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Risk Factors That Develop During Pregnancy

During pregnancy, a problem may occur or a condition may develop a high-risk pregnancies.

DEFINITIONS
During pregnancy, a problem may occur or a condition may develop a high-risk pregnancies. For example, pregnant women can be exposed to something that can produce birth defects (teratogens), such as radiation, certain chemicals, drugs, or infection. Or a disruption could occur. Some disorders associated with (the complications of) pregnancy

Drugs

Some medications used during pregnancy causes birth defects. For example, alcohol, isotretinoin (used to treat acute acne), some antikonsulvan, lithium, some antibiotics (such as streptomycin, kanamycin, and tetracycline), thalidomide, warfarin, and inhibitors of angiotensin-converting enzyme (ACE) (used during the end of the second trismester). Using drugs that inhibit folic acid (such as methotrexate immunosuppressant or antibiotic trimethoprim) can also cause birth defects (folic acid deficiency increases the risk of having deformed babies from birth). Using cocaine can cause birth defects, premature release of the placenta (placental abruption), and premature births. Smoking increases the risk of having a baby with low birth weight. Early pregnancy, women were asked if they use these drugs. Especially to note is that alcohol, cocaine, and smoking.

Disorders That Occurred During Pregnancy

During pregnancy, women may experience problems that are not directly related to pregnancy. Some disorders increase the risk of problems in pregnant women or fetuses. These include disorders that cause high fever, infection, and disorders that require abdominal surgery. Certain disorders are more likely to occur during pregnancy because many changes occur in pregnancy in a woman’s body. For example, thromboembolic disease, anemia, and urinary tract infections.
1. Fever: a disorder that causes the temperature greater than 103 º F (39.5 º C) during the first trimester increases the risk of miscarriage and damage to the brain or spinal cord in infants. Fever late in pregnancy increases the risk of premature delivery.
2. Infection: several infections that occur coincidentally during pregnancy can cause birth defects. German measles (rubella) can cause birth defects, especially once the heart and the inside of the eye. Cytomegalovirus infection can cross the placenta and damage the liver and brain of the fetus. Other viral infections that could harm the fetus or cause birth defects, including herpes simplex, and chicken pox (varicella). Toxoplasma, protozoan infection, can cause miscarriage, fetal death, and serious birth defects. Listeriosis, a bacterial infection, can also harm the fetus. Bacterial infection of the vagina (such as bacterial vaginosis) during pregnancy can cause premature labor or fetal membrane containing fall prematurely. Treatment of infections with antibiotics could reduce the likelihood of these problems.
3. Disorders requiring surgery: during pregnancy, the disorder that requires emergency surgery include the stomach may be executed. This type of surgery increases the risk of premature labor and cause a miscarriage, especially in early pregnancy. Also, surgery is usually delayed as long as possible unless long-term health of the woman likely be affected.

If appendicitis occurs during pregnancy, surgery to remove the appendix (appendectomy) performed immediately because of rupture of the appendix can be fatal. Appendectomy is not likely harm the fetus or cause miscarriage. However, appendicitis may be difficult to be recognized during pregnancy. Painful cramps Pain in appendicitis-like contractions of the uterus, which is common during pregnancy. The appendix is ​​pressed into the upper abdomen as pregnancy progresses, so the location of the pain of appendicitis may not be as expected.

If ovarian cysts occur during pregnancy, surgery is usually delayed until 12 weeks of pregnancy. Cysts are likely to produce hormones that help with pregnancy and often disappears without treatment. However, if the cyst or other mass enlarges, surgery may be needed before 12 weeks. Some of the possible cancerous mass.

