Part Five

Pregnancy Complications

Chapter 40.

What Are Pregnancy Complications?

Chapter Contents.Section 40.1-Overview of Pregnancy Complications .............. 338 Section 40.2-Bed Rest May Reduce Risk of Pregnancy Complications ...................................................... 344 337.

Pregnancy and Birth Sourcebook, Third Edition Section 40.1 Overview of Pregnancy Complications Excerpted from "Pregnancy Complications," by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, March 2009.

Complications of pregnancy are health problems that occur during pregnancy. They can involve the mother's health, the baby's health, or both. Some women have health problems before they become pregnant that could lead to complications. Other problems arise during the pregnancy. Keep in mind that whether a complication is common or rare, there are ways to manage problems that come up during pregnancy.

Health Problems before Pregnancy If you have an ongoing health problem, make sure to talk to your doctor before pregnancy. Your doctor might want to change the way your health problem is managed. Some medicines used to treat health problems could be harmful if taken during pregnancy. At the same time, stopping medicines that you need could be more harmful than the risks posed should you become pregnant. Be a.s.sured that you are likely to have a normal, healthy baby when health problems are under control and you get good prenatal care for health problems such as: * Asthma: Asthma: Poorly controlled asthma may increase risk of preeclampsia, poor weight gain in the fetus, preterm birth, cesarean birth, and other complications. Poorly controlled asthma may increase risk of preeclampsia, poor weight gain in the fetus, preterm birth, cesarean birth, and other complications.

* Depression: Depression: Depression that persists during pregnancy can make it hard for a woman to care for herself and her unborn baby. Having depression before pregnancy also is a risk factor for postpartum depression. Depression that persists during pregnancy can make it hard for a woman to care for herself and her unborn baby. Having depression before pregnancy also is a risk factor for postpartum depression.

* Diabetes: Diabetes: High blood glucose (sugar) levels during pregnancy can harm the fetus and worsen a woman's long-term diabetes 338 High blood glucose (sugar) levels during pregnancy can harm the fetus and worsen a woman's long-term diabetes 338 What Are Pregnancy Complications?

complications. Doctors advise getting diabetes under control at least 3 to 6 months before trying to conceive.

* Eating disorders: Eating disorders: Body image changes during pregnancy can cause eating disorders to worsen. Eating disorders are linked to many pregnancy complications, including birth defects and premature birth. Women with eating disorders also have higher rates of postpartum depression. Body image changes during pregnancy can cause eating disorders to worsen. Eating disorders are linked to many pregnancy complications, including birth defects and premature birth. Women with eating disorders also have higher rates of postpartum depression.

* Epilepsy and other seizure disorders: Epilepsy and other seizure disorders: Seizures during pregnancy can harm the fetus, and increase the risk of miscarriage or stillbirth. But using medicine to control seizures might cause birth defects. For most pregnant women with epilepsy, using medicine poses less risk to their own health and the health of their babies than stopping medicine. Seizures during pregnancy can harm the fetus, and increase the risk of miscarriage or stillbirth. But using medicine to control seizures might cause birth defects. For most pregnant women with epilepsy, using medicine poses less risk to their own health and the health of their babies than stopping medicine.

* High blood pressure: High blood pressure: Having chronic high blood pressure puts a pregnant woman and her baby at risk for problems. Women with high blood pressure have a higher risk of preeclampsia and placental abruption (when the placenta separates from the wall of the uterus). The likelihood of preterm birth and low birth weight also is higher. Having chronic high blood pressure puts a pregnant woman and her baby at risk for problems. Women with high blood pressure have a higher risk of preeclampsia and placental abruption (when the placenta separates from the wall of the uterus). The likelihood of preterm birth and low birth weight also is higher.

* Human immunodeficiency virus (HIV): Human immunodeficiency virus (HIV): HIV can be pa.s.sed from a woman to her baby during pregnancy or delivery. Some HIV medicines can lower the chances of HIV being pa.s.sed to the baby. But the effects of some medicines on the fetus are not clear or not known. Good prenatal care will help protect a woman's baby from HIV and keep her healthy. HIV can be pa.s.sed from a woman to her baby during pregnancy or delivery. Some HIV medicines can lower the chances of HIV being pa.s.sed to the baby. But the effects of some medicines on the fetus are not clear or not known. Good prenatal care will help protect a woman's baby from HIV and keep her healthy.

