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.

Maternal routine problems 1.1 Back pain 1.2 Carpal tunnel syndrome 1.3 Constipation 1.4 Contractions 1.5 Dehydration 1.6 Edema 1.7 Gastroesophageal Reflux Disease (GERD) 1.8 Hemorrhoids 1.9 Pica 1.10 Lower abdominal pain 1.11 Increased urinary frequency 1.12 Varicose veins 1.13 Diastasis recti or abdominal separation

2 Serious maternal problems 2.1 Pelvic girdle pain (PGP) 2.2 Severe hypertensive states 2.3 Deep vein thrombosis

3 Serious fetal problems 3.1 Ectopic pregnancy (implantation of the embryo outside the uterus) 3.2 Placental abruption (separation of the placenta from the uterus) 3.3 Multiple pregnancies

Maternal routine problems

Back pain Common, particularly in the third trimester when the patient's center of gravity has shifted. Treatment: mild exercise, gentle massage, heating pads, paracetamol (acetaminophen), and (in severe cases) muscle relaxants or narcotics.
Carpal tunnel syndrome Occurs in between an estimated 21% to 62% of cases, possibly due to edema Edema Caused by: compression of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities. Treatment: raising legs above the heart, patient sleeps on her side.

Constipation Cause: decreased bowel motility secondary to elevated progesterone (normal in pregnancy), which causes the "smooth muscle" along the walls of the intestines to relax. Thus, making sure that the future mother will absorb as much nutrients from her diet as possible in order to nourish the fetus and herself. As a side effect the feces can get extremely dehydrated and hard to pass. Treatment: increased PO fluids, stool softeners, bulking agents Drinking plenty of water and eating fruit and fiber enriched foods often help A woman experiencing sudden defecation should report this to her practitioner. Contractions occasional, irregular, painless contractions that occur several times per day are normal and are known as Braxton Hicks contractions Caused by: dehydration Treatment: fluid intake regular contractions (every 10-15 min) are a sign of preterm labor and should be assessed by cervical exam.

Dehydration Caused by: expanded intravascular space and increased Third spacing of fluids Treatment: fluid intake Complication: uterine contractions, which may occur because dehydration causes body release of ADH, which is similar to oxytocin in structure. Oxytocin itself can cause uterine contractions and thus ADH can cross-react with oxytocin receptors and also cause contractions. Gastroesophageal Reflux Disease (GERD) Caused by: relaxation of the lower esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy) Treatment: antacids, multiple small meals a day, avoid lying down within an hour of eating, H2 blockers, proton pump inhibitors Hemorrhoids Caused by: increased venous stasis and IVC compression leading to congestion in venous system along with increased abdominal pressure secondary to constipation. Treatment: topical anesthetics, steroids, treatment of constipation

Pica cravings for no edible items such as dirt or clay. Caused by Iron deficiency which is normal during pregnancy and can be overcome with Iron supplements or prenatal vitamins. Commonly, avoid ice chips; it may worsen anemia Lower abdominal pain Caused by: rapid expansion of the uterus and stretching of ligaments such as the round ligament. Treatment: paracetam ol (acetaminophen)

Increased urinary frequency Caused by: increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus. Patients are advised to continue fluid intake despite this. Urinalysis and culture should be ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by dysuria (pain when urinating).

Varicose veins Caused by: relaxation of the venous smooth muscle and increased intravascular pressure. Treatment: elevation of the legs, pressure stockings relieve swelling and pain with warm sitz bath. Avoid obesity, lengthy standing or sitting, constrictive clothing and constipation and bearing down with bowel movements

Diastasis recti or abdominal separation Caused by: excessive stretching of the abdominal muscles. Treatment: paliative care, surgery and/or rehabilitation after childbirth

Serious maternal problems

Pelvic girdle pain (PGP) Caused by: PGP disorder is complex and multifactorial and likely to be represented by a series of sub-groups with different underlying pain drivers from peripheral or central nervous system, altered laxity/stiffness of muscles, laxity to injury of tendinous/ligamentous structures to maladaptive body mechanics. Musculo-Skeletal Mechanics involved in gait and weightbearing activities can be mild to grossly impaired. PGP can begin peri or postpartum. For most women PGP resolves in weeks after delivery but for some it can last for years resulting in a reduced tolerance for weightbearing activities. Treatment: The degree of treatment is based on the severity. A mild case would require rest, rehabiltation therapy and pain is usually manageable. More severe cases would also include mobility aids, strong analgesics and sometimes surgery. One of the main factors in helping women cope is with education, information and support. Many treatment options are available.

