PREGNANCY COMPLICATIONS

Morning Sickness

Introduction

Morning sickness refers to nausea and vomiting and affects a large population of pregnant women during their first trimester. It generally occurs from the 4th to the 12th or 14th week of pregnancy, but some women may experience it during their entire pregnancy. Morning sickness is not harmful for the unborn child, but severe cases are called hyperemesis gravidarum and may even require hospitalization.

Nausea, also known as morning sickness, is a sensation of uneasiness and discomfort often accompanied with the urge to vomit.

The high level of progesterone hormone during pregnancy can slow down the digestive tract, causing nausea.

Causes

The cause of morning sickness is unknown, but many metabolic and physical factors have a role to play.

  • Hormonal changes during pregnancy (high oestrogen levels)

  • Blood pressure fluctuations (low blood pressure)

  • Change in the metabolism of carbohydrates

  • Chemical and physical changes

  • Traveling, fatigue, emotional stress, and some foods

Signs and Symptoms

Symptoms of morning sickness include:

  • Nausea

  • Vomiting

  • Loss of appetite

  • Depression and anxiety

Diagnosis

Dr Alexander will diagnose morning sickness based on the signs and symptoms you experience. If hyper emesis gravid arum is suspected, urine and blood tests will be suggested. An ultrasound may also be ordered to detect other underlying causes of nausea and determine the number of foetuses.

Treatment

Most cases of morning sickness do not require treatment; however, Dr Alexander may prescribe vitamin B-6 supplements and anti-nausea medications for severe cases. Hyper emesis gravid arum may require hospitalization and treatment with anti-nausea medications and intravenous fluids.

How to Help Reduce Nausea and Vomiting

Some approaches are:

  • Eating frequent light meals,

  • Avoiding spicy and greasy foods and

  • Drinking plenty of water or fluids

Lifestyle and home remedies

Lifestyle and home remedies may be helpful in relieving morning sickness in some women.

  • Choose your food carefully. You should eat more carbohydrate rich, easily digestible foods. Salty food or food containing ginger may be helpful at times. Snack at regular intervals throughout the day instead of having large meals. Eating a few plain sweet biscuits or dry crackers after waking up may help reduce the nauseous feeling. Avoid food that triggers nausea or makes it worse, like greasy and spicy food.

  • Consume plenty of fluids. Keep sipping ginger flavoured drinks or water frequently. Sucking on ice cubes or hard candy may be beneficial.

  • Take walks and try and get plenty of fresh air.

Prevention

Morning sickness can be reduced to a certain extent with prenatal vitamins.

Early Pregnancy Complications

What to expect

Pregnancy is an exciting time for women, but complications may develop sometimes even in healthy women.

Early pregnancy complications are the health problems that occur during the early period or first few months (first trimester) of pregnancy. Complications that occur early in the pregnancy may increase the risk to both the mother and the baby. Most pregnancy complications can easily be detected and prevented with routine prenatal care.

Various medical conditions that may complicate the pregnancy include

  • systemic lupus erythematosus,

  • kidney problems,

  • heart disease,

  • sickle cell anaemia,

  • thyroid abnormalities and

  • clotting disorders.

If you are suffering with kidney disease or lupus, your ability to supply oxygen and nutrients to the baby through the placenta is affected.  In women with these diseases, the babies may not be able to grow and gain appropriate weight and also have an increased risk of stillbirth.

Diabetes can lead to miscarriages, birth defects, and stillbirths. Continuous monitoring and maintaining blood sugar levels under control levels minimises the complications. High blood pressure in late pregnancy may show a serious threat to the mother and the baby and hence needs to be treated appropriately.

Medical conditions such as asthma, epilepsy and ulcerative colitis normally do not interfere with pregnancy, but may be worsened by pregnancy,and therefore need to be monitored throughout the pregnancy.

Dr Alexander may perform an ultrasound every few weeks to see the baby’s growth and health.

Women with structural defects such as a double uterus or a weak cervix may have higher risk of miscarriages. Therefore, Dr Alexander may order diagnostic surgery, ultrasound scans, or x-rays before pregnancy to reveal the cause.

Non-cancerous growths in the uterus that are more common in older women can increase the risk of miscarriage, preterm labour, difficulties during labour, unnatural presentation of the fetus and abnormal position of the placenta.

