Complications During the Prenatal Period Health Article

Although most women do not experience significant complications during pregnancy, you should be aware of the complications that can occur so you can quickly recognize the symptoms and seek treatment. Complications that may occur during the first trimester of pregnancy include miscarriage, hyperemesis gravidarum (extreme vomiting), ectopic pregnancy, and molar pregnancy.

Miscarriage

Miscarriage, or spontaneous abortion, is one of the most common complications of early pregnancy. At least 15 to 20% of all pregnancies end in miscarriage and most miscarriages (about 80%) occur during the first trimester.

More than one-half of all miscarriages are caused by problems with the fetus' chromosomes. As the cells of the embryo divide, genetic mishaps occur that make the fetus nonviable and it is miscarried. These genetic problems are not usually inherited chromosomal defects from the parents.

Symptoms of miscarriage include spotting, bleeding, cramping, and passage of tissue. If you have these symptoms, contact your doctor immediately.

Your doctor may perform a pelvic exam, ultrasound, and certain blood tests to diagnose miscarriage. Sometimes, it is necessary to have a procedure known as a dilation and curettage (D and C) to empty the uterus and stop the bleeding. Women who have Rh-negative blood will be given an injection of immunoglobulin (RhoGAM) after miscarriage to help prevent isoimmunization problems with future pregnancies.

When miscarriage happens, it is common for a woman and her partner to feel that they somehow caused it. Generally, this is not the case. Miscarriage is not caused by having sex, arguing, vomiting, or falling. Many couples that experience a miscarriage have a successful pregnancy in the future. Multiple miscarriages can occur, but are rare overall.

After experiencing a miscarriage, it is normal to grieve. This is a normal process for such an important loss, even if the loss occurred early in pregnancy. Give yourself the time you need to overcome your loss.

Hyperemesis Gravidarum

Most women experience some nausea during early pregnancy, and many also have spells of vomiting. In the majority of women, this is temporary. In about one of every 300 women, vomiting is excessive and persistent. This is known as hyperemesis gravidarum and can lead to dehydration, poor nutrition for mother and fetus, and episodes of fainting. If it lasts long enough, hyperemesis gravidarum can affect the fetus.

Hyperemesis is not well understood. It is thought to be caused by high levels of the hormones beta-hCG and estrogen. It is more common in a first pregnancy, in younger women, and in those with multiple gestations (twins, triplets, etc).

Because a few other conditions can mimic hyperemesis, diagnosis involves examination and tests to rule out thyroid disease, gastrointestinal disorders, and molar pregnancy.

Treatment, involving rest, dietary changes, intravenous fluids, and medications to reduce vomiting, can help reduce the severity and frequency of symptoms. In severe cases, hospitalization and intravenous liquid nutrition is recommended. Most women's symptoms go away by about 16 weeks (four months) of pregnancy. Fortunately, the fetus does well and rarely suffers consequences.

Ectopic Pregnancy

Ectopic pregnancy (tubal pregnancy) is a pregnancy located outside the uterus, usually in the fallopian tubes. In rare instances, the fertilized egg may implant on the ovary, in the cervix, or within the abdomen.

What Causes Ectopic Pregnancy?

Ectopic pregnancy is primarily caused by tubal scarring from pelvic infection, such as PID (pelvic inflammatory disease), chlamydia, previous surgery such as tubal ligation, and endometriosis. Because chlamydia, a common sexually transmitted disease, can cause a "silent" infection (without symptoms), many women will not know that they have had a past infection and are at risk for an ectopic pregnancy. About 1% of pregnancies are ectopic.

The fallopian tubes are narrow, about the size of pencil lead, and cannot hold a growing pregnancy for an extended period of time. As the pregnancy grows, the tube stretches and eventually bursts. Life-threatening internal bleeding can occur. A woman may feel pain or faint, but have little or no external bleeding. About 50 women die each year in the from ruptured, ectopic pregnancies.

How Is Ectopic Pregnancy Diagnosed?

Diagnosis is accomplished by a pelvic exam, lab tests, ultrasound examination, and possibly a diagnostic laparoscopy or dilation and curettage or D and C (dilating the cervix and scraping the uterine lining) and/or culdocentesis (aspirating fluid through a needle inserted into the pelvis through the vagina).

Symptoms of ectopic pregnancy include pain, faintness, and slight bleeding from the vagina.

How Is Ectopic Pregnancy Treated?

Surgery is sometimes required to remove the abnormal pregnancy, especially if the tube has ruptured and there are signs of internal bleeding. If the ectopic pregnancy is small and there are no signs of internal bleeding, it may be dissolved using a methotrexate injection, a highly effective chemotherapy drug.

Can I Get Pregnant After Having an Ectopic Pregnancy?

Once a woman has had an ectopic pregnancy, she is at increased risk to have another one. However, if the fallopian tubes