Pregnancy Complications

Complications of pregnancy are the symptoms and problems that are associated with pregnancy. There are both routine problems and serious, even potentially fatal problems. The routine problems are normal complications, and pose no significant danger to either the woman or the fetus. Serious problems can cause both maternal death and fetal death if untreated.

A. Abortion

  • expulsion of the fetus before it is viable;
  • may be spontaneous or induced
  • the most common bleeding disorder of early pregnancy
  • Occur in 15-20% of recognized pregnancy

    Causes of Spontaneous Abortion:

  1. Fetal abnormalities – or abnormal development of the zygote, embryo or fetus
  2. Maternal Factors – these are congenital or acquired conditions of the mother and environmental factors that had adversely affected pregnancy outcome and led to abortion. These includes diabetes mellitus, problems of the reproductive tract, exposure to radiation and infection and endocrine disturbances.

    Types of Abortion

ectopic pregnancy B. Ectopic Pregnancy

  • a pregnancy that develops outside of the uterus; 90 percent are tubal
  • the second leading cause of bleeding in early pregnancy

     Types  of Ectopic Pregnancy

  1. Tubal
  2. Ovarian
  3. Cervical
  4. Abdominal
  5. Broad Ligaments
  6. Tubo-uterine
  7. Tubo-abdominal
  8. Tubo-ovarian
  9. Heterotypic pregnancy

C. Hyperemesis Gravidarum

  • severe, persistent vomiting during pregnancy
  • or excessive nausea and vomiting  which leads to electrolyte, metabolic and nutritional imbalances in the absence of other medical problems

   Causative Factors:

  1. High levels of hCG in early pregnancy
  2. Metabolic or nutritional deficiencies
  3. More common in unmarried white women and first pregnancies
  4. Ambivalence toward the pregnancy of family-related stress
  5. Thyroid dysfunction

placenta previa D. Placenta Previa

  • the placenta partially or completely covers the internal os of the cervix
  • the most common bleeding disorder of the third trimester

    Types of Placenta Previa:

  1. Complete or Total Placenta Previa – the placenta completely covers the internal os when the cervix is fully dilated.
  2. Partial Placenta Previa – the placenta partially covers the internal os.
  3. Marginal Placenta Previa – the edge of the placenta is lying at the margin of the internal os.
  4. Low lying Placenta Previa – the placenta implants near the internal os, its edges can be felt by the examining finger on IE.

    Causes of Placenta Previa

  1. Multiparity
  2. Multiple pregnancy
  3. Advance of maternal age – over 35 years old
  4. Smoking
  5. Previous cesarean section and abortion
  6. Uterine incisions
  7. Prior placenta previa
  8. Abnormal placentas – placenta increta and accreta

abruptio placenta E. Abruptio Placentae

  • separation of the placenta from the uterus before the baby’s birth
  • also called placental abruption and accidental hemorrhage

    Causes of Abruptio Placentae:

  1. Uterine anomalies
  2. Multiparity
  3. Preeclampsia
  4. Previous cesarean delivery
  5. Renal or vascular disease
  6. Trauma to the abdomen
  7. Previous third trimester bleeding
  8. Abnormally large placenta
  9. Short umbilical cord

    Types of Abruptio Placentae:

  1. Covert/Central Abruptio Placentae – Separation begins at the center of placenta attachment resulting in blood being trapped behind the placenta, bleeding, then, is internal and not obvious.
  2. Overt or Marginal Abruptio Placentae – Separation begins at the edges of the placenta allowing blood to escape from the uterus cavity. Bleeding is external.

    Classification of abruptio placentae is based on extent of separation (ie, partial vs complete) and location of separation (ie, marginal vs central).

  1. Grade 0: asymptomatic. Diagnosis is made retrospectively by finding an organized blood clot or a depressed area on a delivered placenta.
  2. Grade 1: mild and represents approximately 48% of all cases.
    • No vaginal bleeding to mild vaginal bleeding
    • Slightly tender uterus
    • Normal maternal BP and heart rate
    • No coagulopathy
    • No fetal distress
  3. Grade 2: moderate and represents approximately 27% of all cases. Characteristics include the following:
    • No vaginal bleeding to moderate vaginal bleeding
    • Moderate-to-severe uterine tenderness with possible tetanic contractions
    • Maternal tachycardia with orthostatic changes in BP and heart rate
    • Fetal distress
    • Hypofibrinogenemia (ie, 50-250 mg/dL)
  4. Grade 3: severe and represents approximately 24% of all cases. Characteristics include the following:
    • No vaginal bleeding to heavy vaginal bleeding
    • Very painful tetanic uterus
    • Maternal shock
    • Hypofibrinogenemia (ie, <150 mg/dL)
    • Coagulopathy
    • Fetal death

preeclampsia F. Pregnancy Induced Hypertension 

  • preeclampsia is a hypertensive disorder of pregnancy developing after 20 weeks gestation and characterized by edema, hypertension and proteinuria
  • eclampsia is an extension of preeclampsia and is characterized by the client experiencing seizures

