Common Momma Complications

Naturally I worry about a lot of different things that can happen during pregnancy. Here’s a list of the most common “complications.” This list is definitely not all-inclusive, and I will be posting a separate post on preeclampsia and miscarriages later this month, so stay tuned for more details!

High Blood Pressure or Hypertension

  • Definition/Background – caused by narrowing of the arteries that carry blood throughout the body, resulting in decreased blood flow to the fetus
  • Risk Factors
    • Hypertension pre-pregnancy
  • What you can do
    • Eat a healthy diet and exercise regularly
  • Treatment
    • Talk to your healthcare provider about treatment options. Sometimes diet and exercise are enough to treat high blood pressure. Other times medical management may be necessary.

Gestational Diabetes

  • Definition/Background – when insulin is not used normally or produced at a normal rate in previously healthy pregnant women most commonly seen in the second and third trimesters. Estimated that this occurs in about 4% of pregnancies. Gestational diabetes may increase risk for preterm labor, hypertension, preeclampsia, macrosomia (bigger than average babies) and C-sections.
  • Risk Factors
    • Over 25 years old
    • Have a close relative who has diabetes
    • BMI over 30 (pre-pregnancy)
    • Have Polycystic Ovarian Syndrome
    • Take a glucocorticoid, beta-blocker or antipsychotic drug
    • Have previously had gestational diabetes
    • 1st degree family history of gestational diabetes
    • Have had a large baby before
    • African American, Native American, Asian American, Hispanic or Pacific Islander
  • What you can do
    • Follow an exercise plan
    • Eat a healthy and balanced diet
    • Call a Doctor if:
      • You’re very thirsty
      • Peeing more often than usual
      • Feeling abnormally tired
      • Feeling abnormally nauseous
      • Have new onset of blurred vision
    • Treatment
      • Insulin injections
      • Monitoring your blood sugars
      • Education
      • Dietary and lifestyle changes

Diabetes chart Pic.png

Preeclampsia

  • Definition/Background – constricted blood vessels reduce blood flow to all major organs including the placenta which can cause maternal hypertension, kidney damage and organ failure as well as decreased fetal growth or miscarriage. It is estimated that this occurs in about 5% of pregnancies. Symptoms include unusual swelling, especially around the face and eyes, hands or excessive and sudden swelling of the feet and ankles, gaining > 4 LBs in a week, severe or persistent HA, vision changes, increased pain in the upper abdomen, nausea and vomiting in the 2nd or 3rd trimester and difficulty breathing. HELP syndrome is a rare presentation of preeclampsia, typically seen before the 3rd trimester and is usually more severe. If both are left untreated, women may develop eclampsia resulting in maternal seizures.
  • Risk Factors
    • Gestational Diabetes
    • Hypertension
    • First pregnancy
    • Preeclampsia in a previous pregnancy
    • Existing conditions such as kidney disease, systemic lupus erythematosus, thrombophilia, antiphospholipid syndrome
    • Being older than 35 years or younger than 20 years
    • Carrying multiples
    • Obesity with a BMI > 30 pre-pregnancy
    • Being African American
    • Having in vitro fertilization
  • What you can do
    • If at risk, the ACOG recommends beginning a low-dose aspirin after 12 weeks (talk to your health care practitioner first!!)
  • Treatment
    • Frequent BP, urine and blood tests, non-stress tests as well as more frequent US’s to monitor baby’s growth
    • Often induced at 37 weeks
    • May have restricted activity to limit the stress placed on blood vessels
    • If severe, you may have to remain in the hospital, placed on a BP med and Magnesium Sulfate to decrease chance of seizures and a corticosteroid to improve baby’s lung growth in case of preterm labor