Damage to the intestine during pregnancy can be very serious. If the damage leads to intestinal gangrene and peritonitis (inflammation of the membrane that crosses the abdominal cavity), a woman’s miscarriage and her life in danger. Exploratory surgery is usually done immediately when a pregnant woman experiencing symptoms of intestinal damage, especially if they had undergone abdominal surgery or abdominal infection.
4. Thromboembolic disease: the United States, thromboembolic disease is the leading cause of death in pregnant women. In thromboembolic disease, blood clots form inside blood vessels. It flows through the bloodstream and block an artery. Risks to the formation of thromboembolic disease increased approximately 6 to 8 weeks after delivery. Most complications cause blood penggumpalam a result of diseases that occur during childbirth. Risks multiply after a cesarean delivery than after a normal delivery.

Blood clots usually form in arteries outside of the foot such as thrombophlebitis or blood in such vessels in thrombosis. Symptoms include swelling, pain in the calf, and tendons. Acute symptoms are not related to severe disease. Clots can move from the legs to the lungs, which can inhibit one or more arteries in the lungs. This blockage, called a pulmonary embolism, can be life threatening if clots block arteries that supply the brain, producing strokes. Blood clotting can also occur in the pelvis.

Women who experienced blood clots in the previous pregnancy may be given heparin (an anticoagulant) during subsequent pregnancies to prevent blood clot formation. If women have symptoms that are suspected thrombosis, Doppler ultrasound performed to examine the possibility of freezing. If blood clots are known, heparin be started without delay. Heparin probably injected into the vein (intravenously) or under the skin (subcutaneous). Heparin is not through the placenta and not harm the fetus. Treatment was continued for 6 to 8 weeks after birth, when the risk of high blood clotting. After delivery, warfarin may be used as a substitute for heparin. Warfarin can be taken by mouth, has a low risk of complications compared to heparin., And can be used by women who breastfeed.

If a suspected pulmonary embolism, lung ventilation and perfusion scan performed to confirm the diagnosis possible. This procedure involves injecting radioactive material in small amounts into the vessel. This procedure is safe during pregnancy because a small dose of radioactive material. If the diagnosis of pulmonary embolism remains uncertain, pulmonary angiography is required.
5. Anemia: most pregnant women experience some degree of anemia because iron is needed to produce red blood cells in the fetus. Anemia can occur during pregnancy due to folic acid deficiency. Anemia can usually be prevented or treated by using iron and folic acid supplements during pregnancy. However, if anemia becomes severe and prolonged, the blood capacity to carry oxygen decreases. As a result, the fetus can not get enough oxygen, which are required for normal growth, especially in the brain. Pregnant women who experience severe anemia can become excessive fatigue, labored breathing, headache, dizzy. Increased risk of preterm birth. The number of abnormal bleeding during labor and delivery can cause anemia which is very dangerous at this woman. Women with anemia were more likely to become infected after birth. Also, if folic acid is reduced, the risk of having babies with birth defects in the brain and spinal cord, like spina bifida, increases.
6. Urinary tract infection: urinary tract infection common during pregnancy, probably due to widening of the uterus slows the flow of urine by tapping the pipe that connects the kidney to the bladder (ureters). When urine flow is slow, bacteria can not flush the urine channel. increases the risk of an infection. These infections increase the risk of preterm birth and rapidly disintegrating on the membranes containing the fetus. Sometimes an infection of the bladder or ureters spreads into the urine channel and toward the kidneys, causing. Treatment consists of antibiotic therapy.
Pregnancy Complications
Complications of pregnancy is a problem that occurs only during pregnancy. It can affect the woman, fetus, or both and can occur at different times during pregnancy. For example, complications such as misplaced placenta (placenta previa) or premature release of the placenta from the uterus (placental abruption) can cause bleeding from the vagina during the last 3 months of pregnancy. Women who bleed in time at risk of losing the baby or excessive bleeding (hemorrhaging) or dying during labor and delivery. However, most complications of pregnancy can be treated effectively.

Ectopic pregnancy: pregnancy misplaced

Normally, the egg is fertilized in the fallopian tube and implanted in the uterus. However, if the pipe is narrowed or blocked, the egg may move slowly or stuck. Fertilized egg cell that can not ever get to the uterus, resulting in an ectopic pregnancy. Ectopic pregnancies usually occur in one of the fallopian tubes (as a tubal pregnancy) but can occur elsewhere. Fetus in an ectopic pregnancy can not survive.

