Pregnancy Complications

Complications of pregnancy are health problems that occur during pregnancy. They can involve the mother's health, the baby's health, or both. Some women have health problems before they become pregnant that could lead to complications. Other problems arise during the pregnancy. Keep in mind that whether a complication is common or rare, there are ways to manage problems that come up during pregnancy.

Health Problems Before Pregnancy

Before pregnancy, make sure to talk to your doctor about health problems you have now or have had in the past. If you are receiving treatment for a health problem, your doctor might want to change the way your health problem is managed. Some medicines used to treat health problems could be harmful if taken during pregnancy. At the same time, stopping medicines that you need could be more harmful than the risks posed should you become pregnant. Be assured that you are likely to have a normal, healthy baby when health problems are under control and you get good prenatal care.

Here is a list of possible health problems and the effects it can have on pregnancy:

Asthma - Poorly controlled asthma may increase risk of pre-eclampsia, poor weight gain in the foetus, pre term birth, caesarean birth, and other complications. If pregnant women stop using asthma medicine, even mild asthma can become severe. If pregnant women stop using asthma medicine, even mild asthma can become severe.

Depression -Depression that persists during pregnancy can make it hard for a woman to care for herself and her unborn baby. Having depression before pregnancy also is a risk factor for post-partum depression.

Diabetes - High blood glucose (sugar) levels during pregnancy can harm the foetus and worsen a woman's long-term diabetes complications. Doctors advise getting diabetes under control at least three to six months before trying to conceive.

Eating disorders - Body image changes during pregnancy can cause eating disorders to worsen. Eating disorders are linked to many pregnancy complications, including birth defects and premature birth. Women with eating disorders also have higher rates of post-partum depression.

Epilepsy and other seizure disorders - Seizures during pregnancy can harm the foetus, and increase the risk of miscarriage or stillbirth. But using medicine to control seizures might cause birth defects. For most pregnant women with epilepsy, using medicine poses less risk to their own health and the health of their babies than stopping medicine.

High blood pressure - Having chronic high blood pressure puts a pregnant woman and her baby at risk for problems. Women with high blood pressure have a higher risk of pre-eclampsia and placental abruption (when the placenta separates from the wall of the uterus). The likelihood of pre-term birth and low birth weight also is higher.

HIV - HIV can be passed from a woman to her baby during pregnancy or delivery. Yet this risk is less than 2 percent if a woman takes certain HIV medicines during pregnancy. Women who have HIV and want to become pregnant should talk to their doctors before trying to conceive. Good prenatal care will help protect a woman's baby from HIV and keep her healthy.

Migraine - Migraine symptoms tend to improve during pregnancy. Some women have no migraine attacks during pregnancy. Certain medicines commonly used to treat headaches should not be used during pregnancy. A woman who has severe headaches should speak to her doctor about ways to relieve symptoms safely.

Overweight and Obesity - Recent studies suggest that the heavier a woman is before she becomes pregnant, the greater her risk of a range of pregnancy complications, including pre-eclampsia and pre-term delivery. Overweight and obese women who lose weight before pregnancy are likely to have healthier pregnancies.

Sexually transmitted infections (STIs) - Some STIs can cause early labor, a woman's water to break too early, and infection in the uterus after birth. Some STIs also can be passed from a woman to her baby during pregnancy or delivery. Some ways STIs can harm the baby include: low birth weight, dangerous infections, brain damage, blindness, deafness, liver problems, or stillbirth.

Thyroid disease - Uncontrolled hyperthyroidism (over-active thyroid) can be dangerous to the mother and cause health problems such as heart failure and poor weight gain in the foetus. Uncontrolled hypothyroidism (under-active thyroid) also threatens the mother's health and can cause birth defects.

Uterine fibroids -  Uterine fibroids are not uncommon, but few cause symptoms that require treatment. Uterine fibroids rarely cause miscarriage. Sometimes, fibroids can cause pre-term or breech birth. Caesarean delivery may be needed if a fibroid blocks the birth canal.

Pregnancy Related Problems

Sometimes pregnancy problems arise — even in healthy women. Some prenatal tests done during pregnancy can help prevent these problems or spot them early. Use this list to learn about some common pregnancy complications. Call your doctor if you have any of the symptoms on the list. If a problem is found, make sure to follow your doctor's advice about treatment. Doing so will boost your chances of having a safe delivery and a strong, healthy baby.

