2) Antepartum Haemorrhage
Before 24 weeks (6 months),
bleeding from the vagina may result in a miscarriage.
After this time, the foetus is considered viable, and could thus survive
outside the womb.
Bleeding after 24 weeks
is known as ANTEPARTUM HAEMORRHAGE
The 2 main causes of this bleeding, are caused by problems in the position
of the placenta.
A) Abruptio Placentae- if the placenta detaches from the uterus wall,
it will bleed.
The blood builds up, and eventually escapes around the membranes and
through the cervix.
Treatment may be bedrest, ultrasound monitoring, possibly followed
by induction or caesarian to ensure the health of your child.
If you do experience vaginal bleeding after 6 months of pregnancy,
visit your doctor or local emergency room immediately.
B) Placenta Praevia-
when the placenta is attached to the lower segment of the uterus.
If it lies so low down that it covers the cervix, it may cause bleeding
during labour and cut off the blood supply to the foetus.
It is detected by ultrasound scan.
If there is any bleeding, you may have to be admitted to hospital,
or you will be closely monitored by your antenatal clinic. Your baby
may be delivered by elective C-section.
3. Diabetes
This usually does not
affect your pregnancy or the birth of your child. It MUST, however,
be well controlled before conception to ensure your health and that
of your child. You may need to be seen more frequently at your antenatal
clinic to check your sugar levels more regularly. Make sure you also
visit your doctor who will control your drug requirements as they may
vary during pregnancy. Watch your diet!
Don't be alarmed by the
presence of sugar in your urine - it does not necessarily mean that
you are diabetic. Pregnancy may cause the kidney to allow some sugar
to filter through. You will need to have blood tests for accurate diagnosis
of Diabetes.
4. Ectopic Pregnancy
In this case, the fertilized
ovum does not reach the uterus. It attaches to the wall of the Fallopian
Tubes. This pregnancy usually only lasts 8-10 weeks, at which point
the tube bursts. Signs that may indicate that something is wrong may
be pain in the lower abdomen (usually on one side), vaginal bleeding,
and sometimes fainting. If you experience any one of these symptoms,
you should see your doctor as soon as possible. He will investigate
the cause of your discomfort, and if an ectopic is diagnosed, it will
be surgically removed from the fallopian tubes. Note that in some cases,
there is no forewarning of an ectopic pregnany.
You will most likely find a decrease in your fertility after one ectopic
episode.
If you are using contraceptives, be aware that the use of IUCD's can
cause inflammation and blockage of the Fallopian Tubes.
5. Heart Disease
Pre-existing heart diseases
often hold no effect on your pregnancy. Ensure that you are closely
monitored by your doctor or antenatal clinic. Also rest more to relieve
strain that may be exerted on your heart. This should involve at least
2 naps during the day and a good 12 hour's sleep at night. Things to
look out for are an increase in temperature, chest infection, or a swelling
of the hands, face or your feet. If these are noticed, contact your
doctor immediately.
6. Hypertension (Increased
blood Pressure)
Normal blood pressure
is 120/80. A rise in the lower number is more concerning as it measures
how hard the heart is pumping at rest. Consult your doctor if you have
high blood pressure prior to conception, and if it is monitored and
controlled throughout your pregnancy, there is no reason for your pregnancy
to be other than normal. You may, however, be admitted to hospital early.
In late pregnancy, a raised blood pressure may be a sign of pre-eclampsia,
and it is always taken very seriously.
If you are having your blood pressure taken, it may be increased by
anxiety, stress, and your emotional state. So try to be as relaxed as
possible to ensure an accurate reading.
7.
Incompetent cervix
Normally, the cervix
remains closed during pregnancy so that the foetus does not fall into
the vagina. If the end of the cervical canal is open, this is known
as an incompetent cervix. The most common causes are a late termination
of pregnancy or a cone biopsy of the cervix, which may damage the muscle
fibres that hold the cervix closed.
Usually, an incompetent
cervix remains hidden until the 1st miscarriage. The cervical canal
begins to open by the 14th week and by the 20th, has opened to about
2,5cm. This is large enough for the bag of waters to bulge into the
cervix and break resulting in loss of water followed by a miscarriage
and little pain.
A special stitch can be inserted around the cervix to tighten it- known
as Shirodkar or purse-string stitch. This stitch is removed at about
36-38 weeks and labour begins shortly afterwards, naturally or is induced.
Some women do go to term.
8. Multiple Pregnancy
Twins can be identical
(1 egg fertilised by 2 sperm) or non-identical (2 eggs each fertilised
by their own sperm). Identical twins usually share the placenta.
If you are carrying twins,
you will have special antenatal care with emphasis on avoiding anaemia.
Have many blood pressure checks and rest a lot to prevent it from rising
and also to dampen the sensitivity of the uterus. Multiple pregnancies
do put an extra stress on your joints and digestive organs. Attend to
any minor flatulence or dyspepsia. Due to your digestive organs being
crowded, eat less but, more often. Fill your self with salads and light
nutritious snacks to prevent becoming too uncomfortable. Maintain a
good posture at all times - this applies to all pregnancies and not
just twins. The large size of the uterus can also cause shortness of
breath, piles, varicose veins and abdominal discomfort.
9. Miscarriage
Miscarriage, or spontaneous
abortion, is when the embryo or foetus is expelled from the uterus before
the 24th week. After the 24th week, if the baby does not survive it
is called a still birth.