Preterm Labor

  • Definition/Background – regular contractions followed by labor that begin before 37 weeks gestation which puts the infant at increased risk for health problems and delays. Not all women who experience preterm contractions and labor give birth prior to 37 weeks. Delivery is often preventable with modern medicine until 37 weeks. About 12% of all births in the US are considered preterm.   Symptoms include significantly increased vaginal discharge with a change in color or texture, vaginal bleeding, severe abdominal pain, more than 4 contractions per hour, increased pressure in the pelvic area, and low back pain (especially if it’s dull, rhythmic and new).
  • Risk Factors
    • Frequent infections
    • Shortened cervix or cervical insufficiency
    • Previous preterm births
    • Some STD’s
    • Placenta previa
    • Excessively large uterus
    • Abdominal surgery during pregnancy
    • Multiple births
    • Younger than 17 or older than 35
    • African American
    • Underweight pre-pregnancy or you don’t gain enough weight during pregnancy
    • Moderate to severe anemia
    • Smoking, alcohol and drug use during pregnancy
    • Gave birth within the last 18 months
    • Had no prenatal care
    • Are pregnant due to fertility treatments
    • Low socioeconomic status
    • High levels of stress throughout pregnancy such as women who experience domestic abuse during pregnancy
    • Women who work extremely physical jobs throughout pregnancy
  • What you can do
    • If you are a high-risk pregnancy, you may be a candidate for extra screening during pregnancy to measure your cervix and screen for fetal fibronectin. This is not recommended for low risk pregnancies.
    • Eat a healthy diet, get plenty of rest and exercise regularly throughout pregnancy
    • Pay attention to baby’s movements throughout the third trimester and call your doctor if you notice your baby stop moving or significantly decrease movement.
  • Treatment
    • Progesterone supplementation (directed by a physician)
    • Corticosteroids to rapidly boost baby’s organ growth
    • Treatment highly depends on how far along you are in your pregnancy, if your water has broken or not, and if you or the baby are in any medical danger. Labor will most often be prevented as long as it is safe to do so, but sometimes it is safer to deliver early for both you and your baby.

Miscarriage

  • Definition/Background – Loss of a pregnancy before 20 weeks. More than 80% of miscarriages occur before 12 weeks. Up to 20% of pregnancies end in a miscarriage. Some symptoms include vaginal bleeding, cramping, new onset of low back pain or fluid/tissue passing from the vagina.
  • Risk Factors
    • Rh-negative blood
    • Maternal age over 40
    • History of miscarriages
    • Chronic disease or disorders such as diabetes, blood clotting disorders, autoimmune disorders and hormonal disorders
    • Uterine or cervical problems
    • Familial history of birth defects or genetic disorders
    • Infections such as listeria, mumps, rubella, measles, cytomegalovirus, parvovirus, gonorrhea and HIV
    • Some OTC and prescription medications
    • Environmental toxins such as arsenic, formaldehyde, benzene, ethylene oxide, radiation, anesthetic gasses, exposure to mercury, lead and pesticides
    • Obesity
  • What you can do
    • Eat a balanced diet and exercise regularly
    • Stop taking medications unless a OBG-YN approves them
    • Seek regular prenatal care
  • Treatment
    • Most women will pass the placenta and fetal tissue (may look grayish and include blood clots) without any medical treatment. Some medical professionals recommend attempting to save this for testing
    • If you don’t pass the tissue on your own, your healthcare provider may recommend suction curettage or a traditional D&C to remove it.

Stillbirth

  • Definition/Background – loss of a pregnancy after 20 weeks. 50% of these stillbirths have no found cause but may be related to chromosomal abnormalities, placental problems, poor fetal growth and maternal health issues.
  • Risk Factors
    • Rh-negative blood
    • Maternal age over 40
    • History of miscarriages
    • Chronic disease or disorders such as diabetes, blood clotting disorders, autoimmune disorders and hormonal disorders
    • Uterine or cervical problems
    • Familial history of birth defects or genetic disorders
    • Infections such as listeria, mumps, rubella, measles, cytomegalovirus, parvovirus, gonorrhea and HIV
    • Some OTC and prescription medications
    • Environmental toxins such as arsenic, formaldehyde, benzene, ethylene oxide, radiation, anesthetic gasses, exposure to mercury, lead and pesticides
    • Obesity
  • What you can do
    • Eat a balanced diet and exercise regularly
    • Stop taking medications unless a OBG-YN approves them
    • Seek regular prenatal care
  • Treatment
    • Most women will pass the placenta and fetal tissue (may look grayish and include blood clots) without any medical treatment. Some medical professionals recommend attempting to save this for testing
    • If you don’t pass the tissue on your own, your healthcare provider may recommend suction curettage or a traditional D&C to remove it.

Ectopic Pregnancy

  • Definition/Background – the fertilized egg implants outside of the uterus, which occurs about 2% of all pregnancies. If not caught early, this may results in a ruptured fallopian tube, severe abdominal pain and bleeding. Often symptoms include abdominal pain or tenderness, vaginal bleeding and spotting, shoulder pain (especially when laying down) and in severe cases a weak/racing pulse, dizziness, fainting and fever.
  • Risk Factors
    • Surgery such as tubal ligation, tubal ligation reversal or other surgeries on or around the fallopian tubes
    • Previous ectopic pregnancy
    • Pelvic inflammatory disease
    • Endometriosis
    • Maternal age over 35
    • Smoking
  • What you can do
    • Seek regular prenatal screening
  • Treatment
    • Ending the pregnancy as it is often potentially dangerous to the mother and the fetus. Pregnancies are either ended with medication if caught early enough and the mother has no adverse symptoms or through surgery if medication is not an option.