Deep vein thrombosis

For more info on DVT and pregnancy, see Deep vein thrombosis.
Deep vein thrombosis (DVT) has an incidence of 0.5 to 7 per 1,000 pregnancies, and is the second most common cause of maternal death in developed countries after bleeding. Caused by: Hypercoagulability as a physiological response to potential massive bleeding at childbirth. Treatment: Prophylactic treatment, e.g. with low molecular weight heparin may be indicated when there are additional risk factors for deep vein thrombosis.

SERIOUS FETAL PROBLEMS

The following problems occur in the fetus or placenta, but may have serious consequences on the mother as well.
Ectopic pregnancy (implantation of the embryo outside the uterus)

Main article: Ectopic pregnancy Caused by: Unknown, but risk factors include smoking, advanced maternal
age, and prior damage to the Fallopian tubes. Treatment: If there is no spontaneous resolution, the pregnancy must be aborted either surgically or by the drug methotrexate. Types of Ectopic Pregnancy

Tubal Ovarian Cervical Abdominal Broad Ligaments Tubo-uterine Tubo-abdominal Tubo-ovarian Heterotypic pregnancy

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

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

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: Complete or Total Placenta Previa the placenta completely covers the internal os when the cervix is fully dilated. Partial Placenta Previa the placenta partially covers the internal os. Marginal Placenta Previa the edge of the placenta is lying at the margin of the internal os. 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 Multiparity Multiple pregnancy Advance of maternal age over 35 years old Smoking Previous cesarean section and abortion Uterine incisions Prior placenta previa Abnormal placentas placenta increta and accreta Abruptio Placentae separation of the placenta from the uterus before the babys birth also called placental abruption and accidental hemorrhage

Causes of Abruptio Placentae: Uterine anomalies Multiparity Preeclampsia Previous cesarean delivery Renal or vascular disease Trauma to the abdomen Previous third trimester bleeding Abnormally large placenta Short umbilical cord Placental abruption (separation of the placenta from the uterus)

Main article: Placental abruption Caused by: Various causes; risk

factors include maternal hypertension, trauma, and drug use. Treatment: Immediate delivery if the fetus is mature (36 weeks or older), or if a younger fetus or the mother is in distress. In less severe cases with immature fetuses, the situation may be monitored in hospital, with treatment if necessary.

Types of Abruptio Placentae:

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. 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). Grade 0: asymptomatic. Diagnosis is made retrospectively by finding an organized blood clot or a depressed area on a delivered placenta. 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

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) 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

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

Severe hypertensive states

Further information: Gestational hypertension

Potential severe hypertensive states of pregnancy are mainly: Preeclampsia = gestational hypertension, proteinuria (>300 mg), and edema. Severe preeclampsia involves a BP over 160/110 (with additional signs) Eclampsia = seizures in a preeclamptic patient HELLP syndrome = Hemolytic anemia, Elevated liver enzymes and low platelet count Acute fatty liver of pregnancy is sometimes included in the preeclamptic spectrum.

Predisposing Factors of PIH: Primigravida status higher incidence in primiparas below 20 and above 35 years old. Low socioeconomic status Previous hypertension of pregnancy, hydatidiform mole, diabetes mellitus, multiple pregnancy, polyhydramnios, renal disease, heart disease Genetic or immunologic

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

Anemia (Iron deficiency) iron deficiency anemia is the most common anemia of pregnancy affecting 1550% 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: Poor diet and poor nutrition Heavy menses Pregnancies at close intervals; successive pregnancies Unwise reducing programs

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

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: History of traumatic birth Repeated dilatation and curettage Clients mother treated with diethylstilllbestrol (DES) when pregnant with the client Congenitally short cervix Uterine anomalies Unknown etiology

Polyhydramnios characterized by excessive amount of amniotic fluid, more than 2000 ml Predisposing Factors of Polyhydramnios: Multiple pregnancy Fetal abnormalities-esophageal atresia, anencephaly, spina bifida Diabetes mellitus

Oligohydramnios amniotic fluid is less than 300 ml or amniotic fluid index less than 5 cm Causes of Oligohydramnios: Fetal renal anomalities that results in anuria Premature rupture of membranes Exposure to angiotensin converting enzyme inhibitors

TIME TO SLEEP

THE END