problems in pregnancy.docx

themotherchild.com - an online parenting encyclopedia
Chief Author - Dr. Suraj Gupte MD, FIAP, FSAMS (Sweden) & FRSTMH (London)
Chairman- (Pediatric Education Network), Professor of Pediatrics and Principal Advisor -
Children’s Health Institute™ (A web based collaboration of the World Parenting Organization
(WPO) & International Society for Girl Child & Rights Inc. USA); Editor-in-Chief: Recent
Advances in Pediatrics (now volume 27), The Short Textbookof Pediatrics (13th edition in print)
Common Problems in Pregnancy
Pregnancy is a unique experience for the mother. While the “new life” is growing
inside her womb, she is given to dreaming beautiful dreams. That’s all very fine. “In
fact, it is very much desirable,” if I may quote a world-renowned obstetrician.
Like any normal individual with responsibilities pregnancy put extra load on her
systems, and she may suffer from certain medical problems. The special
significance of these problems is inasmuch as that these may have adverse effect
on the progress and outcome of pregnancy.
Anaemia
Believe it or not, on an average, total blood volume during pregnancy shoots up
by about 45 per cent. As a result of high dilution of the body blood, ordinary
technique of blood examination will show anaemia (apparent) with haemoglobin
level between 10 and 11 g/dl.
True, during pregnancy a woman saves about 25 mg of iron since she is no more
losing blood in menstrual periods. But then the foetus needs about 400 mg of
iron, the placenta 150 mg and lactation 300 mg for the pregnancy and the first
three months of lactation. Thus, a pregnant women suffers from iron-deficiency if
an extra amount of iron is not administered to her. Such other problems as can
accompany pregnancy (poor dietary intake, worm infestations, chronic infections
like tuberculosis) usually further aggravate existing anaemia. These factors may
cause vitamin B12 and folic acid deficiency in addition, thereby introducing an
element of megaloblastic anaemia.
Anaemia during pregnancy causes vague but widespread manifestations. The
woman develops pallor of skin, nails and conjunctiva underlying the lids. There is
loss of appetite, giddiness and insomnia (sleeplessness). She gets tired easily and

has a feeling of being unwell. She may become increasingly conscious of
heartbeat (palpitations) which becomes quite fast (tachycardia). Nails may become
brittle and flattened (platynechia) or spoon-shaped with a definite concavity
(koilonychia).
In advanced cases, she may begin to become breathless on little exertion. Swelling
of feet and ankles occur in some anaemic women.
Red and swollen tongue, indigestion and difficulty in swallowing are seen in many
a case.
Remember, anaemia can have an adverse effect not only on the mother but on the
baby as well. If you neglect it, your baby runs the risk of being a low birthweight
infant. And that is not a small risk.
If you are pregnant and anaemic as well, chances are you have not been taking
your doctor’s advice seriously. Or, maybe you have not as yet had regular
antenatal check-ups. Report to your doctor immediately. He will get your blood
and stool (maybe some other things also) tested.
You must cooperate with your doctor in treating your anaemia. He would expect
you to take a diet that is rich in iron. But, you also need medicinal iron which he
may like to give you as tablets or injection(s). If your anaemia is quite significant
and pregnancy is fairly advanced, the doctor may want to raise your haemoglobin
through blood transfusion.
Though iron-deficiency plays a pivotal role in causation of nutritional anaemia
during pregnancy, folic acid and vitamin B12 deficiencies may also contribute to it.
Folic acid needs during pregnancy is twice that of the non-pregnant women. The
worst danger of folic acid deficiency is in the form of “neural tube defects” (NTDs)
which means the defects of spinal cord in the growing foetus. The neural tube

