Complications of pregnancy

Complications of pregnancy
Classification and external resources
Specialty obstetrics
ICD-10 O00-O48
ICD-9-CM 630-648
MeSH D011248

Complications of pregnancy are health problems that are caused by pregnancy. There is no clear distinction between complications of pregnancy and symptoms and discomforts of pregnancy. However, the latter do not significantly interfere with activities of daily living or pose any significant threat to the health of the mother or baby. Still, in some cases the same basic feature can manifest as either a discomfort or a complication depending on the severity. For example, mild nausea may merely be a discomfort (morning sickness), but if severe and with vomiting causing water-electrolyte imbalance it can be classified as a pregnancy complication (hyperemesis gravidarum).

In the immediate postpartum period, 87% to 94% of women report at least one health problem.[1][2] Long term health problems (persisting after 6 months postpartum) are reported by 31% of women.[3] Severe complications of pregnancy are present in 1.6% of mothers in the US[4] and in 1.5% of mothers in Canada.[5] The relationship between age and complications of pregnancy are now being researched with greater impetus.[6]

In 2013, complications of pregnancy resulted globally in 293,000 deaths down from 377,000 deaths in 1990. The most common causes include maternal bleeding, complications of abortion, high blood pressure of pregnancy, maternal sepsis, and obstructed labor.[7]

Maternal problems

The following problems originate mainly in the mother.

Gestational diabetes

Gestational diabetes is when a woman without diabetes develops high blood sugar levels during pregnancy.

Hyperemesis gravidarum

Hyperemesis gravidarum is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common morning sickness and is estimated to affect 0.5–2.0% of pregnant women.[8][9]

Pelvic girdle pain

High blood pressure

Potential severe hypertensive states of pregnancy are mainly:

Deep vein thrombosis

Deep vein thrombosis (DVT) has an incidence of 0.5 to 7 per 1,000 pregnancies, and is the second most common cause of maternal death in developed countries after bleeding.[16]

Anemia

Levels of hemoglobin are lower in the third trimesters. According to the United Nations (UN) estimates, approximately half of pregnant women suffer from anemia worldwide. Anemia prevalences during pregnancy differed from 18% in developed countries to 75% in South Asia.[17] Treatment varies due to the severity of the anaemia, and can be used by increasing iron containing foods, oral iron tablets or by the use of parenteral iron.

Infection

A pregnant woman is more susceptible to certain infections. This increased risk is caused by an increased immune tolerance in pregnancy to prevent an immune reaction against the fetus, as well as secondary to maternal physiological changes including a decrease in respiratory volumes and urinary stasis due to an enlarging uterus.[18] Pregnant women are more severely affected by, for example, influenza, hepatitis E, herpes simplex and malaria.[18] The evidence is more limited for coccidioidomycosis, measles, smallpox, and varicella.[18] Mastitis, or inflammation of the breast occurs in 20% of lactating women.[19]

Some infections are vertically transmissible, meaning that they can affect the child as well.

Peripartum cardiomyopathy

Peripartum cardiomyopathy is decrease in heart function which occurs in the last month of pregnancy, or up to 6 months post-pregnancy. It increases the risk of congestive heart failure, heart arrhythmias, thromboembolism, and cardiac arrest.[20]

Fetal and placental problems

The following problems occur in the fetus or placenta, but may have serious consequences on the mother as well.

Ectopic pregnancy

Ectopic pregnancy is implantation of the embryo outside the uterus

Miscarriage

Miscarriage is the loss of a pregnancy prior to 20 weeks.[21]

Placental abruption

Placental abruption is separation of the placenta from the uterus.

Placenta praevia

Placenta praevia is when the placenta fully or partially covers the cervix.

Multiple pregnancies

Main article: Multiple birth

Multiples may become monochorionic, sharing the same chorion, with resultant risk of twin-to-twin transfusion syndrome. Monochorionic multiples may even become monoamniotic, sharing the same amniotic sac, resulting in risk of umbilical cord compression and entanglement. In very rare cases, there may be conjoined twins, possibly impairing function of internal organs.

Vertically transmitted infection

Further information: Neonatal infection

The embryo and fetus have little or no immune function. They depend on the immune function of their mother. Several pathogens can cross the placenta and cause (perinatal) infection. Often microorganisms that produce minor illness in the mother are very dangerous for the developing embryo or fetus. This can result in spontaneous abortion or major developmental disorders. For many infections, the baby is more at risk at particular stages of pregnancy. Problems related to perinatal infection are not always directly noticeable.

The term TORCH complex refers to a set of several different infections that may be caused by transplacental infection.

Babies can also become infected by their mother during birth. During birth, babies are exposed to maternal blood and body fluids without the placental barrier intervening and to the maternal genital tract. Because of this, blood-borne microorganisms (Hepatitis B, HIV), organisms associated with sexually transmitted disease (e.g., Gonorrhoea and Chlamydia), and normal fauna of the genito-urinary tract (e.g., Candida) are among those commonly seen in infection of newborns.

