Pregnancy complications

Most pregnancies will continue without any problems at all, however, a small percentage of pregnancies suffer from complications. We have tried to identify some of the more common possible complications and provide a brief overview. If you require more information or advice you should contact your doctor.

Ectopic Pregnancy

An ectopic pregnancy is when your fertilised egg implants inside your fallopian tube instead of your uterus. This is a rare occurrence, but if left untreated can have serious ramifications. If this condition is not diagnosed early in your pregnancy your fallopian tube may rupture. At the very least this can cause future problems for your fertility or it can be a life-threatening situation.

Symptoms

If you suffer from any of the following symptoms seek medical advice immediately.

• Moderate to severe pain starting on one side of your abdomen. This may spread across your entire abdomen.
• Light to heavy bleeding.
• Nausea and vomiting.
• Feelings of weakness, dizziness and fainting.

Diagnosis

If your doctor suspects an ectopic pregnancy s/he may order some tests.

• Blood Test - to measure levels of hCG. If your hCG level has not risen or has fallen this may indicate an abnormal pregnancy.
• Ultrasound - this will indicate if a gestational sac is visible in the uterus or if a pregnancy is developing in your fallopian tube.
• Laparoscopy - this is the ultimate diagnostic tool as it allows your doctor to directly view your fallopian tubes.

Treatment

Unfortunately an ectopic pregnancy usually involves a removal of the fetus by surgery. Every effort is made to ensure your future fertility is protected, although this is not always possible. You will probably have some follow up blood tests and visits with your doctor to ensure that all of the pregnancy tissue has been removed.

It is usually recommended that following a tubal pregnancy that with future pregnancy's you have an early ultrasound around 6-8 weeks to determine the position of the gestational sac.

In addition to losing your baby you may also be dealing with the emotional strain of a reduction to your future fertility. You and your partner may deal with this differently and you may wish to seek counseling.

For more information

• A paper by Dr Eric Daiter
• Estronaut

Gestational Diabetes

During pregnancy your body produces various hormones, sometimes these hormones can stop the insulin your body produces from working properly and you may develop gestational diabetes. As result of diabetes in pregnancy your baby may be born with a low blood sugar which will usually be treated soon after birth. There is evidence to support that women who suffer from Gestational Diabetes give birth to larger and heavier babies than women who do not suffer with the condition. As a result it is more likely that you may need a caesarean delivery, although this is not always the case.

Symptoms

If you are displaying the following symptoms you may be suffering from Gestational Diabetes.

• Excessive hunger and thirst.
• Frequent urination (especially in the 2nd trimester when you should be experiencing some relief from this).
• An increase in your blood pressure.
• Recurrent vaginal infections.

Diagnosis

A routine blood sugar test, or glucose tolerance test, is performed on all women around the 24th-26th week of your pregnancy. If you return an abnormal result you will be required to undergo further tests.

Treatment

• By visiting a nutritionist you will be taught how to control your sugar levels by dietary changes.
• In addition you will be required to perform blood tests at set times throughout the day to check your blood sugar levels.
• If dietary changes have not controlled your Gestational Diabetes then you may need to use insulin injections throughout the remainder of your pregnancy.
• Gestational Diabetes usually disappears after the delivery of your baby.

Miscarriage & Stillbirth

The term miscarriage is used to describe the loss of a baby before 20 weeks of pregnancy and the term stillbirth is used to describe the loss of a baby after 20 weeks of pregnancy.

Statistically most miscarriages occur in the first 12 weeks of pregnancy and are usually attributed to foetal abnormalities.

Late miscarriages are often caused by an incompetent cervix that starts to dilate long before it should. Placental insufficiency is also a cause for late miscarriage. This is when your placenta fails to provide enough oxygen and nutrients to your developing baby.

Symptoms

• Spotting or bleeding from your vagina
• Mild to severe abdominal cramps
• Dizziness
• High fever

Diagnosis

Your doctor may possibly want to perform an ultrasound to determine the health of your baby. This may be an external or internal ultrasound depending on the stage of your pregnancy. Your doctor may also run blood tests to determine your hormone levels.