Anemia – Lower than normal number of healthy red blood cells. Symptoms include: 

• Feel tired or weak
• Look pale
• Feel faint
• Shortness of breath

Treating the underlying cause of the anemia will help restore the number of healthy red blood cells. Women with pregnancy related anemia are helped by taking iron and folic acid supplements. Your doctor will check your iron levels throughout pregnancy to be sure anemia does not happen again.

Depression – Extreme sadness during pregnancy or after birth (post-partum). Symptoms include:

• Intense sadness
• Helplessness and irritability
• Appetite changes
• Thoughts of harming self or baby

Women who are pregnant might be helped with one or a combination of treatment options, including therapy, support groups and medicines. A mother's depression can affect her baby's development, so getting treatment is important for both mother and baby.

Ectopic pregnancy – When a fertilized egg implants outside of the uterus, usually in the fallopian tube. Symptoms include:

• Abdominal pain
• Shoulder pain
• Vaginal bleeding
• Feeling dizzy or faint

With ectopic pregnancy, the egg cannot develop. Drugs or surgery is used to remove the ectopic tissue so your organs are not damaged.

Fetal problems – Unborn baby has a health issue, such as poor growth or heart problems. Symptoms include:

• Baby moving less than normal
• Baby is smaller than normal for gestational age
• Some problems have no symptoms, but are found with prenatal tests

Treatment depends on results of tests to monitor baby's health. If a test suggests a problem, this does not always mean the baby is in trouble. It may only mean that the mother needs special care until the baby is delivered. This can include a wide variety of things, such as bed rest, depending on the mother's condition. Sometimes, the baby has to be delivered early.

Gestational diabetes – Too high blood sugar levels during pregnancy. Symptoms include:

• Usually, there are no symptoms. Sometimes, extreme thirst, hunger, or fatigue
• Screening test shows high blood sugar levels

Most women with pregnancy related diabetes can control their blood sugar levels by a following a healthy meal plan from their doctor. Some women also need insulin to keep blood sugar levels under control. Doing so is important because poorly controlled diabetes increases the risk of:

• Pre-eclampsia
• Early delivery
• Caesarean birth
• Having a big baby, which can complicate delivery
• Baby born with low blood sugar, breathing problems, and jaundice
• High blood pressure (pregnancy related) – High blood pressure that starts after 20 weeks of pregnancy and goes away after birth
• High blood pressure without other signs and symptoms of pre-eclampsia

The health of the mother and baby are closely watched to make sure high blood pressure is not pre-eclampsia.

Hyperemesis gravidarum – Severe, persistent nausea and vomiting during pregnancy — more extreme than "morning sickness" . Symptoms include:

• Nausea that does not go away
• Vomiting several times every day
• Weight loss
• Reduced appetite
• Dehydration
• Feeling faint or fainting

Dry, bland foods and fluids together is the first line of treatment. Sometimes, medicines are prescribed to help nausea. Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins. Usually, women with HG begin to feel better by the 20th week of pregnancy. But some women vomit and feel nauseated throughout all three trimesters.

Miscarriage – Pregnancy loss from natural causes before 20 weeks. As many as 20 percent of pregnancies end in miscarriage. Often, miscarriage occurs before a woman even knows she is pregnant. Signs of a miscarriage can include:

• Vaginal spotting or bleeding*
• Cramping or abdominal pain
• Fluid or tissue passing from the vagina
• *Spotting early in pregnancy doesn't mean miscarriage is certain. Still, contact your doctor right away if you have any bleeding. In most cases, miscarriage cannot be prevented. Sometimes, a woman must undergo treatment to remove pregnancy tissue in the uterus. Counselling can help with emotional healing.
• Placenta previa – Placenta covers part or entire opening of cervix inside of the uterus
• Painless vaginal bleeding during second or third trimester
• For some, no symptoms

If diagnosed after the 20th week of pregnancy, but with no bleeding, a woman will need to cut back on her activity level and increase bed rest. If bleeding is heavy, hospitalization may be needed until mother and baby are stable. If the bleeding stops or is light, continued bed rest is resumed until baby is ready for delivery. If bleeding doesn't stop or if pre-term labor starts, baby will be delivered by caesarean section.

Placental abruption – Placenta separates from uterine wall before delivery, which can mean the foetus doesn't get enough oxygen. Symptoms include:

• Vaginal bleeding
• Cramping, abdominal pain, and uterine tenderness

When the separation is minor, bed rest for a few days usually stops the bleeding. Moderate cases may require complete bed rest. Severe cases (when more than half of the placenta separates) can require immediate medical attention and early delivery of the baby.