General risk factors that may affect your pregnancy include exposure to substances such as radiation, chemicals, drugs, or infections, smoking and alcohol.

Preterm (early) labour is another major concern in women with high-risk pregnancy.

Preterm labour may be caused by

  • past uterine surgery,

  • bleeding,

  • stress,

  • structural defects,

  • a multiple pregnancy,

  • pneumonia,

  • kidney infection, and

  • appendicitis.  

To prevent preterm labour your baby is monitored with electronic heart monitoring and ultrasound scanning.  

With frequent visits to the doctor, women with high-risk pregnancy can enjoy a healthy and successful pregnancy. Having quality prenatal care is necessary to minimise the risks to both you and your baby.

Periodontal Disease and Pregnancy

Periodontal disease, also called gum disease, is a bacterial infection destroying the soft tissues and bones that support your teeth. Pregnancy causes hormonal changes that can increase the risk of dental problems, which in turn can affect the health of your developing baby.

Fusobacterium nucleatum is a common oral bacterium that causes periodontal disease. Pregnant women can experience bleeding gums through which the bacteria F. nucleatum can enter the bloodstream. Once in the bloodstream, the bacteria enter the placenta and amniotic fluid triggering a preterm delivery. Pregnant women with periodontal disease are more likely to deliver premature and low birth weight babies.

Pregnant women have a higher incidence of gingivitis, also known as pregnancy gingivitis, which generally begins in the second or third month of pregnancy and is likely to worsen during the eighth month of pregnancy. During this time, gum tissues may feel tender, swollen, appear red and are more likely to bleed. Sometimes large lumps called pregnancy tumours develop in response to local irritation to the swollen gums. These growths are non-cancerous and usually painless in nature, and may be removed by a dentist.

It is essential to maintain good oral hygiene throughout your pregnancy. You can prevent periodontal diseases by following good oral hygiene habits such as daily brushing and flossing, using anti-gum disease mouth washes, and visiting your dentist regularly during your pregnancy.

If you are planning to become pregnant or suspect you are already pregnant, consult your dentist for a dental health check up. Pregnant women should take care of their oral health and receive appropriate dental treatment, during their pregnancy, to reduce pregnancy complications such as preterm delivery.  Your dentist will evaluate your oral condition and determine a precise treatment plan for the rest of your pregnancy.

Bleeding During Pregnancy

Vaginal bleeding or spotting is a common problem that can occur during the first trimester of pregnancy.

In most cases, continuous bleeding without any known cause may lead to impending abortion.

The causes of bleeding include

  • Erosion of the inner lining of the cervix due to oestrogens,

  • Infection of the vagina or cervix, or

  • Miscarriage or threatened miscarriage

After a bleeding episode, Dr Alexander examines the fetus' health and may order some blood tests for

  • hCG (human chorionic gonadotropin) and

  • Progesterone levels, and

  • An ultrasonography test.

With the help of these test a treatment would be recommended for the bleeding.

Typically effective management by

  • Adequate bed rest,

  • Eating a healthy and nutritious diet,

  • Folic acid supplementation and

  • Hormonal therapy.

Vomiting During Pregnancy

Hyperemesis gravidarum is a condition of excessive vomiting during pregnancy.  

Vomiting is a common complaint during pregnancy, but persistent, frequent and severe vomiting, if left untreated, can affect the health of both the mother and the baby.

Vomiting in pregnancy may occur due to

  • Increased B-hCG and oestrogen levels,

  • Multiple pregnancy (women carrying multiple babies), and

  • Molar pregnancy (abnormal placenta/fetus).

Diagnosis includes observation of findings from:

  • Electrolytes test,

  • hCG (human chorionic gonadotropin), and

  • An ultrasonography test, etc.

Treatment of vomiting during pregnancy (hyperemesis gravid arum) includes

  • Adequate rest and

  • Medications such as antacids and antiemetic (either Maxolon or Zofran).

Dr Alexander may also advise you to drink plenty of fluids to replace the lost fluids.

Pregnant women who have severe vomiting may require hospitalization with intravenous fluids and supplementation.

Back Pain During Pregnancy

Back pain is a common complaint during pregnancy.  Most women experience back pain at some point during pregnancy, usually in the later months.