Treatment

It may not be necessary to take any action if your miscarriage has occurred early in your pregnancy, as it is likely that your body will expel the contents of your uterus naturally. However if this does not happen naturally it may be necessary to perform the surgical procedure called Dilation and Curettage (D&C), to manually remove the remains of your pregnancy.

If you have an incompetent cervix it may be possible to treat this by placing a stitch into the cervix to prevent it from further dilating.

Although most women do not suffer any long-term physical affects from a miscarriage the emotional effects should not be underestimated. You and your partner may cope in different ways after the loss of your baby and seeking help through counseling may be beneficial.

Obstetric Cholestasis

Obstetric Cholestasis is a rare condition that occurs in pregnancy and is characterised by extreme itching in the mother. A normal functioning liver produces bile that moves through the intestine and assists in the digestion of food. In sufferers of Obstetric Cholestasis bile acid levels build up and cause toxins, or poisons, to enter the mother's blood and cause the following symptoms. It is important to identify this condition as it can be a serious concern for the health of your baby, especially after 36 weeks gestation.

Symptoms

• Extreme itchiness, especially on the palm of the hands and soles of the feet. This may be the only symptom that presents itself. Itchiness is often worse at night.
• Itchiness that may spread to the rest of the body.
• Jaundice.
• Dark coloured urine.
• Pale stools.
• These symptoms may become more pronounced with subsequent pregnancies.

Diagnosis

• Often by the process of elimination.
• Blood tests that should include a bile acid test and liver function test.
• If a negative result is first detected and itching persists, tests should be repeated.

Treatment

• There is little that can be done to treat this condition. Some women report finding relief by using homeopathic therapies.
• It is most likely that you will be induced around 36-38 weeks gestation to provide the greatest chance of a safe delivery of your baby.
• Following the birth of your baby, symptoms disappear quite quickly and your liver function should return to normal. However, you should have a follow up blood test to confirm this.

For More Information

• Itchy Moms, an online support group and resource.

• Placenta Praevia

  Placenta Praevia is the term used to describe when your placenta is positioned in the lower half of your uterus. Many women are told early in their pregnancy that they have a low lying placenta, but in about 95% of cases it will move naturally to the upper half of the uterus in the second half of pregnancy.
  
  There are varying degrees of severity of this condition and this will determine your Doctor's treatment:
  
  • Complete Praevia
    • this is when your placenta entirely covers your cervix
  • Partial Praevia
    • this is when your cervix is partially covered.
  • Marginal Praevia
    • this is when your placenta is just touching your cervix.
  If your placenta is completely or partially covering your cervix it may not be possible to give birth to your baby by vaginal delivery.
  
  

  Symptoms

  You will probably be aware of your condition prior to any symptoms becoming apparent.
  
  • You may spontaneously bleed prior to the onset of labour.
  • This bleeding is usually painless and can be brought on by lifting, sneezing and coughing, or sexual intercourse.
  • If you bleed at any time throughout your pregnancy you should seek medical advice.

  Diagnosis

  Placenta Praevia is usually identified during routine ultrasound tests. Internal examination should be avoided as it can cause more bleeding to occur.
  
  

  Treatment

  Depending on the severity of your condition you will probably be advised to
  
  • Be cautious in your physical activities.
  • Get plenty of rest.
  • A follow up ultrasound will be conducted between 28-34 weeks of your pregnancy to assess if your placenta has moved.
  • Possibly be confined to bed rest
  • Possibly be hospitalised and you and your baby will be monitored
  • It is likely that you will have a caesarean section to deliver your baby. All attempts will be made to delay delivery until after the 37th week of your pregnancy.
  For Further Information
  • Better Health Channel - "Placenta Praevia"

  Placental Separation

  This is when your placenta separates or peels away from your uterus. You will suffer from major bleeding either into your uterus or from your vagina and your baby will suffer from reduced oxygen and nutrient supply. Although placental separation is quite rare it is very serious.
  