defects occur in the very first four weeks following conception. It is, therefore,
advisable that women of child-bearing age drink plenty of orange juice, and eat
enough of dried beans, soyabeans, raw spinach and whole-wheat bread. Medicinal
folic acid (available as tablets) may also be taken on doctor’s prescription.
Severe and obstinate vomiting
In some nervous and hypersensitive pregnant women, what begins as morning
sickness becomes severe and persisting, occurring several times a day. The vomit
may contain blood. Too soon the woman stops accepting food and a little later
even rejects water. She becomes anorexic and constipated. Excessive thirst,
dryness of the mouth and fall in the amount of urine results. The blood pressure
falls and the pulse becomes fast and weak.
Treatment of this problem, hyperemesis gravidarum, should be left to the doctor
and his team. Hospitalisation is essential.
What the pregnant woman must do to safeguard against the above-mentioned
serious condition is to take adequate care of the morning sickness which may be a
predecessor to hyperemesis gravidarum. A cup of light tea or a fruit drink together
with sweet biscuits should be taken in a recumbent position. She should sit up
only after this drink and eat on waking up in the morning. During the day, she
should take small amounts of carbohydrate-rich foods at frequent intervals, and
avoid fats, fish, meat and soups.
High blood pressure (Hypertension)
In some nervous and hypersensitive pregnant women, what begins as morning
sickness becomes severe and persisting, occurring several times a day. The vomit
may contain blood. Too soon the woman stops accepting food and a little later
even rejects water. She becomes anorexic and constipated. Excessive thirst,

dryness of the mouth and fall in the amount of urine results. The blood pressure
falls and the pulse becomes fast and weak.
Treatment of this problem, hyperemesis gravidarum, should be left to the doctor
and his team. Hospitalisation is essential.
What the pregnant woman must do to safeguard against the above-mentioned
serious condition is to take adequate care of the morning sickness which may be a
predecessor to hyperemesis gravidarum. A cup of light tea or a fruit drink together
with sweet biscuits should be taken in a recumbent position. She should sit up
only after this drink and eat on waking up in the morning. During the day, she
should take small amounts of carbohydrate-rich foods at frequent intervals, and
avoid fats, fish, meat and soups.
High blood pressure (Hypertension)
Pre-eclampsiais by far the commonest manifestation of toxaemias of pregnancy.
Its earliest signs are high blood pressure and puffiness of the eyes, gain in weight
and swelling over ankles and feet. Generally, swelling of the ankles are found
spreading up the leg. Swelling, called oedema, may spread to other parts of the
body. In severe cases, even external genitals may become swollen. Examination of
urine will show presence of albumin, a protein.
Such a woman may complain of malaise, lassitude, headache, visual disturbances,
vomiting and abdominal pain.
Pregnant women who are regularly attending an antenatal clinic should find little
difficulty in having pre-eclampsia diagnosed at an early stage. It usually occurs in
the second half of pregnancy period.

As a part of its management, your doctor will advise you to have complete bed
rest and to reduce your salt intake. He will also prescribe a sedative, a diuretic and
an hypotensive drug to get rid of the “water logging” and to bring down the
blood pressure.
If you are overweight at the outset of pregnancy, you must reduce it. Also, do not
let anaemia develop and see that your blood pressure is within normal range. All
this will help you to keep pre-eclampsia at an arm’s length.
Eclampsia includes all the manifestations of pre-eclampsia but in addition there
are convulsions and she may go into coma also. It may occur during pregnancy,
labour or after childbirth.
The disease is very serious and may prove fatal.
Immediate hospitalisation is a must. Most good hospitals have special eclampsia
rooms which have maximum quietness.
Chances of foetal death in eclamptic mothers are 25 per cent higher than in
normal women. Also foetal growth retardation is a common observation. The
singlemost important contributory factor to the well-being of the newborn in this
condition is a good antenatal care. In its absence the progress of the disease
remains unchecked, leading to a fatal outcome.
Gestational diabetes
One in 20 pregnant women may develop what is termed “gestational diabetes”
during confinement. It can be controlled by consuming high protein, low
carbohydrate diet. In other words, the recommended foodstuffs are soyabean or
fish, egg and lean meat with restriction of fruit juices, bread and legumes. Some
may need insulin as well.

