Alright, folks, we’re diving straight into the nitty-gritty of pregnancy – the real talk, no sugar-coating. Bringing life into the world is no cakewalk, and sometimes, it’s more like a roller coaster ride with unexpected loops. In this guide, we’re peeling back the layers of the top 19 obstetrical complications. Forget the textbook jargon; we’re talking real-life challenges, surprises, and everything in between.
Hold Your Hats – We’re in for a Wild Ride!
Before we plunge into the complications, let’s set the stage. This is like the sneak peek before the main event:
- Ever heard of pregnancy-induced diabetes? Brace yourselves for gestational diabetes.
- Blood pressure going off the charts during pregnancy? Meet the sneak attack called preeclampsia.
- Placenta causing some chaos? Enter the world of placenta previa.
Enough with the teasers – let’s roll up our sleeves and get elbow-deep into the top 19 obstetrical complications. It’s about to get real, folks!
What are Obstetrical Complications?
Obstetrical complications taking place during pregnancy are rare, but they can and do happen during any stage of pregnancy. Obstetrical complications can be divided into three types on the basis of their occurrence time: during the first trimester, in later pregnancy, and when the baby is ready for birth. Obstetrical complications during pregnancy, taking place in the first trimester, generally end in miscarriage. An estimation done by some doctors states that nearly 10 to 15% of conceptions fail to undergo proper implantation. It can be difficult at this pregnancy stage to differentiate between implantation bleeding and a failed conception.
Pregnancy-related obstetrical complications can often be managed for the remainder of the pregnancy. These obstetrical complications may include a baby that is small and immature for its gestational age or placental problems. In the final stage of complications related to obstetrics, by the time the baby is ready for birth, there can be numerous problems that can block the path of the baby through the birth canal. These obstetrical complications include: placenta previa, shoulder dystocia, etc.
Abruptio placentae is a type of obstetrical complication, also known as placental abruption, that takes place when the placental lining gets abnormally separated from the mother’s uterus after 20 weeks of the gestational period and prior to giving birth to the child. Sudden pain in the uterus, tenderness in the abdomen, occasional vaginal bleeding, and unstoppable contractions are some of the symptoms of this complication. Amniotic Fluid Embolism is a very rare type of obstetrical complication that occurs due to the entry of amniotic fluid, fetal cells, hair, or other debris into the mother’s blood stream through the uterine placental bed, leading to an allergic reaction.
Eclampsia is a toxic condition that occurs during or shortly after pregnancy. This is a serious pregnancy-related complication that is defined by convulsions and sometimes even coma. The relationship between erythrocyte alloimmunization and pregnancy takes place when the pregnant woman’s immune system gets sensitized and reacts to foreign erythrocyte surface antigens. This problem is also known as maternal isoimmunization or alloimmunization. The importance of the evaluation of fetal death is to try and ensure a safe and healthy pregnancy.
Related: Your Pregnancy Symptoms Week by Week
Vanishing Twin Syndrome
Vanishing twin syndrome occurs when a fetus dies in the utero and is completely or partially reabsorbed by the mother during a multi-gestational pregnancy. Vanishing twin syndrome is the detection of a multifetal gestation with the consequent disappearance of one or more fetuses. Except for first trimester vaginal bleeding, there are generally no further problems seen during pregnancy when the fetus is completely absorbed by the mother. On the other hand, if this phenomenon takes place in the second or third trimester, there may be severe complications such as infection caused by the demise of the fetus, premature labor, and hemorrhage.
The incidence of multifetal gestation at conception is higher than the occurrence noted during birth. Since the use of ultrasonography, cases of vanishing twin syndrome have been diagnosed more regularly. The incidence of a vanishing twin is also sometimes referred to as “twin embolization syndrome.” In vitro fertilization techniques have led to a better appreciation of the vanishing twin syndrome. By using these techniques, the pregnancies are closely monitored, and you can also detect the number of implanted fertilized eggs. Vanishing twin syndrome takes place in 21–30% of multifetal gestation and may not even be detected in most cases.
