Any pregnancy, even the happiest one, can have sudden unforeseen pregnancy complications. In my career, I have seen many a normal low-risk pregnancy turn into an abnormal high risk one in a matter of seconds. Statistics as revealed by the latest Confidential Enquiry into Maternal and Child Health [CEMACH] in the UK are alarming: maternal mortality rate in India is approximately 300 per 100,000 live births! It’s shocking that every minute one woman dies from complications of pregnancy and childbirth. These women die in the prime period of their lives and in great distress due to bleeding, difficult labour, infection, raised blood pressure and unsafe abortions.
Long-term consequences of pregnancy-related complications include uterine prolapse [laxity of the pelvic floor], pelvic inflammatory disease, fistula, bladder or bowel incontinence, infertility, and pain during sexual intercourse.
Here, I discuss some complications that might occur during the nine-month long journey.
First trimester [month 1 – 3]
Once you have conceived, you would probably know you are pregnant based on a variety of symptoms. These include:
- A missed period
- Heaviness and tenderness in breasts
- Tiredness throughout the day
- Feeling faint
- Increased vaginal discharge
- Nausea and vomiting
- A strong dislike for certain things such as coffee, cigarette smoke and a frequent need to pass urine.
You can confirm your suspicion using a home pregnancy testing kit using the first urine passed in the morning. The location of the pregnancy can sometimes go wrong here. An internal sonography done after seven weeks of pregnancy is able to identify the pregnancy sac and even see a heart beat. This is very reassuring as it confirms that the pregnancy is in the correct location and helps in dating the pregnancy.
Excessive vomiting: Till 13 weeks of pregnancy, vomiting is common and affects every pregnant woman though with varying degree of severity. After that, it generally settles down. Medications have a limited role to treat this condition. If vomiting becomes severe, there is a risk of dehydration. It is important to take adequate fluid intake to avoid this problem.
Bleeding and pain: These symptoms occur in ectopic pregnancy [pregnancy in the fallopian tube] and miscarriage. If there is pain in early pregnancy, the suspicion of ectopic pregnancy is high. Sometimes, bleeding accompanies pain. Unfortunately, this pregnancy cannot continue further and has to be terminated medically [with injections] or surgically [through a telescope-laparoscopy or by a cut on the tummy]. If ectopic pregnancy is not diagnosed in time, it can rupture leading to serious bleeding inside the tummy, which is an emergency situation.
If pregnancy is located within the womb, bleeding and pain could mean a possible miscarriage [loss of pregnancy]. One must take complete bed rest, stay relaxed and follow your doctor’s advice.
Supporting medications can help, but sometimes the pregnancy may be lost. There are several reasons for miscarriages to happen in the first three months. The commonest one is a developmental defect in the building blocks [chromosomes] of the foetus. Nature’s selection process prevents this abnormal pregnancy from continuing. If three or more miscarriages occur, this condition is called recurrent miscarriages. Investigations may have to be undertaken, but they do not always detect an underlying abnormality. In majority of the women, a normal pregnancy and delivery can happen in spite of previous miscarriages.
Things to avoid in early pregnancy
- Eating heavy meals: Start taking light, but more frequent meals. Avoid eating outside food, especially in the rainy season; a stomach bug may lead to loose motions and this can complicate the pregnancy unnecessarily.
- Visiting friends or relatives in hospital atmosphere: You may catch infections, which can affect the pregnancy.
- Smoking: Evidence suggests that inhaling even second-hand smoke can harm the baby, so encourage your partner to give up smoking. Smoking can cause miscarriages, growth restriction and foetal death.
- Alcohol: Excessive drinking can affect the developing baby.
- Medications: As many drugs can have harmful effects on the baby, it is important that you check with your doctor before taking any.
- Animals: Handling cats and dogs faeces can lead to infection with toxoplasma, which can cause serious harm to the baby.
- Physical and mental exertion
- Travelling on bumpy roads.
At the end of three months [12 weeks]: Frequency of urination may get better, but some women feel constipated. You may have gained about 1kg weight, but this is a very poor indicator of maternal and foetal wellbeing because at this time, the baby is only 6.5cm in length.
Checking for irregularities: A baseline blood pressure measurement should be done early in pregnancy. It is important to conduct blood and urine tests to look for low haemoglobin, abnormalities of sugar, thyroid disorders and Rh negative blood group. Routine screening for HIV, Hepatitis B and syphilis should be done. An ultrasound scan at about 11 weeks measuring the skin fold thickness on the baby’s neck is now an established way to look for Down’s syndrome. At this stage, if history, physical examination and investigations are normal, the pregnancy is classed as low risk. Presence of any abnormality increases the likelihood of complications making it a high risk pregnancy. In either case, it is important to continue regular antenatal care to identify any changes quickly.
