Pregnancy complications and miscarriage
Although most pregnancies are uneventful and result in the birth of a normal healthy baby, complications sometimes arise. These complications include bleeding and spontaneous abortion, premature labor, ectopic pregnancy, pre-eclampsia and eclampsia, chronic and genetic disease, infections,etc.
15 to 20 percent of known pregnancies end in miscarriage (technically called spontaneous abortion). Around 60 percent of all miscarriages the fetus is either anatomically or genetically abnormal. Spontaneous abortion can be viewed as a process of natural selection because a healthy fetus is not easily dislodged. Most miscarriages occur during the first three months. The increase in occurrence is attributed to many factors. For example, the rising rate of sexually transmissible diseases, complications arising from the use of IUD s, and the postponement of pregnancy by more and more women into their late 30s when eggs are likely to develop chromosomal abnormalities.
Although the occurrence of a bloody vaginal discharge reminiscent of menstruation once or twice in early pregnancy is not uncommon, it is sufficient reason to contact your doctor promptly. Until consultation and examination, limit physical activity as much as possible and avoid sexual intercourse. Generally the bleeding stops spontaneously and is no further problem.
The bleeding, however, may be evidence of a threatened abortion- an indication that a spontaneous abortion (miscarriage) may occur. By definition, pregnancies that end before the completion of the twentieth week of gestation are called abortions. If the bleeding is heavy, persists for a number of days or weeks, and is accompanied by cramping pain, it is even more suggestive of a threatened abortion.
An abortion may be, of course, either spontaneous or induced. A threatened abortion becomes an inevitable abortion if the cervix dilates and the membranes rupture. This progresses to a complete or an incomplete abortion according to whether or not all the tissue comes out of the uterus spontaneously. Any tissue or suspected tissue appearing with vaginal bleeding should be kept and shown to your physician. Any tissue remaining in the uterus must be removed by a D&C.
Sometimes an abortion occurs without any bleeding or other symptoms. This is most commonly diagnosed when the uterus stops growing in early pregnancy and is con- firmed by an ultrasound examination that reveals a shriveled sac instead of a live fetus. This is a missed abortion and a D&C is performed to remove the abnormal tissue.
A spontaneous abortion can be a very upsetting experience. It is important to realize that spontaneous abortions are very common and usually cannot be prevented. Furthermore, recent studies on the aborted tissue have shown that many of these pregnancies were not developing normally. Thus, spontaneous abortions help to assure that most pregnancies that reach the sixth month will result in normal, healthy babies. However, if a woman has had one miscarriage or more than one, there is a 25 to 40 should have a complete workup to find out what accounts for the problem.
Recent research indicates that some women with a faulty or under active immune system reject the fetus as a foreign body because they lack a type of antibody that normally fights against this rejection during pregnancy. It is thought that this circumstance may account for as many as half the miscarriages experienced by the 2 million women who have miscarriages of normal fetuses. An experimental treatment for this condition involves the use of donor transplant cells that stimulate the production of the essential antibodies in the recipient.
One relatively uncommon problem that causes bleeding in later pregnancy is placenta previa. The placenta normally attaches to the side or the top of the uterine cavity. In placenta previa it attaches instead to the lowest part of the uterus and covers all or part of the cervix, thus possibly blocking the baby’s exit through the birth canal. Bed rest will decrease the likelihood of bleeding, although extensive bleeding may nevertheless occur. The baby must be delivered by cesarean section if the placenta is blocking the entire cervix.
Another cause of bleeding in pregnancy is separation of a portion of the placenta from the uterine wall (placental abruption). If the detached portion is large, labor may begin. If the placenta detaches completely, the fetus will be unable to receive oxygen and nutrients from the mother and will die. Fortunately, the amount of separation is often small enough to allow the pregnancy to proceed normally.