The causes of vanishing twin syndrome are frequently unknown; however, this condition may be more common in fetuses with chromosomal or genetic deformities. In some cases, inappropriate cord implantation may also be one of the causes of vanishing twin syndrome. Research has shown that women over 30 years of age are at a higher risk of facing vanishing twin syndrome. Also, this syndrome occurs frequently in monozygotic and dizygotic twins. The complications related to sharing a placenta between monochorionic monozygotic twins can also result in the condition.
Through ultrasonography, doctors can diagnose an early twin pregnancy, and with a follow-up ultrasound, the pregnancy loss is detected.
Other tests are performed after the diagnosis of vanishing twin syndrome. In cases of vanishing twin syndrome, proper medical care is prescribed, and the mother is closely monitored. There is no special medical care necessary for uncomplicated cases of vanishing twin syndrome. The living twin ought to receive specialized medical care after a proper examination. There are a number of complications related to the vanishing twin syndrome. Some of these complications include cerebral palsy, associated congenital anomalies, and cutis aplasia.
Abruptio placentae, commonly known as placental abruption, is a pregnancy complication where the lining of the placenta gets separated from the uterus of the mother. Abruptio placentae is the most common cause of late pregnancy bleeding. Generally, placental abruption refers to the abnormal separation after 20 weeks of the gestation period and before childbirth. This complication of pregnancy occurs in 1% of pregnancies throughout the world, with a fetal mortality rate of 20 percent to 40 percent, depending on the separation degree of the placenta. Placental abruption also contributes significantly to maternal mortality. The severity of the abruption can also affect the heart rate of the fetus.
Symptoms of Abruptio Placentae
The four common and major symptoms of abruptio placentae include:
- Pain in the uterus
- Occasional vaginal bleeding
- A feeling of tenderness in the abdomen
- Unstoppable contractions.
The patient may exhibit all or some of the symptoms and signs associated with placental abruption.
Risk Factors for Abruptio Placentae
Some of the relevant risk factors for placental abruption are as follows:
- Maternal trauma like falls, motor vehicle accidents, nosocomial infections, or assaults
- Maternal hypertension, a major factor in 44% of all placental abruptions
- Use of drugs is also a factor, especially cocaine, tobacco, and alcohol
- The umbilical cord shortens
- Retroplacental fibromyoma
- Prolonged rupture of membranes
Previous abruptions can also pose a risk. If the woman underwent an abruption in her previous pregnancies, then she is at greater risk. Another risk factor is maternal age. Pregnant women younger than 20 years or older than 35 years, are at greater risk.
These risk factors for placental abruption can be effectively reduced by eating a healthy diet rich in folic acid, not smoking or drinking alcohol, and maintaining regular sleep patterns.
Symptoms of Uterine Rupture in Pregnancy
The first symptom of a uterine rupture is generally an abnormality in the heart rate of the baby. This is the reason why a woman undergoing a vaginal birth after a previous cesarean, or VBAC, requires constant fetal monitoring. The other symptoms of uterine rupture in pregnancy seen in a mother may include abdominal pain, a rapid pulse, vaginal bleeding, and signs of shock. The mother may also experience pain in her chest as a result of irritation to the diaphragm due to internal bleeding.
Causes of Uterine Rupture in Pregnancy
There are various causes that result in uterine rupture in pregnancy. One of the most common risk factors is a uterine scar from a previous cesarean delivery. Studies have estimated that women who have had one c-section with the characteristic low-transverse uterine incision face less than one percent risk of uterine rupture during pregnancy. On the other hand, women are at a much higher risk of rupture if they have a classical c-section, whereby the incision is made vertically to the upper part of the uterus.
Another cause for uterine rupture in pregnancy is an earlier uterine surgery, like an operation to remove fibroids, repair a previous rupture, or even correct a misshapen uterus. Other than prior uterine surgery, there are also other factors that may lead to a rupture in the uterus during pregnancy. These include having had over five full-term pregnancies or being a woman with an overdistended uterus. The use of Pitocin and other labor-inducing medications such as prostaglandins can also increase the risk of uterine rupture in pregnancy.
