Pregnancy complications are pathological conditions in obstetric practice that have arisen in connection with gestation and violate its natural course. At the initial stages, they may not be accompanied by clinical symptoms, subsequently manifested by pain in the lower abdomen, vaginal discharge, impaired fetal movement, headaches, edema. Ultrasound of the uterus and fetus, MRI pelviometry, laboratory tests, invasive prenatal methods, CTG and other techniques are used for diagnosis. Depending on the condition of the woman and the unborn child, treatment may be aimed at maintaining or terminating pregnancy.
According to specialists in the field of obstetrics and gynecology, only about 30-50% of pregnancies occur physiologically, and this percentage is constantly decreasing. The most common complications of the gestational period, not counting early toxicosis, are miscarriages, which end up to 15-20% of pregnancies, and premature birth (6-10%). At the same time, 30-80% of deeply premature babies suffer from disabling diseases. Approximately 8% of pregnant women experience water scarcity, 3-8% — preeclampsia and eclampsia, 2-14% — gestational diabetes mellitus. Every fiftieth pregnancy is ectopic, and in every two hundredth there is placenta previa. Other types of complications in pregnant women are less common.
The complicated course of the gestational period can be triggered by many factors on the part of the mother or fetus. The most common causes of pregnancy complications are:
- Extragenital somatic pathology. With cardiovascular diseases (hypertension, heart defects, arrhythmias) and urological diseases (glomerulonephritis, pyelonephritis), the risk of late gestosis increases. Gestation can also lead to decompensation of almost any chronic disease.
- Endocrinopathy. With violations of hypothalamic-pituitary regulation and endocrine function of the ovaries, the process of implantation of a fertilized egg suffers, the contractile activity of the myometrium changes. Diabetes mellitus provokes microcirculatory disorders both in a woman’s body and in the fetoplacental system.
- Inflammatory gynecological diseases. With salpingitis, adnexitis, endometritis, the probability of ectopic tubal and cervical pregnancy increases. Chronic cervicitis can provoke cervical insufficiency. With inflammation, intrauterine infection of the fetus is possible.
- Abnormalities of uterine development. Women with intrauterine septum, bicornular, saddle-shaped or infantile uterus are more often diagnosed with spontaneous abortions, premature birth, fetoplacental insufficiency, placental abruption and fetal hypoxia.
- Pathological pregnancy and childbirth in the past. Miscarriages and premature birth increase the likelihood of habitual miscarriage of the fetus. Scarring of the neck after its rupture is the main cause of isthmic—cervical insufficiency. After the rupture of the uterus in childbirth, it is likely to rupture in the late stages of the next pregnancy, especially multiple pregnancies.
- Multiple pregnancy. In the presence of two or more fetuses in the uterus, chronic extragenital pathology is more often aggravated, late toxicosis is observed, polyhydramnios, leakage of amniotic fluid, the threat of premature termination of pregnancy occurs.
- Infectious diseases. Viral and bacterial infections can provoke miscarriage, premature birth, aggravate the course of gestosis, chronic somatic and endocrine diseases, cause complications in the form of inflammation of the membranes. Some pathogens are capable of infecting the fetus in utero.
- Immunological factors. Habitual miscarriage of pregnancy is more often observed with incompatibility of maternal and fetal blood according to the AV0 system or Rh factor, the presence of antiphospholipid syndrome in the patient.
- Genetic abnormalities of the fetus. The most common reason for termination of pregnancy by early miscarriage is incompatible with life defects in fetal development.
- Iatrogenic complications. Performing amnioscopy, amniocentesis, cordocentesis and chorion biopsy, suturing the cervix increases the risk of high rupture of the amniotic bladder, infection and early termination of pregnancy.
Additional provoking factors, in which pregnancy complications are more often observed, are addictions (nicotine, alcohol, narcotic), asocial lifestyle. Pregnant women under 18 and over 35 years of age, patients with irrational nutrition and obesity, women who lead a low-activity lifestyle, experience excessive physical and psychological stress also belong to the risk group.
The clinical classification of pregnancy complications takes into account who has pathological changes and at what level — in the mother, fetus, in the mother-fetus system or in embryonic structures. The main complications in a woman are:
- Conditions and diseases associated with pregnancy. The patient may have early toxicosis, late gestosis, anemia, gestational diabetes and thyrotoxicosis, varicose veins. Functional changes in the calyx-pelvic system contribute to the rapid development of inflammatory urological diseases.
- Complications of existing diseases. Loads on the pregnant woman’s body provoke decompensation of chronic endocrine and somatic pathology — thyrotoxicosis, hypothyroidism, diabetes mellitus, cardiomyopathy, hypertension, gastrointestinal diseases. Violation of the function of organs and systems sometimes reaches the degree of insufficiency (cardiovascular, renal, hepatic).
- The threat of termination and miscarriage of pregnancy. Gestation may end prematurely with early or late spontaneous abortion (up to and including 22 weeks) or early delivery (from 23 to 37 full weeks).