* Migraine: Migraine: Migraine symptoms tend to improve during pregnancy. Some women have no migraine attacks during pregnancy. Migraine symptoms tend to improve during pregnancy. Some women have no migraine attacks during pregnancy.

Certain medicines commonly used to treat headaches should not be used during pregnancy. A woman who has severe headaches should speak to her doctor about ways to relieve symptoms safely.

* Overweight and obesity: Overweight and obesity: Recent studies suggest that the heavier a woman is before she becomes pregnant, the greater her risk of a range of pregnancy complications, including preeclampsia and preterm delivery. Overweight and obese women who lose weight before pregnancy are likely to have healthier pregnancies. Recent studies suggest that the heavier a woman is before she becomes pregnant, the greater her risk of a range of pregnancy complications, including preeclampsia and preterm delivery. Overweight and obese women who lose weight before pregnancy are likely to have healthier pregnancies.

* s.e.xually transmitted infections (STIs): s.e.xually transmitted infections (STIs): Some STIs can cause early labor, a woman's water to break too early, and infection in 339 Some STIs can cause early labor, a woman's water to break too early, and infection in 339 Pregnancy and Birth Sourcebook, Third Edition the uterus after birth. Some STIs also can be pa.s.sed from a woman to her baby during pregnancy or delivery. Some ways STIs can harm the baby include: low birth weight, dangerous infections, brain damage, blindness, deafness, liver problems, or stillbirth.

* Thyroid disease: Thyroid disease: Uncontrolled hyperthyroidism (overactive thyroid) can be dangerous to the mother and cause health problems such as heart failure and poor weight gain in the fetus. Uncontrolled hyperthyroidism (overactive thyroid) can be dangerous to the mother and cause health problems such as heart failure and poor weight gain in the fetus.

Uncontrolled hypothyroidism (underactive thyroid) also threatens the mother's health and can lead to intellectual disabilities in the baby.

* Uterine fibroids: Uterine fibroids: Uterine fibroids are not uncommon, but few cause symptoms that require treatment. Uterine fibroids rarely cause miscarriage. Sometimes, fibroids can cause preterm or breech birth. Cesarean delivery may be needed if a fibroid blocks the birth ca.n.a.l. Uterine fibroids are not uncommon, but few cause symptoms that require treatment. Uterine fibroids rarely cause miscarriage. Sometimes, fibroids can cause preterm or breech birth. Cesarean delivery may be needed if a fibroid blocks the birth ca.n.a.l.

Pregnancy-Related Problems Sometimes pregnancy problems arise-even in healthy women.

Some prenatal tests done during pregnancy can help prevent these problems or spot them early. Use Table 40.1 to learn about some common pregnancy complications. Call your doctor if you have any of the symptoms on this chart. If a problem is found, make sure to follow your doctor's advice about treatment. Doing so will boost your chances of having a safe delivery and a strong, healthy baby.

When to Call the Doctor When you are pregnant don't wait to call your doctor or midwife if something is bothering or worrying you. Sometimes physical changes can be signs of a problem. Call your doctor or midwife as soon as you can if you: * are bleeding or leaking fluid from the v.a.g.i.n.a; * have sudden or severe swelling in the face, hands, or fingers; * get severe or long-lasting headaches; * have discomfort, pain, or cramping in the lower abdomen; * have a fever or chills; * are vomiting or have persistent nausea; 340.

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* feel discomfort, pain, or burning with urination; * have problems seeing or blurred vision; * feel dizzy; * suspect your baby is moving less than normal after 28 weeks of pregnancy (if you count less than 10 movements within 2 hours); * have thoughts of harming yourself or your baby.

Table 40.1. Common Pregnancy Complications (continued on next page) Common Pregnancy Complications (continued on next page) Anemia-Lower than normal number of healthy red blood cells Symptoms: Feel tired or weak; look pale; feel faint; shortness of breath Treatment: Treating the underlying cause of the anemia will help restore the number of healthy red blood cells. Women with pregnancy related anemia are helped by taking iron and folic acid supplements. Your doctor will check your iron levels throughout pregnancy to be sure anemia does not happen again.

Depression-Extreme sadness during pregnancy or after birth (postpartum) Symptoms: Intense sadness; helplessness and irritability; appet.i.te changes; thoughts of harming self or baby Treatment: Women who are pregnant might be helped with one or a combination of treatment options, including therapy, support groups, and medicines. A mother's depression can affect her baby's development, so getting treatment is important for both mother and baby.

