This represents a state of abnormal glucose metabolism
seen during pregnancy. It mimics diabetes but is first detected
during pregnancy and usually after the seventh month.
Reasons
Though any pregnant woman may have gestational diabetes,
it is usually seen in obese, elderly women and those with a family
history of diabetes.
Symptoms
It is most often diagnosed by an oral glucose tolerance
test at around seven months of pregnancy. In this test, a measured
amount of glucose is taken by mouth and repeated blood tests are
done over a 2-hour period. The condition usually causes no symptoms
in the expectant mother. However, early detection of the disease
is necessary as it can prevent pregnancy complications – early
breaking of waters, preterm delivery and complications of the baby
– larger than normal size, respiratory and metabolic problems
at delivery.
Precautions
Testing for blood sugars in later months of pregnancy
for high-risk women help in early detection of the condition and
appropriate management.
General Treatment
Treatment depends on the levels of blood glucose.
For mild cases, a diabetic diet is recommended which corrects the
abnormality. For severe cases, insulin injections will be necessary.
Generally oral medicines are not prescribed. Frequent checking of
blood sugar levels is necessary after the detection of gestational
diabetes. The baby in the womb needs to be monitored by serial ultrasound
examinations.
This refers to a condition in which severe bleeding
is encountered after the delivery of a pregnant woman. It could
be after a normal delivery, instrumental delivery (forceps, vacuum
etc) or after a cesarean section.
Reasons
There are several reasons for heavy bleeding. In
up to 80% of cases, the muscular walls of the womb lose its contractility,
become lax and are unable to compress the traversing blood vessels.
Alternately, trauma to the womb or the birth passage could be
responsible. Retained afterbirth and coagulation disorders are
the other reasons for PPH. Women at greatest risk include - Multigravidas,
those with over distended wombs, prolonged or induced labor, bleeding
early in pregnancy and women who have been given epidural analgesia.
Symptoms
With heavy bleeding - pulse rate increases and
blood pressure falls. This is a serious condition and needs urgent
medical attention. There may be associated giddiness, fainting,
confusion and black outs.
Precautions
PPH should be anticipated for every delivery, more
so for high-risk cases. For prevention of PPH, drugs to contract
the womb may be given in anticipation before the bleeding actually
occurs. Massage of the womb through the tummy is another useful
method for temporary control of bleeding.
General Treatment
Treatment of PPH starts with resuscitation of the
woman. This means starting IV lines and administering fluids and
blood. Stabilizing pulse and blood pressure is a priority along
with identifying the cause of the bleeding and then arresting
it. Tears in the passage need to be stitched up, while relaxed
wombs need to be contracted by medicines. In exceptional cases
when medicines do not work – surgical methods are resorted
to. Removal of the uterus may be required as a life saving measure
in some cases.
The term is used to describe a serious clinical
situation where high blood pressure in pregnancy is compounded
with blood and liver disorders. This is a life threatening condition
with a high chance of the baby being severely affected. Biochemical
abnormalities seen in laboratory tests include elevated liver
enzymes, a decreased clotting ability of the blood and ruptured
blood cells.
Reasons
The cause for this disorder among pregnant women
with high blood pressure is unknown.
Symptoms
Headache, nausea, blurring of vision and severe
upper abdominal pain. The blood pressure is usually very high
and there is loss of protein in the urine. Swelling of the body
especially the legs is often seen.
Precautions
As the exact cause of the disease is unknown, methods
to prevent it are not present.
General treatment
Treatment involves stabilizing the patient by reducing
the blood pressure and correcting coagulation disorders at the
earliest. Early delivery of the baby provides best results for
both baby and the mother. Soon after delivery the condition almost
always regresses in the mother, but it can recur (25% chance)
in a subsequent pregnancy.
Painless, irregular contractions of the womb may
cause varying degrees of discomfort in a woman throughout pregnancy.
These pains are called Braxton-Hicks contractions.
Reasons
Though these innocent aches are the most common
cause of pain in pregnancy, other possibilities like miscarriage,
premature labor and premature separation of the placenta need
to be considered. Infections of the stomach (gastritis), pancreas
(pancreatitis), appendix (appendicitis), gall bladder (cholecystitis)
and urinary bladder (cystitis) can also cause pain in pregnancy.
Often simple ailments like flatulence or bloating, constipation
and indigestion, which are common during pregnancy, may present
as tummy pain in a pregnant women.