Complications following childbirth

Haemorrhage

Main article: Postpartum bleeding

Postpartum haemorrhage is blood loss following childbirth.

Perineal tearing

Perineal tearing is the spontaneous (unintended) tearing of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tearing occurs in 85% of vaginal deliveries.[22] At 6 months postpartum, 21% of women still report perineal pain[3] and 11-49% report sexual problems or painful intercourse.[3]

Incontinence

Urinary incontinence and fecal incontinence have been linked to all methods of childbirth, with the incidence of urinary incontinence at 6 months postpartum being 3-7% and fecal incontinence 1-3%.[3]

Postpartum depression

Postpartum depression is a moderate to severe depressive episode starting anytime during pregnancy or within the four weeks following delivery. It occurs in 4-20% of pregnancies, depending on its definition.[3] In 38% of the cases of postpartum depression, women are still depressed 3 years postpartum.[23] In 0.2% of pregnancies, postpartum depression leads to psychosis.[24]

Posttraumatic stress disorder

Research indicates that 13.6% of women suffer from symptoms of Posttraumatic stress disorder at 6 months postpartum.[25]

General risk factors

Factors increasing the risk (to either the woman, the fetus/es, or both) of pregnancy complications beyond the normal level of risk may be present in a woman's medical profile either before she becomes pregnant or during the pregnancy.[26] These pre-existing factors may relate to physical and/or mental health, and/or to social issues, or a combination.[27]

Some common risk factors include:

High-risk pregnancy

Some disorders and conditions can mean that pregnancy is considered high-risk (about 6-8% of pregnancies in the USA) and in extreme cases may be contraindicated. High-risk pregnancies are the main focus of doctors specialising in maternal-fetal medicine.

Serious pre-existing disorders which can reduce a woman's physical ability to survive pregnancy include a range of congenital defects (that is, conditions with which the woman herself was born, for example, those of the heart or reproductive organs, some of which are listed above) and diseases acquired at any time during the woman's life.

Low-risk pregnancy

A Dutch 2010 research showed that "low-risk" pregnancy in the Netherlands may actually carry a higher risk of perinatal death than a "high-risk" pregnancy.[35]

