Complications in pregnancy
ParentsCentre's expert Dr Stuart Flanagan continues his series of articles by highlighting how to deal with various complications you may experience during pregnancy. Dr Flanagan is an experienced physician who also works as a contributor and medical adviser for a number of BBC projects - you can download his biography at the bottom of this page. He will be writing monthly articles for the site, including bedwetting, Sudden Infant Death Syndrome, discussing contraception with teenagers, acne in adolescence and common diseases in childhood.
Complications in pregnancy
Pre-eclampsia
This is high blood pressure induced by pregnancy and is characterised by
hypertension (raised blood pressure), proteinuria (protein detected in the
urine) and oedema (fluid retention). It occurs in around 10 per cent of
pregnancies in the final three months however, severe forms only occur in
around one in 50 pregnancies.
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 mums with:
- first pregnancy
- diabetes
- previously diagnosed hypertension
- multiple pregnancy (twins or triplets, etc.)
- previous history of pre-eclampsia
- history of kidney disease
Regular blood pressure and urine checks will help your doctor detect pre-eclampsia should it occur in your pregnancy. If the condition is diagnosed, you may require admission to hospital for monitoring and commencement on anti-hypertensive medications. If the condition deteriorates to such an extent that the baby is at risk, your doctor may have to induce labour or perform a Caesarean section.
Ectopic pregnancy is a significant diagnosis and parents will need some counselling after treatment.
Ectopic pregnancy
An ectopic pregnancy literally means a pregnancy in the wrong place. It 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 spontaneously. However, the consequences of an ectopic pregnancy can
be life threatening and it is an important condition to diagnose and treat.
The most common symptoms are abdominal pain and low blood pressure in the
context of a positive pregnancy test or a missed period. Indeed, the pregnancy
test may only be weakly positive, so any woman of child-bearing age with
unusual abdominal pains should be assessed by her doctor. Diagnosis usually
requires an internal examination and ultrasound scan.
Treatment includes two options. Most ectopic pregnancies require surgery -
usually laparoscopic (keyhole) surgery in order to remove the ectopic and in
some cases also the Fallopian tube. Occasionally this may proceed to open
surgery if there are complications. The second option is treatment with
Methotrexate, a drug which has an unlicensed use to reduce the fertilized cells
and shrink down the pregnancy. This is most commonly used in addition to
surgery.
Ectopic pregnancy is a significant diagnosis and parents will need some
counselling after treatment. Generally, after an ectopic pregnancy, around a
third of women will have another ectopic pregnancy, a third will never become
pregnant and a third will have a successful pregnancy.
Gestational diabetes
Diabetes which occurs during pregnancy is known as Gestational
Diabetes. It affects around five per cent of all pregnant women and occurs due
to insufficient production of insulin by the pancreas. Insulin is a hormone
which regulates the body's sugar, or glucose levels. Because pregnancy
demands higher levels of insulin production, some women may develop temporary
diabetes during the second half of their pregnancy.
Some Mums are more at risk of developing diabetes during pregnancy. Risk
factors include:
- obesity
- aged over 35
- history of type II (late-onset) diabetes
- previous history of gestational diabetes
Poor glucose control can result in macrosomic babies - "fat" babies who can run into problems during delivery or develop other problems soon after birth, such a jaundice or breathing problems.
At your antenatal clinics your doctor will send blood tests to check your
blood glucose levels. If they are raised you may need to provide a fasting
sample, or subsequently a sample after taking a glucose tablet. This will
measure your pancreas' response to higher glucose levels.
If you are diagnosed with gestational diabetes you may be referred to a
specialist clinic run by a diabetologist. This is to ensure glucose control is
good for the remainder of the pregnancy. Poor glucose control can result in
macrosomic babies - "fat" babies who can run into problems during
delivery or develop other problems soon after birth, such a jaundice or
breathing problems. You are also at greater risk of stillbirth.
Treatment will involve consultation with a dietician, and developing a plan of
regular gentle exercise. Some women may require 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 II diabetes later in life.
Bleeding
Bleeding during pregnancy is a serious symptom and cannot be ignored.
If bleeding occurs at any time, rest and lie down and arrange a medical
consultation, either by your GP or at the local hospital.
The commonest cause of bleeding in the later stages of pregnancy is harmless
changes in the cervix (the neck of the womb). However it may also be the result
of a condition called Placenta Praevia, where the placenta is in low
position and overlies 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.
After assessment, your doctor will advise you on the management plan. For
Placenta Praevia this may involve inducing labour. For Placental
Abruption, a Casearean section may be indicated. If the symptoms are less
severe, a short period of monitoring in hospital may be all that is
required.
Delivery day
Finally here's a quick list of some things to take for delivery
day - you may find in all the rush you forget some vital items.
- medical records, including lists of any medications or previous medical history
- contact details of next of kin
- wash bag
- underwear
- slippers
- dressing gown
- music for CD player - this will help you to relax during delivery
- nursing bra
- nappies for baby
- carrycot and blanket
Dr Stuart
Flanagan's biography
- download (.doc)
(help)
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