Hyperemesis Gravidarum

  • Definition/Background – severe, persistent nausea and vomiting during the first trimester increasing risk for weight loss, dehydration and poor fetal health.
  • Risk Factors
    • Excessively high levels of HCG
  • What you can do
    • Eat small meals that consist of bland tasting food (such as toast and crackers)
    • Stay hydrated any way possible with water, Gatorade or juice
    • Talk to your health care provider if you are having trouble keeping food and water down for more than 2 days
  • Treatment
    • When severe, may require hospitalization for IV fluids

Anemia

  • Definition/Background – Lower than normal number of healthy red blood cells, which is common during pregnancy. Symptoms often include fatigue, shortness of breath, and pallor
  • Risk Factors
    • Previously anemic
    • Other pre-pregnancy blood disorders
  • What you can do
    • Take a prenatal vitamin regularly
  • Treatment
    • Your healthcare provider may suggest an iron supplement

UTI’s –> See post on UTI’s

Oligohydramnios or Low Amniotic Fluid

  • Definition/Background – low amniotic fluid, which can harm your baby. The amniotic sac provides a cushion to protect your baby, supports the umbilical cord to ensure your baby is receiving proper nutrition and oxygen, maintains a constant temperature in the womb, protects against infection, allows baby to practice inhaling and exhaling and gives room for your baby to practice moving before birth. About 4% of pregnant women have too little fluid, especially in the third trimester.
  • Risk Factors
    • Leaky or ruptured membranes
    • Placental problems
    • Chronic high blood pressure, preeclampsia, diabetes and lupus
    • Carrying multiples
    • Fetal abnormalities
  • What you can do
    • Stay hydrated throughout pregnancy
    • Seek regular prenatal care
  • Treatment
    • Most often, healthcare providers recommend frequent ultrasounds, non-stress tests and other studies to monitor baby’s growth and development
    • During labor, extra measures may be taken to ensure the baby’s safety during delivery

Placenta Previa

  • Definition/Background – a low lying placenta next to or covering the cervix which can cause bleeding and other complications leading to preterm birth. There are three different types (seen in the picture). Only 20% of women who have placenta previa before 20 weeks still have it at delivery.

Placenta Previa Pic.jpg

  • Risk Factors
    • Previous placenta previa
    • Previous C-sections
    • Other uterine surgery
    • Pregnant with multiples
    • Smoking
    • Cocaine use
  • What you can do
    • Seek regular prenatal care
  • Treatment
    • Regular ultrasounds to check placement
    • Possible restriction of activities as pregnancy progresses
    • Possibly a C-section for delivery

Gingivitis and Periodontitis

  • Definition/Background – decreased immune system creates increased risk for microbial colonization in the gums, which may increase the body’s systemic inflammatory pathways, which may influence the placenta and fetus resulting in miscarriage, premature birth, preeclampsia and low birth weight. Most often begins around 8 weeks and may become most severe by the 3r trimester.
  • Risk Factors
    • Smoking
    • Poor oral hygiene
    • Diets rich in refined sugar, carbohydrates and saturated fats
    • Diabetes
    • Lack of dental prior and during pregnancy
  • What you can do
    • See a dentist every 6 months, even when pregnant
    • Quit smoking and use of any nicotine product if you haven’t already
    • Brush and floss regularly
    • Eat a well balanced, healthy diet
    • Exercise regularly
  • Treatment
    • Regular dental visits for cleanings
    • If severe, may require supra and subgingival scaling and debridement of tooth and root surfaces which may require local anesthesia
    • Maintaining good oral hygiene

 

 

 

 

 

 

Moore, Jatinder and Flona Blair. “Periodontal health and pregnancy.” British Journal of Midwifery; 2017: 25 (5).
Mills Lesley, et. al. “Reducing Diabetes-Related Complications in Pregnancy.” British Journal of Midwifery; 2015: 23 (12).
King, Paru. “Gestational Diabetes: A Practical Guide.” Journal of Diabetes Nursing; 2017: 21(3).
https://www.babycenter.com/0_7-pregnancy-complications-to-watch-out-for_10316818.bc
http://americanpregnancy.org/pregnancy-complications/most-common/
http://www.webmd.com/baby/features/7-pregnancy-warning-signs#1
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregcomplications.htm
https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/complications.aspx

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