Contents
Complications during pregnancy can occur in any trimester and for a variety of reasons. It is very important for a future mother to be attentive to her well-being and to know all the symptoms that should alert. Pain and pulling sensations in the lower abdomen, spotting and bleeding, increased uterine tone or prolonged toxicosis – all this is a reason to immediately seek help from a doctor.
Consider the main complications that occur during pregnancy and the reasons why they occur.
What are the possible complications during pregnancy?
Ectopic pregnancy
In a normal pregnancy, the fertilized egg is fixed in the uterus. However, in some cases, it can attach outside the uterine cavity, then an ectopic pregnancy occurs.
The most common tubal ectopic pregnancy occurs when a fertilized egg develops in the fallopian tube (1). This is a life-threatening situation for a woman that requires immediate surgery. With the growth of the fetus, the tube can burst at any time, which will lead to severe bleeding. So, if a suspicion of pregnancy is accompanied by severe pain and spotting, you need to urgently consult a doctor and do an ultrasound to determine where the fetal egg is located. Unfortunately, such a pregnancy cannot be saved.
Toxicosis
Every expectant mother has heard about the horrors of toxicosis. Intolerance even to the smells of food, changes in taste, endless nausea and dizziness … In fact, toxicosis is the most common and in most cases the most harmless complication of pregnancy, which disappears by itself by the end of the second trimester.
How to determine when toxicosis does not harm the mother and child, and when should you see a doctor? Most experts agree that if a pregnant woman feels sick about 3-5 times a day, but in general she feels fine, then there is no reason for concern. And if you feel sick without ceasing, even from a sip of water and any odors, then there is a risk of dehydration and lack of nutrients necessary for the normal growth and development of the fetus. Weight loss, severe dizziness, high blood pressure – all this is a reason to immediately go to the doctor. Sometimes, with severe toxicosis, hospitalization may even be necessary.
The threat of termination of pregnancy
The threat of termination of pregnancy in the early stages can be caused by genetic defects and the initial non-viability of the fetus. That is why in many Western countries, doctors do not seek to keep the pregnancy if there is a threat of interruption at the earliest possible date, considering this a kind of “natural selection”. Also, the threat of termination of pregnancy may arise due to certain diseases of the mother (for example, antiphospholipid syndrome) or due to a lack of hormones that support pregnancy.
The following symptoms can indicate the threat of termination of pregnancy: pulling or cramping pains in the lower abdomen, spotting, strong uterine tone. In this case, you should immediately call an ambulance or see a doctor, as miscarriage and premature birth can cause severe bleeding that is life-threatening.
Frozen pregnancy
Missed pregnancy is another serious and dangerous complication of pregnancy associated with intrauterine fetal death (2). In the early stages, a frozen pregnancy most often ends in spontaneous abortion (miscarriage). If this does not happen, medical intervention is required, otherwise purulent endometritis and sepsis may occur.
Isthmico-cervical insufficiency
Isthmic-cervical insufficiency is a fairly common complication occurring in the second trimester of pregnancy (3). With ICI, the isthmus and cervix do not cope with their “obturator” function and, under the pressure of the growing fetus, begin to gradually open, which raises the risk of miscarriage or premature birth, as well as infection of the uterine cavity and the fetus itself. Isthmic-cervical insufficiency is determined by ultrasound: the cervix is shortened to 25 mm or less, the opening of the internal os is up to 9 mm or less. The pregnant woman herself may not experience any alarming symptoms.
placenta previa
Normally, the placenta is located in the upper and middle thirds of the uterus. If it attaches lower and affects the cervix, there may be a risk of placental abruption and preterm labor. Also, with placenta previa, a caesarean section is required, since the baby’s natural exit is blocked.
Placental abruption
With abruption, the placenta separates from the uterine wall ahead of time. Most often this happens in the last weeks of pregnancy or even during the birth itself.
With placental abruption, a woman experiences severe bleeding, and the baby suffers from hypoxia. The main symptoms: sharp prolonged pain in the lower abdomen, active movements of the child, bleeding. In emergency cases, a caesarean section is performed.
