Pregnancy Complications

Pregnancy can be a wonderful time for any woman or couple. However, there is always the chance of some kind of pregnancy complications. Do not let the word "complications" scare you. Some of them can be minor and you can get through your pregnancy safely. Just be sure to follow your doctor's directions to ensure your health and the health of your unborn baby.

Most Common Complications

Gestational Diabetes

One of the most commonly heard about pregnancy complications is gestational diabetes. This is a type of diabetes that develops in pregnant women. Since pregnancy makes it more difficult for your body to use insulin, you pancreas has to work harder. In some women, this does not happen so they have a form of diabetes while pregnant. Most women do not remain diabetic after giving birth; however, you will want to keep an eye out for it in future pregnancies. Some developing babies tend to be larger than normal if the baby's body can not handle the excess glucose.

If you are diagnosed, your doctor will probably put you on a special diet. You may also have extra ultrasounds to make sure that the baby is not growing too large.

Polyhydramnios/Oligohydramnios

These two pregnancy complications have to do with amniotic fluid. Polyhydramnios means that there is too much fluid in the amniotic sac, while oligohydramnios means there is too little amniotic fluid. Doctors are not always sure what causes these complications but may be able to determine on an individual basis. Some causes of polyhydramnios are multiples (i.e. twins, triplets, etc.), gestational diabetes, or in rare cases, fetal abnormalities. Oligohydramnios can be caused by a leaky or ruptured membranes, multiples, or preeclampsia. If you are diagnosed with oligohydramnios, your doctor will monitor you and your baby closely to make sure the pregnancy continues as it should. If you are close to term, you may be induced. If you are diagnosed with polyhydramnios, it will most likely fix itself, but you will be monitored closely because this condition puts you at risk for preterm labor.

Preeclampsia

Preeclampsia, or toxemia, is another commonly-known pregnancy complication. All this means is that you are generally past your 20th week of pregnancy (it can happen before, but it is VERY rare) and that you have high blood pressure and protein in your urine. The earlier you develop preeclampsia, the more risks involved. Preeclampsia causes blood vessels to constrict which means less blood flow to the uterus. This can cause poor fetal growth and decreased amniotic fluid. If diagnosed, treatment will depend on how far along you are in your pregnancy. If it is mild, you will most likely be put on bed rest and make more frequent trips to the doctor. If you are at least 37 weeks, you will probably be induced immediately or have a scheduled C-section.

Again, these are not the only complications that can arise during pregnancy; they are simply the most commonly known. If you think you are having problems with your pregnancy, be sure to consult your doctor.

Miscarriage

Causes of Miscarriage

A miscarriage is a pregnancy that ends in the first 20 weeks. About 15 percent of known pregnancies will end in miscarriage, usually in the first trimester. After 20 weeks, it is called a stillbirth.

Most miscarriages are random events caused by chromosomal abnormalities in the fertilized egg - usually because the egg or sperm had the wrong number of chromosomes, preventing normal development. Other causes of miscarriage include an egg that does not implant properly or an embryo with structural defects. In some cases, chromosomal problems in the fertilized egg can lead to a blighted ovum - a situation where the placenta and gestational sac begin to develop, but the embryo either fails to develop or stops before there is a heartbeat. Once the heart has started beating, the chances of miscarrying drop dramatically.

A miscarriage can happen to any woman, but there are some factors known to increase the chances. Increasing age (in both the mother and the father) increases the odds of miscarriage. Certain diseases such as lupus, poorly controlled diabetes, and some hormonal disorders can increase the risk. Problems with the uterus or cervix and a family history of certain genetic problems can lead to miscarriage. Smoking, drinking, and recreational drugs can cause a miscarriage, as can some prescription and over-the-counter medications.

In some cases the loss of the pregnancy is discovered during a routine prenatal visit, when the uterus measures small or the practitioner can't find a heartbeat. It's not unusual for the embryo or fetus to stop developing a few weeks before there are symptoms such as bleeding; usually, though, spotting or bleeding will be the first sign of a miscarriage - though spotting does not always mean a miscarriage is about to happen.

