What Can Go Wrong during a Pregnancy

In this article I included a summary of several complications in pregnancy such as: Ectopic Pregnancy, Bleeding during Pregnancy, Pre-eclampsia and Eclampsia, Itching (Intrahepatic Cholestasis), Rhesus Disease and Group B streptococcus carriage.

Any woman who is planning to get pregnant hopes that the journey will be smooth, enjoyable and that she will end up with a beautiful baby. And in the majority of cases this is correct. However, there are few things that can go wrong and all women should be aware of possible complications.

You should always seek advice and assessment from your GP or Obstetrician if you feel something is not quite right with your pregnancy.

Below I have described some important complications that can occur during pregnancy.

Bleeding during Pregnancy

There are multiple causes of bleeding pregnancy. Some causes are not related to the pregnancy at all, but come from the vagina or cervix.

Bleeding in pregnancy can often signify issues with the placenta and therefore should never be taken lightly – you should always consult your GP or midwife.

Ectopic Pregnancy

An ectopic is a pregnancy that attaches outside the womb.

The commonest place for this to occur is in the fallopian tube, and affects about 1 in every 100 pregnancies.

The symptoms are abdominal pain and vaginal bleeding in early pregnancy.

Ectopic pregnancy is potentially life threatening if the fallopian tube ruptures as it can cause serious internal bleeding. Therefore if you are getting pain and have recently had a positive pregnancy test, you should urgently contact your GP.

Occasionally there are no symptoms and the diagnosis is made on the first scan.

There are 3 treatment options for ectopic pregnancy – medicine, surgery or observation (‘wait and see’ policy):

• A medicine called methotrexate is often used and is given as an injection into a muscle. It works by destroying the cells of the pregnancy growing in the wrong place. This method is more common as it avoids the need for surgery
• Surgical removal of the whole tube (if the other tube is healthy) and of the ectopic pregnancy. This is usually performed by keyhole surgery.
• As not all ectopic pregnancies are life-threatening, often the ectopic pregnancy resolves by itself with no future problems. The pregnancy often dies in a way similar to a miscarriage. You would need close observation by your gynecologist with repeated scans and bloods tests, and you would need to have treatment if symptoms develop or worsen.

Pre-eclampsia and Eclampsia

Eclampsia is fitting or having a seizure due to very high maternal blood pressure, and pre-eclampsia literally means the stage before fitting starts.

Eclampsia is a disease completely unique to pregnancy. Therefore once you have your baby the pre-eclampsia resolves.

The cause for eclampsia is uncertain but it is thought that something in the placenta triggers release of chemicals that cause the mother’s blood pressure to rise and makes the kidneys become leaky, so protein starts to show in the urine.

Warning symptoms include:

• Severe headache
• Flashing lights or blurred vision
• Burning pain below the breast bone
• Vomiting
• Sudden swelling of the face, hands or ankles

You will need to be admitted to hospital for treatment which can include blood pressure lowering medications and planning for having the baby early, so as to prevent progression into Eclampsia.

Rest assured, midwives and GPs are constantly on the alert for this condition and it explains why you need to have your blood pressure and urine checked at every antenatal appointment.

Gestational diabetes

Gestational Diabetes simply means the development of diabetes in pregnancy.

If sugar is seen in the routine urine checks, then you will be referred for a glucose tolerance test where you are given a sugary drink and then your blood is tested at intervals afterwards to see how your body deals with the sugar.

You are more likely to develop gestational diabetes if you are obese or if you have a family origin with high diabetic frequency e.g. South Asian, Black Caribbean or Middle Eastern origin.

An obstetrician who specializes in diabetes will care you for and you will need to adopt a low sugar diet. Often you need to start diabetic medication and occasionally women need to inject insulin if it is severe.

Rhesus disease

When talking about blood groups, the most important ones are ABO and Rhesus Negative or Positive.

Most people are Rhesus Positive as they have rhesus proteins (or antigens) on their red blood cell surface.

If you do not have rhesus antigens you are said to be Rhesus Negative hence blood group A – or A + for example.

If the mother is Rhesus Negative and the unborn baby is Rhesus Positive (inherited from a Rhesus Positive father), then the mother’s immune system may produce anti-rhesus antibodies that can attack and destroy the baby’s blood cells.

A blood group test is always done on pregnant women early on in pregnancy, rhesus status is checked and treatment can be started during pregnancy to prevent problems for the baby.

Treatment is in the form of injections of a medication called anti-D immunoglobulin at 28 weeks and 34 weeks, which helps to remove the Rhesus Positive fetal blood cells from the maternal circulation before they can cause sensitization and production of anti-rhesus antibodies.

Group B Streptococcus Carriage

Group B Streptococcus is a type of bacteria that harmlessly lives inside the vagina and gut of up to 25% of the population.

Occasionally during pregnancy, the bacteria can be passed onto to the baby and can cause blood poisoning, pneumonia and meningitis.

Anyone found to carry Group B Strep during pregnancy is offered antibiotics through a drip every 4 hours during labour until delivery. Occasionally the baby will also need antibiotics after birth.

Testing from Group B Strep is not done routinely on the NHS. Here at ROC Private Clinic we can arrange a simple test consisting of a self-taken rectal and vaginal swab taken between 35 and 37 weeks of pregnancy, and the results will be personally given to you within 48 hours.

Itching (Intrahepatic cholestasis of pregnancy)

Itching in pregnancy is very common. It may be all over the body or it may be localized to one area. All-over itching is often due to skin dryness, and stretching of skin (particularly on the tummy (abdomen) so make sure you moisturize regularly.

Less commonly, itching in pregnancy can be due to the gallbladder not working properly as seen in intrahepatic cholestasis of pregnancy or ICP. It causes sudden onset itching in the final weeks before birth without a rash, often felt in the palms and soles. This can sometimes cause problems for your baby so if you do develop itching, it is important to see your GP or midwife. They will arrange a simple blood test to make sure that your gallbladder is working properly. For more information about ICP click on www.icpsupport.org. It is ICP awareness week from the 1st-8th March 2015.