PREGNANCY COMPLICATIONS

Bringing a new life into this world is a beautiful, and yet, challenging task. A little deficiency in nutrition or manipulation in hormones or mutation in genes can cause severe complications. Hence, it is advised to be aware of these complications so that the mother can notice them at an early stage and they can be remedied accordingly. 

Most of these complications arise due to either existing health issues of the mother (process complications) or due to the bodily changes of the mother during pregnancy. Some complications are common and can be cured while some turn out to be fatal for the baby and mother.

It's best to discuss any such expected complication with the OB/GYN in advance.

Types of pregnancy complications - process complication and bodily complications

PROCESS COMPLICATIONS DURING PREGNANCY

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1. MISCARRIAGE | The Spontaneous Abortion

Miscarriage is a condition which leads to the sudden termination of pregnancy by the mother's body. This is an involuntary act and the mother could not have consented to it. 

  • In this case, the embryo or the foetus dies within the first 20 weeks of pregnancy term 

  • Miscarriage can leave the women traumatised mentally and physically for a longer term than expected

  • Statistics state that, 10-20 % of pregnancies come to an end due to miscarriage 

  • Although the reasons of miscarriage are not always known, there are few possible conditions that lead to miscarriage

Common reasons of Miscarriage

  • When the chromosomal abnormalities in the child's DNA prevent appropriate development of the fertilised egg

  • When the health problems in the mother’s reproductive system affect the growth of the embryo

  • The under-development of the genes causes deformity in the foetus

  • The abnormal levels of thyroid hormones in the mother

  • Development of gestational diabetes in the mother, i.e., if the blood sugar level consistently increases, the life of the baby gets into risk which mostly leads to miscarriage

  • Interference of external factors or teratogens. Teratogens are substances like drug, tobacco and alcohol 

  • Uterine infections that disrupt the growth of the foetus

  • Self- medication or over the counter (OTC) medicines, may interfere with the pregnancy

Symptom of Miscarriage

  • Vaginal spotting (slight brownish in colour) to intense bleeding

  • Severe abdominal pain along with cramping

  • Vaginal fluid discharge

  • Vaginal tissues or clots discharge

  • Extreme fatigue

  • Sudden back pain, mild to severe

  • Sudden weight reduction

  • Sudden contractions

  • Absence of prominent pregnancy symptoms

Precautions to avoid Miscarriage

  • Avoid self-medication or OTC medicines. Always consult the doctor for concerns and take prescribed medicines only

  • Avoid using public toilets, as they may attract infections

  • Ensure proper sanitation of the toilets that you use, even at home

  • No drugs, alcohol, cigarettes or such products should be consumed

  • Maintain the sugar levels, irrespective of the cravings. Get the sugar levels checked periodically

  • Keep a constant check on the thyroid hormones levels

  • Consume balance diet and nutrition rich food as prescribed only

  • Do not take stress

  • Do not do heavy exercises or work beyond bodily capacity. Listen to the body and be aware of the symptoms

  • Do not enter rooms with slippery floors

  • Do not wear excessively tight clothing

  • Inform your doctor about complete medical history to help them prepare better for any health issues

  • Visit the OB/GYN at-least once a month in first trimester. Increase the frequency of visit in subsequent months as prescribed by doctor

Treatment after Miscarriage

Miscarriage will definitely end the pregnancy. The residual tissue of the embryo/baby need to be taken out of mother's body. If the miscarriage happens within the first 12 weeks of pregnancy, the tissues dissolve or pass out through mother's vagina on its own. It does not require surgical interference. Although minor medical procedures or medications might be required to remove the tissues completely. If the miscarriage occurs between 12th to 20th week of pregnancy, surgery might be required. Always consult the doctor. 


 

2. ECTOPIC PREGNANCY

The first step to pregnancy is fertilisation of egg. The egg meets the sperm in fallopian tube and post fertilisation, it travels down from fallopian tube to uterus and gets implanted there. In ectopic pregnancy, the fertilised egg/zygote gets implanted in the fallopian tube (in 90% of the cases) or somewhere outside uterus (in cervix or ovary, etc). Now, due to lack of nurturing tissues and growth space, the zygote cannot divide further. This results in miscarriage. If the ectopic pregnancy is identified on time, the baby tissues can be removed with medicines or surgically. A delay in identifying this condition can lead to rupture of fallopian tube and internal bleeding in mother, which can be fatal. A surgery is mandatory to treat the mother then.

Ectopic pregnancy must be treated within 6 weeks of pregnancy.