Preeclampsia
Preeclampsia, or as it is also called late preeclampsia, is another dangerous complication that occurs in late pregnancy. The main symptom is the presence of protein in the urine of a pregnant woman, as well as a sharp increase in blood pressure and swelling. With preeclampsia, the work of many organs and systems of a woman is disrupted (4), which affects the prenatal state of the baby. In this case, immediate hospitalization is required.
Fetal complications
There are also complications of pregnancy from the fetus: these are genetic abnormalities, intrauterine infection, hypoxia (oxygen deficiency) and malnutrition (intrauterine growth retardation of the fetus). Each of these pathologies requires the observation of a pregnant woman by a doctor and timely treatment.
Causes of complications during pregnancy
The causes of complications during pregnancy can be very different. Let’s consider the main ones.
Mother’s illnesses
Most often, pregnancy complications occur with hypertension and high blood pressure, heart defects, pyelonephritis (5) and other kidney diseases, and diabetes mellitus. The risk of developing gestosis increases. Viral and bacterial infections are also of great danger.
Inflammatory gynecological diseases
Salpingitis, adnexitis, endometritis can cause ectopic pregnancy, and chronic cervicitis can provoke isthmic-cervical insufficiency. Also, inflammatory processes in the pelvis can lead to infection of the fetus.
Uterine anomalies
Congenital anomalies of the uterus (bicornuate, saddle, infantile uterus) can lead to miscarriage or premature birth, as well as malposition of the placenta or placental abruption.
Anomalies in the development of the fetus
Genetic malformations of the fetus most often cause miscarriages in the early stages or premature birth, as well as intrauterine death of the fetus.
Rh-conflict of mother and child
Rh-conflict (when the mother has a negative Rh factor, and the fetus is positive) manifests itself in the fact that the mother develops antibodies to the blood of her child, which destroy his red blood cells. This can lead to the most serious consequences – for example, to a miscarriage or death of the fetus.
Multiple pregnancy
With multiple pregnancies, the risk of preeclampsia, preeclampsia, and premature birth increases. Often there is polyhydramnios, leakage or premature rupture of amniotic fluid.
Medical interventions affecting the uterus
Amniocentesis (puncture of amniotic fluid for analysis), cordocentesis (puncture of the umbilical cord vessels), chorionic biopsy and other manipulations affecting the uterus increase the risk of miscarriage, rupture of the membranes and intrauterine infection of the fetus.
Other reasons
Also at risk for the development of pregnancy complications are too young women and over 40 years old, overweight, bad habits, a sedentary lifestyle, and if there is already a history of unsuccessful pregnancies or complicated births.
Methods for the treatment of complications during pregnancy
The tactics of pregnancy management and treatment of complications directly depend on their nature, severity and risk to the life of the mother and fetus. If the pathologies do not threaten the woman’s life, and the fetus is viable and develops normally, then the pregnancy is preserved and drug therapy is prescribed. The doctor may prescribe:
- hormonal drugs (normalize the endocrine balance in the body),
- tocolytics (reduce the contractile activity of the endometrium),
- antibiotics (prevent the development of infection, minimize pathogenic flora),
- anti-inflammatory drugs (relieve inflammation and pain syndrome),
- glucocorticoids (accelerate the maturation of the lungs of the fetus with the threat of premature birth),
- sedatives (relieve emotional stress),
- vitamin and mineral complexes.
If your cervix is short and you are at risk of preterm labor, your doctor may stitch your cervix or place an obstetric pessary (a silicone or plastic ring that is inserted into the vagina to prevent the cervix from opening).
If pathologies of the fetus, placenta or amniotic fluid are detected during pregnancy, then in some cases it is possible to perform fetal operations (when the fetus is operated directly in the uterine cavity), as well as intrauterine blood transfusion and infusion.