Left untreated, even gestational diabetes may cause serious problems to the
growing foetus in the form of a heavy baby weighing over four kg with large
deposits of body fat. Such a baby is difficult to deliver by the normal process.
There is also a risk of premature delivery and stillbirth, especially if the gestational
diabetes is severe enough to need insulin for its control.
Majority of the pregnant mothers with gestational diabetes become all right by six
weeks after delivery. Only a small proportion may develop adult-onset diabetes.
Diabetes mellitus
In half or even more of the pregnant women with diabetes the disease is known to
be present before pregnancy occurs. The woman must apprise her doctor with this
information. Even if she is not aware of it, she should report to him such
manifestations as increased thirst, greater frequency of micturition (urination),
increased appetite or itching in the region of the vulva. Remember, diabetics are
more prone to develop toxaemias of pregnancy.
Management of pregnancy complicated with diabetes is best done by an
obstetrician in collaboration with a physician.
Foetus of such a woman runs the risk of dying anytime during pregnancy. This risk
is greater during the last month. The baby is likely to be larger and heavier than an
average born at full term.
Be mentally prepared if you are such a mother. The chances are that either you
would have to undergo a caesarean section or surgical induction of labour. The
large, oedematous baby should immediately by examined by a child specialist. He
requires special care. Despite his being overweight, he needs to be treated
as premature if delivered before term.

Malaria
High-swinging fever as a result of malaria can complicate pregnancy. Abortion,
premature labour and foetal death may occur. The mother’s health deteriorates. In
malaria, especially when it has caused severe anaemia also, complications in
childbirth occur. Anaemia and poor material resistance predisposes to superadded
infections.
If your pregnancy has somehow been complicated by malaria, do cooperate with
your doctor in curing malaria. Remember pregnancy is not a contraindication for
using anti-malarial drugs. Anti-malarial agents do not cause abortion. Risk, if any,
is just very slight. At any rate, it is practically zero compared to the dangers
involved in not treating the disease. If malaria is left untreated, it can even cause
the mother’s death.
Disorders of urinarytract
Cystitis is a bacterial infection of the urinary bladder. Painful micturition (dysuria),
episodes of retention of urine and fever should arouse suspicion about the
infection.
Your doctor will get the diagnosis confirmed by the presence of red blood cells,
pus cells and bacteria (the last-named are grown in culture discs).
He will prescribe chemotherapeutic drug(s) to get rid of the infection. Don’t forget
to take plenty of fluids during treatment.

Acute pyelonephritis, in 90 per cent of the instances, shows an infection by a
bacteria, E. coli, known to occur in about 2 per cent of the pregnant women. The
usual route of infection is from the bladder and uterus to the kidneys.
High fever with chills and rigors, nausea, vomiting, low backache (usually at the
junction of the spine with the lowermost rib) should arouse suspicion of this
disease, particularly if the onset has been abrupt. Difficult micturition and passing
of little blood through urine may occur. Urine contains pus cells. Urine culture
shows growth of the causative bacteria and helps in deciding about the
chemotherapeutic agent.
Your doctor will prescribe drugs as soon as he is convinced of the diagnosis on
urine examination. Later, chemotherapeutic agent may have to be changed if
suggested by the culture-sensitivity report on urine. Take adequate bed rest
during the acute phase.
As a general rule, pyelonephritis during pregnancy must not be regarded as cured
unless and until repeated urine examinations reveal that urine is normal.
Inadequate treatment may cause chronic pyelonephritis and renal failure in due
course.
In a mild case of chronic pyelonephritis, the patient needs to be hospitalised.
Incidence of intra-uterine death is 50 per cent. Those born alive are smaller in size.
Many authorities advocate termination of pregnancy whereas others favour
caesarean section at the 38th week.
When the disease is severe, outlook for the mother as well as baby is very poor. It
is better to terminate the pregnancy.

