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Pregnancy Complications Explained

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Pregnancy is a joyous and exciting time for women, and, as a general rule, is a healthy state to be in. However, there is potential for complications and disease to affect mother or the developing baby which can be threatening. This is the reason for regular assessment by an antenatal practitioner and tests to rule out or monitor these conditions.

Miscarriage & Stillbirth

Some pregnancies have an early demise and have the sad outcome of loss of the unborn baby. A miscarriage is any loss prior to viability which is at 22 weeks. Death of the foetus after 22 weeks is termed as a still birth.

Miscarriage is the most common in the 1st trimester of pregnancy, where it is the sad outcome of up to a fifth of pregnancies. Miscarriage can be for a number of unforeseen and sometimes unknown reasons but it can be due to a fatal genetic defect in the foetus, poor implantation or a reaction in utero. Miscarriage can happen to any woman, and whilst a very painful and disappointing event, does not often mean it will occur again or there is a problem with either partner. If a woman experiences 3 or more consecutive miscarriages she should see a specialist for investigations.

Pre-eclampsia

This is a complex yet relatively common complication of the latter stages of pregnancy that can be threatening to both mother and baby.

A problem with the placenta (the organ which connects mother and baby in the uterus) causes the mother to develop high blood pressure and kidney problems (which causes protein to be shed in the urine) as well as swelling and headaches. This makes the mother at more risk of seizures, coma and even brain damage or death.

Whilst pre-eclampsia may present silently to a woman, the Doctors & midwives will be meticulous in checking for subtle signs such as rising blood pressure or protein in the urine. Other signals may be headache, increasing abdominal pain, twitchiness and swelling of the arms and legs.

Managing this condition appropriately is critical & dependent on the situation; a woman may need close monitoring, medications to decrease blood pressure, and, if the baby has grown sufficiently, early inducement to deliver the baby safely to avoid harm.

Pregnancy Hypertension

Separate from pre-eclampsia, this is when a pregnant woman’s blood pressure rises during pregnancy, which can lead to problems with the function of the placenta and growth of the baby. Monitoring and potentially treating the woman’s blood pressure is key.

Gestational Diabetes

Some women are more susceptible to developing diabetes in pregnancy. For some reason a pregnant woman’s ability to store glucose is compromised since her body can become intolerant to her body’s insulin. The result is the woman will have higher than normal circulating blood glucose; the risk of this in pregnancy is excess growth of the baby, leading to issues at the time of delivery, increased chance of intervention which is threatening to mother and baby.

Gestational diabetes is checked for in all pregnant women at 28 weeks with an oral glucose tolerance test. If positive a woman will be advised to modify her diet and check her blood glucose at home before and after meals. If the blood glucose remains high a woman may need to be placed on insulin for the remainder of the pregnancy.

Preterm Birth

Any baby delivered prior to 36 weeks is classed as preterm. Since the baby goes through very important growth, neurological, immune, lung and other organ development in the latter weeks of pregnancy, preterm delivery is a very risky problem for the health of the baby.

Some women can go into preterm labour due to a number of factors such as development of an infection, having twins or triplets etc. Obstetricians will try to stabilise the labour and stall the delivery for as long as possible so the baby is as developed as possible and for the opportunity of giving the woman steroidal medication to assist with the baby’s lung maturation.

However, a preterm baby, especially one born prior to 33 weeks is very vulnerable to illness such as respiratory failure and infections as well as will have troubles feeding. For this reason a premature baby will need to be placed in an incubator with close monitoring in a neonatal unit.

Rhesus Isoimmunisation

This is a complex issue that can arise since the mother’s antibodies could reject a developing baby due to her blood group/rhesus status.

Specifically a woman who has a ‘rhesus negative’ blood group has no rhesus D protein on her blood cells. Since being rhesus negative is rare, it is more than likely the baby will have rhesus D protein (be ‘rhesus positive’) which is inherited from the father’s genes. When the pregnant woman’s blood comes into contact with the baby’s it is highly likely her body could mount an immune antibody response to the baby’s blood/rhesus D protein, consequently leading to the mother’s blood ‘attacking’ the baby’s blood at a subsequent exposure (which may be a second pregnancy). Such an immune attack can be catastrophic, leading to miscarriage, stillbirth or severe anaemia of the baby.

To avoid such a problem every woman should have her blood group checked and logged. When any potential exposure to the baby’s blood (e.g. miscarriage, significant bleeding, intervention etc) occurs a rhesus positive woman should receive an injection of rhesus D antibody (which acts to soak up stray rhesus D protein). It is also common protocol to automatically give every rhesus negative pregnant woman anti D injections at 28 and 30 weeks too.

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