One of 100 to 200 pregnancies is ectopic pregnancy. Risk factors for ectopic pregnancy include the disturbance in the fallopian tubes, pelvic disease imflammatory, previous ectopic pregnancy, fetal exposure to diethylstilbestrol, or tubal ligation (fertilization procedure) that does not work or have operated in reverse.

Symptoms include unexpected vaginal bleeding and convulsions. The fetus may grow enough to tear down the structure containing it is / if the fallopian tubes collapse (usually after about 6 to 8 weeks), a woman usually feels severe pain in your lower abdomen and can faint. If the tube then collapse (after about 12 to 16 weeks), increased risk of death in women, because the fetus and placenta is enlarged and lose more blood.

If a woman does not believe that she is pregnant, a pregnancy test done. If she is pregnant, an ultrasound done to ensure the location of the fetus. If the uterus is empty, the doctor may suspect an ectopic pregnancy. If ultrasonography shows the fetus is outside the uterus, the diagnosis is confirmed. Doctors can use elastic vessels called laparoscope, is inserted through a small incision just below the navel, to see an ectopic pregnancy directly.
Ectopic pregnancy should be resolved as quickly as possible to save the life of the woman. In most women, fetus and placenta in an ectopic pregnancy must be removed surgically, usually with a laparoscope but sometimes through surgery on the stomach (a procedure called laparotomy). Rarely, uterine damage requiring hysterectomy Occasionally, the drug methotrexate is usually given in one injection, can be used instead of surgery. The drug causes an ectopic pregnancy shrink and disappear. Sometimes, surgery is needed in addition to methotrexate.
Some problems that occur from hormonal abnormalities during pregnancy only minor incidents, while symptoms in pregnant women. For example, the effects of normal hormones of pregnancy can slow the movement of bile through the bile ducts, cholestasis of pregnancy can occur. The most obvious symptom is itching all over the body (usually in the last few months of pregnancy). There was no rash. If severe itching, cholestyramine can be given. This disorder is usually resolved after delivery but tends to recover in subsequent pregnancies.
1. Hyperemesis gravidarum: hyperemesis gravidarum is a tremendous feeling of nausea and vomiting excessively hard during pregnancy. Hyperemesis gravidarum differs from ordinary morning sickness. If women often suffer from nausea, vomiting and sustained their weight loss and become dehydrated, they suffer from hyperemesis gravidarum. If women vomit occasionally but gain weight and not dehydrated, they do not experience hyperemesis gravidarum. The cause of hyperemesis gravidarum is unknown.

Because hyperemesis gravidarum can be life threatening pregnant women and fetuses, women who suffer must be treated in hospital. Infusion fluid inserted into the vein to provide fluids, sugar (glucose), electrolytes, and sometimes vitamins. Women who experienced complications are not allowed to eat or drink anything for at least 24 hours. Sedatives, antiemetics, and other drugs are given as needed. After rehydration woman and vomiting subsided, they can begin eating frequent, food mashed with a little portion. Portion size is increased if they can receive plenty of food. Typically, the vomiting stopped within a few days. If symptoms recur, treatment is repeated. Rarely, if it continues to lose weight and prolonged symptoms despite treatment, women are given food through a tube straight through the nose and down into the esophagus to the small intestine as long as necessary.
2. Preeclampsia: about 5% of pregnant women experience preeclampsia (toxemia of pregnancy). In this complication, the increase in blood pressure accompanied by protein in the urine (proteinuria). Preeclampsia usually occurs between the 20th week of pregnancy and the end of the first week after delivery. The cause of preeclampsia is unknown. but more often in women who are pregnant for the first time, which carries two or more fetuses, who have preeclampsia in subsequent pregnancies, which already have high blood pressure or blood vessel disorders, or who suffer from sickle cell disease. It is also more common in girls aged 15 years or younger and women aged 35 years or older.

