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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 treatment.

Some 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.

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. 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

Bleeding during pregnancy can be serious and should never be ignored. If bleeding occurs, contact your midwife, doctor or hospital immediately. Generally bleeding is caused by minor changes in the neck of the womb and is harmless.

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

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 - 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

This is a condition of high blood pressure and protein in the urine brought on by pregnancy. 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 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

The regular blood pressure and urine checks carried out during pregnancy 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.