Symptoms
Pain usually starts in the low back or lower tummy
and is of a cramping nature. It is most often transient. Persistent
severe pain, associated with fever, vomiting or other localizing
symptoms need urgent evaluation.
Precautions
It is important to know when to approach a doctor.
In cases of doubt, it is always advisable to visit a doctor anyway.
General Treatment
Depending on the type of pain and severity, varying
degrees of intervention may be necessary. Labor pains are typically
intermittent with increasing intensity and frequency. Most often,
the pain is mild, temporary and subsides on its own. Rarely, an
anti spasmodic like drotaverine may be used to alleviate discomfort.
Surgical intervention is required in exceptional cases only.
This refers to a type of bacteria, normally
present in a woman’s body, which can infect a pregnant mother
and have serious consequences in the baby.
Reasons
Normally these bacteria are present in the
urinary tract and rectal areas and do not cause any disease. It
is in some women during pregnancy, they creep into the birth passage
and infect the membranes causing complications.
Symptoms
Usually no symptoms are seen in the mother.
Yet, it may cause PPROM and preterm labor pains. In the baby,
two types of illness can occur. Immediately after birth, a respiratory
illness can develop causing breathing difficulty. A delayed illness
seen after the first week can involve the brain and cause neurological
problems.
Precautions
In high risk women screening for the bacteria
can be done and appropriate antibiotics are then administered.
The same antibiotics may be required during the time of delivery
to prevent transmission to the baby.
Treatment
All women who are colonized with the bacteria
do not get infected in pregnancy. Only a small number of pregnant
women affected will transmit the bacteria to their babies. However,
as the disease in the babies is a serious one and more so if born
preterm, all women diagnosed with group B streptococci ought to
receive appropriate antibiotics at the time of delivery.
The word ‘placenta’ is used for the
afterbirth, which carries blood and nutrients from the mother
to the baby when it is in the womb. The placenta is normally positioned
in the upper portion of the womb. When the placenta is situated
in the lower part of the womb, partially or totally obstructing
the birth passage, the term placenta previa or low lying placenta
is used.
Reasons
This condition is seen in about 20% of women early
in pregnancy (before 20 wks). As pregnancy advances, the afterbirth
usually migrates to the upper part of the womb and the chance
of the condition persisting at delivery is about 2 - 3%.
Symptoms
In this condition, there may be bleeding - mild to heavy at different
stages of pregnancy, usually in the later months. In most cases
however, the baby is not affected as the blood lost comes directly
from the mother.
Precautions
There is no way to prevent the condition but early
identification by ultrasonography is helpful. The woman is advised
to limit her physical activity and avoid intercourse. Iron tablets,
injections or blood transfusions are liberally used throughout
pregnancy to boost the blood hemoglobin level in the mother. Hospitalization
is advised as soon as any bleeding occurs. There are no medicines
to stop the bleeding but in many cases it stops on its own.
General Treatment
Delivery by the abdominal route (cesarean section) is indicated
when the placenta partially or totally obstructs the birth passage.
Heavy bleeding, not responding to conservative treatment, requires
a termination of pregnancy. Blood transfusion facilities should
be available at the time of delivery.
Usually the afterbirth or placenta separates from the wall of
the womb after the baby is delivered. When some degree of separation
occurs when the baby is still in the womb the condition is called
placental abruption.
Reason
Placental Abruption is a serious clinical condition.
It may be seen in pregnant women with high blood pressure, after
a sudden break of waters, in cases of multiple pregnancies or
in women with other medical disorders. However, the condition
is often unpredictable and presents as an emergency.
Symptoms
Abruption often presents as bleeding in the later
part of pregnancy along with abdominal pain. On examination, the
womb is tender and there is varying degrees of distress to the
baby inside the womb. In the severe cases, the bleeding may be
concealed i.e. occurs inside the tummy or more commonly in the
wall of the womb. Severe compromise and often death of the baby
occurs in severe cases of abruption. Maternal complications include
heavy blood loss, clotting disorders and kidney dysfunction.
Precautions
General Treatment
Early suspicion and prompt diagnosis of the condition
is the key to success. Delivery should be done in the fastest
possible way. If the baby is alive a cesarean section is often
the best mode of delivery especially when the neck of the womb
is not open. As the chances of the baby being distressed are high,
neonatologists need to be informed for looking after the baby
immediately after the delivery. In conditions where the baby has
already died in the womb, urgent delivery is still warranted keeping
in view the maternal complications possible.
