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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 the treatment you receive.

Common complications

Some of the most common complications and their treatments include:

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. The most common symptoms are abdominal pain and low blood pressure after a positive pregnancy test or a missed period.

Any woman of child-bearing age with unusual abdominal pains should see a doctor. Diagnosis usually requires an internal examination and ultrasound scan. Most ectopic pregnancies require an operation - 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. A second option is treatment with Methotrexate, a drug which reduces the fertilized cells. This is usually an addition to surgery.

Bleeding

Vaginal bleeding is not normal in pregnancy and should never be ignored. Some causes of vaginal bleeding are more serious than others so it’s important to find the cause straight away. If bleeding occurs, contact your midwife, doctor or hospital immediately.

However, if your placenta is low lying (over the neck of the womb) this may cause bleeding. Your doctor or midwife should make you aware of this.

Occasionally, bleeding may be due to a condition called placental abruption where the placenta has come away from the wall of the womb. This will usually be accompanied by pain and is very serious for both you and your baby.

Gestational diabetes

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

When you book for antenatal care 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 - who can encounter problems during delivery or develop other problems soon after birth, such as 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 the birth, most women will no longer require insulin. However, they are at higher risk of developing type 2 diabetes later in life.

Pre-eclampsia

During pregnancy your blood pressure will be checked at every antenatal appointment. Your urine will also be checked. This is because a rise in blood pressure and protein in the urine can be the first sign of pre-eclampsia which is brought on by pregnancy.

It can run in families and occurs in around 10 per cent of pregnancies usually in the final three months and can be accompanied by generalised swelling called oedema.

Most cases are mild and cause no trouble. Severe forms only occur in around one in 50 pregnancies and can be serious for both mother and baby. The causes are not entirely clear but there are some mothers who are more at risk of developing pre-eclampsia. These include mothers with:

  • a first pregnancy
  • diabetes
  • previously diagnosed hypertension
  • multiple pregnancy (for example twins or triplets)
  • a previous history of pre-eclampsia
  • a history of kidney disease

Pre-eclampsia can cause fits in the mother (called eclampsia) and affects the baby’s growth. It is life-threatening if left untreated so that is why routine antenatal checks are so important.

Pre-eclampsia usually happens towards the end of pregnancy, but it may happen earlier. It can also happen after the birth. It is likely to be more severe if it starts earlier in pregnancy.

Treatment may start with rest at home, but some women need admission to hospital and medicines that lower high blood pressure. Occasionally, pre-eclampsia is a reason to deliver the baby early- this may be either by induction of labour or by caesarean section.

Severe itching and obstetric cholestasis

Severe itching can be a sign of a condition called obstetric cholestasis. This is a potentially dangerous liver disorder that seems to run in families, although it can occur even if there is no family history.

The main symptom is severe generalised itching without a rash, most commonly in the last four months of pregnancy. Obstetric cholestasis can lead to premature birth, stillbirth or serious health problems for your baby. It can also increase the risk of maternal haemorrhage after the delivery.

You should see your doctor if:

  • the itching becomes severe – particularly if it affects your hands and feet
  • you develop jaundice (yellowing of the whites of the eyes and skin)
  • you get itching and a severe rash.

Baby's movements reduce or change

Most women first become aware of their baby moving when they are 18 to 20 weeks pregnant. Never go to sleep ignoring a reduction or change in your baby’s movements, always seek professional help immediately. Do not rely on any home kits you may have for listening to your baby’s heartbeat.

The care you will be given will depend on the stage of your pregnancy and may involve one of the following or a combination of:

  • listening to your baby’s heartbeat
  • ultrasound scan
  • referral to a specialist fetal medicine centre
  • monitoring the baby’s heartrate, usually for at least 20 minutes.

These investigations usually provide reassurance that all is well. Most women who experience one episode of reduction in their baby’s movements have a straightforward pregnancy and go on to deliver a healthy baby.

If there are any concerns about your baby, your doctor and midwife will discuss this with you.

Deep vein thrombosis (DVT)

Deep vein thrombosis is a serious condition where clots develop, often in the deep veins of the legs. It can be fatal if the clot travels from the legs to the lungs. The risk may increase if you are on a long-haul flight (over five hours), where you sit still for a long time.

If you develop swollen and painful legs or have breathing difficulties, go to your GP or your nearest accident and emergency department immediately.

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