Complications can arise in pregnancies for many reasons. Sometimes a woman’s existing health conditions can contribute to problems, and other times new conditions arise because of body and hormonal changes that occur during pregnancy. Some of the most common complications include:
Miscarriage is the loss of a pregnancy in the first 20 weeks of pregnancy. The reasons for miscarriage are not always known. Most miscarriages occur in the first trimester (first 13 weeks of pregnancy). Chromosomal abnormalities can prevent proper development of the fertilized egg. Other times physical problems with a woman’s reproductive system can make it difficult for a healthy fetus to grow.
Miscarriage is sometimes called spontaneous abortion as the body rids itself of the fetus much like a procedural abortion. The most common sign of a miscarriage is abnormal vaginal bleeding.
Other symptoms can include:
- Lower abdominal pain and cramping.
- Disappearance of pregnancy symptoms, such as morning sickness.
Most miscarriages don’t require surgical intervention. When a miscarriage occurs under 12 weeks, the tissue will often dissolve or pass spontaneously without the need for further intervention. Some patients will require medicine or a minor procedure in the office to help with the passage of the tissue.
A fertilized egg implanted outside the uterus in an ectopic pregnancy. The egg generally settles in one of the fallopian tubes. Because of the space limitations and the lack of nurturing tissues there, a fetus cannot properly grow. An ectopic pregnancy can cause severe pain and damage to a woman’s reproductive system. An ectopic pregnancy is a potentially life-threatening condition. As the fetus continues to grow, it can cause the fallopian tube to burst leading to severe hemorrhage (internal bleeding).
In an ectopic pregnancy, the fetus will not survive. Surgery and medication are necessary, as well a careful monitoring of a woman’s reproductive system by a gynecologist. Causes of ectopic pregnancies include endometriosis (a condition in which cell tissue like that in the uterus grows elsewhere in the body) and scarring to the fallopian tubes from a previous sexually transmitted infection.
Gestational diabetes is a form of diabetes that is diagnosed during pregnancy. Being diagnosed with gestational diabetes means that there are additional concerns to be addressed during your pregnancy and that you are at higher risk for diabetes. Like other types of diabetes, gestational diabetes is caused by an inability of a woman’s body to make enough insulin. For most women, gestational diabetes does not cause any noticeable symptoms.
While most women with gestational diabetes give birth to healthy babies, the condition can increase the risk that the baby will have macromasia (larger-than-normal body). Other health risks to the baby include:
- respiratory distress syndrome
- abnormally low levels of minerals in the blood
Gestational diabetes is treated through changes in diet and close monitoring of the blood sugar levels; intake of insulin may also be necessary. The goal is to keep the mother's sugar levels within a normal range for the remainder of the pregnancy so the mother and fetus remains healthy.
Cervical Insufficiency (Incompetent cervix)
A growing baby puts continual pressure on a pregnant woman’s cervix. In some (rare) cases, the pressure becomes too much for the cervix to handle, and the cervix will start to open before the baby is ready to be born. Women who have previously had a pregnancy complicated by cervical insufficiency or who have had surgery on their cervix are most susceptible.
Symptoms are often very vague and non-specific. In fact, most women who have cervical insufficiency have no idea that their cervix is thinning and/or shortening. The hallmark of this condition is that it is painless. However, some women do report a feeling of pressure or mild cramping.
Cervical insufficiency is diagnosed by measuring the length of the cervix with ultrasound. The treatment may include bed rest, vaginal suppositories of the hormone progesterone, or a procedure called cerclage. A cerclage is a minor surgery in which bands of strong thread are stitched around the cervix to reinforce it and hold it closed.
The treatment for cervical insufficiency will depend on many factors including the length of your cervix, your gestational age, and the outcome in previous pregnancies if you have been pregnant before.
Placental abruption occurs when the placenta completely or partially separates from the uterus before a baby is born. This separation means a fetus cannot receive proper nutrients and oxygen. A placental abruption happens most commonly in the third trimester of a pregnancy. Common symptoms include vaginal bleeding, contractions, and abdominal pain.
There is no definitive answer as to why abruptions occur. It is thought that physical trauma can disrupt the placenta. High blood pressure can also damage the connection between the placenta and the uterus.
A number of factors can increase your risk for abruption. Pregnant women with high blood pressure are much more likely to have an abruption. This is true for blood pressure problems that are unrelated to pregnancy (chronic hypertension) as well as pregnancy-related problems like toxemia (pre-eclampsia).
The likelihood of abruption is closely related to the number and nature of your previous pregnancies. The more babies you’ve had, the greater your risk of abruption. More importantly, if you’ve had one abruption in the past, you have about a one in 10 chance of having an abruption with your next pregnancy.
Other factors that may increase the risk for placental abruption include:
- cigarette smoking
- drug use (particularly amphetamines and cocaine)
Placenta Previa (Low-Lying Placenta)
Placenta previa is a rare pregnancy complication that occurs if the placenta attaches to the bottom part of a woman’s uterine wall, partially or completely covering the cervix. When it occurs, it usually happens during the second or third trimester.
It is common, however, for some women to have a low-lying placenta in early pregnancy. The condition will be monitored by a doctor, but often the placenta moves to the appropriate place without any intervention.
Placenta previa becomes a more serious condition in the second or third trimesters, and can result in heavy vaginal bleeding. If left untreated, placenta previa can lead to bleeding heavy enough to cause maternal shock or even death. Luckily, most cases of the condition are recognized early on and treated appropriately.
