Complications
Should I be watching out for any pregnancy complications?
Watch out for, yes. Worry, no. Most pregnancies are healthy, and most deliveries are uneventful. So, try not to get anxious about possible complications. That said, there are some signs you should always bring to your doctor or midwife’s attention right away. These include: bleeding, severe nausea or vomiting, sudden decline in the movement or activity of the baby, early contractions, persistent headache, severe abdominal pain, changes in vision, significant swelling, and flu-like symptoms. Women should call their OB or midwife for any of these symptoms to find out what to do next.
What is preeclampsia?
This is a condition that starts after 20 weeks, causing high blood pressure and other problems in the mother, which can stress the baby. Also called toxemia, preeclampsia causes high blood pressure, swelling in the hands and face, stomach pain, blurred vision, dizziness, and headaches. It can cause organ damage or even death, if untreated. The only cure is to deliver the baby. If it is too soon to do so, the mother is often placed on bed rest and monitored, with medications and other therapies to lower her blood pressure. Resting may even take place in the hospital, in a specialized antepartum unit.
What are the symptoms of preeclampsia?
The main sign of preeclampsia is high blood pressure, which often doesn’t have symptoms. That’s one reason why regular prenatal care is so important. If women do have symptoms of preeclampsia, they may experience:
- Throbbing headaches (dull or severe)
- Dizziness
- Changes in vision (e.g., blurriness, spots, flashing lights, auras, light sensitivity)
- Swelling, especially around the eyes, face, and hands
- Stomach pain, especially under the ribs on the right side
- Nausea and vomiting, especially after 20 weeks
- Flu-like symptoms
- Shoulder pain, like someone is deeply pinching along the bra strap or neck
- Sudden weight gain
- Shortness of breath
- Anxiety
- Lower back pain, especially with other symptoms above
Am I at higher risk for preeclampsia?
Women with one or more of the factors below are at a higher risk of preeclampsia. It is important to note, though, that it is possible to get preeclampsia even if none of these risk factors are present.
- First pregnancy
- Pregnant with multiples (e.g., twins, triplets)
Previous history or family history of preeclampsia - History of high blood pressure, diabetes, kidney disease, polycystic ovarian syndrome (PCOS), sickle cell, or autoimmune disease (e.g., lupus, rheumatoid arthritis, multiple sclerosis)
- Previous organ transplant
- Body mass index (BMI) of 30 or greater
- Mother is over age 35 or under age 20
- African-American heritage
How is preeclampsia treated?
Preeclampsia treatment involves very close monitoring of both the mother and the baby. They may be admitted to the hospital or placed on bed rest at home. Blood tests to measure mom’s kidney and liver functions and medications to lower blood pressure may be used. If high blood pressure continues, mom may also need medications to prevent preeclampsia related seizures or stroke. The baby will be closely monitored for signs of stress. If the baby is not growing enough or shows other signs of stress, doctors may recommend early delivery as the safest solution for mother and baby. The only way to cure preeclampsia is to deliver the baby.
How is preeclampsia diagnosed?
Preeclampsia is diagnosed with a blood pressure reading and tests for too much protein in the mother’s urine. Since it has no symptoms, regular blood pressure monitoring is part of women’s prenatal visits.
Do I need to see a specialist for preeclampsia?
Most OBGYN providers feel comfortable in caring for patients with preeclampsia. Depending on the severity and other pre-existing conditions, the provider may refer to a maternal-fetal medicine doctor for a specialist’s input. Until you deliver, this specialist is likely to remain a part of your care team.
What is gestational diabetes?
Gestational diabetes is when women, who have never had diabetes in the past, have high blood sugar (glucose) during pregnancy. It often produces no symptoms and can put both mom and baby at risk. Pregnant women are regularly tested for gestational diabetes between the 24th and 28th week of pregnancy to make sure it is caught early. If left untreated, it could lead to preeclampsia, premature birth, and other problems that can complicate delivery. The mom’s blood sugar usually returns to normal after delivery. But having gestational diabetes does increase a woman’s risk of developing type 2 diabetes or having gestational diabetes again during a future pregnancy. The baby’s risk of developing type 2 diabetes later in life is also increased.
How is gestational diabetes diagnosed?