There are a few things you can do to minimise your back pain and concentrate on the arrival of your baby.

Causes of Back Pain During Pregnancy

Back pain during pregnancy may be caused by a number of factors including

  • Hormonal changes,

  • Weight gain,

  • Spinal alignment and

  • Activity levels.

Hormonal changes in pregnancy can loosen the joints and ligaments making them softer and more elastic, in preparation for the birthing process. These changes affect the spinal stability and natural back support mechanism, especially as the weight of the baby increases.

Your centre of gravity shifts as the baby grows, which causes your posture to change. The abdominal muscles become stretched and may weaken, causing back pain. This can lead to a noticeable "sway-back" appearance causing back pain. The pressure on the sciatic nerve or on a spinal disc can also cause radiating pain through the hips, buttocks and legs.  

Prevention of Back Pain During Pregnancy

Listed below are preventive measures you can implement to help reduce the occurrence of back pain during pregnancy:  

  • Maintain a reasonable amount of activity and include exercises to strengthen your back and abdomen as recommended by your physician or physical therapist.

  • If prolonged sitting is required, take frequent breaks to stretch the legs and back.

  • Practice good posture to reduce the strain in the lower back. Standing as straight as possible, keeping the shoulders back and relaxed, can do this.  If possible, in sitting position keep the feet slightly elevated. Choose a chair with good back support or use a small pillow for support and change the position frequently.

  • To pick up things you should squat down using your knees and keep the back straight. Avoid positions that require twisting and bending movements and also any activities that are painful.

  • Avoid wearing high heel shoes and instead wear ‘sensible shoes' with low heels and good arch support.

  • Wear a support belt under your lower abdomen, later in your pregnancy.

  • Get a sufficient amount of sleep. Practice relaxation techniques to keep your stress level down. Sleep on one side of the body rather than on the back with the knees bent. If needed, place a pillow around the abdomen for extra support and between the knees to keep the spine aligned.

Management of Back Pain During Pregnancy

If you experience back pain, consult Dr Alexander to discuss your options. Two common approaches are physiotherapy and massage therapy for control of the pain.

You can also consult a physiotherapist without a referral. The physiotherapists and massage therapists are skilled and experienced in treating pregnancy-related back pain.

Commonly recommended therapies for managing pregnancy - related back pain include

  • Hot or cold therapy,

  • A warm bath,

  • Hot bags, or

  • An ice pack.

Dr Alexander is  experienced and specifically trained to manage pregnancy-related back pain safely and effectively.

Referred experienced and highly skilled physiotherapists to determine the best treatment can do an initial assessment. Often, the treatment plan includes massage therapy, special exercises, posture instruction, stretches and other pain-relieving techniques.  

Physiotherapy Programs

As your pregnancy progresses, a physiotherapy program may be recommended to manage any discomfort.

Specific pelvic–floor and lower back exercises also may be prescribed to reduce the pain and improve the strength.

Massage therapy can help relieve the discomfort of pregnancy-related back pain and also help with stress, tension, and pregnancy-related anxieties and provide comfort to the expecting mother. The therapists available are highly skilled and experienced in treating musculoskeletal pain during pregnancy.

Back Pain or Labour

If you experience a dull, cramping lower back pain, it can be a sign of preterm labour.

If severe and sudden back pain occurs along with fever or vaginal spotting or bleeding, call Dr Alexander right away.

Any numbness or weakness in the legs, buttocks, groin and genital area also requires Dr Alexander’s immediate attention.

If required, analgesic medications may be recommended by Dr Alexander.

Molar Pregnancy

A molar pregnancy is an Abnormal growth or development of placental cells in the embryo. It occurs when the tissue that normally becomes a foetus instead develops into a non-cancerous tumour in the uterus.

It is also referred to as gestational trophoblastic disease (GTD). Molar pregnancy is caused by chromosomal abnormalities in the sperm or egg, or both.

Symptoms that Indicate a Molar Pregnancy

The common early symptoms of molar pregnancy resemble a normal pregnancy and include missed period or morning sickness.

Dr Alexander may spot molar pregnancy during an ultrasound scan carried out between weeks 10-16 of pregnancy. As this condition is associated with serious complications, early treatment is recommended.