Low or Excess Amniotic Fluid
Amniotic fluid cushions the womb to keep a fetus safe from trauma. It also helps maintain the temperature inside the womb. Having too little amniotic fluid (oligohydramnios) or too much amniotic fluid (polyhydramnios) interferes with some of the normal functions of the womb.
Most cases of excess amniotic fluid are mild and do not cause problems. In some rare cases, too much amniotic fluid can cause premature rupture of amniotic membranes, placental abruption, preterm labor and delivery, or postpartum hemorrhage.
An absence or excess of fluids is usually detected during the second trimester when the fetus begins to practice breathing and sucks in amniotic fluid. For those with too little amniotic fluid, saline solution may be pumped into the amniotic sac to help reduce the risk of compression or injury to the child’s organs during delivery.
For those with too much amniotic fluid, medication can be used to reduce fluid production. In some cases, amnioreduction, a procedure to drain excess fluids, may be required. In either case (excess or low amniotic fluid) if these treatments prove ineffective, an induced pregnancy or cesarean section may be required.
Preeclampsia is a condition marked by high blood pressure and high protein count in a woman’s urine. Doctors are not sure what causes preeclampsia. Preeclampsia can range from mild to severe—in serious cases, symptoms may include:
- severe headaches
- blurred or temporary loss of vision
- upper abdominal pain
- decreased urine output
- sudden weight gain
- swelling in the face and hands
If you have severe headaches, blurred vision, or severe pain in your abdomen, you should call your doctor or go to the emergency room immediately.
For most women, preeclampsia will not affect the health of the baby. However, some cases of preeclampsia—especially those that are severe and develop earlier in the pregnancy—can prevent the placenta from getting enough blood. Preeclampsia can cause serious complications in both mother and baby. Some complications include:
- slow growth
- low birth weight
- preterm birth
- breathing difficulties for the baby
- placental abruption
- HELLP syndrome
The only cure for preeclampsia is delivery. However, the symptoms of preeclampsia can be treated with medication and bed rest. Bed rest can help lower blood pressure and increase blood flow to the placenta. In many cases, anti-seizure medication is taken as seizures can be a common and serious complication for both mother and child. Antihypertensives (medication for hypertension) are sometimes taken to lower blood pressure, and corticosteroids can be used to help mature a baby’s lungs to prepare them for an early delivery.
Labor is considered preterm when it occurs after 20 weeks and before the 37th week of pregnancy. Traditionally, the diagnosis is made when regular uterine contractions are associated with either dilation (opening) or effacement (thinning out) of the cervix.
The majority of premature labor and births occur spontaneously; however, up to one-fourth of the cases of preterm birth are a result of an intentional decision to deliver the baby early. These cases are generally due to complications in either the mother or the baby which are best treated by proceeding with delivery, despite the fact that the mother is not yet at her due date.
Preterm labor requires prompt medical attention, which can try to halt or postpone labor and delivery. A woman who experiences symptoms of premature labor may be put on bed rest or be given medication to stop contractions; a large number of these patients actually go on to deliver at term.
There are a host of risk factors associated with premature labor and delivery, including:
- inadequate prenatal care
- a history of multiple abortions
- a history of preterm births
- an incompetent cervix
- uterine fibroids
- urinary tract and other infections
Venous thrombosis is a blood clot that normally develops in a vein in a leg. Women are susceptible to clots throughout pregnancy and delivery, and particularly postpartum. The body increases the blood’s clotting ability during childbirth, and sometimes the enlarged uterus makes it difficult for blood in the lower body to return to the heart. Clots near the surface are more common, while deep vein thrombosis, which is much more dangerous, is thankfully less common.
A greater risk of developing clots in women includes:
- a family history of thrombosis
- being over 30
- having had three or more previous deliveries
- having been confined to a bed
- being overweight
- having undergone a cesarean delivery in the past
Other less common complications include:
A molar pregnancy is an abnormality of the placenta, where an abnormal mass, instead of a normal embryo, forms inside the uterus after fertilization. Also called gestational trophoblastic disease (GTD), hydatidiform mole or mole, molar pregnancies are rare, occurring in one out of every 1,000 pregnancies in the United States.
There are two types of molar pregnancies: complete and partial. Complete molar pregnancies occur when the sperm fertilizes an empty egg. The placenta grows and produces the pregnancy hormone hCG, but there is no fetus inside. A partial molar pregnancy occurs when a mass forms which contains both the abnormal cells and an embryo that has severe defects. In this case, the fetus will quickly be overcome by the growing abnormal mass.
A molar pregnancy requires an immediate Dilation and Curettage (D&C), and a careful follow up as the molar issue can start growing again and even develop into a cancer.
Fetal Alcohol Syndrome
Fetal alcohol syndrome occurs when there are mental and physical defects that develop in a fetus when a mother drinks alcohol during pregnancy. Alcohol crosses the placenta and has been linked to stunted growth and damaged brain development. As many as 40,000 babies are born with some type of alcohol-related complications each year in the United States.
HELLP Syndrome (Hemolysis, Elevated Liver enzymes and Low Platelet count) is a condition characterized by liver and blood abnormalities. HELLP syndrome can occur on its own, or in association with preeclampsia. Symptoms often consist of nausea, gastrointestinal pain, headaches and severe itching. Treatment of HELLP usually requires immediate delivery, as there is increased risk of serious health complications for the mother, including permanent damage to her nervous system, lungs, and kidneys.
Eclampsia occurs when preeclampsia progresses and attacks the central nervous system, causing seizures. It’s a very serious condition that, if left untreated, can be fatal for both mother and baby. However, with proper prenatal care, it is very rare for the more manageable preeclampsia to progress into eclampsia.