Normal pregnancy compared to an ectopic pregnancy

Symptoms of Ectopic Pregnancy

The warning signs of ectopic pregnancy can be noticed within first month itself, sometimes even before the pregnancy is confirmed

  • Vaginal spotting

  • Vaginal bleeding (this is different than periods, the mother may soak a pad in less than 2-3 hours)

  • Pelvic and abdominal pain, can be sharp

  • Shoulder and neck pain

  • Increased bowel movement

  • Vomiting

  • Dizziness or fainting

 

Cause of Ectopic Pregnancy

A woman is at increased risk of ectopic pregnancy, if she has

  • History of ectopic pregnancy

  • Endometriosis, a disease where tissues lining the uterus - grow outside of the uterus

  • Sexually transmitted diseases (specially pelvic inflammatory disease)

  • Previous surgeries of fallopian tube

  • IUD (intrauterine devices) as a method of contraception 

  • Smoking

  • Aged above 35 years

Impact of Ectopic Pregnancy

  • Causes acute damage to the reproductive organs of the pregnant woman which can be life- threatening

  • Growth of foetus leads to the rupture of fallopian tube. This can cause haemorrhage due to severe internal bleeding

  • This kind of pregnancy is fatal for the foetus
     

Consult the doctor if you want to conceive again. Ideally, give your body 3-6 months to heal before trying again. Also, having a normal pregnancy might not be easy especially if your fallopian tube is removed. Discuss the scenarios with OB/GYN and then plan the next pregnancy carefully.

 

3. BREECH BIRTH

In normal pregnancy, the baby's head faces downwards towards cervix for delivery. Breech position exists when instead of head, baby's other body parts (hand, fist, buttocks, feet, etc) face down towards cervix. This makes normal vaginal delivery very difficult. There are three common breech positions at birth,

  • Frank breech, also known as extended breech. This is the most common type of breech. Here the baby's legs are up next to its abdomen, with its knees straight and its feet next to its ears

  • Complete breech, also known as flexed breech.  Here the baby appears as though it is sitting crossed legged with its legs bent at the hips and knees

  • Footling breech is more common in babies born prematurely or before their due date. Here, baby’s feet are born first instead of the head

Procedure followed for Breech Birth

  • In this case, the doctors will proceed with proper precautions, monitoring and planning 

  • If the breech position is detected weeks before delivery, the doctor might try to change the baby’s positioning

  • If the baby is large, the doctor generally opts for caesarean section delivery

  • If the mother’s pelvis is roomy and the size of the baby is small, the doctor may opt for breech vaginal delivery upon double conformation of the size

  • If the mother is bearing twins, the doctor opts for caesarean section delivery because firstly, they are usually born premature and secondly, with limited space for movement, either both or one of the babies is/are mostly in breech position

Twin pregnancy with breech birth

4. PREECLAMPSIA

Preeclampsia, also termed as toxaemia, is a pregnancy complication which occurs due to drastic increase in blood pressure and protein levels in the mother’s urine. 

This condition is usually observed at later stages of pregnancy, i.e., after about 20 weeks of gestation or even during postpartum. It some rare cases it may further develop into eclampsia, the onset of convulsions/seizures.

Common Symptoms of Preeclampsia

  • Sudden weight gain

  • Upper abdominal pain

  • Dizziness

  • Nausea and vomiting

  • Severe headaches

  • Blurry or temporary loss of vision

  • Change in quantity of urination 

  • Swelling in the face, feet, legs and arms
     

Complications caused due to Preeclampsia

  • Preeclampsia in the mother, can prevent the placenta from receiving adequate blood supply, hence causing some serious complications for both the mother and the foetus

  • Kidney related problems 

  • Excessive fluid volume

  • Slow development of the foetus

  • Pre-mature delivery

  • Low weight of the new-born

  • Respiratory issues in the baby

  • Placental abruption

  • Eclampsia, commonly known as seizures or convulsions

Treatments for Preeclampsia

  • Constant monitoring by the concerned OB/ GYN is required

  • Medication to control blood pressure levels

  • Medication (corticosteroids) and treatments to help the baby develop its lungs faster than usual

  • Anti-seizure medications, if necessary.

  • Pre-mature delivery of the baby and the placenta, preventing the spread of the disease

  • Extending the delivery due date, to allow more time for foetus development

5. PLACENTAL PREVIA

Placental previa is a rare condition, when the placenta grows too deep into the mother's uterus and gets attached to the bottom of the uterus lining or wall, covering the opening of cervix either partially or completely.

Note: Placenta is the organ that provides the foetus with oxygen and nutrition through the mother’s blood. It also removes the waste generated by baby. It is connected to the umbilical cord. This organ develops only during pregnancy and, post the delivery of child, placenta is also expelled from the mother's body. Normally, the placenta is located at the top of uterus (away from cervix)

Normal birth compared to birth with placenta previa condition

Symptoms of Placental Previa

  • Vaginal bleeding during the last 20 weeks of pregnancy

  • Cramps or sharp pain in the pelvic area
     

Diagnosis of Placental Previa

  • Placenta previa is diagnosed through an ultrasound. It can be noticed in a routine check up by the OB/GYN or after an episode of vaginal bleeding in the mother

  • Mostly a combination of abdominal ultrasound and transvaginal ultrasound is used to diagnose the complication
     

Complications due to Placental Previa 

  • During childbirth, the cervix opens up. If the placenta is attached to cervix, it will tear up due to cervix dilation. This can cause excessive bleeding in mother, leading to haemorrhages, which may be fatal