- Ectopic pregnancy. When the fetal egg is attached outside the uterine cavity, ectopic pregnancy is observed. Currently, this condition in 100% of cases ends with the death of the fetus and the occurrence of severe complications in a woman (internal bleeding, hypovolemic shock, acute pain syndrome).
In some cases, the main pathological changes occur in the fetus. This group of complications consists of:
- Genetic anomalies. Malformations caused by genetic defects cause miscarriages, and during pregnancy — severe neurological, mental and somatic disorders in the child.
- Intrauterine infection. Infection can be caused by bacteria, mycoplasmas, chlamydia, fungi, viruses. Its complications are impaired fetal maturation, early termination of pregnancy, multiple malformations, fetal death, and the pathological course of childbirth.
- Fetal hypoxia. This condition is noted with insufficient oxygen supply, can cause ischemia and necrosis in various organs. The result of prolonged hypoxia is congenital pathology of the newborn or antenatal fetal death.
- Hypotrophy. With a pronounced delay in fetal development from the gestational period, birth hypoxia, problems with independent breathing, aspiration of meconium with the subsequent development of pneumonia, thermoregulation disorders, hyperbilirubinemia, brain damage may occur.
- Incorrect position and presentation. With pelvic and oblique presentation, there is a high probability of complications in childbirth, with transverse independent childbirth becomes impossible.
- Frozen pregnancy. Intrauterine death of a child with its preservation in the uterine cavity leads to the development of severe inflammatory complications — purulent endometritis, peritonitis, sepsis, which pose a threat to the health and life of a woman.
With complications from the embryonic structures that provide nutrition and protection of the fetus, the unborn child most often suffers, who may develop inflammatory diseases, hypoxia, hypotrophy, leading to congenital pathology or antenatal death. In addition, such complications provoke premature and pathological childbirth. Taking into account the level of lesions , there are:
- Pathology of the placenta. Cysts and tumors may occur in the placental tissue, infectious and inflammatory processes (deciduitis, villitis, intervillesitis) may develop. There may be anomalies of the placental disc, violations in the attachment of the placenta to the uterine wall — tight attachment, increment, ingrowth and germination. Serious complications are low location, presentation and premature placental abruption.
- Pathology of the umbilical cord. When the inflammatory process spreads to the umbilical cord tissue, funiculitis occurs. The main anomalies of the umbilical cord development are its shortening, elongation, shell attachment, formation of false and true nodes, cysts, hematomas, teratomas, hemangiomas.
- Pathology of the membranes. The most common complications from the fetal sac are low and polyhydramnios, premature rupture and leakage of water, formation of amniotic cords, chorioamnionitis.
A separate group of complications is represented by disorders in the system of interaction between mother and fetus. The main ones are:
- Rhesus conflict. The condition is accompanied by the destruction of fetal erythrocytes and the development of various complications, from hemolytic jaundice to the death of the child.
- Fetoplacental insufficiency. Violation of the morphological structure and functional capabilities of the placenta, caused by various reasons, leads to hypoxia, hypotrophy, and in particularly severe cases — fetal death.
When classifying complications, it is equally important to take into account the time of their occurrence. There are early complications, often leading to termination of pregnancy, and late ones, affecting the development of the fetus and the course of labor.
Despite the relationship between certain pathological conditions and the gestation period, there are a number of common signs indicating a complicated course of pregnancy. The first of them is abdominal pain. Usually they are localized in the lower part of the abdominal cavity, they can give to the groin and lower back. Less often, the pain begins in the epigastrium, and then passes into the lower abdomen. Pain syndrome occurs during ectopic pregnancy, the threat of miscarriage and premature birth, threatening rupture of the uterus (in pregnant women with a scar on the uterus). In such cases, there is weakness, dizziness, and sometimes loss of consciousness. Pain in inflammatory diseases is often combined with an increase in temperature.
The complication of pregnancy is indicated by vaginal discharge. Miscarriage, premature birth, detachment or placenta previa are accompanied by bloody discharge. Purulent and mucopurulent whites are observed in inflammatory processes. The watery nature of the discharge is characteristic of premature outpouring or leakage of amniotic fluid.
Almost any changes in a woman’s general well-being can be a sign of possible complications. In the first trimester, pregnant women are worried about nausea, vomiting and other signs of early toxicosis. With late gestosis, dizziness, pain in the occipital region, the appearance of “flies” in front of the eyes, swelling on the legs, nausea, vomiting occur. A sudden increase in temperature can be observed with the development of inflammatory complications or with an infectious disease. A pregnant woman may notice the appearance or intensification of symptoms characteristic of extragenital pathology — dry mouth, frequent palpitations, shortness of breath, heartburn, varicose veins, etc.
Pregnancy complications from the fetus are often detected by a change in the frequency of movements. If the movements are not felt for more than 4 hours, there is no reaction to the usual stimuli (stroking the abdomen, music, food), it is worth urgently contacting an obstetrician-gynecologist. Hypoxia is characterized by active stirring and a feeling of hiccuping of the fetus.