See also

References

  1. Glazener CMA, Abdalla M, Stroud P, Naji S, Templeton A, Russell IT. Postnatal maternal morbidity: Extent, causes, prevention and treatment. Br J Obstet Gynaecol 1995; 102:282–7.
  2. Thompson JF, Roberts CL, Currie M, Ellwood DA. Prevalence and persistence of health problems after childbirth: Associations with parity and method of birth. Birth 2002; 29:83–94.
  3. 1 2 3 4 5 Borders, N. (2006). After the afterbirth: a critical review of postpartum health relative to method of delivery. Journal of Midwifery & Women's health, 51(4), 242-248.
  4. Bajwa, Haripriya. "Pregnancy in Women Above Age 35: An Emerging Concern for the Health Sector". Journal of Innovation for Inclusive Development. 1.
  5. GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet. 385: 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604Freely accessible. PMID 25530442.
  6. Summers, A (July 2012). "Emergency management of hyperemesis gravidarum.". Emergency nurse. 20 (4): 24–28. doi:10.7748/en2012.07.20.4.24.c9206. PMID 22876404.
  7. Goodwin, TM (September 2008). "Hyperemesis gravidarum.". Obstetrics and gynecology clinics of North America. 35 (3): 401–17, viii. doi:10.1016/j.ogc.2008.04.002. PMID 18760227.
  8. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence European Spine Journal Vol 13, No. 7 / Nov. 2004 W. H. Wu, O. G. Meijer, K. Uegaki, J. M. A. Mens, J. H. van Dieën, P. I. J. M. Wuisman, H. C. Östgaard.
  9. Villar J, Say L, Gulmezoglu AM, Meraldi M, Lindheimer MD, Betran AP, Piaggio G; Eclampsia and pre-eclampsia: a health problem for 2000 years. In Pre-eclampsia, Critchly H, MacLean A, Poston L, Walker J, eds. London, RCOG Press, 2003, pp 189-207.
  10. Abalos, E; Cuesta, C; Grosso, AL; Chou, D; Say, L (September 2013). "Global and regional estimates of preeclampsia and eclampsia: a systematic review.". European journal of obstetrics, gynecology, and reproductive biology. 170 (1): 1–7. doi:10.1016/j.ejogrb.2013.05.005. PMID 23746796.
  11. Haram K, Svendsen E, Abildgaard U (Feb 2009). "The HELLP syndrome: clinical issues and management. A review" (PDF). BMC Pregnancy Childbirth. 9: 8. doi:10.1186/1471-2393-9-8. PMC 2654858Freely accessible. PMID 19245695.
  12. Mjahed K, Charra B, Hamoudi D, Noun M, Barrou L (2006). "Acute fatty liver of pregnancy". Arch. Gynecol. Obstet. 274 (6): 349–353. doi:10.1007/s00404-006-0203-6. PMID 16868757.
  13. Reyes H, Sandoval L, Wainstein A, et al. (1994). "Acute fatty liver of pregnancy: a clinical study of 12 episodes in 11 patients". Gut. 35 (1): 101–106. doi:10.1136/gut.35.1.101. PMC 1374642Freely accessible. PMID 8307428.
  14. 1 2 Venös tromboembolism (VTE) — Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008
  15. Wang S, An L, Cochran SD (2002). "Women". In Detels R, McEwen J, Beaglehole R, Tanaka H. Oxford textbook of public health (4th ed.). Oxford University Press. pp. 1587–601.
  16. 1 2 3 Kourtis, Athena P.; Read, Jennifer S.; Jamieson, Denise J. (2014). "Pregnancy and Infection". New England Journal of Medicine. 370 (23): 2211–2218. doi:10.1056/NEJMra1213566. ISSN 0028-4793.
  17. Kaufmann R.; Foxman B. (1991). "Mastitis among lactating women: occurrence and risk factors". Social science & medicine. 33 (6): 701–705. doi:10.1016/0277-9536(91)90024-7. PMID 1957190.
  18. Pearson, G. D.; Veille, J. C.; Rahimtoola, S.; Hsia, J.; Oakley, C. M.; Hosenpud, J. D.; Ansari, A.; Baughman, K. L. (2000-03-01). "Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review". JAMA. 283 (9): 1183–1188. ISSN 0098-7484. PMID 10703781.
  19. "Pregnancy complications | womenshealth.gov". www.womenshealth.gov. Retrieved 2016-11-13.
  20. McCandlish, R., Bowler, U., Asten, H., Berridge, G., Winter, C., Sames, L., ... & Elbourne, D. (1998). A randomised controlled trial of care of the perineum during second stage of normal labour. BJOG: an international journal of obstetrics & gynaecology, 105(12), 1262-1272.
  21. Vliegen N.; Casalin S.; Luyten P. (2014). "The course of postpartum depression: a review of longitudinal studies". Harvard Review of Psychiatry. 22 (1): 1–22. doi:10.1097/hrp.0000000000000013.
  22. Sit D.; Rothschild A. J.; Wisner K. L. (2006). "A review of postpartum psychosis". Journal of women's health. 15 (4): 352–368. doi:10.1089/jwh.2006.15.352.
  23. Montmasson H.; Bertrand P.; Perrotin F.; El-Hage W. (2012). "[Predictors of postpartum post-traumatic stress disorder in primiparous mothers]". Journal de gynecologie, obstetrique et biologie de la reproduction. 41 (6): 553–560. doi:10.1016/j.jgyn.2012.04.010. PMID 22622194.
  24. "Health problems in pregnancy". Medline Plus. US National Library of Medicine.
  25. 1 2 3 4 5 6 Merck. "Risk factors present before pregnancy". Merck Manual Home Health Handbook. Merck Sharp & Dohme.
  26. Centers for Disease Control and Prevention. 2007. Preventing Smoking and Exposure to Secondhand Smoke Before, During, and After Pregnancy.
  27. Centers for Disease Control and Prevention. 2009. Tobacco Use and Pregnancy: Home. http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/index.htm
  28. 1 2 "New Mother Fact Sheet: Methamphetamine Use During Pregnancy". North Dakota Department of Health. Retrieved 7 October 2011.
  29. Grotta, Sheri; LaGasse, Linda; Arria, Amelia; Derauf, Chris (30 June 2009). "Patterns of Methamphetamine Use During Pregnancy: Results from the IDEAL Study". Matern Child Health J. 14 (4): 519–527. doi:10.1007/s10995-009-0491-0. PMC 2895902Freely accessible. PMID 19565330.
  30. Gavin, AR; Holzman, C; Siefert, K; Tian, Y (2009). "MATERNAL DEPRESSIVE SYMPTOMS, DEPRESSION AND PSYCHIATRIC MEDICATION USE IN RELATION TO RISK OF PRETERM DELIVERY". Women's Health Issues. 19 (5): 325–34. doi:10.1016/j.whi.2009.05.004. PMC 2839867Freely accessible. PMID 19733802.
  31. Eisenberg, Leon; Brown, Sarah Hart (1995). The best intentions: unintended pregnancy and the well-being of children and families. Washington, D.C: National Academy Press. ISBN 0-309-05230-0. Retrieved 2011-09-03.
  32. "Family Planning - Healthy People 2020". Retrieved 2011-08-18.
  33. Evers, A. C. C.; Brouwers, H. A. A.; Hukkelhoven, C. W. P. M.; Nikkels, P. G. J.; Boon, J.; Van Egmond-Linden, A.; Hillegersberg, J.; Snuif, Y. S.; Sterken-Hooisma, S.; Bruinse, H. W.; Kwee, A. (2010). "Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study". BMJ. 341: c5639. doi:10.1136/bmj.c5639. PMID 21045050.
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