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Pregnancy Complications

The journey of pregnancy can be both exciting and frightening. Women who are expecting face physical and hormonal changes but may also experience additional stress due to unplanned medical events, which can threaten the health of both mother and baby.

Pregnancy ComplicationsPregnancy is the time which occurs after conception but before childbirth.  Also called gestation, pregnancy is when one or more offspring are developing inside of a mother.  A “multiple” pregnancy occurs when there are two or more babies, resulting in twins, triplets or more.

Pregnancy occurs after conception when an egg or ovum from the mother is fertilized by a sperm.  In a normal pregnancy, the fertilized egg travels into the uterus where it attaches to the uterine wall and begins to grow.  The fetus will be surrounded by a placenta which provides nutrients and oxygen and will be enclosed in an amniotic sac, filled with fluid.

Ectopic pregnancy, also called tubal pregnancy occurs when the fertilized egg does not travel to the uterus but implants itself in the fallopian tube.  An ectopic pregnancy is not considered viable and, in many cases,, will require surgical removal of the fallopian tube.  It is extremely painful and should be treated as a medical emergency as it can be fatal to the mother.

Early Pregnancy Signs

The first signs of pregnancy can occur within a few days of conception. In many cases, a missed period will be the first symptom.  Other early pregnancy symptoms may include

  • Nausea or vomiting
  • Breast tenderness
  • Appetite changes
  • Fatigue
  • A headache
  • Mood swings

Pregnancy can usually be confirmed with a home pregnancy test.  A doctor’s appointment should be scheduled as soon as possible to confirm the pregnancy and start prenatal care.

Even when taking birth control, sexually active women of reproductive age can become pregnant as no contraceptive is 100% effective, including methods like Mirena IUD and Essure, both of which have caused numerous problems.

Pregnancy Stages

Pregnancy normally lasts about 40 weeks.  Any birth that occurs between 38 weeks and 42 weeks is usually considered normal.  At 42 weeks or before, labor may be induced if it has not begun on its own.  Premature births, or preterm births, are those occurring before week 37 and may present significant risks to the infant.

Pregnancy is generally split into thirds or “trimesters” which are approximately 3 months long.

First Trimester

The first trimester begins at conception when the egg is fertilized by a sperm to become a zygote.  Within the first 24 hours, the zygote will begin dividing to form an embryo.  On about the 7th day of pregnancy, the embryo will have implanted or attached itself to the uterine lining.  After implantation, cell division increases in pace until about the 8th week when the embryo becomes a fetus.  The internal organs like the kidneys and brain begin to function and features of a fetus begin to look more recognizable as a human.

During this period, particularly in the first weeks, many women do not know they are pregnant.  They may believe that changes related to pregnancy may be symptoms of illness or other health conditions.  Particularly bothersome, maybe morning sickness or pregnancy-related nausea which can occur at all times of the day.

Women may require treatment for severe morning sickness.  Some women have taken antiemetic medications such as Zofran, which has not been approved for use in pregnancy and has resulted in a number of Zofran lawsuits filed by women who claim their babies developed birth defects due to Zofran.

First Trimester

 Pregnancy SymptomsEmbryo/Fetal Developments
  • Missed period
  • Nausea and vomiting (morning sickness)
  • Tender or sore breasts
  • Fatigue
  • Mood swings
  • Appetite changes
  • Food cravings or aversions
  • Constipation
  • Frequent urination
  • Heartburn
  • Headaches
  • Breasts and abdomen swell
  • Changes in weight
4 Weeks

 

  • Brain and spinal cord form
  • Heart forms
  • Arm and leg buds begin

8 weeks

  • Major organs such as kidneys, lungs form
  • Arms and legs lengthen
  • Fingers and toes form
  • Facial features begin to appear
  • Sex organs form

12 weeks

  • Nerves and muscles begin working
  • Eyelids close
  • Head growth slows

Second Trimester

The second trimester begins around the 13th week of pregnancy.  The fetus continues to develop body structure, developing organs begin to function and movement becomes intentional and noticeable.  About the 20th week, most women will begin to feel movement in the fetus.  By the end of the second trimester or about the 28th week, all of the major organs including lungs and sex organs will have developed and begun functioning.  Minor features such as hair, fingernails, and toenails will have formed, and the fetus will have begun making purposeful movements such as sucking the hand.

