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PREGNANCY & CHILDBIRTH COMPLICATIONS

Making a Difference

There are numerous pregnancy complications and childbirth issues that women experience. However, there are a few which are especially dangerous and/or are common so we have gone into detail about their incidence, risk factors, effects and treatment.

 

HYPEREMESIS GRAVIDARUM

  • Characterized by severe nausea and vomiting

  • Estimated to occur in 0.3-3% of pregnancies

  • Can cause mental stress, numerous physiological effects, financial burden, issues later in the pregnancy due to inadequacies in nutritional intake, gastrointestinal trauma, and neurological damage (in extreme cases). 

  • Believed to develop as a result of an amalgamation of hormonal factors. Genetic, infectious and psychiatric factors may also be at play. 

  • Mortality as a result of Hyperemesis Gravidarum is rare, but the death of both the mother and fetus as a result of it has been reported. 

  • Treatment often involves supportive measures to alleviate the symptoms. 

  • Therapies which concentrate on parental antiemetic medications, electrolytic repletion and nutritional support

(Austin et al., 2019; London et al., 2017)

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GESTATIONAL DIABETES MELLITUS (GDM)

  • Refers to diabetes which is first diagnosed during pregnancy

  • Affects around 6% of pregnant women

  •  Mother’s tissues slowly become insensitive to insulin due to placental hormones, obesity and other factors during normal pregnancy

  • Pregnant women need to increase insulin secretion by 200%-500% in order to compensate for the insensitivity.

  • GDM is the condition which occurs when this compensatory insulin response is inadequate

  • Prevalence is increasing proportionally to the epidemic of obesity and type 2 diabetes

  • In pregnancies where GDM is an issue, there is a greater risk for a cesarean or operative vaginal delivery, fetal macrosomia (a baby that is much larger than average size when delivered), shoulder dystocia (when the baby’s shoulders get stuck in the mother’s pelvis), neonatal hypoglycemia (low glucose) and hyperbilirubinemia (excessive bilirubin in blood)

  • Mother’s with a history of GDM are at a higher risk of getting type 2 diabetes mellitus in the years after their pregnancy 

  • Their children are more likely to become obese or get type 2 diabetes mellitus at an early age

  • Treatment is mainly through modifications in diet and lifestyle

  • Medical treatment with the use of metformin, glyburide, and insulin can also be administered when required

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PLACENTA PREVIA

  • Placenta Previa occurs when the placenta is irregularly implanted in the lower uterine segment (the part of the uterine musculature which goes through circumferential dilatation during labour) 

  •  It also partially or completely covers the internal cervical os which is the opening of the cervix that connects to the uterus 

  • The rising numbers of cesarean sections in the past 50 years have been thought to be a cause for the increasing cases of Placenta Previa . 

  • Risk factors: advanced age of the mother, grand multiparity (when patient has had multiple births previously), previous history of cesarean sections or abortions and smoking while pregnant

  • Having Placenta Previa is a very important risk factor for postpartum hemorrhage which is when a woman experiences heavy bleeding right after birth, leading to morbidity and mortality of the mother and newborn child

  •  If this occurs, a safe vaginal delivery is generally not a possibility and the child must be delivered through a cesarean section 

  • Placenta Previa has also previously been linked to preterm birth, low birth weight, low APGAR scores (a score system which evaluates a newborn’s wellbeing), higher blood transfusion rates and just generally more time spent in the hospital 

  • Treatment for this diagnosis is scheduled elective delivery at around 36 to 37 weeks through a cesarean section although occasionally patients may require earlier delivery if they present any complications

 

PREECLAMPSIA

  • Preeclampsia is a complication that occurs during pregnancy and has a considerable correlation to maternal and fetal morbidity and mortality, especially in low-income countries. 

  • It is a condition that affects an approximated 3-5% of pregnant women and is distinguished by edemas (excess fluid in the body’s tissues which causes swelling), hypertension (high blood pressure) and proteinuria (high protein levels in urine)

  • It is very dangerous for both the mother and child and can progress to serious complications such as multi-organ dysfunction, fetal growth restriction hepatic, renal and cerebral disease and sometimes even death. 

  • The causes of preeclampsia are still disputed but it is theorized that the placenta is at the centre of this condition’s pathogenesis.