If spotting appears, the practitioner should be notified right away. If it is a miscarriage, there may be abdominal pain, which can feel crampy or persistent, mild or sharp. There may be lower back pain or pelvic pressure. The placenta and embryonic or fetal tissue may be passed, which will look grayish and may contain blood clots. If this happens, this tissue should be saved if possible, in a clean container in case the practitioner wants it tested.

While distressing, it's important to remember that most first miscarriages are random events that will not be repeated. Chances are that a subsequent pregnancy will bring a much healthier and happier outcome.

Preterm Labor and Premature Birth

Preterm labor is the precursor to premature birth, which is defined as birth before 37 weeks. It’s important to find out early if you are experiencing preterm labor. If you catch it early on, doctors may be able to delay it longer. These last few weeks of pregnancy are important in the development of your baby; however, hospitals are equipped with incubators to control the temperature, oxygen flow, and feeding of the baby, helping adapt and develop if premature birth is necessary. Usually, premature babies are easier and faster to deliver because their heads are smaller and softer than full-term babies.

Almost half of premature labor cases are from unknown causes. However, there are certain circumstances that can contribute to it.

• Preeclampsia
• Multiple births
• Premature rupture of membranes
• Uterine abnormalities
• Stress
• Anemia
• Malnutrition
• Overexertion

Preterm labor starts, usually without warning, when your membranes rupture (water breaks), or uterine contractions begin, or there’s vaginal bleeding before 37 weeks. If this happens, go to the hospital where you can be closely monitored and get the treatment necessary. However, if the contractions are not regular and don’t increase in frequency, the pain is in your lower abdomen (not back), contractions subside when walking, or if vaginal discharge is brownish, this may be false labor and isn’t cause for concern.

Delivery Complications

Even if the pregnancy has been low risk, sometimes complications arise during birth.

Cesarean Section

A vaginal birth may not always be possible. In many cases, this may be apparent before you even go into labor. The most common causes for an elective cesarean are that the baby's head is too large to pass through the birthing canal, the baby is in breech position (feet first), or the baby is lying across your pelvis. Other reasons include placenta previa and certain types of medical conditions. The surgery itself takes 35-45 minutes, but the baby is out within the first 5-10 minutes.

What Happens

1. Pubic hair will be shaved and a catheter inserted.
2. The abdomen will be cleaned.
3. An IV infusion will be prepared in case additional medication is needed.
4. Anesthesia will be given (this could include an epidural, spinal block, or general anesthetic)
5. Once the anesthesia has taken effect two cuts will be made.
   • One will be made in your lower abdomen.
   • The second will be in the lower section near your uterus.
6. The fluid inside will be suctioned out.
7. The baby will be lifted out while pressure is applied to the upper portion of the uterus.
   • You may feel some pulling or pressure.
8. The baby's nose and mouth will be suctioned.
   • This is when you'll hear the baby's first cry.
9. The umbilical cord will be clamped.
10. The placenta will be removed.
11. Doctor will stitch up the incisions made.

Cesarean births usually require more time to recover over vaginal births. The bandages will be removed 3-4 days after delivery, and most stitches will dissolve on their on. Otherwise, they'll be removed about a week later. Lots of rest is required, and it may take several weeks before you can resume normal day activities.

Breech Delivery

When a baby is in breech position, this means that instead of the baby's head coming out first, the buttocks will be first through the birthing canal. With babies that are full term and in breech position, usually a cesarean section is performed. However, in some cases when labor is progressing well, a baby can be born vaginally, with the help of an episiotomy (an incision made to widen the vagina). Breech deliveries account for 4 out of every 100 babies.

Return to Pregnancy

Resources

Weiss, Robin Elise. “The About.com Guide to Having a Baby.” F+W Publications, Inc. 2006. Eisenberg, Arlene; Murkoff, Heidi E.; Hathaway, Sandee E. “What to Expect When You’re Expecting” Workman Publishing. 1996. Stoppard, Miriam. "Dr. Miriam Stoppard’s New Pregnancy and Birth Book.” Ballantine Books. 2009.