Acute renal failure during pregnancy is an extremely serious condition. Urine
becomes very, very less or nil. Such a woman should immediately be transferred to
a good centre.
Intestinal parasitic infestations
Intestinal parasites is a leading cause of ill-health. When one or more of such
parasites complicate a pregnancy, it becomes worse. Common parasites infesting
Indian women are Entamoebahistolytica, Girardialambia, H. nana (Dwarf
tapeworm), hookworm, roundworm and threadworm.
The worst enemy of a pregnant woman is, however, hookworm. A large number of
hookworms attach themselves firmly to the upper intestinal mucose, sucking
blood. Appetite of an infested woman gets markedly decreased. The patient
becomes lethargic and apathetic. Vague abdominal pain and palpitations are
common. Ankle swelling (oedema) and breathlessness may occur.
Your doctor would go for one or more stool examinations to confirm the presence
of hookworm. Blood and sometimes bone-marrow may also be tested.
Hookworm disease makes prognosis for the child as well as mother unfavourable.
The mother may develop pre-eclamptic toxaemia and superimposed bacterial
infections. In neglected cases, chances of abortion, premature birth and stillbirth
are high.
Fortunately, it is easy to cure the disease. Very effective drugs are now available.
Many obstetricians prefer giving anti-hookworm treatment as a routine in early
months of pregnancy.

Mind you, the management of hookworm disease does not end with the
administration of an anti-hookworm drug. You must follow the doctor’s
instructions regarding treatment of accompanying anaemia. If anaemia is mild to
moderate, oral iron tablets will do. If it is severe, he may like to give you
intravenous or intramuscular iron injections. At times it may become necessary to
give a blood transfusion or two to raise haemoglobin speedily.
Heart disease
About one in a hundred pregnant women suffer from one or another heart
disease. Most of such diseases have rheumatic origin, monopoly being that of
mitral stenosis. The next group is congenital heart disease.
Every woman with a known heart disease must consult her doctor before rushing
into pregnancy. Later, she should remain under strict antenatal care. What causes
worst difficulties in such cases is the risk of heart failure. A major objective of
antenatal check-ups is to prevent it and, if that does not work, at least to diagnose
it early so that prompt treatment can be given.
All pregnant women with heart disease should be hospitalised after 34th week in
mild cases and 39th week in moderate to advanced cases. If heart problem
becomes acute, immediate hospitalisation, irrespective of the stage of pregnancy
is recommended. It is a practice on the part of obstetricians to treat such cases in
consultation with a physician or a cardiologist.
It is a common experience that complete bed rest, a few weeks before the
expected date of delivery, goes a long way in ensuring relatively safe delivery at
the time of labour. In most cases, normal vaginal delivery is considered the best.

High blood volume
An important development during pregnancy is the increase in blood volume to
provide for the needs of the growing foetus, leading to some undesirable effects.
Bleeding from gums on brushing is another outcome of increased blood volume
during pregnancy. If you are otherwise healthy, it need not bother you. Moreover,
it shouldn’t become a bottleneck in your maintaining orodental hygiene.
Varicose veins
A common observation during the later months of pregnancy is the development
of prominent, enlarged and tortuous veins which protrude out of the skin. The
varicose veins are usually seen over the legs. Vulva, rectum, anus and vagina are
the other sites.
Heredity is said to play a significant role in the development of varicosity. What
seems a striking observation is that most of the women who develop it are the
ones who stand or sit for long spans of time.
Among various causes of varicosity are rise in total amount of blood and greater
intra-abdominal pressure during pregnancy.
To safeguard against varicosity, you should avoid standing for long hours during
pregnancy. Try to sit with feet propped up every now and then. Lying down with
feet raised also helps.
Once varicosity develops, it helps to wear elastic stockings.
In order to safeguard against varicosity in the rectum (piles or haemorrhoids) see
that you do not have constipation. Take good deal of leafy vegetables and fruits.
Taking warm baths and avoiding straining when using the toilet also helps.