During the second trimester, physical changes to the woman’s body become more apparent, the most notable being the appearance of the “baby bump”.  Many women also find they have more energy and some of the early symptoms such as nausea, are subsiding.

Second Trimester

 Pregnancy SymptomsEmbryo/Fetal Developments
  • Aches and pain in abdomen, back, groin, or thighs
  • Stretch marks may appear on  abdomen, thighs, buttocks, or breasts
  • Melanocyte-stimulating hormones may cause skin darkening or coloration changes including darkened nipples, facial patches or mask (melasma/chloasma), and a dark line between naval and pubis (linea nigra)
  • Carpal tunnel syndrome symptoms including tingly or numb hands
  • Itchy abdomen, palms, and soles of the feet
  • Swelling around the ankles, face, and finger
16 Weeks

 

  • Musculoskeletal system development continues
  • Translucent skin forms
  • Sucking reflex begins

20 weeks

  • Kicking and other activity becomes noticeable
  • Fingernails, toenails, eyelashes, and eyebrows develop

24 weeks

  • Bone marrow begins producing blood cells
  • Taste buds, head hair, and fingerprints/footprints develop
  • Sex organs are fully formed

All symptoms or changes should be discussed with a healthcare practitioner.  Bothersome or severe symptoms should be reported right away as they may indicate a more serious condition.

Third Trimester

In the third trimester, most of the fetus’s organs and body systems are formed and functioning, though some such as the lungs and skeleton, will continue to grow and develop.  During the last few months, the fetus will dramatically increase in size.  As the trimester comes to a close, the baby begins to move and shift into preparation for delivery.

The changes that women experienced in the second trimester will continue as the fetus continues to grow.  More pressure may be put on the abdominal organs and spine which may cause worsening of some symptoms such as indigestion, urinary frequency, leg pains, and others.  As the due date approaches, the cervix of the mother will thin and soften in preparation for childbirth.

Third Trimester

 Pregnancy SymptomsEmbryo/Fetal Developments
  • Increased swelling of the ankles, face, and fingers
  • Worsening or continued breast tenderness
  • Leakage of colostrum from breasts
  • Shifting of the belly as fetus drops and rotates
  • Protruding belly button
  • Continued aches and pains
  • Contractions as the due date approaches
  • Difficulty sleeping
  • Heartburn
  • Shortness of breath
  • Frequent urination
  • Difficulty emptying bladder completely
32 Weeks

 

  • Bones are formed but still flexible
  • Lungs begin “practice breathing”
  • Increased kicking and movement

36 weeks

  • Thickening of the vernix, (protective waxy coating on fetus skin)
  • A movement may be less forceful or less frequent as the fetus has less room to maneuver

Final weeks

  • At 37 weeks, the baby is considered “full term” and is no longer premature
  • Organs can function independently
  • Baby starts to turn and rotate head down into the birth canal

Birth

Pregnancy ends with the birth of the child.  There are two types of birth – vaginal and cesarean section.

Vaginal Birth

Vaginal birth is considered to a “normal” birth and accounts for about two-thirds of deliveries in the U.S.  Spontaneous vaginal birth occurs when the process of labor begins without the use of medications or other induction techniques.  Induced vaginal birth occurs when labor is initiated by the use of medications or other induction techniques.

Cesarean Birth or C-Section

A cesarean birth or c-section is done through an incision made in the woman’s abdomen, into the uterus, through which the birth occurs.  C-sections are often needed when complications are experienced during labor such as fetal distress or breech birth, or in case of a multiple pregnancies.  The procedure is a major surgery which requires a much longer recovery period and will result in a permanent scar.  About one-third of all births in the U.S. are done through cesarean section, more than the 10-15% recommended by the World Health Organization.