Amniotic Fluid Embolism
Amniotic fluid embolism (AFE) is a rare and incompletely understood type of obstetric emergency. In this obstetrical complication, amniotic fluid, hair, fetal cells, or other debris enters the bloodstream of the mother via the placental bed of the uterus and activates an allergic reaction. This allergic reaction then leads to cardiorespiratory (heart and lung) collapse and coagulopathy. Amniotic fluid embolism was first formally described in 1941. This pregnancy problem ranks as #5 on the list of causes of maternal mortality.
Causes of Amniotic Fluid Embolism (AFE)
Most agree that this obstetric emergency condition is caused by the entry of amniotic fluid into the uterine veins, and there are three prerequisites for this condition to occur. These three prerequisites are: a pressure gradient from the uterus to the veins; ruptured cervical or uterine veins; and ruptured amniotic sac membranes. Even if exposure to fetal tissue is quite common and detecting fetal tissue within the maternal circulation is not so significant, still, in a small percentage of women, this very exposure can lead to a complex chain of events that eventually result in collapse and even death. There is some evidence stating that amniotic fluid embolism can be related to abdominal trauma.
Phases of Amniotic Fluid Embolism
This condition is so rare that most doctors and gynecologists do not get the opportunity to encounter it in their medical careers, and so the exact process of this problem remains poorly understood. However, it is considered that once the entry of the fluid and fetal cells takes place in the maternal pulmonary circulation, a two-phase process happens:
The patient with amniotic fluid embolism suffers from acute shortness of breath paired with hypotension. This state rapidly progresses, leading to cardiac arrest since the heart chambers fail to dilate and there is a reduction in the level of oxygen reaching the lungs and the heart.
Not long after this phase, the patient will pass into a coma. In this case, 50% of patients die within the first hour of symptoms.
Though many patients fail to survive beyond the first stage of amniotic fluid embolism, around 40% of the initial survivors pass onto the second phase. This phase is known as the hemorrhagic stage and can be followed by severe coughing, shivering, the sensation of a bad taste in the mouth, vomiting, and excessive bleeding as the blood loses its capability of clotting. Cardiovascular collapse progresses to fetal distress and death until the child is swiftly delivered.
A boon for any woman is the gift of procreation, and as a result, pregnancy is always a pure joy for the expecting mother. A breach in this that results in fetal death is therefore always cause for concern for both the mother and the physician. As a result, medical researchers place a high value on evaluating fetal deaths, which could be a sign of a sneaky disease hunting the new mother’s anatomy. In an effort to distinguish between early pregnancy loss, or natural abortion, and abortion in the late stage of pregnancy, there is a greater emphasis on the evaluation of fetal death so that the fatal demise of the fetus can be checked. In the United States, there are nearly 6.9 fetal deaths per 1000 births. This figure is, however, much higher if global numbers are considered.
In the strictest sense of the term, “fetal death” is actually the state when there is a termination of pregnancy before the expulsion of the fetus. In this context, induced abortion does not come under the purview of natural fetal death. The importance of evaluating a fetal death is that, through a meticulous study and analysis of such facts, obstetricians and gynecologists try to ensure a safer and healthier pregnancy. Evaluation of fetal death is therefore particularly effective when simple steps are followed to prevent such an unfortunate consequence.
Causes of Untimely Fetal Death
There could be several causes that lead to the untimely death of the fetus. Natural abortion can occur for a variety of reasons, including systemic lupus erythematosus, eclampsia, infection, hemoglobinopathy, maternal and paternal age factors, prolonged pregnancy, maternal hypertension, and cord accident, to name a few. Doctors study the various reasons for fetal death in a woman, so that they can prescribe remedial measures to curb such a disaster.
Diagnosis for Evaluating Fetal Death
The death of a fetus is diagnosed medically by viewing the fetal heart and meticulously studying the cardiac activity. This is medically confirmed through an ultrasonography of the woman’s lower abdomen.
Medical Management Post Fetal Death
There should be no delay in seeking medical expertise as soon as the evaluation of fetal death is done. In the event that the dead fetus remains in the uterus for more than 4 days, it could lead to coagulopathy, which could be fatal for the mother as well. In the event that a natural abortion occurs, doctors operate on the woman’s cervix to expel the dead fetus.
Apart from drugs that relieve physical pain, the woman also requires a lot of love and understanding from her close ones.