  • There are numerous risk factors for this illness such as maternal comorbidities including chronic kidney disease, hypertension and obesity. 

  • There are other general risk factors like history of preeclampsia in the family, nulliparity or multiparity (zero or multiple past pregnancies respectively), history of preeclampsia in the individual or intrauterine fetal growth restriction

  • The most reliable treatment for preeclampsia is the timely delivery of the fetus but other types of management include preconception counselling, perinatal blood pressure control, management of other complications and postpartum surveillance

  •  In more drastic situations, the mother and fetus should be stabilized before termination of the pregnancy

 

PRETERM LABOUR

  • Preterm birth is the primary cause of perinatal morbidity and mortality in numerous developed countries and the frequency percentage in most countries is between 5% to 9%

  •  Preterm labour is when infants are born at fewer than 37 weeks in three situations; when membranes are still intact but spontaneous labour occurs, when membranes rupture prematurely and causes labour, or when there is a need for induced labour/cesarean delivery due to maternal or fetal issues

  • Certain groups of women have an increased risk of around 30% for preterm delivery; women with a history of preterm delivery, women who have a small cervical length at midgestation, women carrying twins, and women who have been treated with tocolytic medication for preterm labour 

  •  Currently, intervention for preterm birth takes a multifaceted approach that includes public health and educational programs, changes to lifestyle, increased access and effectivization of obstetric care 

  • Progesterone therapy and cervical cerclage and pessary are some of preventative measures for preterm births. Preterm labour management is primarily through corticosteroid therapy, magnesium sulfate, tocolysis and antibiotics

 

IMPACT OF COVID-19 ON PREGNANCY AND CHILDBIRTH

  • Women who went through labour amidst the pandemic have been noted to experience higher stress levels than normal in the process. 

  • The percentage of women who experienced postpartum depression after giving birth during the pandemic was much higher than usual.

  • COVID-19 has significant consequences on both reproductive and perinatal health as a result of both direct viral infection and the indirect impacts of the pandemic on the healthcare system, social policies and economic situations.

  • COVID-19 does not only have physiological impacts on pregnant women but also contributes to serious mental health issues in many countries, including anxiety and depression.

  • In terms of physiological impacts on the mother and fetus, COVID-19 in pregnancy is shown to have correlations with preeclampsia, stillbirth and preterm birth when compared to those without COVID-19.  

  • Pregnant women with symptomatic COVID-19 have been shown to go through more critical outcomes than individuals who are not pregnant.

  • Symptomatic COVID-19 has also proven to exacerbate the risk of cesarean delivery and preterm birth when compared to asymptomatic COVID-19. 

  • Studies have also shown that severe manifestations of the virus have associations with preeclampsia, gestational diabetes, preterm birth, low birth weight and NICU admission

  • It is also known that severe COVID-19 can lead to maternal and neonatal morbidity. These risks do not seem to apply to those with only mild COVID-19.

  • There seems to be a low likelihood of vertical transmission (virus transmission between the mother and fetus in the time shortly before and after birth) of COVID-19 but antibodies against SARS-CoV-2 were formed in infants who tested negative for the virus but were vertically exposed to it. 

 

HOW YOU CAN HELP

  1. Many hospitals have volunteer programs where you can volunteer and help make patient experiences a little better. Look for nearby hospitals and apply to be wayfinder, recreational volunteer or other such jobs.

  2. Volunteer with places like “Baby’s Breath” and the “Sunnybrook Pregnancy and Infant Loss Network”. Both these organizations offer supportive services to those who have experienced pregnancy or child loss, helping bereaved parents and families cope with their grief. In Baby’s Breath, you can volunteer as a peer support volunteer, a local council chair, or a social media coordinator volunteer. In Sunnybrook Pregnancy and Infant Loss Network, you can be a peer support volunteer or a community volunteer. 

  3. Monetary contributions are also greatly appreciated by many organizations. “March of Dimes” is an organization that contributes to eliminating health inequities, improving healthcare access and ending preventable preterm birth and maternal death. “Braving Beginnings” is an organization that supports children born preterm. “Pregnancy and Infant Loss Support Centre” is a centre that is helping families deal with such loss and remove the stigma around this loss. You can also choose to donate recyclables here.