Pregnancy Complications And Congenital Illnesses

Abruptio Placenta

Abruptio Placenta is one of the major cause of bleeding occurring before deliverywhich is known as Antepartum Hemorrhage (Ante = Before, Parturition = Processof childbirth, Hemorrhage = Bleeding). Placenta is the organ that delivers oxygenand nutrients from the mother to the child. Placenta normally separates after thebaby is born. In this process blood vessels get torn, and heavy bleeding ensues.However, after the delivery, the hormone known as Oxytocin contracts themuscles of uterus and shuts them down preventing bleeding. In the absence of itheavy bleeding occurs and can be life-threatening to both mother and babydepending on the severity of the condition.

Symptoms

• Abdominal discomfort to severe pain depending on the severity
• Bleeding from the vagina or blood stained discharge
• The body of mother may look pale (Pallor)
• It may be difficult to feel fetal parts while the doctor is examining theabdomen, the height of uterus may not correspond to the gestational age andfetal heart rate( heart rate of the baby) may not be normal.

Causes

• Trauma (Accidents leading to blow on abdomen)
• Sudden decompression for example following the delivery of first baby oftwins, premature rupture of membranes
• Short cord
• Anomaly in the placenta
• Folic acid deficiency.

Treatment

Treatment usually depends on the amount of blood loss and the status of thebaby. Immediate resuscitation is first done by administering fluids to the mother.Doctor may send some tests to check for various blood indices. Then immediatedelivery is done either via normal vaginal delivery or via operation (Cesareansection). If the status of the baby is reassuring observation may be done providedthat immediate intervention can be carried out promptly.

Amniotic Fluid Embolism

Amniotic fluid is the liquid material that surrounds the baby in the uterus. Smallamount of fluid entering the circulation of mother through a slight tear in theplacenta or uterus is normal. However, sometimes debris from the tissuesurrounding fetus enters the maternal circulation and blocks the blood vesselsentering lungs of the mother. Furthermore, this debris starts to clot the bloodinside the mother’s circulation clogging blood vessels causing a wide variety ofproblems.

Symptoms

• Low blood pressure in the mother
• Difficulty breathing
• Fluid buildup in the lungs (Pulmonary edema)
• Abnormal heart rate of the baby
• Signs of bruising, prolonged bleeding even at small wounds.

Risk factors

• More than 5 previous pregnancies (Multiparity)
• Old mother (age greater than 35 yrs)
• Trauma.

Treatment

Immediate resuscitation is carried out which is directed at providing oxygen tothe lungs and replacing blood and blood components necessary for clotting.Immediate delivery may be required in some cases.

Ectopic Pregnancy

After the sperm fertilizes the ovum, the resulting fertilized egg is known as zygote. Thiszygote must travel down the fallopian tube and usually implants itself on the uterus onthe eighth or ninth day. Sometimes, the egg gets fertilized outside the fallopian tube orfails to travel down to the uterus for implantation and development occurs outside theuterus resulting in the condition known as ectopic pregnancy.

Symptoms

Most of the symptoms are caused when ectopic pregnancy ruptures the fallopian tube ofthe mother and presents as:

• Severe pain in lower stomach
• Bleeding from the vagina
• Pain on shoulder tip, especially while breathing in occurs due to pooling of blood insidethe stomach.

Causes

• IUCD use and failure of contraception
• Previous reconstruction surgery on the fallopian tubes
• Infection on the fallopian tube (Salpingits, Pelvic Inflammatory Disease)
• IVF (Test tube baby): High rates of Ectopic Pregnancy in IVF has been found

Treatment

At first life-saving measures are performed estimating the blood loss andcondition of the mother. Emergency Laparotomy is an operation in which belly isopened and bleeding stopped by tying the blood vessels. It is performed if themother is not stable. In stable patients, the ectopic pregnancy can be terminatedusing medicine such as Methotrexate or can be terminated surgically.

Postpartum Haemorrhage requiring hysterectomy

Postpartum Hemorrhage (Post = After, Parturition = childbirth, Hemorrhage =bleeding) refers to abnormal bleeding from the genital tract usually more than500 ml in normal vaginal delivery and 1000 ml during operation (Cesareandelivery) within 24 hours following the delivery. However, in practice anybleeding from genital tract causing hemodynamic compromise in the mother (low blood pressure, increased heart rate, pale body) within 42 days after deliveryis considered PPH (Post – Partum hemorrhage). Therefore, it is classified intoprimary (occurring within 24 hours) and secondary ( occurring within 42 days) PPH. When primary measures such as medicine and introduction of a smallballoon into the uterus (balloon tamponade) fail to stop bleeding and stabilizethe condition of mother, hysterectomy may be required. Hysterectomy is asurgical procedure where doctors cut out and remove the uterus of the mother.This is usually done as a last resort to save the life of the mother.