  • Drop in mother's blood pressure, due to haemorrhage, resulting in failure of vital organs like kidney, liver, or lungs in the mother

  • Pre-term labour

  • Pre-mature delivery of under-developed baby (if emergency c-section delivery is performed)
     

Treatment of Placental Previa

  • If there is mild to no bleeding, doctor will ask for complete bed rest. As the uterus grows, the placenta might pull back to it's normal position without any medicines

  • Although there is no medical or surgical cure for this condition, there are multiple ways to tackle the vaginal bleeding depending upon the intensity of the blood discharge 

  • In case of emergencies, the doctor might perform the C-section delivery to avoid complications

BODILY COMPLICATIONS DURING PREGNANCY

Bodily complications during pregnancy like high blood pressure, diabetes, anaemia and infections

1. HIGH BLOOD PRESSURE

During pregnancy, the blood volume in mother's body increases. This in-turn increases the pressure on the wall of the arteries, which carry blood from the heart to other body parts and the placenta for the foetus. 


Causes of High Blood Pressure

  • Over weight

  • Lack of physical activity/exercise

  • Smoking

  • First pregnancy

  • Having twins or more children

  • Age of mother is above 35 years

  • Assistive Reproductive Technology (such as in vitro fertilisation, or IVF)
     

Complications due to High Blood Pressure

  • The constant rise in the blood pressure of the mother during pregnancy may lead to pre-term delivery of the baby 

  • Mostly in such cases, the baby is pre-mature, which makes it hard for it to survive in the external condition

  • Constant high blood pressure can lead to preeclampsia

2. GESTATIONAL DIABETES

During pregnancy, placenta generates glucose into the mother's body to provide for the baby's need. Generally the pancreas create enough insulin to absorb this glucose, but during pregnancy, the insulin amount might not be sufficient. This leads to increase in glucose levels in the mother's blood causing gestational diabetes.

Symptoms of Gestational Diabetes

  • Tiredness

  • Blurred vision

  • Frequent urge to drink water

  • Frequent urge to pass urine

Causes of Gestational Diabetes

  • Over weight

  • High Blood Pressure

  • Family history of diabetes

  • Carrying multiple babies

  • Gaining way too much weight during pregnancy

  • History of PCODs

Complications due to Gestational Diabetes

  • Mother might develop type2 diabetes

  • Baby might be over-weight at birth

  • Baby might develop respiratory issues on birth

3. ANAEMIA

Anaemia is the condition where the body is deficient of healthy RBCs in the blood that carry adequate oxygen throughout the body.  During pregnancy, the blood volume increases. The body may not be able to generate enough RBCs without extra nutrients/iron supplies.

Symptoms of Anaemia

  • Fatigue and extreme weakness

  • Paleness of skin

  • Respiratory issues like breath shortness

  • Feeling dizzy

  • Feeling cold all the time
     

Complications of Anaemia

  • Pre-mature delivery

  • Under-weight baby at birth

  • The child born may have anaemia

  • Postpartum depression

  • Baby's development may get hampered
     

Treatment of Anaemia

  • Intake of prescribed iron and folic acid supplements/medicines helps in curing anaemia

  • Intake of prescribed iron and folic acid rich diet, like apples, pomegranate , ​spinach, meat, fish, broccoli, beans, eggs, etc


 

4. INFECTIONS

Certain microorganisms such as bacteria, viruses, and parasites, etc (not generally present in human body) can cause various diseases when they enter the human body. This invasion and multiplication of disease causing microorganisms is referred to as an infection. 

All sorts of infection can be hazardous to the mother and the baby.

Some common infections are

  1. Urinary tract infection of the mother

  2. Bacterial vaginosis, i.e., bacteria in the vagina 

  3. Toxoplasmosis, a parasitic disease caused by toxoplasma gondii either through oral consumption or transmission.  

  4. Influenza, a viral infection that attacks your respiratory system

How to prevent infections

  • Maintain proper sanitation all the time

  • Take prescribed vaccinations to build immunity against infections

  • Stay away from pets, especially cats

  • Avoid raw and undercooked food

TRANSMITTABLE DISEASES | DISORDERS

  • There are several common diseases or disorders that can be transmitted from the mother to the child

  • Placental spread (also known as vertical spread) occurs when a disease is transmitted from the mother to the child, during the term
    of pregnancy through placenta or during vaginal childbirth

  • However, some of these diseases can be prevented either by vaccination or by opting for aesarean delivery
     

Common transmittable Diseases or disorders

  • Rubella

  • Mumps

  • Poliomyelitis

  • Toxoplasmosis

  • Syphilis

  • Malaria

  • Cytomegalovirus

  • HIV

  • Chlamydia

  • Zika virus

  • Hepatitis C, D and E

  • Herpes simplex

The woman bearing the foetus is not to be blamed in any case of any complication during the term of pregnancy. Nevertheless, the precautions taken by the mother can help in prevention or recovery of such pregnancy complications to a large extent along with guidance from the doctors.