Pre-eclampsia – A condition starting after 20 weeks of pregnancy that causes high blood pressure and problems with the kidneys and other organs. Also called toxemia. Symptoms include: 

• High blood pressure
• Swelling of hands and face
• Too much protein in urine
• Stomach pain
• Blurred vision
• Dizziness
• Headaches

The only cure is delivery, which may not be best for the baby. Labor will probably be induced if condition is mild and the woman is near term (37 to 40 weeks of pregnancy). If it is too early to deliver, the doctor will watch the health of the mother and her baby very closely. She may need medicines and bed rest at home or in the hospital to lower her blood pressure. Medicines also might be used to prevent the mother from having seizures.

Pre-term labor – Going into labor before 37 weeks of pregnancy. Symptoms include:

• Increased vaginal discharge
• Pelvic pressure and cramping
• Back pain radiating to the abdomen
• Contractions

Medicines can stop labor from progressing. Bed rest is often advised. Sometimes, a woman must deliver early. Giving birth before 37 weeks is called "pre-term birth." Pre-term birth is a major risk factor for future pre-term births.

Infections During Pregnancy

During pregnancy, your baby is protected from many illnesses, like the common cold or a passing stomach bug. But some infections can be harmful to your pregnancy, your baby, or both. This list provides an overview of infections that can be harmful during pregnancy. Learn the symptoms and what you can do to keep healthy. Easy steps, such as hand washing, practising safe sex, and avoiding certain foods, can help protect you from some infections.

Bacterial vaginosis (BV)  - A vaginal infection that is caused by an overgrowth of bacteria normally found in the vagina. BV has been linked to pre-term birth and low birth weight babies. Symptoms include:

• Grey or whitish discharge that has a foul, fishy odour
• Burning when passing urine or itching
• Some women have no symptoms

How to prevent BV is unclear. BV is not passed through sexual contact, although it is linked with having a new or more than one sex partner. Women with symptoms should be tested for BV. Antibiotics are used to treat BV.

Cytomegalovirus (CMV) - A common virus that can cause disease in infants whose mothers are infected with CMV during pregnancy. CMV infection in infants can lead to hearing loss, vision loss, and other disabilities. Symptoms include:

• Mild illness that may include fever, sore throat, fatigue, and swollen glands
• Some women have no symptoms

Good hygiene is the best way to keep from getting CMV. No treatment is currently available. But studies are looking at antiviral drugs for use in infants. Work to create a CMV vaccine also is under-way.

Group B strep (GBS) - Group B strep is a type of bacteria often found in the vagina and rectum of healthy women. One in four women has it. GBS usually is not harmful to you, but can be deadly to your baby if passed during childbirth.

• No symptoms

You can keep from passing GBS to your baby by getting tested at 35 to 37 weeks. This simply involves swabbing the vagina and rectum and does not hurt. If you have GBS, an antibiotic given to you during labor will protect your baby from infection. Make sure to tell the labor and delivery staff that you are a group B strep carrier when you check into the hospital.

Hepatitis B virus (HBV) - A viral infection that can be passed to baby during birth. Newborns that get infected have a 90 percent chance of developing lifelong infection. This can lead to liver damage and liver cancer. A vaccine can keep newborns from getting HBV. But 1 in 5 newborns of mothers who are HBV positive don't get the vaccine at the hospital before leaving. There may be no symptoms. Or symptoms can include:

• Nausea, vomiting, and diarrhoea
• Dark urine and pale bowel movements
• Whites of eyes or skin looks yellow

Lab tests can find out if the mother is a carrier of hepatitis B. You can protect your baby for life from HBV with the hepatitis B vaccine, which is a series of three shots:

• First dose of hepatitis B vaccine plus HBIG shot given to baby at birth
• Second dose of hepatitis B vaccine given to baby at 1-2 months old
• Third dose of hepatitis B vaccine given to baby at 6 months old (but not before 24 weeks old)

Influenza (flu) - Flu is a common viral infection that is more likely to cause severe illness in pregnant women than in women who are not pregnant. Pregnant woman with flu also have a greater chance for serious problems for their unborn baby, including premature labor and delivery. Symptoms include:

• Fever (sometimes) or feeling feverish/chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Feeling tired
• Vomiting and diarrhea (sometimes)

Getting a flu shot is the first and most important step in protecting against flu. The flu shot given during pregnancy is safe and has been shown to protect both the mother and her baby (up to 6 months old) from flu. (The nasal spray vaccine should not be given to women who are pregnant.) If you get sick with flu-like symptoms call your doctor right away. If needed, the doctor will prescribe an antiviral medicine that treats the flu.