Various acute preeclampsia, called the HELLP syndrome, occurs in some women. Consists of the following things below:
o hemolysis (destruction of red blood cells)
o An increase in liver enzyme levels, indicating liver damage
o The number of low platelet count, could not keep the blood clot and increase the risk of bleeding during and after childbirth.
1 of 200 women who have preeclampsia, blood pressure becomes high enough to cause seizures, the condition is called eclampsia. A quarter of cases of preeclampsia occur after delivery, usually on the first 2 to 4 days. If not treated immediately, eclampsia may be fatal.

Preeclampsia can cause premature release of the placenta from the uterus (placental abruption). Infant in women suffering from preeclampsia 4 or 5 times more likely to rapidly experience problems after birth than babies of women who did not experience complications. Babies are less likely caused by damage to the placenta or due to be born prematurely.

If mild preeclampsia occurs in early pregnancy, the possibility of adequate rest at home, but some women should see a doctor as often as possible. If preeclampsia is severe, women are usually hospitalized. There, they were being treated in bed and watched closely until the fetus is mature enough to be born safely. Antihipertensis may be needed. Several hours before delivery, magnesium sulfate may be given intravenously to reduce the risk of seizures. If preeclampsia occurs near the date of birth, labor is usually induced and the baby was born.

If preeclampsia is severe, the baby was probably born with cesarean delivery, which is a shortcut, except cervix is ​​open (dilated) to immediately give birth normally. Fast delivery reduces the risk of complications in women and the fetus. If high blood pressure, drugs to lower blood pressure, such as hydralazine or labelatol, may be given intravenously before birth performed. Treatment of HELLP syndrome in preeclampsia is usually the same weight.

After birth, women who already suffer from preeclampsia or eclampsia are monitored closely for 2 to 4 days because they increase the risk of attack. As their condition continuously improved, they are encouraged to walk. They can stay in the hospital for several days, depending on keakutan preeclampsia and its complications. After returning to the house, this woman could need medication to lower blood pressure, in particular, they have a checkup at least every 2 weeks for the first few months after giving birth. Their blood pressure may remain high for 6 to 8 weeks. If it remains high, the cause is probably not associated with preeclampsia.
3. Diabetes during pregnancy: about 1 to 3% of pregnant women develop diabetes during pregnancy. This disorder is known as gestational diabetes. Undetected and untreated, gestational diabetes can increase the risk of health problems of pregnant women and fetuses and the risk of death in the fetus. Gestational diabetes is most common in obese women and certain ethnic groups, especially native Americans, Pacific islands, and female Mexican, Indian, and Asian descent.

Most women with gestational diabetes have it because they do not produce enough insulin as the insulin requirement increased in late pregnancy. More insulin needed to control elevated levels of sugar (glucose) in the blood. Some women may have diabetes before pregnancy, but it is not known until they are pregnant.

Some doctors routinely check every pregnant woman for gestational diabetes. Another doctor examined only women who have risk factors for diabetes, like obesity and certain ethnic backgrounds. Blood tests are used to measure sugar levels garah with a home blood sugar monitoring device.

Treatment consists of eliminating the high sugary foods from the diet, eat to avoid excess weight gain during pregnancy, and, if high blood sugar levels, insulin is given. After delivery, gestational diabetes usually disappears. Even so, many women suffer from gestational diabetes have type 2 diabetes when they grow old.
4. Rh Incompatibility: Rh incompatibility occurs when a pregnant woman has Rh-negative blood and the fetus has Rh-positive blood, down from a father who has Rh-positive blood. Approximately 13% of marriages in the United States, men who have Rh-positive blood and a woman has Rh-negative blood.

Rh factor is a molecule that occurs on the surface of red blood cells in some people. The blood was Rh-positive if red blood cells have the Rh factor and Rh-negative if you do not have. Problems can occur if the fetus has Rh-positive blood into the woman’s bloodstream. Woman’s immune system can recognize fetal blood cells as foreign and produces antibodies, called Rh antibodies, to destroy fetal red blood cells. production of antibodies is called Rh sensitization.

