Complications during pregnancy

What are the various abnormalities that increase the risks during pregnancy?

Pregnancies in which there is risk to the mother, foetus or the newborn baby, before, during or after delivery, are called high risk pregnancies. All pregnancies at a risk of being high-risk, are monitored from inception. The risk factors could range from maternal weight problem to diseases contracted during pregnancy. The most common abnormalities that affect pregnancy are:

• Spontaneous abortion
• Ectopic pregnancy
• Pre-eclampsia and eclampsia
• Placenta praevia
• Erythroblastosis foetalis
• Hyperemesis gravidarum
• Multiple pregnancies

Spontaneous abortion (Miscarriage)

Termination of pregnancy that occurs before the 28th week is called abortion. When abortion is natural and not induced, it is called spontaneous miscarriage or abortion. If the pregnancy terminates between the 28th and 40th week, it is not called an abortion, but premature labour. The incidence of abortion is far higher than what is generally believed and may be as high as 30%.

The various causes of a miscarriage are:

• Abnormalities in the foetus
• Intra uterine death due to infections contracted by the mother (eg. Smallpox, typhoid, dysentery etc.) and effects of X-rays or drugs
• Abnormalities of the placenta
• Abnormalities of the maternal genital organs.

Ectopic pregnancy:

Pregnancies that occur when the fertilised egg implants itself outside the uterus are called ectopic pregnancies. Two kinds of ectopic pregnancies are most common – tubal pregnancy (when the egg gets implanted in the fallopian tubes) and ovarian pregnancy (when the implantation takes place in the ovaries).

• Tubal pregnancies often end in spontaneous abortion since the fallopian tubes do not have enough space for a foetus to grow. In such cases, the uterus is also enlarged and may look like a normal pregnant uterus of about 2 months. Women who already have a blockage in the tubes are more prone to ectopic pregnancy. Also, women who have had surgery to reverse tubal sterilisation are also at an increased risk of tubal pregnancy.
• Ovarian pregnancies, though rare, are more difficult to detect than tubal pregnancies. In this, the sperm penetrates the egg before the latter has had a chance to come out of the ovary. Implantation takes place in the walls of the ovary.

Hyperemesis gravidarum

It is a condition characterised by excessive nausea and vomiting during pregnancy, which leads to weight loss. The pregnant woman remains dehydrated most of the time and has to be on medication. The patient may need to be hospitalised till the situation is brought under control. She is given liquid nutrition intravenously after which very light fluid diet may be resumed. The patient is under continuous medical supervision, and the doctor may have to terminate the pregnancy in rare cases. Usually, the pregnant woman is able to regain her lost weight once the condition is successfully treated.

Placenta praevia

A complicated medical condition where the placenta covers the opening of the cervix into the vagina. In most cases, an early ultrasound may detect a low lying placenta, but the situation usually resolves itself as the uterus grows larger.

The condition may be detected by sudden and heavy vaginal bleeding towards the end of the second trimester. There is no pain and there may be danger to the life of the mother and the baby if the bleeding does not stop. In most cases of incessant bleeding, the baby is delivered by caesarean section if the pregnancy is beyond the 30th week. If the pregnancy is not in the last stages, the patient is advised complete bed rest and any kind of sexual arousal is avoided.

Abruptio placentae

It is a condition in which the placenta begins to separate from the wall of the uterus before the end of pregnancy. It is a relatively rare condition and women with heart problems, high blood pressure and those who smoke are more at risk of developing detached placenta.

The main symptom of the condition is bleeding and cramps in the abdominal region, the severity of which depends on the extent of dislocation. In mild cases, the patient can resume her normal routine after some days of bed rest. Adequate rest is the most effective treatment for mild to moderate cases. In case the bleeding is very severe, immediate delivery is required to prevent any harm to the mother and the baby.

Erythroblastosis fetalis

This is a condition caused by incompatibility of certain blood components of the mother and the baby. Also called Rh incompatibility, there is destruction of the fetal blood cells due to the antibodies transmitted from the maternal blood. The first child is usually normal and healthy. The effects are usually seen in subsequent children, when the antibodies are already present in the mother's body. The scenario occurs when a woman with Rh negative blood group is impregnated by a man with Rh positive blood group and the foetus happens to be Rh +ve. The foetal blood causes antibodies to be generated in the mother's body, which may be transferred to the subsequent babies.

Treatment measures aim at improving the immunity of the mother's body. In some cases, the foetal blood may have to be transfused within the uterus. If the pregnancy proceeds without much problem, the baby will be delivered as normally as possible and the attending doctor will be prepared to transfuse the blood in the newborn if necessary.

Multiple pregnancies

Though not a complicated pregnancy in the strictest sense, multiple foetuses may require more attention. Apart from competition for nutrition and space, multiple babies may be placed abnormally inside the uterus. In some cases, one baby may be head down (normal), while the other may be bottom down (breach baby). Some babies may also be entwined laterally (like a T).