Miscarriages are as frequent
as 1 in 10, the 1st pregnancies being the most likely to miscarry. It
is thought that a young uterus may need to "mature" by having
a "trial run" before it is ready to carry a child to full
term. Secondly, it is thought that the majority of miscarriages are
due to a defect in either the sperm or the ovum, resulting in an abnormal
embryo which the body rejects. Most miscarriages occur in the 1st trimester
and often before the women even knows she is pregnant. The following
are other conditions that may result in a miscarriage after the 3rd
trimester:
- An incompetent cervix
- An incompatible blood type see later) which causes antibodies to your
partners blood type and results in the death of the foetus.
- Placental insufficiecy- if the placenta is not well developed or is
not functioning well it will not support the foetus.
- Diabetes
What happens:
A miscarriage occurs
with bleeding from the vagina, with or without abdominal pain. An early
miscarriage may cause no more discomfort than a normal menstrual period
without menstrual cramps. Bleeding does not automatically mean a miscarriage
is inevetible but, do go and see your doctor. The bleeding may be light
or heavy; accompanied by the passage of mucous or not; and there may
be some backache or discomfort in the lower abdomen. A threatened abortion
may be due to a hormone imbalance or hormone insufficiency. If bleeding
is because of this and the hormone levels remain low, an abortion will
almost certainly follow.
There is no treatment
for a miscarriage. Doctors used to suggest bedrest but, this does not
really affect the outcome. If a miscarriage is going to occur, it will
happen whether you rest or not. If bleeding does stop and pregnancy
continues normally, it may be suggested that you refrain from penetrative
sexual intercourse and strenuous exercise until foetal movements can
be felt ( 20 weeks in 1st pregnancy and 18 weeks with subsequent pregnancies).
If bleeding does not stop or abdominal pain appears or worsens (uterus
is contracting to expel the foetus), most doctors do not feel that efforts
should be made to salvage the pregnancy. If bleeding appears after the
miscarriage, the miscarriage may be incomplete and surgical intervention
will be needed. It is important to have the uterus cleaned out to prevent
further haemorrhage and pelvic infection.
Types of miscarriage
Threatened abortion: An abortion is possible but, not inevitable. There
is bleeding from the vagina but, rarely pain.
Inevitable abortion: Vaginal bleeding together with pain due to the
uterus contracting.
Missed abortion: The foetus is no longer alive but, is still in the
uterus. It will be expelled eventually.
Complete abortion: The foetus and placenta are expelled from the uterus.
Incomplete abortion: The foetus has been lost but, some of the products
of conception are still in the uterus and will have to be removed.
Recurrent abortion: An abortion has occurred on more than 1 occasion,
for different reasons and at different stages of the pregnancy.
Habitual abortion: 3 or more miscarriages have occurred at the same
time and possibly for the same reason. High temperature and abdominal
pain after the abortion indicate an infection.
Emotional effects: A
miscarriage, especially in the 2nd trimester, has profound psychological
effects on a women. This is due to the loss of the baby as well as the
sudden withdrawal of pregnancy hormones.
10. Pre-eclampsia
This is a potentially serious condition that can affect 1 in 10 women
(especially 1st and multiple pregnancies). This condition does tend
to run in families. It arises in the placenta and the baby may grow
slower than normal.
Pregnancy cannot be restored
to normal and you will be monitored very closely. Delivery of the baby
tends to reverse the condition. If your pre-eclampsia was severe enough
to risk convulsions, one should not leave the hospital early at the
risk of having a fit for up to 5 days post-delivery.
Signs of pre-eclampsia:
- Raises blood pressure consistently over a couple of weeks.
- Protein is detected in your urine which signals damage to your kidneys.
- There is swelling to the feet, ankle, hands, and it could affect the
face as well.
- Sudden excessive weight gain.
11. Rhesus Incompatibility
A blood sample will be
taken at your first antenatal visit which reveals your blood type. Besides
being told if you are A,B or O, you will be given a rhesus grouping,
positive or negative. Special attention is given to rhesus negative
mothers as only 20% of the population has this.
If this is the case
and your partner is rhesus positive, the chances are that you will have
a positive baby. As a rhesus negative person, your immune system will
perceive the positive blood from your baby as foreign. If one has already
been exposed to the positive blood , possibly through a blood transfusion,
your body will already have developed antibodies to the positive blood
which will subsequently kill them. If your baby is positive and their
blood cells pass into your circulation. your body's antibodies will
try and destroy them. With your first child there is little danger as
your body will be exposed to the rhesus positive blood cells for the
1st time and the level of rhesus antibodies will be low or even absent.
It may be more dangerous during the 2nd pregnancy when you already have
the antibodies against positive blood. Here, your doctor will constantly
check the antibody levels. At certain levels of antibodies, there may
be damage to the developing baby. (Only about 10% of women reach this
level).
What can be done?
Rhesus incompatibility
is becoming less of a problem as it is now more understood. Some women
are given anti-Rhesus globulin which prevents the baby from having an
incompatibility problem. There is no problem if the mother has not had
this treatment as an amniocentesis can be done and if the baby is affected,
an intrauterine transfusion normally follows. The doctor may decide
that your baby must be born before term in which instance a Caesarian
section must be done. Some babies do need a blood transfusion to replace
those cells that were damaged during the pregnancy.
