Common Pregnancy Complications and Their Management

Definition: Anaemia in pregnancy is when the haemoglobin (Hb) level falls below 11 g/dL. It’s one of the most common complications — especially in developing countries.

Causes:

• Iron and folate deficiency.
• Poor diet or multiple closely spaced pregnancies.
• Malaria and hookworm infections.
• Blood loss (from bleeding disorders or placenta problems).

Symptoms:

• Fatigue, dizziness, paleness, shortness of breath, and rapid heartbeat.

Complications:

• Preterm delivery, low birth weight, increased risk of death during delivery.

Management:

• Iron and folic acid supplements (60 mg iron + 400 μg folic acid daily).
• Diet rich in iron (leafy greens, liver, beans, eggs).
• Treat malaria and deworming after first trimester.
• In severe cases: Blood transfusion may be needed.

Prevention:

• Routine antenatal supplements.
• Early detection through haemoglobin testing.

These include Gestational Hypertension, Pre-eclampsia, and Eclampsia.

a. Gestational Hypertension

• High blood pressure (≥140/90 mmHg) after 20 weeks of pregnancy without protein in urine.
• Usually resolves after delivery.

b. Pre-eclampsia

Features:

• High blood pressure + protein in urine.
• Headache, blurred vision, swelling of face/hands.

Complications:

• Eclampsia (seizures), organ damage, fetal growth restriction, stillbirth.

Management:

• Regular BP and urine monitoring.
• Antihypertensive drugs (e.g., methyldopa, labetalol).
• Magnesium sulphate to prevent seizures.
• Delivery if condition is severe and baby is mature enough.

c. Eclampsia

Management:

• Stabilize mother: Airway, oxygen, IV fluids.
• Control convulsions: Magnesium sulphate.
• Control BP: Hydralazine or labetalol.
• Deliver the baby once mother is stable.

Definition: A condition where blood glucose rises during pregnancy due to insulin resistance caused by pregnancy hormones.

Risk factors:

• Obesity, family history of diabetes, previous big baby (>4 kg), or history of stillbirth.

Symptoms:

• Often none — detected during routine screening.
• Sometimes excessive thirst, frequent urination, or fatigue.

Complications:

• Large baby (macrosomia), difficult delivery, low blood sugar in newborn, and later maternal diabetes.

Management:

• Dietary control (balanced, low-sugar diet).
• Regular exercise (under supervision).
• Insulin therapy if needed — oral agents usually avoided.
• Regular glucose monitoring.

Prevention:

• Maintain healthy weight and diet before and during pregnancy.

Why it’s serious: Malaria can cause anaemia, miscarriage, stillbirth, and low birth weight.

Symptoms:

• Fever, chills, weakness, headache.

Management:

• Intermittent Preventive Treatment (IPT) with Sulfadoxine–pyrimethamine (SP) from the second trimester.
• Use of insecticide-treated bed nets (ITNs).
• Prompt treatment with safe antimalarial drugs (e.g., quinine in early pregnancy, artemether-lumefantrine later).

Prevention:

• Regular antenatal visits for preventive doses.
• Avoid mosquito bites through ITNs and protective clothing.

Common in pregnancy due to hormonal changes and pressure on the bladder.

Symptoms:

• Painful urination, frequency, urgency, or fever.

Complications:

• Can lead to kidney infection or preterm labor if untreated.

Management:

• Urine test and antibiotics safe in pregnancy (e.g., amoxicillin, cephalexin).
• Encourage adequate hydration.

Prevention:

• Good hygiene, avoid holding urine, drink plenty of water.

Definition: Severe, persistent vomiting during early pregnancy leading to dehydration and weight loss.

Symptoms:

• Inability to retain food or fluids, dizziness, weakness.

Complications:

• Dehydration, electrolyte imbalance, poor fetal growth.

Management:

• IV fluids, vitamin B6, and antiemetic drugs (metoclopramide or ondansetron).
• Frequent small meals, rest, and psychological support.

Definition: Labor occurring before 37 completed weeks of gestation.

Causes:

• Infections, multiple pregnancy, uterine abnormalities, stress.

Symptoms:

• Regular contractions, back pain, vaginal discharge or bleeding.

Management:

• Tocolytics (e.g., nifedipine) to delay labor.
• Corticosteroids (e.g., dexamethasone) to mature fetal lungs.
• Treat infections if present.

Prevention:

• Regular antenatal checkups and early treatment of infections.
• Rest and reduced physical strain for at-risk mothers.

Definition: Rupture of the amniotic sac before labor starts.

Risks:

• Infection, preterm birth, cord prolapse.

Management:

• Hospital admission for observation.
• Antibiotics to prevent infection.
• Induce labor if baby is mature or infection develops.

Definition: Placenta implanted low in the uterus, covering or near the cervix.

Symptoms:

• Painless vaginal bleeding in late pregnancy.

Complications:

• Severe bleeding (haemorrhage), shock, preterm delivery.

Management:

• Hospitalization and close monitoring.
• Avoid vaginal examination.
• Cesarean delivery if bleeding persists or placenta covers the cervix.

Definition: Premature separation of a normally placed placenta.

Symptoms:

• Painful vaginal bleeding, hard abdomen, fetal distress.

Complications:

• Shock, fetal death, disseminated intravascular coagulation (DIC).

Management:

• Emergency hospitalization, fluid/blood transfusion, and immediate delivery if severe.

Occurs when: An Rh-negative mother carries an Rh-positive fetus.

Complications:

• Fetal anaemia, jaundice, and death in severe cases (erythroblastosis fetalis).

Prevention:

• Anti-D immunoglobulin injection at 28 weeks and within 72 hours after delivery (if baby is Rh-positive).

Definition: Excessive bleeding (≥500 mL) after delivery.

Causes:

• Uterine atony (failure of uterus to contract), retained placenta, lacerations.

Prevention & Management:

• Active management of third stage of labor.
• Uterotonic drugs (oxytocin or misoprostol).
• Massage uterus and control bleeding.
• Surgical intervention if bleeding persists.

Definition: Persistent sadness, anxiety, or hopelessness during or after pregnancy.

Risks:

• Hormonal changes, stress, lack of support.

Management:

• Psychological counseling and emotional support.
• Safe antidepressants if prescribed by a doctor.
• Support from family and community is crucial.

Definition: The fetus is smaller than expected for gestational age due to poor growth.

Causes:

• Maternal malnutrition, hypertension, smoking, infections, placental problems.

Management:

• Nutritional improvement.
• Treat underlying cause.
• Regular ultrasound to monitor growth.
• Early delivery if baby is distressed.

Definition: Fetal death after 28 weeks of pregnancy but before birth.

Causes:

• Poor antenatal care, pre-eclampsia, infections, placental issues.

Prevention:

• Regular antenatal visits, danger sign awareness, and timely medical help.