With fetoplacental insufficiency, antiplatelet agents and anticoagulants are prescribed, which restore uteroplacental blood flow. When a Rh conflict occurs, a pregnant woman is given an anti-Rhesus immunoglobulin. (6)
In case of an ectopic pregnancy, intrauterine death of the fetus or gross malformations of its development, an abortion is performed (abortion or artificial birth).
Prevention of complications during pregnancy
Also, in order for the pregnancy to proceed without complications, a woman should follow a few simple but very important rules.
Monitor your health
If there are any chronic diseases, it is important to ensure that they do not worsen. High blood pressure, pyelonephritis, glomerulonephritis, diabetes mellitus – all these diseases can cause serious complications, up to abortion.
If a woman had numerous miscarriages and missed pregnancies in her anamnesis, then before the onset of a new pregnancy, she should consult a geneticist.
Monitor your diet
During pregnancy, it is important to watch your diet. Diets or starvation are unacceptable, as the baby may lack nutrients and trace elements. It is better to give up fast carbohydrates (sweets, pastries) in favor of fresh vegetables and fruits. It is also important to observe the drinking regimen.
Keep track of your weight
A large weight gain can lead to preeclampsia and oxygen starvation of the fetus, so you should not lean on food, eating “for two”. The best option is to eat more often, but in small portions.
Don’t forget about physical activity
It is important not to overdo it here – it is definitely not acceptable to spend hours in the gym. It is better to walk more often in the fresh air, in winter you can ski. Physical activity can be combined with yoga, breathing exercises.
To refuse from bad habits
Alcohol and nicotine have an extremely negative effect on the condition and development of the fetus, cause oxygen starvation and can lead to intrauterine death of the child and premature birth.
Avoid any stress
Stress seriously changes the hormonal background and leads to uterine hypertonicity and hypoxia. Chronic hypoxia is the main cause of intrauterine growth retardation and neurological problems in the child in the future. If a pregnant woman smokes, the baby may be born underweight and susceptible to colds.
Follow the daily routine
Getting at least 8 hours of sleep a night is essential for a healthy pregnancy.
The best drugs for the prevention of complications during pregnancy
During pregnancy, a woman’s body especially needs vitamins and microelements, the deficiency of which can affect the baby. For example, a lack of folic acid can lead to neural tube defects and placental abnormalities. Iodine deficiency can cause such malformations as deafness and mental retardation, with a lack of iron, hypoxia occurs, intrauterine growth retardation, and in severe cases, premature birth.
Often, doctors prescribe special drugs to prevent pregnancy complications. Let’s consider the best of them.
1. “Korilip”
For the health of the expectant mother and her child, scientists have created a unique drug “Korilip”. It contains three important components: cocarboxylase hydrochloride (activates tissue metabolism, participates in the synthesis of nucleic and amino acids, regulates carbohydrate metabolism), riboflavin (vitamin B2, which is involved in the synthesis of hemoglobin and is responsible for restoring body cells) and lipoic acid, which saturates the body energy.
Korilip is suitable for both women who are just planning to become a mother, and already pregnant – and from the first weeks. The drug contributes to the normal course of pregnancy, reduces the risk of complications, protects against viruses and infections, supports immunity, and also energizes.
2. «Pregnoton Mama»
Vitamin-mineral complex “Pregnoton Mama” is intended for women during and after pregnancy. The drug contains 16 important substances necessary for the development of the fetus and the health of the expectant mother.
In the composition: folates and folic acid, which reduce the risk of developing neural tube defects, preeclampsia and preterm birth, iodine, Omega-3, B vitamins, biotin, selenium, zinc and liposomal iron – it prevents the development of iron deficiency anemia (causes developmental delay and lack of fetal weight), while it is better absorbed and does not cause side effects from the gastrointestinal tract.
“Pregnoton Mama” is available in the form of soft gelatin capsules that are easy to swallow. The course of taking the drug is 1 month, before taking it, a doctor’s consultation is required.
3. “Minisan Mama”
“Minisan Mama” is a vitamin and mineral complex developed by Finnish specialists and provides a woman with the necessary micronutrients during pregnancy planning, childbearing and breastfeeding.
