Complications of pregnancy

# Overview
Complications of pregnancy are the symptoms and problems that are associated with pregnancy. There are both routine problems and serious, even potentially fatal problems. The routine problems are normal complications, and pose no significant danger to either the woman or the fetus. Serious problems can cause both maternal death and fetal death if untreated.

# Routine problems of pregnancy

## Back pain
- Common, particularly in the third trimester when the patient's center of gravity has shifted.
- Treatment: mild exercise, gentle massage, heating pads, paracetamol (acetominophen), and (in severe cases) muscle relaxants or narcotics

## Constipation
- Cause: decreased bowel motility secondary to elevated progesterone (normal in pregnancy), which can lead to greater absorption of water.
- Treatment: increased PO fluids, stool softeners, bulking agents Drinking plenty of water and eating fruit and fibre enriched foods often help
A woman experiencing sudden defecation should report this to her practitioner.

## Contractions
- occasional, irregular, painless contractions that occur several times per day are normal and are known as Braxton Hicks contractions
- Caused by: dehydration
- Treatment: fluid intake
- regular contractions (every 10-15 min) are a sign of preterm labor and should be assessed by cervical exam.

## Dehydration
- Caused by: expanded intravascular space and increased Third Spacing of Fluids
- Treatment: fluid intake
- Complication: uterine contractions, which may occur because dehydration causes body release of ADH, which is similar to oxytocin in structure. Oxytocin itself can cause uterine contractions and thus ADH can cross-react with oxytocin receptors and also cause contractions.

## Edema
- Caused by: compression of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities.
- Treatment: raising legs above the heart, patient sleeps on her side

## Flank pain
- Caused by: overstretching of the soft tissues surrounding the uterus and outward pressure on the rib by the growing uterus.
- Treatment: paracematol (acetominophen)

## Gastroesophageal Reflux Disease (GERD)
- Caused by: relaxation of the lower esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy)
- Treatment: antacids, multiple small meals a day, avoid lying down within an hour of eating, H2 blockers, proton pump inhibitors

## Hemorrhoids
- Caused by: increased venous stasis and IVC compression leading to congestion in venous system along with increased abdominal pressure secondary to constipation.
- Treatment: topical anesthetics, steroids, treatment of constipation

## Increased urinary frequency
- Caused by: increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus. Patients are advised to continue fluid intake despite this. Urinalysis and culture should be ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by dysuria (pain when urinating).

## Lower abdominal pain
- Caused by: rapid expansion of the uterus and stretching of ligaments such as the round ligament.
- Treatment: paracematol (acetominophen)

## Pica
- Cravings for nonedible items such as dirt or clay. Commonly, patients will be placed on ice chips to chew on instead of these nonedible items.

## Uterine torsion
- A very rare cause, reported earliest during the 6th gestational week and the latest during the 43rd gestational week.
- Caused by: Cause is usually unknown. But few of the the reported predisposing and associated factors are abnormal fetal presentation, distortion in uterine shape, Mullerian anomalies, pelvic adhesions, large ovarian neoplasms that distort the shape or position of the uterus, a weakness at the junction of the cervix and uterine corpus, external cephalic version procedures, sudden maternal movements, abnormal pelvic architecture.
- Treatment: Treatment is based on the gestational age. Before 24 weeks, promptly returning the uterus to the normal position without conducting a delivery is best. Between 24 and 34 weeks, it is unclear. There has to be a balance between relieving the torsion and unknown fetal/maternal complications. After 34 weeks, the best will be to prompt a cesarean delivery.

## Varicose veins
- Caused by: relaxation of the venous smooth muscle and increased intravascular pressure.
- Treatment: elevation of the legs, pressure stockings

# Serious problems of pregnancy

## Ectopic pregnancy (implantation of the embryo outside the uterus)
- Caused by: Unknown, but risk factors include smoking, advanced maternal age, and prior damage to the Fallopian tubes.
- Treatment: If there is no spontaneous resolution, the pregnancy must be aborted either surgically or by the drug methotrexate.

## Pelvic girdle pain (PGP) (gait and weightbearing syndrome)
- Caused by: With some pregnancies ligaments become stretched either by injury or excess strain and could cause pelvic joint pain, malalignment and instability. For most women pelvic girdle pain resolves in weeks after delivery but for some it can last for years resulting in a reduced tolerance for weight bearing activities.
- Treatment: One of the main factors in helping women cope is with education, information and support. Many treatment options are available.

## Placental abruption (separation of the placenta from the uterus)
- Caused by: Various causes; risk factors include maternal hypertension, trauma, and drug use.
- Treatment: Immediate delivery if the fetus is mature (36 weeks or older), or if a younger fetus or the mother is in distress. In less severe cases with immature fetuses, the situation may be monitored in hospital, with treatment for hypovolemia if necessary.