Later stage symptoms that are cause for concern include

  • dark brown to bright red bleeding and tissue discharge from the vagina

  • the presence of grape-like clusters in the uterus seen by an ultrasound

  • severe nausea and vomiting.

  • absence of fetal heart tone,

  • high hCG levels

Miscarriage

The spontaneous loss or termination of pregnancy before the 20th week is referred to as a miscarriage or abortion. It is also known as spontaneous abortion, or early pregnancy loss.

The majority of miscarriages occur during the first three months of the pregnancy (first trimester).

The chances of miscarriage are higher during the first trimester because of the incompletely developed organ systems. Most miscarriages occur due to chromosomal abnormalities in the fertilized egg.

Symptoms that Indicate a Miscarriage

  • Vaginal bleeding, cramps or abdominal pain, and

  • fluid or tissue coming from your vagina

Miscarriages often cannot be prevented in most cases and treatment requires complete removal of pregnancy tissue from the uterus. Always contact Dr Alexander if you have any concerns during your pregnancy.

Miscarriage is the natural death of a baby in its mother's womb before 20 weeks.This usually occurs in the first trimester (13 weeks) of pregnancy. Symptoms include vaginal spotting or bleeding, abdominal pain or cramping, and fluid or tissue passing from the vagina. If you have any of these symptoms, you should call Dr Alexander who may do an ultrasound scan and a pelvic examination to confirm miscarriage.

Most miscarriages are caused due to genetic abnormalities that occur by chance and are not related to the mother or father's health. Other causes include infection, certain medications, hormonal effects, structural abnormality of the uterus, and disease conditions such as severe kidney disease, congenital heart disease and uncontrolled diabetes.

Repeated Miscarriage

Repeated miscarriage is the occurrence of two or more consecutive miscarriages. About one woman in 100 experiences this condition, however, many of these women go on to have a successful pregnancy later on. All of the causes leading to this condition are not known. There are, however, a few known causes that include abnormal genetic and or metabolism of the embryo, luteal phase defect where there is a lack of progesterone in the first 8 weeks of the pregnancy, endometrial inflammation, autoimmune disease, clotting disorder, diabetes and thyroid disease and uterine structural abnormalities such as a septate (divided into two) uterus, fibroids and polyps (noncancerous growths) of the uterus and Asherman syndrome (adhesions and scarring in the uterus)..

Diagnosis and treatment

To determine the causes, Dr Alexander will ask questions about your medical history and past pregnancies. He or she may do a thorough physical examination accompanied with a pelvic examination, blood tests and imaging tests. If genetic causes are suspected, then a test called Karyotype and Microarray testing would be ordered. Treatment measures vary and are specific to the cause leading to the condition. It may also involve medications or corrective surgery.

Group B Streptococcus (GBS)

GBS is a type of bacteria that may be present in a woman's vagina or rectum, although it is not a sexually transmitted disease. It is usually harmless; however, if present in pregnant women, it can cause serious health problems if passed to a newborn during delivery.

Symptoms

The majority of pregnant women with GBS show no symptoms. Some may develop a urinary tract infection or infection of the uterus. However, a woman infected with GBS in the later stages of pregnancy can pass the bacteria to her baby during the delivery process causing complications for the baby. GBS symptoms in a new born baby may occur in the first 24 -48 hours following birth (early onset infections) or after 1 week to several months (late onset infections) and can lead to a blood infection, lung infection or meningitis in the newborn. Early onset infections are characterised by shortness of breath and lethargy whereas high fever, vomiting, poor feeding and irritability are characteristic of late onset infections in newborns.

Detecting GBS in pregnancy

GBS can be detected during weeks 35 and 37 of pregnancy with a culture test. Using a swab, a sample is taken from the woman's vagina and rectum and sent for laboratory testing.

Treatment

If the test result is positive for GBS, IV antibiotics are given during labour to protect the newborn from contracting it from the mother. Penicillin is the commonly prescribed antibiotic but alternative antibiotics can be provided if you are allergic to penicillin.

Birthing is the act or process of giving birth to offspring. Labour or childbirth experience may differ in every woman. Common initial signs of labour include strong regular contractions, backache, draining of water (amniotic fluid) or sticky and mucous-like substance through the vagina. The average time for which you will be in labour may be approximately 12-18 hours. The most common risks and complications that may occur during labour are discussed below

Ectopic Pregnancy

An ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus. This may be caused when the fallopian tube has been scarred, damaged or the shape is changed.