During the first pregnancy, Rh sensitization is not possible, because no significant amount of fetal blood may be to enter the woman’s bloodstream until delivery. So that the fetus or newborn rarely have problems. However, once women become sensitive, more problems may occur with each subsequent pregnancy where the fetus is Rh positive blood. In each pregnancy, women produce Rh antibodies faster and in greater numbers.

If the Rh antibodies cross the placenta to the fetus, they can destroy some red blood cells of the fetus. If the red blood cells were destroyed faster than the fetus to produce new ones. The fetus may experience anemia. some damage called hemolytic disease of the fetus (erythroblastosis fetalis) or newborn (erythroblastosis neonatorum). In severe cases, the fetus may die.

On the first visit to the doctor during pregnancy, women are screened to determine whether they have blood with Rh-positive or Rh-negative. If they have Rh-negative blood, their blood tested for Rh antibodies and blood type father ascertained. If the father has Rh-positive blood, Rh sensitivity as a risk. In some cases, the blood of pregnant women screened for Rh antibodies gradually during pregnancy. Pregnancy can be processed during normal Sebagimana no detectable antibodies.

If antibodies are detected, the steps taken to protect the fetus is possible, depending on how high antibody levels. If levels become too high, the possibility of amniocentesis performed. In this procedure, a needle is inserted through the skin to draw fluid from the amniotic sac. Levels of bilirubin (yellow pigment produced by the disintegration of normal red blood cells) measured in fluid samples. If levels are too high, the fetus is given a blood transfusion. transfusion is usually given until the fetus is mature enough to be born safely. Then labor induced. Infants may require additional transfusions after birth. Sometimes with no transfusions required until after birth.

As a precaution, women who have Rh-negative blood is given an injection of Rh antibodies at 28 weeks gestation and within 72 hours after giving birth to a baby who has Rh-positive blood, even after a miscarriage or abortion. Antibodies given called Rh0, D) immune globulin. The treatment is to destroy any red blood cells from infants who had entered the woman’s bloodstream. thus, there were no red blood cells from infants to trigger the production of antibodiy by this woman, and subsequent pregnancies are usually not harmful.
5. Fatty liver in pregnancy: This rare disorder occurs toward pregnancy. The cause is unknown. symptoms include nausea, vomiting, abdominal discomfort, and jaundice. The disorder can be worsened, and liver failure may develop. Diagnosis is based on liver function tests and possibly confirmed by liver biopsy. Doctors may recommend to immediately stop the pregnancy. The risk of death for women and the fetus is high, but those who survive recover fully. Usually, the disorder is not repeated in subsequent pregnancies.
6. Peripartum cardiomyopathy: the heart wall is damaged on the possibility of pregnancy or after childbirth, causing peripartum cardiomyopathy. The cause is unknown. peripartum cardiomyopathy tends to occur in women who have been pregnant a few times, the older one, which implies twins, or who experience preeclampsia. In some women, cardiac function did not return to normal after pregnancy. They could have peripartum cardiomyopathy in subsequent pregnancy. This woman should not become pregnant again. Peripartum cardiomyopathy can occur in heart failure is treated.

The problems with the amniotic fluid: too much amniotic fluid (polyhydramnios) in membranes containing the fetus (amniotic sac) stretch of the uterus and put pressure on the diaphragm pregnant women. These complications can cause severe respiratory problems for women or birth prematurely.

Too much fluid tends to accumulate when pregnant women have diabetes, containing more than one baby (multiple pregnancy), or produce antibodies to Rh fetal blood. Another cause is damage to the fetus is born, especially esophageal blockage or damage to the brain and spinal cord (such as spina bifida). About half the time, the cause is unknown.