Ectopic pregnancy-When a fertilized egg implants outside of the uterus, usually in the fallopian tube Symptoms: Abdominal pain; shoulder pain; v.a.g.i.n.al bleeding; feeling dizzy or faint Treatment: With ectopic pregnancy, the egg cannot develop. Drugs or surgery is used to remove the ectopic tissue so your organs are not damaged.

Fetal problems-Unborn baby has a health issue, such as poor growth or heart problems Symptoms: Baby moving less; baby is smaller than normal for gestational age; fewer than 10 kicks per day after 26 weeks; some problems have no symptoms, but are found with prenatal tests Treatment: Treatment depends on results of tests to monitor baby's health. If a test suggests a problem, this does not always mean the baby is in trouble. It may only mean that the mother needs special care until the baby is delivered.

This can include a wide variety of things, such as bed rest, depending on the mother's condition. Sometimes, the baby has to be delivered early.

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Pregnancy and Birth Sourcebook, Third Edition Table 40.1. Common Pregnancy Complications (continued from previous page) Common Pregnancy Complications (continued from previous page) Gestational diabetes-Too high blood sugar levels during pregnancy Symptoms: Usually, there are no symptoms. Sometimes, extreme thirst, hunger, or fatigue; screening test shows high blood sugar levels Treatment: Most women with pregnancy related diabetes can control their blood sugar levels by a following a healthy meal plan from their doctor. Some women also need insulin to keep blood sugar levels under control. Doing so is important because poorly controlled diabetes increases the risk of preeclampsia; early delivery; cesarean birth; having a big baby, which can complicate delivery; baby born with low blood sugar, breathing problems, and jaundice.

High blood pressure (pregnancy related)-High blood pressure that starts after 20 weeks of pregnancy and goes away after birth Symptoms: High blood pressure without other signs and symptoms of preeclampsia Treatment: The health of the mother and baby are closely watched to make sure high blood pressure is not preeclampsia.

Hyperemesis gravidarum (HG)-Severe, persistent nausea and vomiting during pregnancy Symptoms: More extreme than morning sickness; nausea that does not go away; vomiting several times every day; weight loss; reduced appet.i.te; dehydration; feeling faint or fainting Treatment: Dry, bland foods and fluids is the first line of treatment. Sometimes, medicines are prescribed to help nausea. Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins.

Usually, women with HG begin to feel better by the 20th week of pregnancy. But some women vomit and feel nauseated throughout all three trimesters.

Miscarriage-Pregnancy loss from natural causes before 20 weeks. As many as 20 percent of pregnancies end in miscarriage. Often, miscarriage occurs before a woman even knows she is pregnant Symptoms: Signs of a miscarriage can include v.a.g.i.n.al spotting or bleeding; cramping or abdominal pain; fluid or tissue pa.s.sing from the v.a.g.i.n.a Treatment: In most cases, miscarriage cannot be prevented. Sometimes, a woman must undergo treatment to remove pregnancy tissue in the uterus.

Counseling can help with emotional healing.

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Table 40.1. Common Pregnancy Complications (continued from previous page) Common Pregnancy Complications (continued from previous page) Placenta previa-Placenta covers part or entire opening of cervix inside of the uterus Symptoms: Painless v.a.g.i.n.al bleeding during second or third trimester; for some, no symptoms Treatment: If diagnosed after the 20th week of pregnancy, but with no bleeding, a woman will need to cut back on her activity level and increase bed rest. If bleeding is heavy, hospitalization may be needed until mother and baby are stable. If the bleeding stops or is light, continued bed rest is resumed until baby is ready for delivery. If bleeding doesn't stop or if preterm labor starts, baby will be delivered by cesarean.

Placental abruption-Placenta separates from uterine wall before delivery, which can mean the fetus doesn't get enough oxygen Symptoms: v.a.g.i.n.al bleeding; cramping, abdominal pain, and uterine tenderness Treatment: When the separation is minor, bed rest for a few days usually stops the bleeding. Moderate cases may require complete bed rest. Severe cases (when more than half of the placenta separates) can require immediate medical attention and early delivery of the baby.

Preeclampsia-A condition starting after 20 weeks of pregnancy that causes high blood pressure and problems with the kidneys and other organs. Also called toxemia.

Symptoms: High blood pressure; swelling of hands and face; too much protein in urine; stomach pain; blurred vision; dizziness; headaches Treatment: The only cure is delivery, which may not be best for the baby. Labor will probably be induced if condition is mild and the woman is near term (37 to 40 weeks of pregnancy). If it is too early to deliver, the doctor will watch the health of the mother and her baby very closely. She may need medicines and bed rest at home or in the hospital to lower her blood pressure. Medicines also might be used to prevent the mother from having seizures.

