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Pregnancy Problems

Pregnancy Problems - What it is

Will My Pregnancy Be Smooth-Sailing?

The answer to this is yes, most of the time. Most expectant mothers will have an uneventful pregnancy and a smooth delivery. However, unexpected problems can arise in some, and these are often unpredictable. The purpose of the information here is to let you know why sometimes a pregnancy may not be smooth-sailing.

Miscarriage

Approximately 15% of all pregnancies miscarry. This often occurs within the first three to four months of pregnancy. Most of the time, a cause cannot be found. In some cases, abnormalities of the fetal chromosomes or abnormal development of the embryo may cause a miscarriage. Certain types of illnesses in the mother such as infections, abnormal development within the uterus (womb) or laxity of the cervix (neck of the womb) can also cause miscarriages, but there are actually quite rare.

Having one or even two miscarriages is not necessarily a bad sign. The likelihood of having a successful subsequent pregnancy is still very good and in the range of 70 - 80%.

Fetal Abnormality

Abnormalities in the fetus can be chromosomal (material in a living cell) or structural (the baby looks abnormal but is not due to a genetic cause). The most common chromosomal abnormality is Down syndrome (Mongolism). Down syndrome is often associated with elderly mothers. It is possible to diagnose this during pregnancy and you may wish to discuss this with your obstetrician.

Approximately 2% of births have structural birth defects. About 60% of structural abnormalities can be picked up on an ultrasound scan. This is called a screening scan, and it is usually carried out when you are about five months pregnant. However, minor abnormal developments and even some major ones cannot always be detected with ultrasound screening scans.

Still Birth / Intrauterine Death

All expectant mothers look forward to bringing home a healthy baby. Unfortunately, stillbirths or intrauterine deaths can unexpectedly occur. These events are quite infrequent. Causes include birth defects, severe restriction of fetal growth within the womb, uncontrolled high blood pressure or diabetes in the mother, abnormal presentation of the umbilical cord or sudden unexplained separation of the placenta before labour. Our hospital statistics show that in approximately 50% of stillbirths and intrauterine deaths, a cause cannot be found despite extensive investigation.

When such an unfortunate event occurs, the doctors will carry out several investigations to determine the cause. You and your husband can give your consent to have autopsy performed on the dead infant, as the additional information obtained could prove useful in handing your future pregnancies.

Shoulder Dystocia

This means that following vaginal delivery of the baby's head, it is not possible to deliver the body because the baby's shoulder is jammed in the mother's pelvis. This is an infrequent and unpredictable emergency. The baby can die from lack of oxygen or suffer severe brain damage.

Although this condition is more common in pregnancies complicated by diabetes, maternal obesity, big babies, postdates and mothers who have delivered three or more babies before, shoulder dystocia is difficult to predict before labour takes place.

During such an emergency, specific maneuvers have to be performed in order to save the life of the baby. Such maneuvers, even skillfully performed, may risk fractures to the baby's collar bones or arms. Some of the nerves running down the baby's neck to the arms may be injured. Most of these injuries heal with time although a small number may not do so.

Vulval Haematoma

This refers to a collection of blood in the vulva (the female external private parts which lead to the vagina). This can occur following a vaginal delivery. If the haematoma is big and painful, it will need to be drained in the operating theatre with pain relief given by the anaesthetist.

Postpartum Haemorrhage

This condition refers to excessive bleeding from the vagina after delivery. Most of such bleeding occurs within 24 hours of delivery (primary postpartum haemorrhage). Some occur after the patient is discharged from hospital (secondary postpartum haemorrhage).

The main causes of primary postpartum haemorrhage include failure of the placenta to detach from the uterus after birth, inability of the womb to contract after delivery (atony), or tears involving the birth canal.

Injections of certain drugs can assist the uterus to contract and stop bleeding. Sometimes, a blood transfusion may be necessary. If the placenta fails to detach, the doctor can manually remove it in the operating theatre under anaesthesia. Severe tears involving the birth passage are also stitched up in the operating theatre.

Secondary postpartum haemorrhage is commonly due to infection, retained placental fragments or blood clots in the uterus. After delivery, the placenta is normally carefully inspected to ensure its completeness. However, it is well documented that despite this precautionary measure, small remnants of the placenta, or sometimes an extra lobe, may be present and remain undetected till bleeding recurs some time after birth.

An evacuation of the uterus is then required to remove the retained placental tissue. Infection is treated with antibiotics.

Caesarean Hysterectomy

This is a relatively rare operation to remove the uterus, after the baby has been delivered vaginally or by caesarean section.

This operation is sometimes performed to save the mother's life in the event of severe blood loss after delivery due to uterine or placental complications.

Please be assured that a caesarean hysterectomy is only carried out when there are no other ways to save the mother's life.

Maternal Death

Maternal death is very infrequent. The National Maternal Mortality Rate for 1999 is 10-20 per 100,000 live-births and stillbirths. The common causes are thromboembolism (blood clots travelling up the veins to the heart and lungs), uncontrolled high blood pressure in pregnancy (this can cause strokes, heart and kidney failure), severe bleeding in pregnancy and amniotic fluid embolism (leakage of amniotic fluid into the circulation).

Maternal death is less common following a vaginal delivery than after a caesarean delivery.

Pregnancy Problems - Symptoms

Pregnancy Problems - How to prevent?

Pregnancy Problems - Causes and Risk Factors

Pregnancy Problems - Diagnosis

Pregnancy Problems - Treatments

Pregnancy Problems - Preparing for surgery

Pregnancy Problems - Post-surgery care

Pregnancy Problems - Other Information

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