Complications of pregnancy 2300688 224241701 2008-07-07T23:22:51Z 128.95.114.71 /* Back pain */ '''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]] (acetaminophen), and (in severe cases) [[muscle relaxant]]s or [[narcotic]]s ===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 [[obstetrics|practitioner]]. ===Contractions=== * occasional, irregular, painless contractions that occur several times per day are normal and are known as [[Braxton Hicks contraction]]s * ''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 [[antidiuretic hormone|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 ===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 ===Pica (disorder)|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. ===Lower abdominal pain=== * ''Caused by'': rapid expansion of the uterus and stretching of ligaments such as the [[round ligament]]. * ''Treatment'': [[paracematol]] (acetominophen) ===Increased urinary frequency=== * ''Caused by'': increased intravascular volume, elevated GFR ([[glomerular filtration rate]]), and compression of the [[urinary bladder|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). ===Varicose veins=== * ''Caused by'': relaxation of the venous [[smooth muscle]] and increased intravascular pressure. * ''Treatment'': elevation of the legs, pressure stockings * relieve swelling and pain with warm sitz bath. * Avoid obesity, lengthy standing or sitting, constrictive clothing and constipation and bearing down with bowel movements ===Diastasis recti|Abdominal separation=== * ''Caused by'': excessive stretching of the abdominal muscles. * ''Treatment'': paliative care, surgery and/or rehabilitation after childbirth ==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 tube]]s. * ''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|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]], [[Physical trauma|trauma]], and drug use. * ''Treatment'': Immediate [[birth|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. ==See also== * [[List of obstetric topics]] [[Category:Obstetrics]] [[Category:Pregnancy]] [[Category:Massage]] [[fr:Complications de la grossesse]] [[sv:Graviditet#Möjliga komplikationer]]