Pregnancy Termination

Pregnancy may be ended through termination of the fetus or embryo.  When it occurs naturally, it is known as spontaneous abortion but more commonly called “miscarriage”.  Spontaneous abortion may be a result of complications, improper formation of the fetus or other issues related to the health status of the mother.

When pregnancy termination is done through the use of a medication or medical procedure, it is termed “abortion”.  Abortion laws vary from country to country but in the U.S. are considered protected by the constitution, though state laws may restrict conditions and impose limits.  Though often considered a simple “choice”, in some cases, abortion may be performed due to risk to the mother if pregnancy is allowed to continue and/or condition of the fetus or likelihood of survival.

High-risk Pregnancy

Some women will be more likely to develop complications during pregnancy.  Certain health conditions or other factors related to the mother may increase the chance for a “high-risk” pregnancy.  A number of medical devices or drugs may increase the chance for a high-risk pregnancy, birth injury or birth defect.

Factors which contribute to high-risk pregnancy include:

Teen pregnancy – pregnancy which occurs in teenagers are more likely to result in premature infant and/or low birth weight infants.  Due to the stigma of teen pregnancy, young women may also be less likely to receive adequate prenatal care which may place them at risk of further or untreated complications.

Pregnancy over the age of 35 – pregnancy which occurs in women over the age of 35 is sometimes called “advanced maternal age”.  After 35, women are more likely to develop gestational diabetes, gestational hypertension, and complications like toxemia.  In addition, the risk of a chromosomal abnormality like Down syndrome or other conditions is increased.  After 35, the chance of multiple pregnancy increases but the risk of complications which result in c-section, miscarriage or stillbirth also increase.

Pre-existing health conditions – disorders like diabetes, high blood pressure, thyroid disorder, and other conditions may affect the health of both mother and fetus.  Women with pre-existing conditions should speak to their healthcare practitioner before becoming pregnant and should seek treatment as soon as pregnancy occurs.  Some medical conditions may require different treatment or medications during the course of the pregnancy.

Multiple pregnancies – occurs when two or more fetuses are developing at the same time.  Multiple pregnancies have a much greater risk of complications for both mother and fetuses, including miscarriage.  Over 60% of twin pregnancies result in pre-term delivery and the risk is even higher for triplets and greater.  Women with multiple pregnancies are also at increased risk of gestational diabetes, hypertension and anemia and multiples are more likely to have birth defects such as heart abnormalities or cerebral palsy.

Obesity – excess maternal weight or obesity increases the mother’s risk of developing gestational diabetes which can result in an excessively large infant.  Obesity may also increase the risk of developing a condition known as preeclampsia which can be life-threatening and increases the risk of preterm birth.

Pregnancy Complications

With routine prenatal care and monitoring during pregnancy, most women do not develop complications.  Some complications are unavoidable, and while most can be managed, others may occur suddenly and cannot be avoided.

Spontaneous Termination

The sudden termination of a pregnancy may occur at any point after conception, up until birth occurs.  When a sudden termination event occurs early in the pregnancy, it is called spontaneous abortion or more commonly, miscarriage.  Most spontaneous terminations occur before the 20th week, and in many cases, the woman may not have known she was pregnant.  After 20 weeks, the spontaneous termination is known as stillbirth and may require medical removal or induced/simulated labor to remove the deceased fetus.

Symptoms of spontaneous termination include vaginal bleeding or spotting, and cramping or pain in abdomen, pelvis or lower back.   In some cases, symptoms of termination may occur but the pregnancy has not ended.  Any symptoms of miscarriage or a sudden lack of movements during a pregnancy should be reported to a healthcare practitioner right away.

Certain medications may increase the risk of miscarriage and should not be taken during pregnancy unless medically necessary.  A woman who intends to become pregnant should discuss options with her doctor before doing so and must report medications and health conditions immediately if she becomes pregnant.

Gestational Diabetes

Gestational diabetes occurs when a non-diabetic mother develops diabetes during pregnancy.  In most cases, it will go away after the pregnancy has ended.  Symptoms of gestational diabetes are similar to other diabetes symptoms and include excessive hunger and thirst, frequent urination and fatigue.  These symptoms may also be interpreted as symptoms of pregnancy itself and many women do not have symptoms or do not know they have gestational diabetes.