The afterbirth or placenta is the organ in the
womb through which blood, oxygen and nutrients reach the baby
from the mother. When the placenta fails to function properly,
the baby is unable to grow optimally and the condition is called
placental insufficiency.
Reasons
Placental insufficiency could arise from maternal
diseases - high blood pressure, kidney problems, immunological
disorders and other diseases affecting the blood vessels of the
afterbirth. The same condition may arise if the afterbirth becomes
too ‘old’ or the pregnancy goes much beyond the expected
date of delivery.
Symptoms
Placental insufficiency may be suspected if the
water is in the womb around the baby is reduced on examination
or if the baby grow sub optimally. A more definite diagnosis is
made by ultrasonography (often many) and Doppler studies. In the
later, blood vessels of the placenta and baby are examined to
detect reduced flow of blood.
Precautions
Early detection of the condition helps in assessing
the time of delivery and minimizing the risks for the baby inside
the womb.
General Treatment
Medical treatment of placental insufficiency has
never been encouraging. A decision for early delivery, depending
on the severity of the condition is usually made. The decision
needs to be balanced against the risks of delivering a premature
baby. Though normal delivery is not contraindicated, in severe
cases of insufficiency cesarean section may be preferred.
Normally the delivery date is calculated by adding nine months
and seven days to the first day of the last menstrual period.
This rule holds good for regular periods only. In cases where
the periods are irregular or the date of the last period is unknown,
an early ultrasound done in the first few months, can give a reliable
guide to the delivery date. When the duration of pregnancy extends
two weeks beyond the delivery date it is labeled as post term.
Reasons
Post term pregnancy may be seen in 3-10%
of normal pregnancies. Before a diagnosis is made, the dates need
to be checked and confirmed. It is seen more in women pregnant
for the first time and in those with previous post term pregnancies.
Symptoms
Mothers and relatives are generally found to be quite anxious
in post term pregnancies. The worries are of placental insufficiency
and decreased water around the baby in the womb. While the former
could lead to decreased supplies from the mother, the later may
lead to choking in the womb.
Precautions
Regular visits to the doctor especially
near the time of delivery can help in preventing complications
due to postdates.
General Treatment
If there are no signs of compromise in the
baby as assessed by ultrasound the options need to be discussed.
Waiting may allow labor to set in on its own. If this does not
happen or signs of compromise in the baby are seen, the patient
needs to be hospitalized and medicines need to be administered
to start labor pains.
Normally the delivery date is calculated by adding nine months
and seven days to the first day of the last menstrual period.
This rule holds good for regular periods only. In cases where
the periods are irregular or the date of the last period is unknown,
an early ultrasound done in the first few months, can give a reliable
guide to the delivery date. When the duration of pregnancy extends
two weeks beyond the delivery date it is labeled as post term.
Reasons
Post term pregnancy may be seen in 3-10%
of normal pregnancies. Before a diagnosis is made, the dates need
to be checked and confirmed. It is seen more in women pregnant
for the first time and in those with previous post term pregnancies.
Symptoms
Mothers and relatives are generally found to be quite anxious
in post term pregnancies. The worries are of placental insufficiency
and decreased water around the baby in the womb. While the former
could lead to decreased supplies from the mother, the later may
lead to choking in the womb.
Precautions
Regular visits to the doctor especially
near the time of delivery can help in preventing complications
due to postdates.
General Treatment
If there are no signs of compromise in the
baby as assessed by ultrasound the options need to be discussed.
Waiting may allow labor to set in on its own. If this does not
happen or signs of compromise in the baby are seen, the patient
needs to be hospitalized and medicines need to be administered
to start labor pains.
This is a condition where raised blood pressure
in pregnancy is usually combined with loss of protein in the urine.
There is a varying degree of swelling in the body especially the
legs. Though some swelling of the body is normal in pregnancy,
when associated with high blood pressure, the woman needs evaluation.
In extreme situations of high blood pressure, convulsions may
be seen – a condition called eclampsia.
Reasons
The cause for pre eclampsia is essentially unknown. It is suggested
that a vascular defect at the placental level may be responsible.
Immuological and genetic factors could also contribute to pre
eclampsia.
Symptoms
In cases of mild elevation of blood pressure
the woman may not have any problems. In cases of severe elevation
there may be headache, nausea, pain in the upper tummy and blurring
of vision. The baby may be growth restricted especially if preeclampsia
is long standing.
Precautions
Though there are few reports claiming the
benefit of calcium and aspirin, more research on the subject is
due.
