Problems During Pregnancy

There are many problems that can arise during pregnancy. Some are trivial, but some can be serious.

Early Pregnancy Bleeding

There are many causes of bleeding during pregnancy. Possible causes depend upon when it occurs. If you experience bleeding early in your pregnancy, we’ll perform a pelvic exam and sonogram to determine the cause. Two serious causes of early pregnancy bleeding are miscarriage and ectopic pregnancy.

Miscarriage is the most common serious cause of early bleeding and occurs in 15-20% of all pregnancies, usually within the first three months. Most miscarriages cannot be prevented. They are nature’s way of dealing with pregnancies that are not developing properly. A miscarriage is characterized by bleeding more than a heavy period and there is usually cramping.

An ectopic pregnancy, or the fertilization of an egg outside the womb (usually in a fallopian tube), is another serious cause of early bleeding. Ectopic pregnancies occur in less than one percent of all pregnancies and are almost always associated with severe pain. Most of the bleeding is internal, which can be life-threatening because of its hidden nature.

Late Pregnancy Bleeding

Bleeding late in pregnancy can be serious, but the most common cause is “bloody show, one of the first signs of labor. This is caused by the thinning of the cervix and is usually associated with thick mucous. Cervical irritation and pelvic exams can also cause bleeding.

The most serious late-pregnancy bleeding is caused by either placenta previa or placental abruption. When these conditions occur, they are most often in the final 3 months of the pregnancy.

Placenta previa results when the placenta partially or completely covers the cervix. As your cervix thins in preparation for labor, massive bleeding occurs. The other serious cause of late bleeding, placenta abruption, occurs when the placenta prematurely detaches from the inner lining of the womb. This is usually accompanied by abdominal pain. Either condition can lead to the death of the unborn baby.

If you experience significant bleeding late in your pregnancy, you may be hospitalized for observation and evaluation. If bleeding is serious, or if fetal distress is detected by the fetal monitor, a Cesarean delivery may be required.

Most bleeding is the result of minor causes that require no treatment. It is important, however, for you to know that bleeding can indicate serious problems. You should report all bleeding to us immediately.

High Blood Pressure in Pregnancy

Fewer than ten percent of pregnant women develop high blood pressure, also known as toxemia or preeclampsia. The cause of this potentially serious condition is unknown. When changes of blood pressure are detected and treated early, the mother and the baby can avoid serious problems. If untreated, however, high blood pressure can cause permanent damage to the eyes, kidneys, brain and liver of the mother. The fetus can suffer from a lack of oxygen and nutrients which can lead to growth problems, mental retardation or even death.

Teenage mothers are more likely to develop the disorder, usually during the last three months of their first pregnancy. Women who are overweight, diabetic or older than 35 years are also at risk. Mothers with kidney disease, twins or a history of high blood pressure are also likely candidates.

High blood pressure is caused when the blood vessels in the body contract, increasing the pressure and lessening the amount of blood flowing to the uterus, the placenta and the fetus. Mild changes in blood pressure for a brief period are unlikely to cause problems. However, pro­longed and severe spasm of the vessels can be potentially harmful to mother and baby.

A sudden weight gain of more than two pounds per week or swelling of the face and hands can indirectly signal high blood pressure. Some women experience no distinct symptoms at all. Headaches, visual disturbances, or pain in the upper abdomen may indicate a more serious blood pressure problem. By monitoring your blood pressure, weight and urine at each prenatal checkup, we are able, for the most part, to make an early diagnosis of the problem and avoid serious complications.

We treat each case of preeclampsia differently depending upon a variety of factors usually determined by special testing and by how close you are to your due date. Bed rest at home or hospitalization may become necessary, but the eventual delivery of your baby will cure the disorder.

Diabetes

There are several kinds of diabetes, all relating to the delicate balance of sugar (glucose) in the blood. Insulin is a hormone that converts glucose into the body’s main source of energy. When the body fails to produce enough insulin or produces too much glucose, the level of sugar in the blood becomes too high, which can be dangerous for you and your baby. Gestational diabetes is a kind of diabetes that only occurs in pregnant women. The condition usually subsides after pregnancy, but women who have had gestational diabetes are more likely to develop permanent diabetes later in life.

Some women are more likely to develop gestational diabetes than others, particularly those who have previously delivered a large infant weighing 9 pounds or more, and women who are obese. Women who have had stillborn babies or a family history of diabetes may also develop diabetes.

Gestational diabetes is a serious condition because it can cause the birth of a large baby, which may mean a difficult vaginal birth or a Cesarean delivery. Babies born to gestational diabetics are also prone to having low blood sugar levels and jaundice after delivery which can lead to permanent neurological problems.

Pregnant mothers with gestational diabetes may also have too much fluid surrounding the baby which can cause premature labor and increase the risk of respiratory distress syndrome in the baby. They are also more susceptible to urinary tract infections and high blood pressure.

Because it is important to detect and treat gestational diabetes, we will test your blood for gestational diabetes at 24-28 weeks of pregnancy, regardless of predetermining factors. This simple and safe test requires only that you drink a sugar cola and have a blood sample checked one hour later. This is called a one-hour glucose tolerance test. If the test reveals a high level of glucose in your blood, we’ll conduct a more extensive three-hour glucose test to make a more definitive diagnosis of your condition.

