Pathology of pregnancy

Some health problems arise only during pregnancy, while others, although affecting the general population, when combined with pregnancy could lead to complications, requiring the appropriate treatment. Please find below useful information on gestational diabetes, high blood pressure, headaches, and other problems that may arise during pregnancy that can help you minimize their effects and promote recovery.

A high-risk pregnancy is one of greater risk for the mother and her fetus than an uncomplicated pregnancy. Reasons that a pregnancy may be considered high-risk include maternal age (women who will be under age 18 or over age 35 when their baby is due are at greater risk of complications than those between their late teens and early 30s), hyperpigmentation, multiple pregnancies, severe medical conditions (such as diabetes, anemia or chronic hypertension) and/or surgical problems in pregnancy, urogenital disorders, special infections, spontaneous or artificial abortions, congenital fetal anomalies, previous cesarean sections or other surgical procedures of the uterus.

A multiple pregnancy is a pregnancy with two or more fetuses. Twin pregnancies can occur by fertilizing one or two eggs. In recent years has been an increase in the rate of multiple pregnancies mainly due to the increase in both maternal age and assisted reproduction techniques.

Premature birth, is the birth of a baby at fewer than 37 weeks’ gestational age, as opposed to the usual about 40 weeks. Premature birth is one of the most serious obstetric complications. About 1 in 10 pregnancies results in the premature birth of a small-size baby.

While a baby is in the womb, it is situated within the amniotic sac, a bag formed of two membranes. The fetus grows and develops inside this sac, surrounded by amniotic fluid. When the amniotic sac breaks before the 37th week of pregnancy is called premature rupture of the membranes (PROM). A significant risk of PROM is that the baby is very likely to be born within a few days of the membrane rupture. Other complications that may occur with PROM include placental abruption (early detachment of the placenta from the uterus), compression of the umbilical cord, cesarean birth, and postpartum (after delivery) infection.

A normal pregnancy can last up to 41 weeks. The term prolongation of pregnancy is used to describe a pregnancy that persists longer than 41 weeks from the first day of the last menstrual period with 28 days menstruation cycle. The incidence of post term pregnancy is about 7% of all pregnancies. The prevalence varies depending on population characteristics and local management practices.

In premature abortion, the placenta separates early from the uterus before the childbirth. Separation is expected to occur normally after delivery.

Placenta Accreta occurs when the placenta—the organ that provides nutrients and other support to a developing fetus—attaches too deeply to the uterine wall. This often leads to two major complications: the placenta cannot normally deliver after the baby’s birth, and attempts to remove the placenta can lead to heavy bleeding.

Spontaneous abortion can be defined as the termination of pregnancy that took place before the 20th week of pregnancy. The clinical classification is as follows:

  • Threatened miscarriage means that there is vaginal bleeding in early pregnancy. Contractions may or may not exist.
  • Inevitable miscarriage means that there is dilatation of the cervix, pain, abdominal pain or lower back pain and possibly rupture of membranes.
  • A miscarriage is labeled “incomplete” if bleeding has begun and the cervix is dilated, but tissue from the pregnancy still remains in the uterus.
  • Complete miscarriage means when the fetus, all the membranes around the fetus and the placenta are expelled completely and the cervix closes prior to 20 weeks.
  • Early miscarriage means the necrosis and retention of the fetus, without pain and blood, possibly for a long time and lack of the common early signs of pregnancy, such as nausea and breast tenderness
  • Septic abortion is serious uterine infection during or shortly before or after an abortion.

The term “recurrent miscarriage” is used to describe those cases where there are 3 or more consecutive automatic miscarriages without having given birth. Embryonic losses take place at gestational age less than 20 weeks and with embryos weighing less than 500 grams.

Anemia is one of the most common complications associated with pregnancy. Due to the physiological changes observed during pregnancy, anemia is even more common than in non-pregnant women. It is associated with poor nutrition and lack of adequate medication. Anemia during pregnancy can be classified either as Iron-deficiency, Vitamin B12 deficiency, or Folate deficiency.

Hyperemesis gravidarum (HG) is an extreme form of morning sickness that causes severe nausea and vomiting during pregnancy, causing weight loss and dehydration.

The most common classifications include Type 1 diabetes mellitus, Type 2 diabetes mellitus, and Gestational diabetes.

Where insulin is required, is called type I or insulin dependent or juvenile D. Unlike in the past, in pregnant women with D type I and a normal course of pregnancy, a normal birth can take place with the completion of 40 weeks of pregnancy, as long as there is no macrosomia of the fetus.

Where insulin administration is usually not necessary and is called type II or non-insulin dependent D. Type II D occurs in most cases after the age of 30 and these patients have an increased appetite and are obese. Therefore, these patients may be of reproductive age and the condition is associated with serious complications during pregnancy. When ΙΙ D is present during pregnancy, the pregnant woman must be monitored by a diabetologist. Improper monitoring increases the risk of complications in the fetus (such as hydration, respiratory distress, death). Overweight newborns occur with increased frequency in cases of Type II D. Breastfeeding should be encouraged as it can reduce the mother’s insulin requirements and help the newborn. Children of diabetic parents are at greater risk of developing diabetes in the future

Macrosomia is a term used in obstetrics to describe embryos larger compared to gestational age, referring to a growth of the fetus beyond a certain threshold (threshold ranging from a body weight of 4,000 grams to above 5,000 grams).