Symptoms

• Dizziness
• Increased heart rate
• Abnormal/Strange heart beat
• Weakness
• Pale body
• Urine output is decreased or urine stops completely
• Air hunger/ Difficulty breathing.

Causes

• Failure of uterus to contract (Uterus usually responds to oxytocin hormone andcontracts periodically in order to prevent torn blood vessels from bleeding)
• Tears, ruptures during passage of the baby in the genital tract
• Failure of placenta to come out properly
• Presence of disease in the mother where the blood doesn’t clot properly.

Treatment

First the uterus is massages externally to help it to contract fully, then doctors mayuse medicine, repair any tears, tie up bleeding blood vessels, perform a compressionas shown in the picture (bimanual compression), use a small balloon inside theuterus and finally as a last resort remove the uterus through the procedure knownas hysterectomy.

Pre-eclam psia and Eclam psia

If a pregnant woman with a previous normal blood pressure develops a highblood pressure greater than 140/90 (mm of mercury) and there is presence ofprotein in the urine after 20 weeks of pregnancy, such condition is known as Pre-eclampsia. The condition is called Eclampsia when the pregnant woman with Pre-eclampsia starts developing seizures (abnormal body contractions). In addition, liver, brain and kidneys are also affected.

Symptoms

• High blood pressure
• Swelling first over ankles and then progress to the whole body
• Headache
• Pain in the left upper stomach
• Eye symptoms such as blurring, dimness, a blind spot in the visual field orcomplete blindness in severe cases
• Abnormal weight gain (more than five pounds in a month or more than onepound a week in later months).

Causes

Exact cause is unknown. Some risk factors include first pregnancy, family history of Pre-eclampsia, defects in the placenta, Obesity and Pre-existing diseases relatedto blood vessels.

Treatment

Adequate rest and diet is managed. Doctors may use medicine known asMagnesium Sulfate to prevent seizures. Crises arising from extremely high bloodpressure are managed accordingly. If there is excessive fluid in the body, medicines may be used to manage it. If the seizures are life-threatening, termination of pregnancy may be required to save the life of the mother.

Congenital Illnesses

Atrial Septal Defect

Our heart has four chambers: Right and left Atria as well as Right and Left Ventricles. They are separated by a muscle tissue known as Septum. Right atriumreceives blood from the body and sends to right ventricle from where it goes tothe lungs. From lungs oxygenated blood reaches left atrium and then to leftventricle and then to the rest of the body. A septal defect occurs when there is ahole in the septum. When this occurs, oxygenated blood in the left atrium andthe blood coming from the body mix together.

Treatment

If the defect is small sized, monitoring may be sufficient. However for largedefects repair may be required via a catheter or open heart surgery.

Cleft Lip and Cleft Palate

While the baby is still developing in the womb it is known as embryo. Duringembryological development, various organs and structures are developing. Acertain defect in the development may cause the baby’s lips to be joined togetheror may cause a defect in the upper palate (roof of the mouth). Ear may also getaffected sometimes.

Treatment

Surgery is the mainstay of treatment. Medications may be required to control earinfections.

Development Dysplasia of the Hip

The bone in the upper leg is known as femur. Femur has a head which fits in thehip socket. When this socket is shallow or if there are other problems the femoralhead doesn’t fit in it’s socket, DDH occurs. (Dysplasia = Abnormal Growth).

Treatment

Either a special device or a cast if hip continues to develop abnormally may berequired for the baby. If other methods do not succeed to put hip back into place,surgery may be required.

Down’s Syndrome

Human beings have two sets of 22 chromosomes and one pair of sexchromosomes with one chromosome either being X or Y. Sometimes in additionto normal two sets, a third chromosome is present in chromosome number 21.

This condition is known as Down’s Syndrome. Babys with Down’s Syndrome may have defects in the heart, eyes, blood and brain. They may also have speech anddevelopmental disorders.

Treatment

Treatment is usually aimed at rehabilitation, and correcting defects at majororgan systems.

Cerebral Palsy

Palsy refers to weakness. Cerebral meaning brain. People have cerebral palsycannot control their movements due to some abnormalities in their brain. Inaddition, muscles may be stiff or there may be involuntary movements. Some ofthe patients also have associated abnormalities in their sensation, speech andhearing.

Treatment

Treatment is usually aimed at physical rehabilitating so that the child can walk onhis/her own and has better control of muscles. This is achieved via use of certainspecialized devices. Speech rehabilitation is also done so that the child can speakeasily.