Most gestational diabetics can control their sugar levels with mild exercise and modified diets. Occasionally, however, gestational diabetes is severe enough to require insulin injections to control sugar levels.

A dietician or a person specially trained in modification of diet to lower blood sugar will assist you in your diet changes. The dietary principles to lower blood sugar involve a reduction of calorie consumption, and eating smaller and more frequent meals consisting of more complex carbohydrates such as rice, pasta, bread, corn, cereal and beans. Foods with simple sugars will be limited or excluded from your diet.

By our carefully screening and treating you for gestational diabetes, you will be more likely to have an uneventful pregnancy and a successful delivery of a normal baby. And mothers who have had gestational diabetes can avoid the development of overt diabetes later by continuing strict diet and weight control following the pregnancy.

Warning Signs of Preterm Labor

Premature labor is labor that starts before 37 weeks of pregnancy, or more than 3 weeks before your due date.  Premature labor can often be stopped if you catch it early.

These are the signs:

• Uterine contractions - more than 4 in one hour.
• Menstrual cramps - may come and go or be constant.
• Abdominal cramps - with or without diarrhea.
• Low backache - comes and goes or constant.
• Pelvic pressure - feels like baby pushing down.
• Change in vaginal discharge - a sudden increase in amount or it may become mucous-like, watery or slightly bloody.

If you have one or more of these symptoms, you might be in premature labor and you should call your healthcare provider.

Preterm Labor

Labor usually occurs sometime after the thirty-seventh week of pregnancy. (40 weeks is term.) A baby born before 37 weeks is premature. These infants may require special care in breathing and maintaining their body temperatures. This complication is the greatest risk to your newborn baby.

Rh Disease and Its Prevention (RhoGam)

A routine blood test will be performed at one of your prenatal checkups to determine your blood type and Rh factor. The most common blood type is Type 0; the most common Rh factor is positive. People with Type 0, B, A, or AB positive blood have a positive Rh factor. Those with Type 0, B, A, or AB negative blood have a negative Rh factor.

When your blood type is Rh negative, and the father’s is Rh positive, the baby could inherit the father’s positive blood type, which could cause a problem during pregnancy or, more frequently, at the time of delivery.

If your blood type is Rh negative, your body’s immune system can recognize the baby’s Rh positive blood cells that escape into your circulation. These cells are different from yours. Because they are different from yours, your body will produce antibodies to destroy your baby’s red blood cells. These antibodies not only attack the baby’s blood cells that are in your circulation, but also cross the placenta to destroy the baby’s blood cells in its circulation. These antibodies may not be a problem during your first pregnancy, but can lead to a serious dis­ease with subsequent pregnancies called hemolytic disease of the newborn. These kinds of antibodies can also be produced as a result of a blood transfusion, amniocentesis, turning of a breech baby, pregnancy termination, tubal pregnancy and miscarriage.

When your body produces a high level of antibodies, more of your baby’s blood cells are destroyed. Eventually, this produces anemia in your baby which can lead to fetal death prior to the baby’s birth. Live births can be complicated by severe jaundice which can lead to mental retardation, hearing loss or cerebral palsy. With each successive pregnancy, the risk of hemolytic disease of the newborn increases.

Fortunately, we can prevent hemolytic disease of the newborn most of the time by giving you a special injection of gamma globulin (RhoGam) that prevents your immune system from reacting to your baby’s red blood cells. The RhoGam finds the fetal red cells in your circulation and neutralizes them so you don’t produce antibodies against your baby’s red blood cells. We give this injection routinely at 28 weeks of pregnancy and within 72 hours following delivery.

If your Rh factor matches the father’s or you are Rh positive, you have nothing to worry about. Rh disease cannot affect you or your baby.

Group B Strep - (GBS)

Group B Strep is a common bacteria (germ) that can be found in up to 4 of 10 pregnant women. In women it is most commonly found in the vagina or rectum and may cause seri­ous medical problems for the newborn baby. Fortunately, most babies who acquire this infection from their mothers do not have any problems.

Only 1-2% of all babies who are exposed to GBS during pregnancy become infected. Babies can develop early infections during the first week of life or later, after they leave the hospital. The early infections can be quite severe and affect the baby’s lungs, blood, spinal cord or brain which can lead to death in 15% of affected babies. Late infections usually man­ifest themselves as meningitis which can have long-term effects on the baby’s nervous system.

There is considerable debate within the medical community about this disorder. Cultures for GBS during pregnancy are not very successful because the bacteria may be present only part of the time. A culture of the vagina, rectum and urine may reveal GBS at one time and not at another.

In addition, treatment of pregnant women with GBS cannot always prevent infection in the baby. A pregnant woman can become positive again for GBS after treatment before the baby is born. The best way to prevent GBS infection is the use of antibiotics during labor.

Certain risk factors increase the chance that a baby of a mother with GBS will become infected. These women may benefit from treatment with antibiotics during labor and delivery. Mothers at high risk for GBS are those with:

• Fever during labor

• Previous child with GBS

• Ruptured membranes more than 18 hours

• Rupture of membranes before 37 weeks of pregnancy

• Premature labor (less than 37 weeks of pregnancy)

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