    Predisposing Factors of PIH:

  1. Primigravida status – higher incidence in primiparas below 20 and above 35 years old.
  2. Low socioeconomic status
  3. Previous hypertension of pregnancy, hydatidiform mole, diabetes mellitus, multiple pregnancy, polyhydramnios, renal disease, heart disease
  4. Genetic or immunologic

Mild Preeclampsia

Severe Preeclampsia

Eclampsia

Increased BP (systolic increase 30 mm hg convulsions over baseline; diastolic   clip_image00115

1+ Proteinuria

Edema especially of hands and face

 
 
BP 160/110

Proteinuria 3-4+

Very edematous

Elevated BUN, serum
creatinine, uric acid

Oliguria (. 400cc/24 hrs)

Cerebral or visual
disturbances

Epigastric pain, vomiting

Tonic-clonic

Possible coma

Renal shutdown

gestational diabetes G. Gestational Diabetes

  • diabetes diagnosed during pregnancy
  • it is a disorder of late pregnancy (typically) caused by the increased pancreatic stimulation associated with pregnancy.
  • babies born to mothers with gestational diabetes are at increased risk of problems typically such as being large for gestastional age (which may lead to delivery complications), low blood sugar, and jaundice

     2 Subtypes of Gestational Diabetes (diabetes which began during pregnancy):

  • Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting and 2 hours after meals; diet modification is sufficient to control glucose levels
  • Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required

    Predisposing Factors of Gestational Diabetes:

  1. A previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, or impaired fasting glycaemia
  2. A family history revealing a first degree relative with type 2 diabetes
  3. Maternal age – a woman’s risk factor increases as she gets older (especially for women over 35 years of age)
  4. Ethnic background (those with higher risk factors include African-Americans, Afro-Caribbeans, Native Americans, Hispanics, Pacific Islanders, and people originating from the Indian subcontinent)
  5. Being overweight, obese or severely obese increases the risk by a factor 2.1, 3.6 and 8.6, respectively.[7]
  6. A previous pregnancy which resulted in a child with a high birth weight (>90th centile, or >4000 g (8 lbs 12.8 oz))
  7. Previous poor obstetric history

anemia H. Anemia (Iron deficiency)

  • iron deficiency anemia is the most common anemia of pregnancy affecting 15-50% of pregnant women.
  • also called the physiologic anemia of pregnancy
  • hemoglobin value of less than 11 mg/dL or hematocrit value less than 33% during the 2nd and 3rd trimester.

    Predisposing factors of Anemia:

  1. Poor diet and poor nutrition
  2. Heavy menses
  3. Pregnancies at close intervals; successive pregnancies
  4. Unwise reducing programs

I. Hydatidiform Mole

  • a benign disorder characterized by degeneration of the chorion and death of the embryo
  • the chorionic villi rapidly proliferate and become grape like vesicles that produce large amount of hCG

    Predisposing Factors of Hydatidiform Mole:

  1. Higher incidence in asian women
  2. Low socioeconomic status
  3. Below 18 years old and above 40 years old.

IncomptentCervix J. Incompetent cervix

  • characterized by a painless dilation of the cervical os without contractions of the uterus
  • commonly occurs at about the 20th week of pregnancy

    Predisposing Factors of Incompetent Cervix:

  1. History of traumatic birth
  2. Repeated dilatation and curettage
  3. Client’s mother treated with diethylstilllbestrol (DES) when pregnant with the client
  4. Congenitally short cervix
  5. Uterine anomalies
  6. Unknown etiology

Polyhydramnios K. Polyhydramnios

  • characterized by excessive amount of amniotic fluid, more than 2000 ml

   Predisposing Factors of Polyhydramnios:

  1. Multiple pregnancy
  2. Fetal abnormalities-esophageal atresia, anencephaly, spina bifida
  3. Diabetes mellitus

L. Oligohydramnios

  • amniotic fluid is less than 300 ml or amniotic fluid index less than 5 cm

   Causes of Oligohydramnios:

  1. Fetal renal anomalities that results in anuria
  2. Premature rupture of membranes
  3. Exposure to angiotensin converting enzyme inhibitors

M. Premature Labor

  • labor that begins after 20 weeks gestation and before 37 weeks gestation.

    Causes of Preterm Labor:

  1. PROM
  2. Preeclampsia
  3. Hydramnios
  4. Placenta previa
  5. Abruptio placentae
  6. Incompetent cervix
  7. Trauma
  8. Uterine structural anomalies
  9. Multiple gestation
  10. Intrauterine infection (chorioamnionitis)
  11. Congenital adrenal hyperplasia
  12. Fetal death
  13. Maternal factors, such as stress (physical and emotional)
  14. Urinary tract Infection
  15. Dehydration

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