General Treatment
Treatment depends on the severity of the
hypertension, the time of pregnancy it was first detected and
the condition of the baby. In severe cases, urgent delivery needs
to be considered esp. if the baby is mature. Sometimes even if
the baby is immature pregnancy needs to be terminated, keeping
in mind the serious complications that may occur in the mother.
For mild cases however, a more conservative approach may be justified.
Medicines to lower blood pressure need to be administered to keep
it to optimal levels. A close watch for signs of worsening hypertension
needs to be sought as convulsions can occur in extreme cases.
Any sign of labor seen before 37 completed weeks
of pregnancy is called preterm labor. Contractions of the womb
(pain lower abdomen) and the opening of the neck of the womb are
signs of impending delivery. The risks mainly lie for the premature
baby who may not yet be prepared for a life outside the mother’s
womb. The extent of the risk depends on how early preterm labor
sets in.
Reasons
Preterm labor, like many things in obstetrics,
is generally unpredictable. However in certain subsets of women
the risk is high - women experiencing preterm labor in earlier
pregnancies, those with over distended wombs, infections in the
birth passage and poor holding capacity of the neck of the womb.
Symptoms
Labor pains are classically described as being
rhythmic and usually start in the lower back. They gradually increase
in intensity, frequency and duration.
Precautions
At early stages of labor especially when the pregnancy
is less than 34 weeks, medicines are administered to arrest the
delivery process. In pregnancies which are greater than nine months
in duration or when labor is in an advanced stage – delivery
is allowed. Care needs to be taken of the newborn and intensive
care treatment for preterm babies is often required. Difficulty
in breathing, inability to feed initially and bleeding from the
gut and brain are problems encountered in babies born too early.
How the baby fares depends on how early the delivery has taken
place and the efficiency of the baby care unit in the hospital.
General Treatment
Though cesarean section is often employed for delivering
preterm babies, there is a lack of definite benefit in the practice.
Premature rupture of membranes refers to the breaking
of waters before the onset of labor. ‘Preterm’ means
the rupture occurs prior to 37 completed weeks of pregnancy.
Reasons
It often happens due to infection - the commonest
cause. Other causes include secondary to the onset of delivery
pains, over distended wombs (excess water or twins) and medical
disorders complicating pregnancy. Sometimes, no cause may be found.
Symptoms
A sudden gush of fluid from the birth passage often
without warning is the first evidence of PPROM. The leakage could
be in small quantities where it may be mistaken initially for
urine. Early identification is important as associated infections
need to be treated and in some cases premature labor pains may
start.
Precautions
Prevention strategies have been futile in most cases. Infections
– urinary or genital tract if identified early need to be
treated.
General Treatment
There is no way to stop the leaking of fluid. Treatment
depends on when the leaking starts, how immature the baby is and
presence of infections or medical problems in the mother. If membranes
rupture very early in pregnancy – fifth or sixth month,
a conservative approach is taken and often leaking stops on its
own. Leaking after the completion of the eighth month however
tilts the favor towards an early delivery. A short course of steroids
is often prescribed to accelerate lung maturity in the preterm
baby.
This term applies to diseases occurring in a woman
within the first six weeks of her delivery.
Reasons
Infections are most common of the puerperal disorders. They could
affect the uterus (womb), breast, urinary bladder, lungs or the
delivery wound. Breast problems include engorgement, localized
collections of pus and cracked or sore nipples. Other puerperal
disorders include bleeding and a variety of psychiatric problems.
Symptoms
Most infections present with fever and localizing signs. The cause
of fever needs to be found out and treatment instituted. Breast
pain could be due to infection, engorgement of milk due to inability
to express or a localized collection of pus. Bleeding could be
due to several factors and of varying amounts. Some mood changes
are noticed in many women in the first week after a delivery.
A close watch is essential to detect worsening.
Precautions
Plenty of oral fluids in the post delivery period
are helpful in avoiding urinary infections. Breast-feeding should
be monitored in the first few days to ensure correct methods are
being used. Breasts need to be emptied after every feed. Nipples
need to be cared for from the last three months of pregnancy.
Treatment
After identifying the cause of infection, appropriate
treatment needs to be instituted. Hospitalization and the intravenous
route for antibiotics may be needed in severe cases of sepsis.
Otherwise outpatient treatment may suffice. Caution needs to be
governed keeping in mind that most antibiotics are excreted in
breast milk. Breast engorgement needs decompressing by a breast
pump while localized pus collections need to be drained. Psychiatric
problems need supportive treatment failing which medicines need
to be started.