Fetal Growth Restriction
Fetal growth restriction, also known as intrauterine growth restriction, or IUGR, is a major cause of pregnancy complications. In cases of such an abnormality, the mother gives birth to a baby that is smaller than the optimum size. According to medical research, fetal growth restriction is not only common in developing nations but also occurs in the richer and more developed nations of the world.
Definition of IUGR: According to medical practitioners, fetal growth restriction is the state where the baby stops growing at the desired pace, while it is inside the uterus. Mothers experiencing IUGR give birth to babies not only with a reduced weight but also with a reduced height, and in extreme cases, there are anatomical deformations as well. It is significant to note, that not all small babies are the result of IUGR. According to doctors, only one-third of small babies are the result of IUGR.
Fetal Growth Restriction Causes
There could be a variety of causes for intrauterine growth restriction. Apart from congenital defects and genetic disorders, there could also be other reasons for such a state. For instance, mothers suffering from acute infections, high blood pressure, and hypertension are more susceptible to such a disorder. Pregnant women who are open to drinking, using drugs, and smoking have a high possibility of experiencing fetal growth restriction. In such an abnormal state, the placenta is affected. Apart from these, there could also be idiopathic reasons behind IUGR.
Diagnostic Tests to Prove Fetal Growth Restriction
In order to ensure a normal birth of a baby, doctors conduct medical tests, to check on the growth of the fetus in the placenta. Exams like an ultrasound are effective in determining the size of the baby’s head, abdomen, and legs. Apart from these, fetal monitoring is also used to constantly check the growth of the fetus.
Precautions for IUGR
A few handy steps, if followed religiously, can definitely avoid such situations or complications during pregnancy. One of the primary checkpoints is to stop smoking or drinking during this period. Apart from this, it is important to undergo regular tests, so that doctors can detect such a situation well in advance.
Another important thing is to take enough rest while you are carrying.
Malposition of the Uterus
Reproduction is not only a blessing in the life of a woman; it is also one of the most complex physiological processes in the human body. A slight complication in any of the gynecological organs, can lead to a severe obstetrical disorder, which might have many dire consequences. Malposition of the uterus is one such condition in which the female body has to encounter several problems, including complications during pregnancy. Also known as uterine retroversion, most modern gynecologists these days feel that malposition of the uterus is not a disease but a normal variant that might take place in a small percentage of the female population. It has been medically proven that almost 1 out of 5 women, who have never been pregnant is thought to have a uterine malposition. However, malposition of the uterus is quite common in pregnant women.
Causes for Malposition of the Uterus
According to medical research, the reason for uterine incarceration is not exactly known. There could be both congenital factors and acquired conditions as well. However, some conditions responsible for malposition of the uterus are chronic salpingitis with pelvic adhesions, pelvic congestion, or Allen-Masters syndrome, Müllerian anomalies, and endometriosis with adhesions.
Diagnosis of Malposition of the Uterus
In the case of a non-pregnant woman, a pelvic examination is the most authentic way to diagnose uterine retroversion. In the case of a pregnant woman, the test is done during the early part of the third trimester. Malposition of the uterus can be both simple and complicated. In the case of a normal uterine malposition, there are no grave manifestations in the body.
Symptoms of Malposition of the Uterus
The manifestations of uterine malposition can be varied. Only in some cases could there be gross problems related to pregnancy and conception. Other than that, some common effects of such a normal variation include discomfort or pain in the pelvic region, difficulties related to the urinary system, menstrual problems, infertility, natural abortion, constipation, etc. Malposition of the uterus in a non-pregnant woman has almost the same discomforting features as a woman experiences during pregnancy.
Treatment of Malposition of the Uterus
If the condition is just a case of normal variation, physicians generally do not recommend any drugs.
But if such a retroversion of the uterus leads to severe manifestations, in that case, therapies like drainage of the bladder by using a catheter are recommended. Other treatments include surgical replacement and colonoscopic manipulation, just to name a few.
The placenta is the round organ that feeds the fetus nutrients through the umbilical cord. Placenta previa is a condition when the placenta is located lower in your uterus. In this condition, the placenta either lies near the cervix or covers it.