Preterm labor-Going into labor before 37 weeks of pregnancy Symptoms: Increased v.a.g.i.n.al discharge; pelvic pressure and cramping; back pain radiating to the abdomen; contractions Treatment: Medicines can stop labor from progressing. Bed rest is often advised.

Sometimes, a woman must deliver early. Giving birth before 37 weeks is called preterm birth.

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Pregnancy and Birth Sourcebook, Third Edition Section 40.2 Bed Rest May Reduce Risk of Pregnancy Complications "Surviving Bed Rest," October 2007, reprinted with permission from www.kidshealth.org. Copyright 2007 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or wwwTeensHealth.org.

Until this point in your pregnancy, you've probably been going about your normal activities of work, ch.o.r.es at home, spending time with family and friends, and exercise. But one day, suddenly or perhaps planned in advance, your doctor tells you that for your health and the health of your baby, you'll be restricted to bed rest.

Even though your friends and family may envy you for what they see as a mini-vacation, don't be fooled-bed rest during pregnancy is no walk in the park. Fortunately, though, there are plenty of ways to make your time in bed more enjoyable and productive, so keep reading and find out how to make the best of bed rest.

Doctor's Orders There are several situations that might cause your doctor to recommend bed rest for some portion of your pregnancy. If your medical history, including previous pregnancies, contains information that might point to a medical complication, your doctor might recommend bed rest. Or, you might experience symptoms, such as bleeding or contractions, that require you to go on bed rest.

Even if your medical history is clear and you experience no symptoms, your doctor may require bed rest if the results of a test or procedure indicate a medical complication or if your baby's growth is determined to be poor.

So what are some common pregnancy complications that often result in bed rest? A few include: high blood pressure (including pregnancy-induced hypertension, preeclampsia, and eclampsia), v.a.g.i.n.al bleeding 344 What Are Pregnancy Complications?

(including placenta previa), premature labor, and cervical changes (such as incompetent cervix and cervical effacement).

If you're having multiples, your pregnancy may be termed high risk and will require close monitoring by your doctor. If you develop any problems, your doctor might place you on bed rest. Bed rest might also be recommended if you've had previous pregnancies that ended in miscarriage, stillbirth, or a premature birth.

Just as every pregnancy is different, every woman's experience with bed rest is different. Some women may know early on that because of their medical histories, they will have to go on bed rest at some point in their pregnancies. Other women may be surprised to hear their doctors announce, after a routine appointment, that they'll be on bed rest for a few weeks.

Some women are on bed rest early in their pregnancies and then released, whereas others spend their entire pregnancies confined to their beds. Your doctor can give you specific information about the duration of your bed rest.

How Does Bed Rest Help?

Women with pregnancy conditions related to high blood pressure may be placed on bed rest to decrease stress, both physical and emotional, with the hope of lowering their blood pressure. v.a.g.i.n.al bleeding can be aggravated by activity, lifting, or exercise, so bed rest may also be used to reduce bleeding. Women experiencing premature labor and contractions may also be restricted, because activity and stress can also aggravate these conditions.

Depending on your condition, your doctor may ask you to lie on your side to facilitate blood flow to the placenta or to rest with your feet up and your back elevated.

What Can-and Can't-You Do on Bed Rest?

Sometimes, doctors recommend modified bed rest or "house arrest,"

which generally allows women to stay on the couch, bed, or in a sitting position, but restricts them from s.e.xual intercourse, exercise, or lifting. Other women may be told to remain in bed, only sitting up for meals or standing to take quick showers. Some women have to remain in bed in the hospital because their pregnancies require closer monitoring by a trained hospital staff.

Whatever kind of bed rest your doctor recommends, if it's long-term, you'll need to remember to exercise your legs to keep the blood 345 Pregnancy and Birth Sourcebook, Third Edition circulating and prevent clots. Because every woman who experiences bed rest is different, be sure to get answers to the following questions from your doctor: * Can I get up to use the bathroom?

* Can I get up to prepare quick meals or to do light ch.o.r.es?

* Can I take a bath or shower?

* What position should I be in while I'm resting?

* Can I go to work or work from home?

* Is driving OK?

* How much walking is safe?

* How much and what kind of s.e.xual activity is OK?

* What activities can I do to increase blood circulation safely?

