to stop the labor and steroids to help the baby’s lungs develop faster. Activity should be limited and you should follow any instructions the doctor gives about what activities you should avoid.
Babies who are born prematurely are treated based on the complications that they have. They may require special equipment, like oxygen tanks, heart monitors, and tube feedings. Most premature infants will need to stay in the hospital for a while. The length of time will depend on how many weeks early and how many complications they have. If you have a premature baby, one of the best gifts you can give is your breastmilk. Breastmilk helps protects baby against infections and gives important nutrients that help baby grow and develop. You may not be able to latch your baby on to the breast for the first few weeks, but there are many other ways to give your baby breastmilk. If you need help, consult the lactation specialist at the hospital or call your WIC peer counselor.
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Links About Complications During Pregnancy
Chorioamnionitis
Merck
http://www.merck.com/mmpe/sec18/ch263/ch263d.html
University of Virginia Health System
http://www.healthsystem.virginia.edu/uvahealth/peds_hrpregnant/chorioam.cfm
WebMD
http://www.emedicine.com/ped/topic89.htm
Deep Vein Thrombosis
American Academy of Family Physicians
http://familydoctor.org/800.xml
Journal of the American Society of Hematology
http://www.bloodjournal.org/cgi/content/full/100/10/3470
Medline Plus
http://www.nlm.nih.gov/medlineplus/ency/article/000132.htm
Merck
http://www.merck.com/mmhe/sec04/ch046/ch046a.html
Ectopic Pregnancy
Kidshealth.org
http://www.kidshealth.org/parent/pregnancy_newborn/pregnancy/ectopic.html Medline
Plus
http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm
Merck
http://www.merck.com/mmhe/sec22/ch258/ch258c.html
Gestational Diabetes
American Academy of Family Physicians
http://www.aafp.org/afp/20031101/1767.html
American Academy of Family Physicians
http://www.aafp.org/afp/991115ap/tips/13.html
American Diabetes Association
http://www.diabetes.org/gestational-diabetes.jsp
American Diabetes Association
http://diabetes.org/for-health-professionals-and-scientists/resources.jsp
Mayo Clinic
http://www.mayoclinic.com/health/gestational-diabetes/DS00316
Mayo Clinic
http://www.mayoclinic.com/health/diabetes-diet/DA00077
Medline Plus
http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm
Medline Plus
www.nlm.nih.gov/medlineplus/ency/article/000896.htm
High Blood Pressure in Pregnancy
National Heart, Blood and Lung Institute
http://www.nhlbi.nih.gov/health/public/heart/hbp/hbp_preg.htm
Placenta Previa
March of Dimes
http://www.marchofdimes.com/pnhec/188_1132.asp
Mayo Clinic
http://www.mayoclinic.com/health/placenta-previa/DS00588/DSECTION=2
Medline Plus
http://www.emedicine.com/ped/topic89.htm
Preeclampsia, Ecclampsia, and HELLP Syndrome
American Academy of Family Physicians
http://familydoctor.org/064.xml
American Academy of Family Physicians
http://www.aafp.org/afp/990901ap/990901b.html
Mayo Clinic
http://www.mayoclinic.com/health/preeclampsia/DS00583/DSECTION=1
Mayo Clinic
http://www.mayoclinic.com/health/preeclampsia/DS00583/DSECTION=4
Medline Plus
http://www.nlm.nih.gov/medlineplus/ency/article/000899.htm
National Institutes of Health
http://www.nichd.nih.gov/health/topics/Preeclampsia_and_Eclampsia.cfm
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9396901&dopt=Abstract
St. Vincent Catholic Medical Centers
http://www.svcmc.org/114820.cfm
Premature or Preterm Birth
March of Dimes
http://www.marchofdimes.com/pnhec/188_1080.asp
March of Dimes
http://www.marchofdimes.com/prematurity/21239_5810.asp
Medline Plus
http://www.nlm.nih.gov/medlineplus/ency/article/001562.htm
Medline Plus
http://www.nlm.nih.gov/medlineplus/ency/article/001562.htm
Surviving Bed Rest
Kidshealth.org
http://kidshealth.org/parent/pregnancy_newborn/pregnancy/bed_rest.html