Women who are receiving routine prenatal care will usually be tested for gestational diabetes in the second trimester.  Untreated gestational diabetes may increase the risk for an excessively large fetus and a premature birth.  It may also increase the chance for other complications like preeclampsia and sudden death of the fetus or infant.  Advanced maternal age and multiple pregnancies may increase the risk of developing gestational diabetes.  Those with the previous history of gestational diabetes are at increased risk for each additional pregnancy.

In many cases, a healthy diet will control gestational diabetes.  Mothers will be required to test their blood glucose on a daily basis or more often and may have dietary restrictions.  In some cases, insulin will be required to control blood sugar.

Preeclampsia

Preeclampsia is a serious condition which develops during pregnancy.  It causes high blood pressure and disruptions in kidney function which can result in protein in the urine and severe swelling of hands, feet, and face.  Preeclampsia generally starts after the 20th week of pregnancy and is only curable by delivering the baby.

Many cases of preeclampsia are managed by bed rest, medications and monitoring but if the baby is near-term, delivery may be induced or c-section may be ordered in severe cases.

Premature Birth

When a birth occurs before the 37th week of pregnancy, the infant is considered premature.  Babies born prematurely are at greater risk of developmental problems like cerebral palsy or other health conditions.   Depending on the preterm development, they may be at greater risk for infection, metabolic issues, and respiratory problems because of underdeveloped immune systems, lungs and other organs.

Premature infants are usually kept in a Neonatal Intensive Care Unit (NICU) for several days, weeks or months after birth until they are able to function independently.  In order to be released to go home, they must be able to breathe, eat and stay warm without assistance from machines.  The more advanced a pregnancy was, the greater the survival rate of the infant.  Babies born at 24 weeks gestation have about 50% chance of surviving but by 28 weeks, the chance has increased to about 92%.  When considering a preterm birth, every day the fetus can remain in utero gives a better chance for survival.

Placental Abruption

Placenta abruptio or placental abruption occurs when the placenta separates from the uterine wall before delivery.  This can interrupt the supply of oxygen to the fetus which may result in brain damage or other complications.  Sudden separation of the placenta will result in bleeding which may be life-threatening for both mother and baby.  Less severe cases may result in vaginal bleeding, abdominal pain or cramping and require bed rest.  In most cases, placental abruption will require delivery by c-section.

Hyperemesis Gravidarum (HG or HeG)

Hyperemesis Gravidarum is nausea and vomiting which occurs during pregnancy that is severe enough to result in weight loss and dehydration.  It is much worse than morning sickness and though it may improve after the 20th week, it may persist much longer.  In some cases, HG may be managed with diet and antinausea medications but some women will require hospitalization to administer fluid and nutrients through intravenous (IV) infusion.

Infection During Pregnancy

Infections that occur during pregnancy can harm both the mother and fetus.  Most infections are preventable and can be avoided with good hygiene, avoiding certain foods, practicing safe sex and avoiding contact with farm and other animals.  Infections that occur during pregnancy which may be harmful include:

Group B Streptococcus (GBS)

Group B Streptococcus is a naturally occurring bacteria which is present in the vagina and rectum of about 25% of all women.  In most adults, it is asymptomatic and is rarely harmful.  When passed to an infant during delivery, it can lead to complications such as pneumonia.  Women who are pregnant will usually be tested for GBS during the first trimester through a simple swab of vagina and rectum.  Women who test positive for GBS may be given an antibiotic before or during labor to prevent the infection from spreading to the infant.

Urinary tract infections

About 10% of pregnant women will develop a urinary tract infection (UTI) during pregnancy.  Bladder infections or UTIs are usually treatable with antibiotic medications but when left untreated, may increase the risk for premature birth.  Care must be taken when selecting a medication for treatment as some antibiotics may pose a risk fo birth defects.

Symptoms of UTI include frequent urination, burning sensation on urination, pain during intercourse, cloudy urine, and urine that smells.  Symptoms of UTI should be reported to a medical professional right away, especially if signs of blood or mucus appear in urine or if UTI symptoms are accompanied by fever.