Causes of Placenta Previa
Usually, with the progress of pregnancy, the low-lying placenta travels upward, and by the third trimester, it is ideally at the top of the uterus. Sometimes it may happen that it remains in the lower parts, on or near the cervix. Placenta previa can occur as a result of uterine fibroids or if the mother has had fibroids surgically removed. Abnormal development of the uterus, multiple pregnancies, uterine surgery, abortions, late pregnancy, smoking, and a scarred lining of the uterus are causes for incurring placenta previa.
Types of Placenta Previa
There are three types of placenta previa, depending on the position occupied by the placenta. The types are:
- Marginal – the placenta covers the side of the cervix without blocking it
- Partial – the cervical opening is partially covered by the placenta
- Complete – cervical opening is completely covered by the placenta
Placenta Previa Symptoms
Vaginal bleeding in the second half of pregnancy is one of the primary signs of placenta previa. Contractions and cramps have also been observed in certain cases. The bleeding usually occurs in the second trimester or early in the third trimester. The diagnosis of placenta previa is made through ultrasound taken during the late second trimester or early third trimester.
Treatment for Placenta Previa
There are many factors that are taken into consideration before chalking out a treatment plan.
The amount of vaginal bleeding and whether it has stopped is one of the many things that are observed. How far along you are in your pregnancy, the condition of the mother, and the health of the baby also need to be taken into account. The course of treatment is determined by the position of the fetus and the placenta.
- Complete bed rest at home
- Hospitalization until delivery
- Premature delivery through C-section
Are some of the treatment methods used depending on the condition? Usually, if the bleeding fails to cease, an emergency C-section is undertaken. If the placenta does not cover the cervix and the bleeding is not heavy, vaginal delivery may be attempted.
Placenta Previa Prognosis
The prognosis is good as, in most cases, the condition is discovered well before it poses a threat to mother and child. Most risks can be avoided with adequate rest and, in most cases, C-section delivery. In the event of excessive vaginal bleeding, you may be forced to have a C-section.
The condition of excessive bleeding that occurs after the birth of a baby is known as postpartum hemorrhage. In cases of C-section delivery, the possibility of this hemorrhage occurring is greater. Mostly, this occurs directly after delivery, but it may occur later on as well. The first 24 hours after birth is the most likely time for the hemorrhage to occur. This is termed primary postpartum hemorrhage after the first 24 hours; if a hemorrhage occurs in the next 24 hours, then it is called secondary postpartum hemorrhage.
Postpartum Hemorrhage Causes
Normally, in a vaginal birth, the amount of blood that is lost is about 500 mL. In a C-section, the amount of blood lost is close to 100 mL. The amount of blood that flows through the placenta in a full-term pregnancy is approximately 600 mL per minute. After delivery, the uterus contracts and the placenta is expelled. While the uterus is contracting, it compresses the blood vessels that were attached to the placenta. If these blood vessels are not properly compressed by the uterus, bleeding occurs. Hemorrhage occurs when blood flows freely without resistance. If some parts of the placenta are left, this also causes bleeding. The most common cause of postpartum hemorrhage is uterine contraction failure.
Risk Factors for Postpartum Hemorrhage
Risk factors merely increase the possibility of their occurrence. Possessing one of the risk factors does not necessarily mean that you will have this problem; it merely implies that you are more prone to it. These are not the causes of postpartum hemorrhage.
- Placental abruption – when the placenta gets detached from the uterus before time
- Pregnancy induced hypertension
- Long labor
- Multiple pregnancy
are some of the factors that can trigger hemorrhage. Another condition that increases the risk of postpartum hemorrhage is if the amniotic fluid is higher or if the baby is larger. Placenta previa, medication during labor, a tear in uterine blood vessels or vaginal tissues, placenta acreta, placenta increta, and placenta percreta are some other risk factors for this hemorrhage to occur.
Postpartum Hemorrhage Symptoms
Uncontrolled bleeding, lowered blood pressure, an increase in heart rate, swelling and aches in the vaginal or perineal areas or both, and a decrease in the count of red blood cells. These are some of the signs that indicate postpartum hemorrhage.
