Complications of pregnancy - Essay Example

?A pregnancy in which fertilized ovum is implanted outside the uterine cavity (Mehboob and Mazhar, . 98% of these pregnancies are located in fallopian tubes while the rest can occur in abdominal cavity, ovary or cervix (Stoppler, 2010). Clinical presentations: Typical signs of ectopic pregnancy include abdominal pain, amenorrhea (absence of menstrual periods), vaginal bleeding or spotting (Stoppler, 2010 ), however symptoms may vary depending upon if the tubal rupture has occurred or not. Delayed menstruation for 1-2 weeks followed by spotting or bleeding is a typical sign of ectopic pregnancy. Gastrointestinal problems may also occur along with lightheadedness and dizziness. Yet if tubal pregnancy remains undetected for 4-6 weeks after conception, the fallopian tube becomes more distended and can rupture leading to symptoms like excruciating abdominal pain, nausea, vomiting and faintness. In some cases, the patient may go into shock or rapid pulse, decreased blood pressure, restlessness, sweating may lead to hemorrhage (Smeltzer, 2009). Adnexal mass might be found upon pelvic examination along with tenderness (Doherty, 2010). Complications/risks: Failure to diagnose ectopic pregnancy especially in patients with few symptoms can increase the risk of internal bleeding which can result in hemorrhage or shock. Management: Treatment choices include surgical intervention either laparotomy or laparoscopy and medication. Surgical management may be salpingectomy (removing the concerned fallopian tube) or salpingostomy (preserving the affected tube) depending on patient’s wish. However, salpingostomy increases the risk of persistent trophoblast and ectopic pregnancy whereas salpingectomy avoids these risks but only one tube remains with reproductive ability. Non-surgical medication treatment includes the use of anti-cancer drug methotrexate (Tembhare, 2010) which can be administered intravenously or intramuscularly (Wolfson, 2009). Delivery before 37th week of pregnancy is classified as pre-term labor (WHO, 1994). Clinical presentations: Clinical signs of preterm labor include uterine contractions, menstrual like cramps, diarrhea, back-ache, pelvic pressure, increased vaginal discharge(Littleton, Engebretson, 2002)vaginal bleeding, ruptured membranes, initial cervical dilation greater than 3 cm and contraction frequency of 4 per hour or more (Creasy, Resnik and lams, 2004). Complications/risks: Risk factors to the mother are largely associated with tocolytic agents used in treatment. Respiratory depression/arrest, pulmonary edema, hypotension and cardiac arrest are complications associated with administration of magnesium; similarly, terbutaline may induce hyperglycemia, hypokalemia and myocardial ischemia. Other drugs (nifedipine and indomethacin) may produce side effects like gastrointestinal problems, renal failure and hepatitis (Littleton, Engebretson, 2002). Neonatal may suffer from renal dysfunctions, necrotizing enterocolitis, patent ductus arteriosus, intracranial hemorrhage preterm deliveries. Management: Obstetric practices for averting preterm labor include bed rest, home uterine activity monitoring, sedation and hydration, however, little evidence is present about success rates of these methods (Goldenberg, 2002). Tocolytic therapy is used for the hindering uterine contractions which include calcium channel blockers (nicardipine, nifedipine), magnesium, ?-mimetics (terbutaline, fenoterol etc.), non-steroidal anti-inflammatory agents (indomethacin) and ethanol. Evidence suggests that tocolytic therapy is significant in preventing preterm labor (Berkman et al., 2003 ). In addition, cervical cerclage is employed where cervical incompetence is found, in which a suture (rescue cerclage) is placed to prevent further dilations. Management of preterm labor includes avoiding neonatal complications through use of corticosteroids and antibiotics to prevent traumatic delivery and streptococcal neonatal sepsis (Goldenberg, 2002) Pre-eclampsia is a condition in which pregnant patient experiences a triad of hypertension, proteinuria and edema. Clinical presentations: Classical symptoms include increased blood pressure (>140/90), edema, proteinuria (300mg/24 hr.). Other signs include unusal weight gain, morning sickness, headache, visual disturbances, epigastric pain (Carr et al., 2003). In severe cases hepatic dysfunction like amplified liver function, hemolysis and low platelets is observed (Schust and Heffner, 2006). Complications/risks: Maternal complications if left untreated may be fatal and may include pulmonary edema, hepato-cellular necrosis, retinal detachment, cerebral edema or hemorrhage, post-operative bleeding and delayed wound healing. Also, the mother may develop preeclampsia in next pregnancy and may develop hypertension or diabetes later in life. Fetal mortality in patients with preeclampsia is 4-20% which may be due to premature delivery, fetal growth restriction or abruption (Carr et al., 2003). However, complications