Too little amniotic fluid (oligohydramnios) can also cause problems. If the amount of fluid is greatly reduced, fetal lungs are not mature and the possibility of fetal distress likelihood, result in deformity; combination of a condition called Potter’s syndrome.

Too little amniotic fluid tends to form when the fetus was damaged in the urinary tract, have not developed as expected, or dies. Other causes include the use of angiotensin-converting enzyme inhibitors (ACE), such as enalapril or captopril, the trimester of the 2nd and 3rd. These drugs are given during pregnancy only when they should be used to treat severe heart failure or high blood pressure. Using antiimflammatory nonsteroidal drugs (NSAIDs) at the end of pregnancy can also reduce the amount of amniotic fluid.
7. Placenta previa: placenta previa is the placement of the placenta over or near the cervix, lower at the top of the uterus. The placenta can be wholly or partially cover the opening of the cervix. Placenta previa occurs in 1 in 200 births, usually in women who had more than one pregnancy or who have structural abnormalities in the uterus, such as fibroids.

Placenta previa can cause painless bleeding from the vagina that suddenly occurs in late pregnancy. Blood red possibilities. Bleeding can be a big, life-threatening to the woman and fetus.

Ultasonografi help doctors identify placenta previa and distinguish it from a premature release of the placenta (placenta abruption)

When bleeding is severe, women at home sakitkan until delivery, especially if the placenta terletek along the cervix. Women who experienced severe bleeding requiring repeated blood transfusions. When mild bleeding and giving birth is not imminent, doctors usually recommend bed rest in hospital. If the bleeding stops, the woman is usually encouraged to walk. If the bleeding does not occur, they usually sent home, put up where they could return easily to the hospital. Cesarean delivery is almost always performed before labor begins. If a woman with placenta previa will give birth, the placenta tends to become loose very quickly, stop the baby’s oxygen supply. Leakage of oxygen can cause brain damage or other problems in infants.
8. Placental abruption (abruptio placentae): placental abruption is the premature release of the placenta in the normal position of the uterine wall. The placenta can be separated incomplete (sometimes only 10 to 20%) or in their entirety. The cause is unknown. disposal of the placenta occurs in 0.4 to 3.5% in all births. Complications are more common in women who experience high blood pressure (including preeclampsia) and in women who use cocaine.

Uterine bleeding from the place where the placenta attached. Blood can exit through the cervix and vagina as external bleeding, or possibly trapped behind the placenta as a concealed hemorrhage. The symptoms depend on the level of release and the amount of blood lost (which is probably a lot). Symptoms can include sudden abdominal pain or cramping continues, soft when the abdomen is pressed, and bouncy. Premature release of the placenta can cause clotting in addition to the dissemination of blood vessels (disseminated intravascular coagulation), kidney failure, and bleeding into the uterine wall, especially in pregnant women who also had preeclampsia. When the placenta loose, supply oxygen and nutrients to the fetus is likely to decrease.

Doctors suspect the release of the placenta prematurely on the basis of symptoms. Ultrasonography can confirm the diagnosis.

The problems with the placenta
Normally, the placenta is located at the bottom of the uterus, firmly attached to the uterine wall until after having a baby. In placental abruption (abruptio placentae), the placenta separated from the uterine wall prematurely, causing uterine bleeding and reduce the supply of oxygen and nutrients the fetus. Women who experience this complication was hospitalized, and the baby probably was born soon. In placenta previa, the placenta is located along or near the cervix, at the bottom of the uterus. It can cause bleeding without pain suddenly started in late pregnancy. Bleeding can be severe, babies are usually born by cesarean delivery.

Women with premature release of the placenta in the hospital. The common treatment is complete rest. If the symptoms diminished, women are encouraged to walk and possible removal from the hospital. If bleeding continues or worsens (presumably the fetus is not getting enough oxygen) or if the pregnancy is approaching its time, early delivery is often best for women and infants. If it is not possible with a normal delivery, cesarean delivery performed.

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  1. a woman’s body has many complications after and during pregnancy

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