Gestational diabetes is diagnosed with a specialized blood test called a glucose tolerance test (GTT). Glucose tolerance testing is usually performed between week 24 and week 28 of pregnancy—or sooner if the mom had gestational diabetes during a past pregnancy. Moms are asked to drink a very sweet liquid that contains a specific amount of glucose. A blood test is performed an hour later to measure blood sugar levels. A blood glucose level of 140 milligrams per deciliter (mg/dL) is considered positive for gestational diabetes. Women with borderline results of 130 – 139 mg/dL may need to take a second test after a period of fasting. The second test involves a larger amount of sugar in the drink and four blood tests taken over a 3-hour period. If two or more of those test results are positive, the woman is diagnosed with gestational diabetes.
What are the symptoms of gestational diabetes?
For most women, gestational diabetes doesn’t cause any symptoms. That is why screening during pregnancy is so important. If symptoms are felt, they may include extreme thirst, hunger, or fatigue.
Do I need to see a specialist for gestational diabetes?
Women with gestational diabetes may benefit from seeing an endocrinologist—a doctor who specializes in metabolic disorders like diabetes and thyroid disease. Endocrinologists can educate patients on what they need to do to monitor their blood sugar, as well as provide medications if needed. Nutritionists can help women understand the diet changes that will help them better control their blood sugar.
What are the symptoms of gestational diabetes?
For most women, gestational diabetes doesn’t cause any symptoms. That is why screening during pregnancy is so important. If symptoms are felt, they may include extreme thirst, hunger, or fatigue.
What is placenta previa?
The placenta provides oxygen and nutrition to a baby in the womb and removes waste through the umbilical cord. In most pregnancies, the placenta attaches to the top or side of the uterus. Placenta previa (or low-lying placenta) means that the placement of the placenta in the womb is between the baby and the birth canal—the placenta is partially or completely blocking the baby’s way out. This can cause bleeding throughout the pregnancy and may mean women will need a C-section to deliver the baby. But, the womb stretches and moves during pregnancy, so a low-lying placenta in early pregnancy may not be a problem come time for delivery.
Will I need to have a C-section for placenta previa?
It depends on the exact placement of the placenta in late pregnancy and the overall health of mom and baby. Women who are told they have a low-lying uterus in early pregnancy should not be too concerned. The womb stretches and therefore the placenta moves during pregnancy, so a low-lying placenta in early pregnancy may not be a problem come time for delivery.
What is a breech delivery?
Breech simply means that that baby is feet or butt down instead of head down at the time of delivery. The ideal position for delivery is a baby that is head down, facing mom’s back with its chin tucked. This is called the vertex position and makes for the most comfortable birth for mom and the least amount of risk for baby. Another abnormal position is called a transverse lie meaning that the baby is sideways in the womb.
Will I need to have a C-section for a breech delivery?
Before 37 weeks, a breech presentation is not much concern because most babies will turn themselves in time for delivery. After 37 weeks, turning is not as likely and the doctor will need to determine whether vaginal delivery is possible.
Why might I need an unplanned C-section?
There are many labor and delivery complications that can lead to doctors making the call that a C-section is the safest route for mom and baby. These include: breech, placenta previa, prolonged labor (failure to progress), premature rupture of membranes, umbilical cord problems, late-term pregnancy, preeclampsia, and uterine bleeding. The bottom line is that mom and baby are monitored carefully during labor and delivery. Any sign that one is in unusual distress may be cause for an emergency C-section.
What is a cerclage?
Cervical cerclage is a procedure that uses stitches or specialized tape to hold the cervix closed during pregnancy. It is sometimes used for women who experience preterm labor or whose cervix begins to open too early. During pregnancy, the cervix gradually gets shorter and softer, then dilates (opens wider) just before delivery. A cervix that opens too soon can lead to premature birth or pregnancy loss. The procedure is usually performed through the vagina at a hospital or outpatient surgery center under anesthesia. Afterwards, women are usually placed on bed rest for some period. The cerclage is then removed around week 37 of pregnancy or at the start of labor.
What should I do if I fall during my pregnancy?
Falls are pretty common during pregnancy, as shifting centers of gravity and loosening tendons affect mom’s balance. Most minor falls won’t cause problems for mom or baby. But sometimes, just the right angle can cause a complication. It’s a good idea to report any fall to your OB. Seek emergency medical attention for any fall that:
- Includes a direct blow to your abdomen
- Results is any vaginal bleeding
- Causes mom’s water to break (or leak)
- Is followed by severe pain in the abdominal or pelvic area
- Causes contractions to start to increase in frequency
- Is followed by less movement or activity by the baby
Do I need to see my OB for minor injuries during my pregnancy?