Listeriosis - An infection with the harmful bacteria called listeria. It is found in some refrigerated and ready-to-eat foods. Infection can cause early delivery or miscarriage. Symptoms include:

• Fever, muscle aches, chills
• Sometimes diarrhoea or nausea
• If progresses, severe headache and stiff neck

Avoid foods that can harbour listeria. Antibiotics are used to treat listeriosis.

Parvovirus B19 (fifth disease) -  Most pregnant women who are infected with this virus do not have serious problems. But there is a small chance the virus can infect the fetus. This raises the risk of miscarriage during the first 20 weeks of pregnancy. Fifth disease can cause severe anemia in women who have red blood cell disorders like sickle cell disease or immune system problems.  Symptoms include:

• Low-grade fever
• Tiredness
• Rash on face, trunk, and limbs
• Painful and swollen joints

No specific treatment, except for blood transfusions that might be needed for people who have problems with their immune systems or with red blood cell disorders. There is no vaccine to help prevent infection with this virus.

Sexually transmitted infection (STI) - An infection that is passed through sexual contact. Many STIs can be passed to the baby in the womb or during birth. Some effects include stillbirth, low birth weight, and life-threatening infections. STIs also can cause a woman's water to break too early or preterm labor.

Symptoms depend on the STI. Often, a woman has no symptoms, which is why screening for STIs during pregnancy is so important. STIs can be prevented by practicing safe sex. A woman can keep from passing an STI to her baby by being screened early in pregnancy. Treatments vary depending on the STI. Many STIs are treated easily with antibiotics.

Toxoplasmosis - This infection is caused by a parasite, which is found in cat faeces, soil, and raw or undercooked meat. If passed to an unborn baby, the infection can cause hearing loss, blindness, or intellectual disabilities. Symptoms include:

• Mild flu-like symptoms, or possibly no symptoms.

You can lower your risk by:

• Washing hands with soap after touching soil or raw meat
• Washing produce before eating
• Cooking meat completely
• Washing cooking utensils with hot, soapy water
• Not cleaning cats' litter boxes

Medicines are used to treat a pregnant woman and her unborn baby. Sometimes, the baby is treated with medicine after birth.

Urinary tract infection (UTI) - Bacterial infection in urinary tract. If untreated, it can spread to the kidneys, which can cause pre-term labor. Symptoms include:

Pain or burning when urinating

• Frequent urination
• Pelvis, back, stomach, or side pain
• Shaking, chills, fever, sweats

UTIs are treated with antibiotics.

Yeast infection - An infection caused by an overgrowth of bacteria normally found in the vagina. Yeast infections are more common during pregnancy than in other times of a woman's life. They do not threaten the health of your baby. But they can be uncomfortable and difficult to treat in pregnancy. Symptoms include:

• Extreme itchiness in and around the vagina
• Burning, redness, and swelling of the vagina and the vulva
• Pain when passing urine or during sex
• A thick, white vaginal discharge that looks like cottage cheese and does not have a bad smell

Vaginal creams and suppositories are used to treat yeast infection during pregnancy.

When to Call the Doctor

When you are pregnant don't wait to call your doctor or midwife if something is bothering or worrying you. Sometimes physical changes can be signs of a problem. If you notice any sudden pain, bleeding, discomfort no matter how small it may be it's best to get it checked out to keep your mind at ease. 

Call your doctor or midwife as soon as you can if you:

• Are bleeding or leaking fluid from the vagina
• Have sudden or severe swelling in the face, hands, or fingers
• Get severe or long-lasting headaches
• Have discomfort, pain, or cramping in the lower abdomen
• Have a fever or chills
• Are vomiting or have persistent nausea
• Feel discomfort, pain, or burning with urination
• Have problems seeing or blurred vision
• Feel dizzy
• Suspect your baby is moving less than normal after 28 weeks of pregnancy (If you count less than 10 movements within 2 hours.)
• Have thoughts of harming yourself or your baby

References

http://www.womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.cfm