Abortion
Abortion means termination of pregnancy before the “little life” in the womb is
capable of “viability” which, as a rule, reaches at 28 weeks. Not all pregnancies,
because of one or another reason, reach the full term successfully. It is estimated
that in around 12 per cent cases abortion occurs.
If a pregnant woman has a slight abdominal pain (colicky), slight bleeding from
the birth passage, high frequency of micturition and backache, she appears to be
heading for what is termed threatened abortion. The woman should immediately
report to the doctor so that he can confirm the diagnosis and take remedial
action. Generally speaking, complete bed rest is essential. Sedatives to relieve pain
and anxiety are helpful. It will depend on your doctor’s judgement whether he
prescribes an oral or intramuscular hormonal preparation, progesterone.
Threatened abortion, if not taken care of, is likely to pass on to either inevitable or
incomplete abortion. Its diagnosis is suggested by the fact that pain becomes
severer and vaginal bleeding more profuse. A part of products of conception may
be protruding through the birth passage.
In most of the cases of inevitable abortion, products of conception are bound to
be expelled spontaneously. In others, active interference by a doctor is indicated.
The doctor will, under aseptic conditions and anaesthesia, evacuate the womb
either digitally or by an instrument.
Missed abortion refers to the condition in which manifestations of abortion do
appear but disappear soon. The dead products of conception are retained in the
uterus. Abdominal pain and vaginal bleeding also more or less stop. The blood in
the uterus clots around this dead ovum which subsequently undergoes lots of

changes. The doctor will evacuate the womb. But this should always be done in a
hospital.
Therapeutic abortion means induction of planned abortion “in the interest of the
mother”. Unfortunately many unscrupulous practitioners and the like are engaged
in performing criminal abortion in the name of therapeutic abortion. This practice
is responsible for a proportion of maternal mortality and morbidity.
Dr. Suraj Gupte (MD, FIAP, FSAMS (Sweden), FRSTMH (London)
Chairman (Pediatric Education Network- Worldwide) , Principal Advisor,
Children’s Health Institute™ (A web based collaboration of World Parenting
Organisation (WPO) & International Society for Girl Child & Rights Inc. USA)
Professor & Head (Emeritus), Postgraduate Department of Pediatrics, MMC &
Hospitals, Khammam, Telangana, India E-mail: drsurajgupte@gmail.com,
www.drsurajgupte.com
Dr Gupte occupies a pride of place for outstanding contribution as a Pediatric
educationist, author, researcher and innovator globally. He, besides holding
important positions in the Indian Academy of Pediatrics (IAP) is too a recipient of
several national and international awards and Visiting Fellowships/ Professorships,
Dr.Suraj Gupte figures in most of the national and international Who’s Who
volumes, including the Marquis’ Who’s Who (NJ, USA) – a pre-eminent database
of outstanding global personalities.
Editor-in-Chief: Recent Advances in Pediatrics (series), The Short Textbook of
Pediatrics, Case-based Reviews in Pediatric Emergencies, Problem-solving in
Neonatal Emergencies and Intensive Care, Pediatric Emergencies, Neonatal

Emergencies, Pediatric Nutrition, Pediatric Gastroenterology, Influenza: Complete
Spectrum, Pediatric Infectious Diseases, etc
Author: Instructive Case Studies in Pediatrics, Differential Diagnosis in Pediatrics,
Influenza, Perspectives in Influenza, Speaking of Child Care, etc, Textbook of
Pediatric Gastroenterology, Hepatology and Nutrition, 2009 (Indo-American
Project with Prof Karoly Horvath, USA)
@themotherchild.com & Child Health Centre® are service initiatives & registered
trademarks of the Pediatric Education Network (A Charitable Trust registered under
Indian Trusts Act of 1882)

problems in pregnancy.docx

Recommended

Recommended

More Related Content

Similar to problems in pregnancy.docx

Similar to problems in pregnancy.docx (18)

More from Tokirshaikh4

More from Tokirshaikh4 (9)

Recently uploaded

Recently uploaded (20)

problems in pregnancy.docx