Complications of pregnancy
||It has been suggested that Risk factors in pregnancy be merged into this article. (Discuss) Proposed since July 2011.|
|Complications of pregnancy|
|Classification and external resources|
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 
- 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
- Cause: decreased bowel motility secondary to elevated progesterone (normal in pregnancy), which causes the "smooth muscle" 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 fetus 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
- 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.
- 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.
- 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
- 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
- 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, prenatal vitamins or if severe enough parenteral iron
- Caused by: rapid expansion of the uterus and stretching of ligaments such as the round ligament.
- Treatment: paracetamol (acetaminophen)(kulot)
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).
- 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 
During pregnancy, many women experience a separation of their stomach muscles, known as diastasis recti. In order to understand this condition, it is important to understand the muscle that it affects. This particular condition affects the rectus abdominis muscle, that muscle that gives you a “six pack”. (See figure)
The rectus abdominis muscle is divided down the middle by the tendinous line called the linea alba. It is kept in line by your transverse abdominal and your oblique abdominal muscles. During pregnancy, the growth of the fetus exerts pressure on abdominal cavity muscles, in particular the rectus abdominis. In pregnancies that experience rapid fetus growth or women with particularly weak abdominal muscles, this pressure can sometimes causes the rectus abdominis muscle to separate along the linea alba, creating a split between the left and right sides of the rectus abdominis.
About one-third of all pregnant women experience diastasis recti at some point in their pregnancy, however it is much more likely to occur during the second trimester or third trimester of pregnancy. However, separation also frequently occurs during labor and delivery, or with women carrying more than one baby. Many cases of diastasis recti correct themselves after birth, but some do not. In cases where it persists, exercise may help improve the condition, and sometimes surgery is needed to correct the problem to prevent pain and future complications.
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 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.
- 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.
Severe hypertensive states 
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 
- 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.
WHO levels of haemoglobin are lower in the three timesters. According to the United Nations (UN) estimates, approximately half of pregnant women suffer from anaemia worldwide. Anemia prevalences during pregnancy differed from 18% in developed countries to 75% in South Asia. 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.
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) 
- 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 can be aborted. but that is the last option if an option at all usually not.
Placental abruption (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.
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 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.
See also 
- List of obstetric topics
- Dermatoses of pregnancy
- Thyroid in pregnancy
- Reproductive Health Supplies Coalition
Extra Links 
- Pregnancy Complications
- Pregnancy complications, Articles JP — Free Article Directory
- Constipation During Pregnancy
- Mondelli M, Rossi S, Monti E, et al. (September 2007). "Long term follow-up of carpal tunnel syndrome during pregnancy: a cohort study and review of the literature". Electromyogr Clin Neurophysiol 47 (6): 259–71. PMID 17918501.
- Saladin, Kenneth S. (2012). Anatomy & Physiology: the Unity of Form and Function (6th ed.). New York NY: McGraw-Hill.
- "Separated Muscles". Pregnancy Info: Birth, Baby, and Maternity Advice. 2011.
- Rohmann, Riana (11 August 2011). "Exercises To Correct Abdominal Separation After Pregnancy". LIVESTRONG.COM.
- "Diastasis Recti". The New York Times. 17 June 2011. More than one of
- Pictures from: Mayo Clinic and GymCompany
- Venös tromboembolism (VTE) — Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008
- Wang S, An L, Cochran SD (2002). "Women". In Detels R, McEwen J, Beaglehole R, Tanaka H. Oxford textbook of public health (4th ed.). Oxford University Press. pp. 1587–601.