Ectopic pregnancy can also occur in the cervix, ovary or abdominal cavity.

Factors that can increase your risk for an ectopic pregnancy include:

  • History of fallopian tube infection such as pelvic inflammatory disease (PID), chlamydia and gonorrhoea

  • Previous ectopic pregnancies

  • Previous surgery on the fallopian tubes or in the pelvic area

  • Taking fertility medications around the time of conception

  • Women who get pregnant while an intrauterine device (IUD) is in place

Effects of Ectopic pregnancy

Ectopic pregnancy can result in the rupture of the fallopian tube and is a life-threatening medical emergency. In such cases, surgical intervention may also be necessary.

Symptoms that Indicate an Ectopic Pregnancy

Vaginal bleeding, sharp or cramping pain in the stomach and abdomen, and

  • low levels of hCG are the usual symptoms of ectopic pregnancy.

  • absence of menstrual periods (amenorrhea),

  • breast pain,

  • lower back pain,

  • nausea,

  • lower abdominal or pelvic pain and

  • mild cramping on one side of the pelvis.

To diagnose ectopic pregnancy, Dr Alexander will perform a pelvic examination.

Dr Alexander may check your human chorionic gonadotropin (BhCG) levels. An abnormal rise in blood BhCG levels may indicate an ectopic pregnancy. If an ectopic pregnancy is suspected, you will probably also have ultrasounds of your pelvis to visualize the location of pregnancy.

A more sensitive ultrasound scan may be done using an intra-vaginal probe (special probe inside the vagina).

If you have a ruptured ectopic pregnancy, you may have fainting, shoulder pain, intense pressure in the rectum, severe lower abdominal pain and low blood pressure.

A laparoscopy can also be performed to provide diagnosis and treatment.

Treatments for Ectopic Pregnancy

Treatment choice for an ectopic pregnancy depends on the size and location of the pregnancy. Treatment options include non-surgical and surgical methods.

Medications for the Treatment of Ectopic Pregnancy

If the ectopic pregnancy is in the fallopian tube and the embryo is still relatively small, you may be given medications to stop the growth of the embryo.

These medications arrest the growth of the embryonic cells without doing any harm to your fallopian tubes or other organs.  As the medications begin to work, you may have abdominal pain and vaginal bleeding, especially within the first several days.

Dr Alexander will monitor your hCG blood levels to make sure that the ectopic pregnancy has been completely removed and no further treatment is needed.

Surgery for the Treatment of Ectopic Pregnancy

If the pregnancy is continuing or if the ectopic pregnancy is big already or ruptured or if you have certain health conditions indicating that medications should not be used, you may need surgery to remove the abnormal pregnancy.

Surgical intervention may also be necessary if the tube has ruptured, damaged or if there is severe bleeding inside the abdomen. The ectopic pregnancy may be removed using laparoscopy, a less invasive surgical procedure.

Women who have had one ectopic pregnancy are later able to have a successful pregnancy. If your fallopian tubes are not damaged after an ectopic pregnancy, then you have better chances of conceiving again, but you will be at higher risk of ectopic pregnancy.

If one of the tubes ruptured or was badly damaged or removed, you still have chances of conceiving again.

When you do become pregnant again, see Dr Alexander as soon as you can to check that your pregnancy is developing in the right place.

Trauma During Pregnancy

Car crashes can be a cause of death and serious trauma during pregnancy. During the third trimester, moving around or sitting for long periods of time becomes difficult. If you do need to travel, be sure to follow a few car safety tips:

  • Limit travelling to a maximum of 6 hours in a day and stop every hour or two and walk around to stretch your legs to keep the blood circulating.

  • You can place a pillow or cushion on your seat to make travel more comfortable.

  • Always remember to fasten your seat belt so that the lap belt portion rests under your abdomen and the shoulder harness is positioned between your breasts.

  • Keep the air bags turned on.

  • Wear comfortable clothes; preferably, loose cotton wear.

  • Keep a charged mobile phone handy for any emergencies.

  • If you are driving, maintain a minimum distance of 10 inches between the steering wheel and the breastbone.