  

  Symptoms

  • Contractions of the uterus
  • Abdominal pain and tenderness
  • Foetal distress
  • You may display symptoms of shock
  • Internal or vaginal bleeding
  
  

  Diagnosis

  Placental separation is usually confirmed by using ultrasound equipment.
  
  

  Treatment

  You will most likely be hospitalised and you and your baby will be monitored. It is likely that your baby will be delivered early by caesarean section.
  
  

  Pre-eclampsia

  Pre-eclampsia is a serious condition in pregnancy and if left untreated can lead to placental failure and eclampsia. Eclampsia can cause maternal seizures, coma and possibly death. It is unlikely that your condition would develop to this stage, as your doctor or midwife should be able to pick up the early warning signs at your regular check ups.
  
  

  Symptoms

  • Sudden and severe swelling of hands and feet and face
  • High blood pressure
  • Headache
  • Dizziness
  • Fever
  • Irritability
  • Blurred vision
  • Decreased urinary output
  • Abdominal pain

  Diagnosis

  It is likely that your doctor or midwife will detect early warning signs during your regular antenatal checkups by checking your
  
  • blood pressure
  • protein levels in your urine
  Pre-eclampsia can come on very suddenly so you will need to be aware of the symptoms and advise your doctor immediately if you suspect anything out of the ordinary.
  
  

  Treatment

  • If your condition is mild you will be required to rest.
  • Possibly given medication
  • Possible hospitalisation
  • It may be necessary to deliver your baby early by caesarean section.
  For More Information
• Pre-eclampsia Research Laboratories
• 
  

  Premature Birth

  If your baby is born prior to 37 weeks gestation they are considered to have been born prematurely.
  
  Most premature babies will suffer some complications as a result of their immature development; however with the care provided by neonatal health professionals survival rates for premature babies continue to improve.
  
  Giving birth to a baby prematurely is not only physically draining but can also be very emotionally challenging. Most mothers and fathers that have gone through the experience would suggest getting as much support as possible.
  
  

  Rhesus Factor Problems

  This problem usually affects second and subsequent pregnancies rather than the first pregnancy. Complications can arise if you and your partner have different Rhesus factors in your blood. You will be checked for your Rhesus factor in your routine blood tests conducted at the beginning of your pregnancy. If you are Rh negative (Rh-) then it is important to test your partner for their Rh factor to detect if they are compatible or not. If your partner is Rh positive (Rh+) it is likely that your baby will also be Rh+ and this is incompatible with your blood group. Your body will make antibodies to fight off this foreign invasion if your blood comes into contact with your baby's blood (this usually happens during the delivery of your first baby).
  
  Your subsequent pregnancies will have the potential for complications as your body tries to fight against your baby's red blood cells.
  
  

  Treatment

  Fortunately Rhesus Factor problems are easily treated.
  
  If you are Rh- you will routinely be given an injection of anti-D, which destroys any antibodies that may have developed in your blood stream after your first pregnancy
  
  For subsequent pregnancies you will be checked for the appearance of any antibodies in your early blood tests. You may also have regular blood tests throughout your pregnancy to ensure that you have not developed any more antibodies.
  
  

  When Should You Call Your Doctor?

  If you suffer from one or more of these symptoms you should call your doctor immediately and seek his/her advice. If your doctor is unavailable you should consider going to your nearest emergency department or call an ambulance.
  
  • Vaginal bleeding or vaginal discharge that is different.
  • If you suspect that you are leaking amniotic fluid.
  • Headaches that are frequent and severe.
  • If passing urine is painful or causes burning sensations.
  • Vomiting or nausea that is severe and persistent.
  • Abdominal pain or cramping.
  • Frequent dizzy spells or fainting.
  • If you suffer from blurred vision, white lights or flashes, or dots in front of the eyes.
  • Sudden swelling in hands, feet, and face.
  • If you have an injury to your abdomen.
  • If you notice a dramatic decrease in your baby's movements.
  • High fever, over 38? Celsius orally.
  • Any symptoms that you are concerned about and would like medical guidance.