It is a good idea to discuss what your OB would like you to do during for minor injuries during your first visit. Many OB prefer moms to call them first for any and all issues, even if they don’t appear to be pregnancy related. It is also important to know which products are safe to use on minor cuts, bruises, aches, and pains. For moms who didn’t have this conversation before becoming injured, the best thing to do is to call the OB’s office for instructions. And, of course, call 9-1-1 at any sign of serious injury.
What is postpartum recovery like with an episiotomy?
Women who had an episiotomy or vaginal tearing will have similar care post-childbirth. This may include:
- Cold packs to lessen pain and swelling
- A ring cushion (donut) so mom can sit comfortably without putting pressure on the wound
- Stool softeners (doctor approved) to prevent constipation and ease the pressure of bowel movements
- A perineal irrigation bottle (peri bottle) that allows you to easily clean the affected area and gently dab, instead of wiping after using the bathroom
- A Sitz bath that holds just enough water to soak the affected area
Does an episiotomy hurt?
Women should not feel the episiotomy at all during the delivery. If they have not had an epidural, leaving the area already numbed, a local anesthetic will be used. After birth, the incision is stitched up and ice is placed on the wound to lessen pain and swelling.
What is postpartum recovery like with tear?
Doctors talk about tears in terms of their severity with first degree being the most mild and fourth degree, the most severe. First and second degree tears often heal within a few weeks, with most of the discomfort during the first week. Third and fourth degree tears take longer to heal, with several weeks of pain and discomfort. Cold compresses, Sitz baths, peri bottles, and stool softeners are all likely to be recommended during healing.
How common is a vaginal tear during childbirth?
Vaginal tearing is very common in first time moms. That’s because vaginal tissue becomes more flexible after one vaginal birth, so tearing is less common for later births. Other factors can also increase the risk of a tear, such as a fast delivery (the vagina has less time to adapt and stretch) or the position of the baby.
Is there anything I can do during my pregnancy to prevent gestational diabetes?
Some of the things that increase a woman’s risk of gestational diabetes cannot be controlled, such as age (under 25), ethnic background, or having a close relative with type 2 diabetes. The risk factors women have some control over include weight, exercise routine, and food choices. But it is important to talk over any changes with an OB first to ensure it is done safely for mom and baby.
Does gestational diabetes affect the baby?
Babies get nutrients from mom’s blood through the placenta. When mom’s blood is high in glucose, babies store that extra sugar as fat, putting on weight faster. Since these babies measure larger than normal earlier in pregnancy, they are more likely to have a pre-term birth or the provider may recommend a C-section. Just after birth, babies are more likely to have low blood sugar, breathing problems, and jaundice (yellowish skin caused by liver problems). Babies are also at higher risk of obesity and diabetes later in life.
What can I do to relieve swollen feet and ankles during pregnancy?
Here are some proven tactics to help relieve swelling in legs and feet during pregnancy:
- Drink lots of water
- Rest with feet elevated
Get up and walk around often - Massage swollen feet and ankles
- Avoid crossing the legs
- Swim (or just rest in the pool—NOT a hot tub)
- Avoid standing for a long time
- Stay cool
- Avoid tight pants, socks, or shoes (especially high heels)
Should I be concerned about foot and leg swelling during pregnancy?
During pregnancy, the uterus puts pressure on the large vein that carries blood from your legs back up to your heart (the inferior vena cava). So, some pooling of fluid in the legs (which leads to swelling) is normal. Women should seek medical attention if swelling is:
- Worse on one side of the body
- Accompanied by pain in the same area
- Accompanied by chest pain or difficulty breathing
- Suddenly in your hands and face
Will my feet change size during pregnancy?
Yes, a woman’s foot size can change during pregnancy. And, yes, it is permanent. Researchers have found that women’s arch height decreases during pregnancy, which causes the foot length to increase—often enough to require a new shoe size. This is thought to be caused by a combination of hormone changes and the extra weight women carry when pregnant.
What is toxoplasmosis?
Toxoplasmosis is an infection by a common parasite found in spoiled food, soil, contaminated water, and cat feces. While the disease often produces mild (or no) symptoms in adults, it is dangerous for people with weakened immune systems and for unborn children. If a mom becomes infected, toxoplasmosis can be deadly or cause serious birth defects in her baby. It is the main reason why doctors advise pregnant women to avoid cleaning cat litterboxes.
Can I scoop my cats' litter during pregnancy?
If at all possible, women should avoid cleaning their cat’s litterbox during pregnancy. If there is no other choice, women can wear gloves and a mask during cleaning and wash their hands thoroughly after. Also, keep cats indoors and avoid feeding them any raw meat, which would increase the risk of cats acquiring toxoplasmosis.