Listeriosis

Listeria is a type of bacteria found in refrigerated foods like deli meats, cheeses, and unpasteurized dairy products.  Ingesting listeria can cause illness in pregnant women but may also increase the risk of miscarriage or premature birth.  Listeriosis can often be treated with antibiotics.  Symptoms of food poisoning, fever or muscle aches should be reported to a healthcare practitioner.

Sexually transmitted infection (STI)

Sexually transmitted infection or sexually transmitted disease (STD) are infectious diseases which are spread through sexual activity.  Some STIs can be passed to the fetus during pregnancy and may increase the risk of miscarriage or premature birth.  Women who have STI should discuss the risks with their healthcare practitioner so that treatment can begin to help prevent the spread of the disease to the infant.

Many STIs can be prevented with safe sex practices.  Safe sex practices should be used when engaging in sexual activity with a new partner or one whose infection status is questionable or unknown.  STIs are not always obvious but any unusual symptoms should be reported to a healthcare practitioner and women who are pregnant should have an STD screening done early in the pregnancy.

Ectopic Pregnancy

Ectopic pregnancy is also called extrauterine pregnancy or more commonly, tubal pregnancy.  It occurs when a fertilized egg does not travel to the uterus but implants in the fallopian tube and begins to grow.  An ectopic pregnancy occurs in about one of 50 pregnancies and rarely results in a viable pregnancy.

During ectopic pregnancy, the growing fetus in the fallopian tube will stretch and rupture the tube, causing severe pain and internal bleeding which may threaten the life of the mother.  Ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester.  Early signs of ectopic pregnancy may mirror a healthy pregnancy.  Signs and symptoms of ectopic pregnancy which differentiate it may include vaginal bleeding, pain in pelvis or abdomen which is sharp, stabbing or cramping in nature.  If an ectopic pregnancy ruptures the fallopian tube, pain may suddenly become severe and disabling and may occur in the abdomen, side, shoulder or back and symptoms should be treated as a medical emergency.

In some cases, ectopic pregnancy may be first diagnosed during the ultrasound when the developing fetus is not found in the uterus.  In most cases, however, pain or other symptoms will bring the first notice.  For further diagnosis, a transvaginal ultrasound (done through the vaginal) and blood tests may confirm both pregnancy and fetal position in the fallopian tube.

Ectopic pregnancies are most commonly caused by blockage of the fallopian tube which prevents the fertilized egg from traveling to the uterus.  Risk factors for tubal pregnancy include:

  • Advanced maternal age (over 35)
  • History of pelvic inflammatory disease (PID)
  • Fertility treatments
  • Conception with IUD in place
  • Conception after tubal ligation (sterilization procedure)
  • History of ectopic pregnancy
  • Previous abortion (induced)
  • Endometriosis
  • Smoking

Women who are at a risk of ectopic pregnancy should speak with their doctor. When caught early, ectopic pregnancy can sometimes be treated with methotrexate, a medication which will allow the body to absorb the fetal tissue.  In some cases, surgery may be needed to remove the fetus and fallopian tube on the affected side.

If symptoms of ectopic pregnancy occur, particularly severe or sudden abdominal, pelvic, shoulder or neck pain, emergency medical treatment is warranted.

Birth Injuries

Birth injury occurs when a child is injured or harmed during labor, during childbirth or immediately after birth.  There are a number of birth injury types that can occur but the most common are:

  • Shoulder Dystocia – baby’s shoulders become stuck in the birth canal and may result in additional risks
  • Erb’s Palsy – paralysis of the upper arm muscles and nerves due to upper brachial plexus injury
  • Klumpke’s Palsy – Paralysis of lower arm muscles and nerves due to lower brachial plexus injury
  • Cerebral Palsy – neurological disorder that affects the brain and impairs development and movement

In many cases, birth injuries are preventable but once they occur, are costly to treat.  If an infant was harmed during childbirth, parents or caregivers may want to discuss legal options with a birth injury lawyer regarding compensation.

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