How to avoid complications
- Diet: Eat fresh food. Most women require taking iron and calcium supplements. You may discontinue folic acid supplements.
- Exercise: Performing antenatal exercises under supervision is recommended. Yoga helps staying physically and mentally fit during pregnancy, delivery and the postnatal period. Familiarise yourself with the care providers and hospital facilities to prepare yourself mentally.
- Posture: Wear low-heeled shoes and hold yourself well to avoid back injury. Avoid bending in your back. If you need to bend, say to pick up something from the floor, go down on your knees. When getting up from the bed, turn to one side and then rise slowly. Standing suddenly can cause giddiness.
At the end of 16 weeks: Undergo blood tests to detect abnormalities such as Downs’s syndrome and neural tube defects in the baby. A detailed sonography is performed from 16 to 20 weeks to detect any abnormality in the baby. This is called an anomaly scan and checks the baby from head to toe. A normal scan at this stage almost completes the investigative process to detect an abnormally developed baby.
Common pregnancy complications
You may start to bleed, which could indicate a miscarriage. Bleeding at this stage of pregnancy happens if the neck of the womb [cervix] is weak. If you bleed, you may need complete bed rest and a stitch to tighten the neck of the womb. Rarely, the screening blood tests and the detailed anomaly scan suggest abnormalities in the baby. If that happens, more reliable tests such as amniocentesis [aspiration of fluid from the pregnancy sac] may become necessary.
Third trimester [month 7 – 9]
At the end of 28 weeks: Make sure to get enough rest in the day. If you have difficulty sleeping, try sleeping on your side with one leg bent and supported on a pillow. You may have gained another 5kg weight. If you are still at work, inform your employer about when you intend to stop working. Sometimes, it becomes necessary to check your haemoglobin and blood sugar levels at this stage. From now on, you will be checked every two weeks.
At 30, 32 and 34 weeks: Keep a count of the foetal movements. You should feel at least 10 movements in a day. Keep your feet up for an hour or two. You may notice swelling of your feet that worsens at the end of the day. Pelvic floor exercises become very important especially if you are suffering from leaking urine.
From 36 weeks onwards: False labour contractions start from now.
Week 40 onwards: If all is well, there is no need to panic. You could deliver anytime from two weeks before the due date to even two weeks after. Generally, most people prefer to start labour 8 to 10 days after the due date. A baby’s heart beat recording [non-stress test] may become necessary to ensure its well-being. Doppler blood flow studies of the baby also help in understanding the foetal well-being.
Possible complications in the last three months
Growth restriction: It is important to monitor the growth of the baby, mainly during the last three months. If the growth slows, additional tests such as blood flow to the baby [Doppler test] may be necessary. If there are abnormalities in the scans, Doppler or the baby’s heart beat recording, the baby may have to be delivered. It is important to look out for the baby’s movements. Decreased movements may indicate reduced oxygen supply to the baby. Resting in the left lateral position and a good diet are helpful.
Preterm labour: The baby becomes fully mature at 37 weeks gestation. Sometimes labour may start before this time. This is generally due to infection, mainly urinary infection. In such situations, it is important to be cared for in a hospital that has neonatal intensive facilities.
Medical disorders in pregnancy: In some patients, either the blood pressure, or the blood sugar rise. Careful monitoring coupled with timely tests can diagnose these disorders early and keep them under control.
Low placenta and abruption: These conditions lead to bleeding in pregnancy. Emergency situations may arise and delivery may become necessary. Low lying placenta warrants complete rest and delivery may have to be by caesarean section. Abruption means sudden separation of the placenta.
Abnormal lie: Occasionally, the baby may be in an abnormal position. This could be breech [presentation by legs], oblique or transverse lie. In such situations, a caesarean section becomes necessary.
If all is well, labour can start anytime after 37 weeks gestation. It is important to monitor labour closely and ensure that proper a assessment is done and in time. Systematic efforts by you and your doctor can ensure that your pregnancy is both, safe and happy.
- Ultrasounds are unsafe in pregnancy. Evidence suggests that this is not true. Timely scans have a crucial role in ensuring that the pregnancy is monitored and complications are prevented.
- Internal sonography is harmful to the pregnancy. The pregnancy is located inside the uterus [womb] and the neck of the womb is closed. So, the vaginal probe stays in the vagina.
- Weight gain is important in the first three months. During this, the baby is very small and hardly weighs much. Hence, pregnant women will mostly not gain weight during this time. Thus, weight is a very poor indicator for the pregnancy health.
- Miscarriages happen because of something you [or the doctor] did. Miscarriages are common and happen due to many reasons. You must not blame yourself [or the doctor] for that. In a majority of the cases, a cause cannot be found even after all possible tests.
- If a miscarriage happens, you must not have another pregnancy for 12 months. You can generally try for another pregnancy immediately after the next period. Fertility is found to be good after a miscarriage.