If you have any bleeding during pregnancy, you should contact your physician. Keep in mind that not all bleeding during pregnancy means that something is wrong. Some women bleed during the first few months of pregnancy at the time they would have had their menstrual period. Sometimes an irritation on the cervix can cause bleeding after intercourse. During the last few weeks of pregnancy many women have some spotting after a vaginal examination. Also, a small amount of bleeding sometimes occurs near the end of pregnancy as the cervix begins to dilate.
In some pregnancies the fertilized egg does not implant in the uterus but in an ectopic (abnormal) location. By far the most common type of ectopic pregnancy is the tubal pregnancy. Other types include abdominal, ovarian, and cervical pregnancy. Some women with an ectopic pregnancy exhibit all of the normal symptoms of pregnant; others have none because of the lower hormone levels associated with ectopic pregnancies.
Spotting is quite common in tubal pregnancies. As the embryo grows and pushes on the walls of the Fallopian tube, pain can develop. Because the diameter of the tube is small, the pregnancy may rupture through the side of the Fallopian tube, causing extensive interred-abdominal bleeding.
In some cases the first sign of an ectopic pregnancy is a fainting spell caused by this sudden loss of blood internally. Ectopic pregnancies almost always cause symptoms that differ from those of a normal pregnancy before 12 weeks. Occasionally, such pregnancies wither away, the woman re- mains well, and they are never diagnosed. They almost never result in a live birth. The chances of developing an ectopic pregnancy are greater among women over 35, and among those who have had a history of pelvic infections, an infection after an abortion, an ectopic pregnancy in the past, or who use intrauterine contraceptive devices . However, ectopic pregnancies often occur in the absence of any of these factors, and they are one of the four major causes of death during pregnancy, the other three being toxemia, infection, and hemorrhaging.
It is a matter of concern that extra-uterine pregnancies have increased dramatically in recent decades, the number tripling from 17,800 in the 1970s to 52,200 in 1980, and the rate doubling among total pregnancies. Some authorities attribute this rise to the increase in cases of gonorrhea, chlamydia, and inadequately treated pelvic inflammatory disease.
In many cases an early tubal pregnancy may be removed and the fallopian tube repaired. However, the tube is irreparably damaged and must be removed. If the other tube is normal, future pregnancies are possible. As more women are learning to recognize the symptoms of a possible ectopic pregnancy and seek earlier care, and with the development of more sophisticated diagnostic techniques such as laparoscopy and sonography, more surgery is being done before the tube is irreparably damaged. This, coupled with improved surgical techniques including laser surgery, means that it is becoming less and less necessary to remove the tube.
An abnormal elevation of blood pressure developing during the latter half of pregnancy (gestational hypertension) may occur in up to 5 percent of all pregnancies. A mild increase in blood pressure without any other symptoms is common. Though bleeding during pregnancy and placental abruption are more common in women with gestational hypertension, in most cases there is no ill effect. If the increase in blood pressure is significant, bed rest may be recommended in an attempt to prevent complications.
However, a rise in blood pressure when accompanied by edema (fluid retention) and protein in the urine, indicates the onset of a condition called pre-eclampsia. Rapid weight gain caused by the fluid retention, severe headaches, and visual disturbances may occur. Pre-eclampsia is more common with first pregnancies. When mild, it can be treated by bed rest and sedation. Severe cases may require large doses of sedatives and medications to lower the blood pressure. In its most severe form pre-eclampsia can be life threatening to both mother and baby, and delivery may be necessary even if the infant is premature. Severe pre-eclampsia is rare and with proper treatment is usually not a problem after delivery.
It is an intensification of the symptoms designated as pre- eclampsia and is also characterized by convulsions. Eclampsia may develop from untreated pre-eclampsia or it may occur without preliminary milder symptoms. No matter when in pregnancy eclampsia occurs, the pregnancy must be terminated after appropriate anticonvulsive-antihypertensive medication has been given. In women without chronic high blood pressure or kidney disease, pre-eclampsia or eclampsia usually does not recur during subsequent pregnancies.