Tips for Surviving Bed Rest Fortunately, there are plenty of ways to make your bed rest enjoyable without becoming addicted to daytime TV. Try these tips: * Stick to a schedule. Stick to a schedule. Even if you have to stay in bed all day, you'll feel better if you take care of yourself. After you wake up, change into comfortable clothes and plan what to do for the day. Even if you have to stay in bed all day, you'll feel better if you take care of yourself. After you wake up, change into comfortable clothes and plan what to do for the day.

Having a plan will make you feel as if you're accomplishing something and will give you something to look forward to.

* Catch up while you can. Catch up while you can. Let's face it, after the baby arrives, you'll be too busy to think about catching up on correspondence or reading your favorite author's latest novel. Try these time pa.s.sers: Let's face it, after the baby arrives, you'll be too busy to think about catching up on correspondence or reading your favorite author's latest novel. Try these time pa.s.sers: * Choose a doctor for your child, find quality child care, or write up a birth plan (if you haven't already done these things).

* Start a journal chronicling your pregnancy-and your bed rest.

* Start a family tree that you can share with your child someday.

* Firm up your baby-name choices-use books and websites for ideas.

* Organize photo alb.u.ms.

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* Read anything-newspapers, magazines, cla.s.sic novels, the latest bestsellers, compilations of fiction or poetry-you could even revisit some of your favorite childhood stories or try out some books from the library for your little one.

* Watch rented videos/DVDs or taped TV shows.

* Answer letters or correspondence.

* Write thank-you cards if you've already had a baby shower- if not, start addressing the envelopes to people (friends and family) whom you know will probably give gifts.

* Build an e-mail and phone list of people to call when the baby comes, if you haven't already done so.

* Start a calendar of important dates to remember (birthdays, anniversaries, etc.).

* Contact your job about your maternity-leave benefits.

* Fill out health insurance paperwork for your baby in ad- vance.

* Designate a guardian for your child and have your lawyer draft a new will.

* Stock up. Stock up. Just because you're on your back doesn't mean you have to be unprepared. You can fully stock your baby's nursery and layette by phone or the Internet. Order all the items you think you'll need for the first 3 months-including diapers! In addition to baby stores and centers, online drugstores often carry a wide variety of baby care items that they'll deliver right to your door. Just because you're on your back doesn't mean you have to be unprepared. You can fully stock your baby's nursery and layette by phone or the Internet. Order all the items you think you'll need for the first 3 months-including diapers! In addition to baby stores and centers, online drugstores often carry a wide variety of baby care items that they'll deliver right to your door.

* Don't be afraid to ask visitors for a.s.sistance. Don't be afraid to ask visitors for a.s.sistance. Your friends and family would probably love to help you with household Your friends and family would probably love to help you with household ch.o.r.es, errands, or meal preparation. Create a task list so that when someone offers help, you can a.s.sign him or her a task. Visits from your friends and family can boost your spirits-just make sure you ask them to come at a time that's convenient and comfortable for you.

* Become a parenting expert. Become a parenting expert. Plenty of parenting books and websites can help to answer many of your parenting and children's health questions. If you feel uncomfortable reading about high-risk pregnancy issues, learn about breastfeeding or how to encourage your child's development instead. You could also get subscriptions to local and national parenting magazines and 347 Plenty of parenting books and websites can help to answer many of your parenting and children's health questions. If you feel uncomfortable reading about high-risk pregnancy issues, learn about breastfeeding or how to encourage your child's development instead. You could also get subscriptions to local and national parenting magazines and 347 Pregnancy and Birth Sourcebook, Third Edition start clipping out useful articles and tips. File your clippings in folders (i.e., new baby care, feeding, crying, sleeping, safety, development, etc.) for future reference when the baby comes. Also file away any articles you print out from the Internet.

* Seek out a support system. Seek out a support system. The Internet is a great place to find support from other moms on bed rest. Check out bed rest message boards and chat rooms, where you can share tips and get advice. The Internet is a great place to find support from other moms on bed rest. Check out bed rest message boards and chat rooms, where you can share tips and get advice.

* Support your support person. Support your support person. You're probably relying heavily on your spouse or partner to tend to household ch.o.r.es, child care, and errands during your bed rest. Make sure you take the time to show your appreciation-you can always order a You're probably relying heavily on your spouse or partner to tend to household ch.o.r.es, child care, and errands during your bed rest. Make sure you take the time to show your appreciation-you can always order a nice gift by phone or online!

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