Postpartum Hemorrhage Treatment
- Manual massage of the uterus
- Examination of the pelvic tissues
- Sponges and sterile materials laced inside the uterus
- Removal of remaining placental pieces
Premature Rupture of Membranes
Premature Rupture of Membranes occurs in patients who are in the 37th week of gestation and have a ruptured membrane. This happens at the onset of labor. Preterm premature rupture of membranes occurs when the rupture occurs before 37 weeks of pregnancy. The latter occurs in only 2% of pregnancies, whereas premature membrane rupture occurs in 10% of pregnancies.
Causes of Premature Rupture of Membranes
The force of contractions and the weakening of the membrane are two of the main causes of premature rupture of membranes. Many other factors can contribute to this condition, including:
- Social problems
- Economic troubles
- Low body weight
- Previous preterm delivery
- Sexually transmitted diseases such as chlamydia and gonorrhea
- Vaginal bleeding
Young mothers are often anxious about delivery. This may also lead to the occurrence of this condition. Lack of care, troubled surroundings together may lead to these complications.
Erythrocyte Alloimmunization and Pregnancy
The relationship between erythrocyte alloimmunization and pregnancy is that a pregnant woman can suffer from this ailment, which takes place when the immune system of a woman gets sensitized to foreign erythrocyte surface antigens. Erythrocyte alloimmunization is also known as maternal alloimmunization or isoimmunization. This stimulates the production of immunoglobulin G (IgG) antibodies. In this relationship of erythrocyte alloimmunization and pregnancy, the most common routes of maternal sensitization take place via fetomaternal hemorrhage (the transplacental passage of fetal erythrocytes) or blood transfusion that is associated with trauma, spontaneous or induced abortion, delivery, invasive obstetric procedures, or ectopic pregnancy.
The immunoglobulin G (IgG) antibodies can cross the placenta of the pregnant woman during pregnancies in alloimmunized women, and, if the fetus reacts positively to the erythrocyte surface antigens, the result will be hemolysis of fetal erythrocytes and anemia. This, in turn, can progress to potentially disastrous effects for the fetus, like a high-output cardiac failure syndrome known as hydrops fetalis.
Causes of Erythrocyte Alloimmunization
Blood transfusions can be one of the major causes of erythrocyte alloimmunization in pregnant women. Fetomaternal hemorrhage also causes maternal alloimmunization. There are two types of fetomaternal hemorrhage: antepartum, and intrapartum. If a woman undergoes spontaneous or therapeutic abortions, she may fall victim to erythrocyte alloimmunization. Placental abruption can also be a cause of this problem, thus establishing a relationship between erythrocyte alloimmunization and pregnancy.
Ectopic pregnancy can be one of the risk factors giving rise to the obstetrical complication of maternal alloimmunization. If the woman undergoes abdominal trauma, then there are also chances of erythrocyte alloimmunization. Other obstetric procedures like amniocentesis, external cephalic version, chorionic villus sampling (CVS), manual removal of the placenta, and percutaneous umbilical blood sampling can be the causes of erythrocyte alloimmunization.
Several types of predictive measures are currently available for estimating the severity of this fetal disease.
Some of these include: perinatal ultrasonography for assessing the well-being of the fetus and identifying findings consistent with hydrops (like effusions, ascites, and edema), amniotic fluid spectrophotometric measurements of bilirubin for estimating the degree of anemia and hemolysis, Doppler ultrasonography for measuring the velocity of the blood flow occurring in the fetal middle cerebral artery as an anemia index, and fetal blood sampling (FBS) or percutaneous umbilical blood sampling (PUBS) for directly measuring the fetal hematocrit.
The treatment of recently recognized erythrocyte alloimmunization accompanied by intraumbilical transfusions is considered to be tougher and is more often connected to other complications.
In conclusion, obstetrical complications can be a serious concern for expecting mothers. However, with proper care and attention from healthcare professionals, these complications can often be prevented or managed effectively. Expecting mothers should always stay informed about the potential risks and symptoms, and should not hesitate to seek medical attention if they suspect a complication. Remember, a proactive approach to obstetrical care is the best way to ensure a safe and healthy pregnancy for both mother and baby. So, let’s work together to ensure the best outcome for all.