COMPLICATIONS IN PREGNANCY

COMPLICATIONS IN PREGNANCY

Pregnancy is straightforward for the majority of women, but occasionally complications occur. The aim of prenatal care is to spot problems early, and hopefully resolve them. It helps to know what is happening and why, but if the problem cannot be resolved you may need extra support and help.

MISCARRIAGE

Most miscarriages occur in the first three month of pregnancy and usually begin with vaginal bleeding, followed by pain low down in the abdomen. It is important to contact your doctor if you experience any vaginal bleeding. You may have to go into hospital for a D and C (dilatation and curettage) to ensure that any remnants of placenta have been removed and in order to avoid further bleeding and possible infection.

                Losing your baby, even early in pregnancy, can be very upsetting. Many women feel a deep sense of loss and blame the miscarriage on something they have done; but it is in fact a natural way of dealing with a problem that cannot be solved, so try not to feel guilty. The next time you become pregnant your risk of miscarriage is only very slightly increased, but many women take things easy in the first few month. Unless your doctor advises against it, there is also no reason to avoid sexual intercourse.

                Sometimes a threatened miscarriage occurs; bleeding begins, but by lying down and resting for a few days the pregnancy stabilizes and continues as normal.

                A few women have a missed abortion. The usual signs of pregnancy such as tender breasts and sickness are no longer present and the woman does not feel pregnant. The uterus may be smaller than usual and an ultrasound scan can confirm that there is a lack of the fetal heartbeat or that no fetus is present.

ECTOPIC PREGNANCY

This is thankfully quite a rare condition in which the fertilized egg implants and begins to grow outside the uterus, usually in one of the fallopian tubes. As it grows the tube begins to stretch, causing a sharp pain on one side of the abdomen. Other symptoms include vaginal bleeding and feeling faint or dizzy. If you have these symptoms, you should contact your doctor immediately. The pregnancy must be
terminated, and usually the fallopian tube has to be removed.

INCOMPETENT CERVIX

Usually the cervix (neck of the womb) stays tightly closed until labor begins, but in some women the cervix is weak and cannot support the growing baby and this can be the cause of a later miscarriage, after the third month of pregnancy. If this is discovered before you miscarry, the cervix can be held closed with a stitch, which is put in place during a minor operation. The stitch is then removed, usually about a couple of weeks before the baby is due, so that labor may progress normally.

PRE- ECLAMPSIA

One in ten mothers suffers from symptoms of pre-eclampsia during late-pregnancy, with raised blood pressure, swelling of the hands and feet, and protein in the urine. Regular and routine prenatal checks ensure that any of these symptoms are detected early and preventive action taken. For example, if your blood pressure is very high bed rest is often suggested or you may be admitted into the hospital for observation. Labor may be delivered by Cesarean section.

RHESUS FACTOR PROBLEMS

If a rhesus negative mother has a rhesus positive first baby, it can activate her defence mechanisms for dealing with foreign bodies. This means that in a subsequent pregnancy her antibodies may damage a rhesus positive baby’s blood cells. It is usual to check the blood group of a baby born to a rhesus negative mother and, if necessary, give the mother an injection to prevent problems arising with future pregnancies.

LOW-LYING PLACENTA

Usually the placenta embeds high up on the wall of the uterus. Occasionally it fixes low down and may cover the cervix. If this happens it is called placenta previa. Often the first sign is bleeding perhaps at about twenty-eight weeks. Sometimes a low-lying placenta is picked up by an ultrasound scan early on, but the condition may correct itself as the uterus grows. If it remains very low, or covers the cervix, a cesarean section will be necessary.

HEALTH PROBLEMS

An existing health problem, such as diabetes, epilepsy or asthma, can cause problems in pregnancy. Discuss your condition with your doctor before becoming pregnant as it is likely that you will need extra care and attention during pregnancy, and possibly in labor.

STILLBIRTH

It is rare now for a baby to die at or around the time of birth as routine prenatal care picks up most problems, especially those related to development abnormalities or failure of the placenta.

However, some babies do die before they are born, sometimes due to high blood pressure; hemorrhage from the placenta, or because of a pre-existing medical problem in the mother.

If, tragically, the baby has died in the womb, your midwife or doctor will explain to you what has happened and talk about the necessity of inducing labor. Once the baby is born, you may be asked if you want to see and hold her. Many parents find this hard at the time, but in fact it can help if you have a chance to say both hello and goodbye to your baby, to hold and look at her and perhaps also have photographs taken. If may help too if you choose a name for your baby.