What are some of the more common complications of pregnancy?

Although most pregnancies are uncomplicated, sometimes, unplanned events happen. The following are some of the more common pregnancy complications.

Amniotic Fluid Complications

Amniotic fluid is the liquid in the sac around the fetus, and too much or too little may be a sign of a problem with the pregnancy. Too much fluid can promote early breaking of the membrane and/or preterm labor, as well as issues such as worsening shortness of breath for the mother.

Common causes of too much fluid are diabetes, twins or triplets (a multiple pregnancy), infections, incompatible blood types and birth defects. Too little fluid may also be a sign of birth defects as well as problems with the placenta, slowed fetal growth, early rupture of membranes or fetal death.

Bleeding

Bleeding, while common in pregnancy, may also be a sign of placental complications, a vaginal or cervical infection, or preterm labor. Bleeding during late pregnancy may raise the risk of serious complications and may be a reason to intervene — even to perform an early delivery. Bleeding any time during pregnancy should immediately be reported to your physician.

Ectopic Pregnancy

An ectopic pregnancy is when an embryo has implanted somewhere besides the inside of the uterus (most commonly in one of the fallopian tubes that connect the ovaries to the uterus). Pregnancies in these locations can be life-threatening and cannot safely continue or be moved to the uterus.

About 1% of all pregnancies are ectopic, and about half of ectopic pregnancies occur with no known risk factors or explanation. Some reasons that the risk of ectopic pregnancy can increase include:

• Fertility treatments to become pregnant
• Previous tubal surgery
• Pelvic inflammatory disease or other uterine infections
• A previous ectopic pregnancy

Early signs that suggest a woman may be experiencing an ectopic pregnancy are abdominal pain and/or bleeding early in pregnancy (typically at about three to six weeks after a missed period). When these conditions occur, a doctor may conduct an ultrasound and monitor hormone levels to help determine the location and health of a pregnancy.

If an ectopic pregnancy is confirmed, treatment can include medication, though surgery may be required. If untreated, an emergency can develop if the pregnancy ruptures.

Having an ectopic pregnancy does not mean you cannot become pregnant again and eventually deliver a healthy, full-term baby. It is important to note, though, that having had an ectopic pregnancy increases the chance of having another. After one ectopic pregnancy, the risk for a second is 10%, and after a second one, the chance of a third is 25%.

Miscarriage or Fetal Loss

A miscarriage is pregnancy loss that happens up to 20 weeks of gestation (most miscarriages happen before 12 weeks). Miscarriages, which occur in 10%–30% of all pregnancies (and maybe more frequently), usually are due to genetic or chromosomal abnormalities when they happen early in pregnancy.

Miscarriages are often preceded by bleeding and intense cramping. To confirm a miscarriage, the doctor may order an ultrasound and blood tests. The fetus and contents of the uterus are often naturally expelled, but if this does not happen, medication can be used to induce that, or a dilation and curettage procedure — which uses special instruments to remove the abnormal pregnancy — can be performed.

Fetal loss in the second trimester may happen for reasons such as problems with the placenta, infection or, in some cases, if the cervix opens too early (known as cervical insufficiency, this was previously called an incompetent cervix). Depending on the cause and the clinical situation, cervical insufficiency may be managed with surgery to place a cerclage — a suture to help hold the cervix closed.

Placental Complications

Under normal circumstances, the placenta attaches to the uterine wall. Complications that may happen include:

Placental Abruption

Sometimes, the placenta becomes detached from the uterine wall too soon, leading to bleeding and less oxygen and nutrients to the fetus. The detachment may be complete or partial. Placental abruption, the cause of which is often unknown, happens in about one in every 100 live births.

Placental abruption is more common among people who smoke, have high blood pressure or have a multiple pregnancy. It also happens more commonly when women have had previous children or a history of placental abruption. Symptoms and treatment depend on the degree of detachment. Symptoms may include bleeding, cramping and abdominal tenderness. Hospitalization is frequently necessary, and early delivery may be required.

Placenta Previa

Normally, the placenta is located away from the cervix (the opening into the uterus). With placenta previa, it is attached close to or covering the cervix. This type of placental complication happens in about one in every 200 deliveries and occurs more often in people who have scarring of the uterus, which is normal after several pregnancies. Placenta previa also may happen in those who have fibroids or other problems in the uterus or had previous uterine surgeries.

Symptoms may include vaginal bleeding that is bright red and may be associated with abdominal tenderness or pain. The baby usually is delivered by cesarean section because the placenta is in the way of a vaginal delivery, making it unsafe.

Preeclampsia or Eclampsia

Preeclampsia is characterized by pregnancy-induced high blood pressure. It may also be accompanied by an abnormal amount of protein in the urine. Eclampsia, the more severe form, is defined as seizures occurring due to this condition. Eclampsia may result in coma, permanent disabilities or even death.

The cause of preeclampsia, which affects about 3%–8% of all pregnant women, is unknown, but preeclampsia is more common during first pregnancies. Other risk factors include:

• Preeclampsia in a prior pregnancy
• High blood pressure, diabetes and kidney and some autoimmune diseases before pregnancy
• Multiple pregnancy (twins, triplets, etc.)
• Age younger than 18 or older than 35 at the time of delivery
• Obesity with a body mass index (BMI) greater than 30
• African American race
• Lower socioeconomic situations

Symptoms may include:

• High blood pressure
• Headache
• New onset of blurred vision or seeing spots
• New or worsening shortness of breath
• Decreased urine output
• Abdominal pain, especially in the upper right side by the liver

Treatment, which varies according to the severity of the condition and the stage of the pregnancy, may include hospitalization, bed rest, medicine to lower blood pressure, close monitoring of the fetus and the mother and, sometimes, early delivery.