developed by preeclampsia disappear after delivery and normal functioning of body starts if no permanent tissue damage is done (Schust and Heffner, 2006). Management: The eventual treatment of is delivery of pregnancy however, management is done through administration of anti-hypertensive drugs to stabilize blood pressure. Beneficial effects of calcium channel blockers (nifedipine) to treat urine output are reported to be beneficial (Lyall and Belfort, 2007). The physician decides the timing of delivery according to gestational age and severity of disease. Patients with preeclampsia beyond 38 weeks are treated by delivery either by cesarean or by induction of labor. Before 38 weeks, mild preeclampsia is treated with bed rest under careful fetal and maternal observation. Delivery at 38 weeks is suggested if the symptoms worsen or fetal lung development has occurred (Carr et al., 2003). Clinical presentations: Early pregnancy loss is with associated with signs like vaginal bleeding and cramping suprapubic pain (Greenberg, 2005). Symptoms such as vaginal bleeding and abdominal pain with or without the removal of products of conception are spontaneous abortion (Kurjak, 2008). Patients of threatened abortion, present signs like continuous pain and without cervical dilations before 20 weeks. Patients with incomplete abortion (after 8 weeks) experience vaginal bleeding, dilations of cervix with pain and presence of conceptual products in vaginal vault (Greenberg, 2005) whereas, in complete abortion, total expulsion of fetus and placenta takes place. Missed abortion is characterized with unrecognized fetal death (Chestnut, 2004). Complications/risks: Risks may include shock characterized by increased respiratory and pulse rate, hypotension, unconsciousness, sweaty palms and infection/sepsis (WHO, 1994). If medical care is not sought patient may suffer from heavy vaginal bleeding, intra-abdominal injury and sepsis (WHO, 1994). Complications in case of D and E comprise of uterine perforation, cervical lacerations, hematometra (accumulation of blood clots in uterus), hemorrhage, retained products of conception and infection (Chestnut, 2004). Management: Treatment in abortion requires surgical debridement which in some cases includes hysterectomy, and antibiotic therapy (Benrubi, 2010). No proven treatment is considered effective in threatened abortion; however bed rest and pelvic rest are recommended which may provide relief. Patients with incomplete abortion require immediate gynecological consultation and suction curettage and in missed abortion no curettage is done unless infection is suspected (Greenberg, 2005). Abortion management includes treatment of vaginal blood loss by replacement of fluids and surgical intervention. Also, management of intra-abdominal injury and sepsis through use of antibiotics and appropriate surgical procedure is important to avoid extensive bleeding and infection including tetanus, peritonitis etc. (WHO, 1994). Ante-partum hemorrhage is a condition in which bleeding occurs from or into genital tract after 28 weeks (Padubidri, Padubidri, Anand, 2006). Clinical presentations: Ante-partum hemorrhage signs include abdominal pain, vaginal bleeding, back ache and decreased fetal movements (McCarthy and Hunter, 2003). Ante-partum hemorrhage can be caused due to two reasons; placenta praevia (low lying placenta) or abruptio placenta (partially or wholly separated placenta from uterine wall before delivery). In other rare cases, bleeding may also occur due to lower genital tract lesions, cervical fibroids, polyps etc. In abruption placenta patient experiences little or no vaginal bleeding with pain, contractions, hypotension, tender uterus, poor urine output or renal failure while placenta praevia patient experience painless vaginal bleeding, pre-eclampsia, sepsis, amniotic fluid embolism, breech position of fetus (Lmpey, 2004). Complications/risks: Maternal risks involve danger of massive hemorrhage and shock in placenta praevia due to excessive blood loss (Lmpey, 2004). Complications of abruption placenta involve coagulopathy and renal failure (McCarthy and Hunter, 2003). Fetal risks include preterm delivery, fetal distress. Intrauterine demise may also occur due to maternal anemia, reduced maternal-placental nutrient exchange. Management: Management of immense hemorrhage is done through maternal resuscitation by blood transfusion and immediate delivery. Coagulopathy and renal failure can be reversed by resuscitation and fluid replacement (McCarthy and Hunter, 2003). If the fetus demise has occurred labor is induced for vaginal delivery. Elective caesarian section is done at 39 weeks or before and in some case earlier if fetal distress is apparent. During the caesarian surgery, vital signs of both mother and fetus are closely monitored for immediate action (Lmpey, 2004). References Berkman, D., Thorp, J., Kathleen N., Lohr., Carey, L., Hartmann, K., Gavin, N., Hasselblad, V., Idicula, A. 2003. 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