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Is My Pregnancy Going Well?

What Can Go Wrong?

Last updated on:
18/04/2012

Contributing Author: Guy Slowik FRCS

Most pregnancies are uncomplicated and end with the birth of a normal, healthy baby. Early diagnosis and treatment of any complications will often prevent serious problems.

Regular check-ups can help you learn to recognize the difference between the normal changes and those that can indicate a problem. Problems during pregnancy include:

Need To Know:

If you experience any of the following symptoms, notify your doctor immediately. Do not wait until your next scheduled checkup.

  • Vaginal bleeding or spotting
  • Sudden pronounced weight gain
  • Sharp or prolonged pain in your abdomen
  • Severe vomiting
  • Visual problems such as dimness, blurring, flashing light, or seeing dots
  • Sudden and serious swelling of the face, hands, and feet
  • Severe and ongoing headache
  • Painful, burning urination
  • Decreased urination
  • Chills and/or fever
  • Sudden escape of fluid from the vagina

Birth Defects

The overall risk of delivering a child with a birth defect is only 3 percent. The most common defects are those associated with the brain and spinal column, heart, and limbs.

The other main defect involves chromosomes in the cells of the fetus. The most common occurrence is Down syndrome. The risk of Down syndrome ranges from less than 1 in 1,000 in young women to 1 in 100 for women who conceive at age 40.

Ectopic Pregnancy

In an ectopic pregnancy, the fertilized egg attaches itself in a place other than inside the uterus. More than 95 percent of ectopic pregnancies occur in a fallopian tube. The narrow fallopian tubes are not designed to hold a growing embryo, so the fertilized egg in a tubal pregnancy cannot develop normally. Eventually, the thin walls of the fallopian tube stretch to the point of bursting. If this happens, a woman experiences severe pain and bleeding, and her life may be in danger.

 

Ectopic pregnancy occurs in 2 percent of reported pregnancies in the United States. Even so, death from ectopic pregnancy is rare, occurring in less than 1 of every 2,500 cases. This low rate is largely a result of new techniques to detect ectopic pregnancy at an early stage, when it can be treated successfully.

Need To Know:

An ectopic pregnancy can cause a rupture of the fallopian tube. If you are pregnant and experience sudden, sharp, severe abdominal pain seek treatment immediately.

Preeclampsia (Toxemia)

Preeclampsia is characterized by high blood pressure, swelling of the face and hands, and protein in the urine after the 20th week of pregnancy. It is a potentially serious condition that, if left untreated, can lead to complications or death in the mother or the baby.

There is no specific treatment for preeclampsia, nor is it known how to prevent it. The only sure way to end the preeclampsia is to deliver the baby, sometimes despite the fact that the baby may be premature.

Bleeding

Up to 25 percent of all pregnant women have bleeding at some point in pregnancy, and of these women, about half will have a miscarriage. Vaginal bleeding is the chief sign of miscarriagein mid-pregnancy. Bleeding in later pregnancy can result from serious problems with the placenta. These could be that the placenta is too low and covering the cervix (placenta previa) or that it has prematurely separated from the uterine wall (abruption). These conditions often need to be treated by doing a cesarean delivery.

Need To Know:

If bleeding is slight or spotty, there may be no cause for concern. But report moderate to heavy bleeding in pregnancy as soon as possible, because it may be a sign of one of the following problems:

  • Miscarriage (if it occurs before 20 weeks)
  • Preterm labor (if it occurs between 20 and 37 weeks)
  • Problems with the placenta (the organ that nourishes the developing fetus) conditions in which it lies too low in the uterus or begins to separate from the inner wall of the uterus before birth

If you have any bleeding along with pain or cramping during pregnancy, immediately call your doctor or go to an emergency room.

Miscarriage

Miscarriage, technically called spontaneous abortion, is defined as the loss of a pregnancy before 20 weeks of gestation. It has been estimated to occur in 15 to 30 percent of all pregnancies.

More than 50 percent of miscarriages in the first trimester are caused by chromosomal abnormalities. Infections, uncontrolled diabetes, uterine abnormalities, or a woman's production of certain antibodies during pregnancy can also cause an early miscarriage. The warning sign of vaginal bleeding and uterine cramps precedes nearly all miscarriages.

Loss of Amniotic Fluid

The developing fetus floats in amniotic fluid, which is contained in the amniotic sac. During pregnancy the amniotic fluid increases in volume as the fetus grows. Amniotic fluid volume is greatest at approximately 37 weeks of gestation, when it averages 1,000 ml.  Approximately 800 ml of amniotic fluid surrounds the baby at full term (40 weeks). This fluid is constantly circulated by the baby swallowing and "inhaling" existing fluid and replacing it through "exhalation" and urination.

Amniotic fluid accomplishes numerous functions for the fetus, including:

  • Protects from outside injury by cushioning sudden blows or movements
  • Allows for freedom of fetal movement and permits symmetrical musculoskeletal development
  • Maintains a relatively constant temperature for the environment surrounding the fetus, thus protecting the fetus from heat loss
  • Permits proper lung development because the fetual breathes the fluid into the lungs

When a woman goes into labor her "water breaks" and amniotic fluid leaks from the uterus and through the vagina. Normally, a woman's water does not break until labor is underway, however, sometimes amniotic fluid is lost too early. This can make it difficult for the fetus to grow and develop fully before birth, cause premature delivery, jeopardize the baby's lung development, and put the fetus at risk for infection. About 35 percent of preterm deliveries occur because of early rupture of the amniotic sac.

If a pregnant woman notices any fluid leaking from her vagina, she should go to the hospital emergency room at once. She may go into pre-term labor, although many mothers' whose waters break early do not deliver for a number of weeks, this allowing the baby to grow bigger and the lungs to mature before birth.

Diseases In Pregnancy

Many of the potential problems in pregnancy are best managed when they are detected early. The exams and tests done as part of routine prenatal care are intended to detect the early signs of these and other complications.

  • Gestational DiabetesA small percentage (one to four percent) of pregnant women develop diabetes mellitus, usually in the second or third trimester, referred to as gestational diabetes. The disease poses a serious threat for both the woman and her unborn child. Gestational diabetes has been linked to neonatal hypoglycemia and having a large newborn. The disease often resolves immediately after delivery.

    For more detailed information about diabetes that develops during pregnancy, go to Diabetes In Pregnancy.

  • Hypertension. Hypertension (high blood pressure) during pregnancy can be life threatening to both the woman and the fetus. Hypertension can cause seizures, organ disturbances, edema (swelling of body tissues) and protein in the urine. Together these symptoms cause a condition called preeclampsia, which can result in premature delivery and fetal death.
  • Rubella. Also known as German measles, the disease is usually not serious in children and adults. But if a woman is infected just before or during pregnancy, the disease can cause heart problems, deafness, and other serious problems for the fetus. A rubella vaccine should not be given to a woman who is pregnant or a woman planning to become pregnant within three months. Most women are immune and, therefore, the baby is not at risk.
 
 

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.