Complications in pregnancy

 

Sometimes pregnancy can lead to medical conditions which may cause you or your baby harm. Signs and symptoms may vary, as may treatment. Here are some of the most common complications, and how they are treated.

 

Causes of pre-eclampsia

The causes are not entirely clear, but are thought be related to defects in the placenta. Some mothers are more at risk of developing pre-eclampsia. These include mothers with:

  • a first pregnancy

  • diabetes

  • previously diagnosed hypertension

  • multiple pregnancy (twins or triplets, etc)

  • a previous history of pre-eclampsia

  • a history of kidney disease

Treatment for pre-eclampsia

Regular blood pressure and urine checks will help detect pre-eclampsia. If the condition is diagnosed, admission to hospital for monitoring and anti-hypertensive medicine may be required. If the condition worsens and the baby is at risk, the doctor may have to induce labour or perform a Caesarean section.

 

Ectopic pregnancy

This occurs when a pregnancy develops outside of the womb, usually in one of the Fallopian tubes. An ectopic pregnancy embryo will not survive and the pregnancy will miscarry. The consequences of an ectopic pregnancy can be life threatening.

 

 Symptoms of an ectopic pregnancy

The most common symptoms are abdominal pain and low blood pressure after a positive pregnancy test or a missed period. The pregnancy test may only be weakly positive, so any woman of child-bearing age with unusual abdominal pains should see a doctor. Diagnosis usually requires an internal examination and ultrasound scan.

 

Treatment for an ectopic pregnancy

Most ectopic pregnancies require surgery - usually keyhole surgery to remove the embryo and in some cases the Fallopian tube as well. This may lead to open surgery if there are complications. The second option is treatment with Methotrexate, a drug which reduces the fertilized cells. This is usually used in addition to surgery.

 

 Gestational diabetes

Diabetes which occurs during pregnancy is known as gestational diabetes. It affects around five per cent of all pregnant women and occurs because the pancreas is not producing enough insulin.

 

 Causes of gestational diabetes

Insulin is a hormone which regulates the body’s sugar, or glucose levels. Because pregnant women need higher insulin levels to keep their blood sugar down, some women may develop temporary diabetes during the second half of their pregnancy. Risk factors include:

  • obesity

  • aged over 35

  • history of type 2 (late-onset) diabetes

  • previous history of gestational diabetes

 

Treatment for gestational diabetes

At your ante-natal clinics your blood glucose levels will be tested. If you are diagnosed with gestational diabetes you may be referred to a specialist clinic run by a diabetologist. This is to ensure your glucose control is regulated for the remainder of the pregnancy.

Poor glucose control can result in macrosomic (fat) babies - babies who can encounter problems during delivery or develop other problems soon after birth like jaundice or breathing problems. You are also at greater risk of stillbirth.

Treatment will involve seeing a dietician and developing a plan of regular, gentle exercise. Some women may need insulin injections to control their glucose levels. Your obstetrician may decide to induce labour a week or two before your due date. Caesarean section is also more common in gestational diabetes.

After birth, most women will no longer require insulin. However, they are at higher risk of developing type 2 diabetes later in life.

 

Bleeding

A small amount of bleeding at term - if you are not experiencing pain and ultrasound scans have shown the placenta to be at the top of the womb - is normal. However, bleeding during pregnancy can be serious and shouldn’t be ignored. If bleeding occurs at any time, rest and lie down and arrange to see a doctor, local maternity services or your midwife immediately. This can be done outside of normal working hours.

 

Causes of bleeding

The most common cause of bleeding in the later stages of pregnancy is due to harmless changes in the cervix (the neck of the womb). However, it may also be the result of a condition called placenta previa, where the placenta is in a low position and lies over the opening to the cervix. It can also be due to a placental abruption, where the placenta has come away from the wall of the womb. Bleeding in abruption is usually accompanied by abdominal pain.

 

Treatment

 Your doctor or midwife will advise you on the right course of action. For placenta previa this may involve inducing labour. For placental abruption, a Caesarean section may be required. If the symptoms are less severe, a short period of monitoring in hospital may be all that is required.

 

 

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