As part of the product: vitamins D, E, C, B1, B2, B5, B6, B12, niacin, as well as magnesium, iron, zinc, copper, selenium, iodine, biotin and folic acid. Magnesium relieves uterine hypertonicity and ensures the full development of the fetus, zinc is responsible for cell division and the formation of baby tissues, and folic acid prevents congenital defects of the spine and central nervous system.
4. Thorne Research Basic Prenatal
The Basic Prenatal vitamin-mineral complex from the American manufacturer Thorne Research is designed for women at the stage of pregnancy planning, childbearing and breastfeeding. It contains all the important micronutrients that ensure the growth and development of the fetus and prevent the development of complications: chromium, zinc, copper, vitamin E, biotin, calcium, vitamin B3, thiamine, magnesium, vitamin C, riboflavin, niacin, selenium, vitamin A, pantothenic acid , molybdenum, folate. Basic Prenatal also contains highly absorbable iron bisglycinate, preventing the development of iron deficiency anemia without causing constipation. And vitamin C and B6 help relieve morning sickness with toxicosis.
Popular questions and answers
The most popular questions regarding possible complications of pregnancy are answered by obstetrician-gynecologist of the highest category, doctor of ultrasound diagnostics of the highest category, doctor of prenatal diagnostics, assistant of the department of the pediatric academy in St. Petersburg Elvira Semenova.
Is it necessary to take tests and undergo a complete examination during pregnancy planning to avoid the risk of complications?
How to prevent the risks of pregnancy complications at the planning stage?
2) It is better to have an ultrasound examination at least once per menstrual cycle in order to make sure that you do not have uterine pathology (large polyps, fibroids inside the uterus, congenital anomalies of the genital apparatus). They are best treated surgically before conception, as they may interfere with pregnancy and/or endure pregnancy.
3) Get tested for significant (!) Sexually transmitted diseases – chlamydia, gonorrhea, syphilis, trichomoniasis, infections caused by Mycoplasma genilalium (and only this mycoplasma), genital herpes, human papillomavirus infection, hepatitis B, HIV.
4) Before pregnancy, check the smear for oncocytological examination, if you have not taken it in the last year.
5) Make a blood test for TORCH infection (for the presence of immunity to the rubella virus, toxoplasma, cytomegalovirus and herpes). These viruses are dangerous for the development of the baby, especially at the beginning of pregnancy. If you do not have immunity to them, the doctor should talk about the need for vaccination and behavior in the absence of class G antibodies.
6) It is necessary to start drinking vitamins for pregnancy planning and folic acid at 400 mcg per day. It has been reliably proven that a lack of folic acid in a woman’s body leads to abnormal development of the embryo and, most often, to non-closure of the neural tube.
Can pre-eclampsia, eclampsia and preterm labor be prevented in early pregnancy?
Sources of
- Ectopic pregnancy in modern conditions. Petrova E.V. Obstetrics and gynecology, 2008. No. 1, art. 31-33.
- Non-developing pregnancy. Sidorova I.S., Sheshukova N.A. Gynecology, 2006. Volume 8, No. 3, art. 4-7.
- Management of patients with isthmic-cervical insufficiency. Levakov S.A., Borovkova E.I., Sheshukova N.A., Borovkov I.M. Obstetrics. Gynecology. Reproduction, 2016. Volume 10, No. 2.
- Preeclampsia and eclampsia as a cause of maternal mortality. Shuvalova M.P., Frolova O.G., Ratushnyak S.S., Grebennik T.T., Guseva E.V. Obstetrics and Gynecology, 2014. Volume 8, Art. 81-87.
- Pyelonephritis during pregnancy. Strizhakov A.N., Baev O.R. Questions of gynecology, obstetrics and perinatology, 2007. Volume 6, art. 76-78.
- Rhesus conflict during pregnancy. Irugova E.Z., Sherhlva A.Z., Bereketova M.A., Nakhusheva A.R. Natural and technical sciences, 2019. Issue 12(138), art. 131-134.