If a pregnancy complication is suspected in the process of collecting anamnesis, provoking factors are identified, an examination is prescribed to determine the type and degree of violations. Recommended for diagnosis:
- External obstetric examination. The size and shape of the uterus, the tone of its muscles, areas of soreness are determined.
- Inspection in mirrors. It allows you to detect secretions, assess the condition of the vaginal mucosa and cervix.
- Microscopy and back – up of a vaginal smear. They are indicated for assessing the state of vaginal secretions, identifying pathogens of infectious diseases.
- Ultrasound of the pelvic organs. It is aimed at determining the size of the uterus, the condition of its wall and scar (if present), assessing the size and condition of the fetus, placenta, umbilical cord, amniotic fluid volume.
- MRI pelviometry. Effectively detects abnormalities in the development of the fetus and embryonic membranes suspected during ultrasound examination.
- Invasive prenatal diagnosis. With the help of amnioscopy, amniocentesis, chorion biopsy, cordocentesis, placentocentesis and fetoscopy, congenital chromosomal abnormalities are excluded, the condition of fetal membranes, the amount and color of amniotic fluid are assessed.
- Non-invasive rapid tests. The determination of specific markers allows, in doubtful cases, to diagnose ectopic pregnancy, to establish the leakage of amniotic fluid, to confirm the premature onset of labor.
- Laboratory monitoring of pregnancy. Determination of the level of hormones — hCG, free beta-hCG and estriol, PAPP-A, placental lactogen and alpha-fetoprotein — is indicative of placental disorders, the presence of fetal pathologies and complications of the gestation process.
- TORCH-complex. During serological examination, infectious diseases affecting the fetus in utero are diagnosed — toxoplasmosis, rubella, cytomegalovirus, herpes, hepatitis B and C, chlamydia, syphilis, gonorrhea, listeriosis, HIV, chickenpox, enterovirus.
- Dopplerography of uteroplacental blood flow. Provides an objective assessment of transplacental hemodynamics.
- Cardiotocography. It is prescribed to assess the fetal heartbeat, timely detection of bradycardia and tachycardia, indicating hypoxia and other complications critical for the child.
General blood and urine tests, blood pressure and temperature monitoring, ECG, and other instrumental and laboratory research methods can be used to dynamically monitor the condition of the pregnant woman and fetus, identify additional risk factors. Differential diagnosis of pregnancy complications is carried out with concomitant diseases (hypertension, renal colic, glomerulo- and pyelonephritis), acute surgical pathology (appendicitis, acute cholecystitis), inflammatory and non-inflammatory gynecological diseases. In difficult cases, a urologist, a surgeon, a therapist, an anesthesiologist-resuscitator, an infectious disease specialist, an immunologist and other narrow specialists are involved in the diagnosis.
Treatment of pregnancy complications
The tactics of managing a pregnant woman in the presence of complications depends on their nature, severity, and degree of risk to the fetus and mother. In the normal condition of the child and pathological disorders that do not pose a serious threat to a woman’s life, medication therapy is prescribed to prolong pregnancy. The treatment plan may include:
- Hormonal drugs. Normalize the endocrine balance in the body.
- Tocolytics. Reduce the contractile activity of the myometrium.
- Antibacterial agents. Destroy pathogenic flora or prevent the development of infection.
- Anti-inflammatory drugs. Reduce the severity of the inflammatory process and pain syndrome.
- Glucocorticoids. Promote the maturation of lung tissue and accelerate the synthesis of surfactant.
- Sedatives. Relieve emotional stress.
According to the indications, the woman is undergoing symptomatic therapy of extragenital pathology, vitamin and mineral complexes are used, infusion solutions. If necessary, sutures are applied to the neck or an obstetric pessary is installed in the vagina. When certain types of fetal, placental and amniotic fluid pathology are detected, fetal drainage and fetoscopic operations, intrauterine transfusions and infusions are indicated.
For the treatment of fetoplacental insufficiency, drugs that improve microcirculation and uteroplacental blood flow are used – antiplatelet agents and anticoagulants. In rhesus conflict, the administration of antiresus immunoglobulin is effective. The detection of gross malformations, the death of a child, an abortion that has begun and conditions that threaten the life of the mother serve as indications for termination of pregnancy and intensive care. Taking into account the term, a medicinal, mini- or medical abortion or artificial childbirth is performed.
Prognosis and prevention
The prognosis of a complicated pregnancy depends on the nature of the pathology. With genetic defects, ectopic pregnancy and miscarriage, the fetus cannot be preserved. In other cases, the probability of pregnancy and the birth of a healthy child is determined by the time of detection and the degree of pathological disorders, as well as the correctness of obstetric tactics. To prevent pregnancy complications, women who plan to conceive a child are recommended to treat concomitant diseases, abandon bad habits, timely registration in a women’s clinic and regular visits to a doctor, especially if there are risk factors.