Complications of Pregnancy

What are some of the more common complications of pregnancy?

Although the majority of pregnancies are uneventful, sometimes complications do occur. The following are some of the more common pregnancy complications:

• Amniotic fluid complications
  Too much or too little amniotic fluid in the membranes surrounding the fetus may indicate a problem with the pregnancy. Too much fluid can put excessive pressure on the mother's uterus, leading to preterm labor, or can cause pressure on the mother's diaphragm, leading to breathing difficulties. Fluids tend to build up in cases of uncontrolled diabetes, multiple pregnancy, incompatible blood types, or birth defects. Too little fluid may indicate birth defects, growth retardation, or stillbirth.

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• Bleeding
  Bleeding in late pregnancy may be a sign of placental complications or a vaginal or cervical infection. Women who bleed in late pregnancy may be at greater risk of losing the fetus and hemorrhaging (bleeding excessively). Bleeding at any time during the pregnancy should be reported to your physician immediately.

• Ectopic pregnancy
  An ectopic pregnancy is the development of the fetus outside of the uterus. An ectopic pregnancy can occur in the fallopian tubes, cervical canal, or the pelvic or abdominal cavity. The cause of an ectopic pregnancy is usually scar tissue in the fallopian tube from infection or disease.
  
  Ectopic pregnancies occur in about one out of 50 pregnancies and can be very dangerous to the mother. Symptoms may include spotting and cramping. The longer an ectopic pregnancy continues, the greater the likelihood that a fallopian tube will rupture. An ultrasound and blood tests may confirm the diagnosis.

• Miscarriage/fetal loss
  A miscarriage is the loss of the fetus up to 12 weeks of pregnancy. Miscarriages occur in about 15 to 20 percent of all pregnancies and are usually due to genetic or chromosomal abnormalities.
  
  Miscarriages are usually preceded by spotting and intense cramping. To confirm that a miscarriage has occurred, an ultrasound and blood tests may be performed. The fetus and contents of the uterus are often naturally expelled. If this process does not occur, a procedure called a dilation and curettage (D & C) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.
  
  Fetal loss in the second trimester may occur when the cervix is weak and opens too early, called incompetent cervix. In some cases of incompetent cervix, a physician can help prevent pregnancy loss by suturing the cervix closed until delivery.

• Placental complications
  Under normal circumstances, the placenta attaches itself firmly to the top of the inner uterine wall. However, two types of placental complications may occur, including:

  • Placental abruption
    Sometimes the placenta becomes detached from the uterine wall prematurely (placental abruption), leading to bleeding and a reduction of oxygen and nutrients to the fetus. The detachment may be complete or partial, and the cause of placental abruption is often unknown. Placental abruption occurs in about one in every 120 live births.
    
    Placental abruption is more common in women who smoke, have high blood pressure, have a multiple pregnancy, and/or in women who have had previous children or a history of placental abruption.
    
    Symptoms and treatment of placental abruption depend on the degree of detachment. Symptoms may include bleeding, cramping, and abdominal tenderness. Diagnosis is usually confirmed by performing a complete physical examination and an ultrasound. Women are usually hospitalized for this condition and may have to deliver the baby prematurely.

  • Placenta previa
    Normally, the placenta is located in the upper part of the uterus. However, placenta previa is a condition in which the placenta is attached close to or covering the cervix (opening into the uterus).
    
    This type of placental complication occurs in one in every 200 deliveries and occurs more often in women who have scarring of the uterine wall from previous pregnancies, in women who have fibroids or other abnormalities in the uterus, or in women who have had previous uterine surgeries.
    
    Symptoms may include vaginal bleeding that is bright red and not associated with abdominal tenderness or pain. Diagnosis is confirmed by performing a physical examination and an ultrasound. Depending on the severity of the condition and the stage of pregnancy, modification of activities or bed rest may be ordered. The baby usually has to be delivered by cesarean section, to prevent the placenta from detaching early and depriving the baby of oxygen during delivery.

• Preeclampsia/eclampsia
  Preeclampsia, also called toxemia, is a condition characterized by pregnancy-induced high blood pressure, protein in the urine, and swelling due to fluid retention. Eclampsia is the more severe form of this condition, which can lead to seizures, coma, or death.
  
  The cause of preeclampsia is unknown, but it is more common in first pregnancies. It affects about seven to 10 percent of all pregnant women. Other risk factors for preeclampsia include the following:

  • A woman carrying multiple fetuses

  • A woman older than 40

  • A woman with pre-existing high blood pressure, diabetes, and/or kidney disease

  Symptoms may include severe swelling of the hands and face, high blood pressure, headache, dizziness, irritability, decreased urine output, abdominal pain, and blurred vision. Treatment will vary according to the severity of the condition and the stage of the pregnancy. Treatment may include hospitalization, bed rest, medication to lower blood pressure, and close monitoring of both the fetus and the mother.