During pregnancy blood pressure can drop in the first trimester, then it increases until the 20th week of pregnancy and near the end of the pregnancy it returns to pre-pregnancy levels. Hypertensive pregnancy is a common complication of pregnancy, which occurs after the 20th week. Blood pressure, in hypertensive pregnancy, is greater than or equal to 140/90 mm Hg, and can be classified as follows:

  • Hypertension that first appears during pregnancy.
  • Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys.
  • Eclampsia is a severe complication of preeclampsia. It’s a rare but serious condition where high blood pressure results in seizures during pregnancy.

Bed rest and childbirth play a key role in treating preeclampsia. After childbirth, in most cases, there is a dramatic improvement of the clinical picture of the patient and childbirth is considered the only effective treatment.

The syndrome is characterized by hemolysis, elevated liver enzymes and low platelet counts (HELLP: Hemolysis, Elevated Liver enzymes, Low Platelet count). It occurs in 50% of pregnant women with eclampsia but can be often manifested by a moderate increase in blood pressure. Predisposition factors of HELLP syndrome are old age and multiparity.

Chronic hypertension, is defined as hypertension diagnosed before pregnancy or before 20 weeks’ gestation or hypertension that persists for more than 6 weeks after delivery. Chronic hypertension in pregnancy is associated with:

  • Serious maternal and fetal complications, including superimposed preeclampsia.
  • Fetal growth retardation.
  • Premature delivery.
  • Placental abruption.

Ectopic pregnancy is the attachment of the embryo outside the uterus. Instead, it may attach to the fallopian tube (in 98% of all ectopic pregnancies), abdominal cavity, or cervix. The causes of an ectopic pregnancy vary and are difficult to identify. In some cases, the following conditions have been linked with an ectopic pregnancy, such as inflammation and scarring of the fallopian tubes from a previous medical condition, infection, or surgery, hormonal factors, genetic abnormalities, birth defects, endometriosis, pre-existing ectopic pregnancy etc. Ectopic pregnancy can be diagnosed by ultrasound, the use of a blood test to determine your levels of hCG, progesterone and finally laparoscopy. Your doctor can prescribe several medications that could keep the ectopic mass from bursting or suggest removing the embryo and repairing any internal damage surgically.

Trophoblastic Disease is a group of diseases that can occur when a pregnancy does not develop properly, resulting in a full-term or partial pregnancy and choriocarcinoma. For approximately every 700 pregnancies which end with a live baby, there will be one pregnancy which develops GTD.

Molar pregnancy (also called hydatidiform mole) is the most common type of GTD. In healthy pregnancies, an embryo (baby) develops when a sperm fertilizes an egg and the genetic material from each combine to produce a baby which has half of its genes from each parent. A molar pregnancy is abnormal from the very moment of conception as a result of an imbalance in the number of chromosomes supplied from the mother and the father.

There are two types – complete mole and partial mole.

Complete moles usually occur when a single sperm fertilizes an ‘empty’ egg which has no genetic material inside, and then divides to give the fertilized egg a normal number of chromosomes, all of which have come from the father. Complete moles can also occur when two sperm fertilize an ‘empty’ egg.

Partial moles occur when two sperm fertilize a normal egg and the developing pregnancy then has three sets of chromosomes or more. In a partial mole, there are usually some early signs of development of a fetus on ultrasound but the fetus cannot survive. If you have a molar pregnancy you may have irregular or heavy bleeding from the vagina, or excessive morning sickness (hyperemesis). Your uterus (womb) may feel larger than your midwife or doctor would expect in early pregnancy. Less commonly, you may develop raised blood pressure, symptoms of an overactive thyroid gland or abdominal pain because of large ovarian cysts

It is important that all pregnant women get tested for HIV, especially now that there are ways of treatment that can reduce the chances of transmitting HIV to your baby.

Chorioamnionitis is a bacterial infection that occurs before or during labor. The name refers to the membranes surrounding the fetus: the “chorion” (outer membrane) and the “amnion” (fluid-filled sac). The condition occurs when bacteria infect the chorion, amnion, and amniotic fluid around the fetus. It can lead to a preterm birth or serious infection in the mother and the baby. It’s most commonly seen in preterm births; it’s also seen in approximately 2 to 4 percent of full-term deliveries. Some women may experience fever, rapid heartbeat, uterine tenderness and discolored, foul-smelling amniotic fluid.

In some women, tissues of the cervix are weak. For unknown reasons, the cervix may open (dilate) long before the baby is due. that results in delivery of the baby during the 2nd trimester of pregnancy.

Cervical cerclage, also known as a cervical stitch, is a treatment for cervical weakness, when the cervix starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth. In women with a prior spontaneous preterm birth and who are pregnant with one baby, and have shortening of the cervical length less than 25 mm, a cerclage prevents a preterm birth and reduces death and illness in the baby. The treatment consists of a strong suture sewn into and around the cervix early in the pregnancy, usually between weeks 12 to 14, and then removed towards the end of the pregnancy when the greatest risk of miscarriage has passed.