10.11: Risks in Pregnancy
Pregnancies that warrant close attention usually come from an existing medical condition such as asthma, diabetes, epilepsy, or a condition developed because of pregnancy. Conditions that arise during pregnancy will require special treatment. The purpose of prenatal care is to detect these conditions, and to monitor and deal with them before they become serious.
- Preeclampsia is the medical term for high blood pressure during pregnancy. It is also characterized by edema, blurry vision, liver pain, and can progress into Eclampsia in which the mother can experience seizures, coma or even death.
- Gestational Diabetes is diabetes mellitus that develops during pregnancy. All women should be tested for the condition at about 28 weeks gestation. Gestational and pre-existing diabetes can cause large for gestational age babies, a sudden drop in a neonates blood sugar after birth, and has a high risk for stillbirth.
Other serious risks include:
- Teratogens (substances that cause birth defects including alcohol and certain prescription and recreational drugs)
- Infection (such as rubella or cytomegalovirus) An infection in the eleventh week is less likely to damage the heart, but the baby may be born deaf.
- Genetics (such as Factor V Leiden) Diabetes, blood conditions, etc.
- Radiation (ionizing radiation such as X-rays, radiation therapy, or accidental exposure to radiation)
- Nutritional deficiencies such as deficient in vitamins D, C, A, K, B-6, and E, as well as iron, folate, calcium, potassium, magnesium, and choline.
- Fetal Alcohol Syndrome or FAS exposure is the leading known cause of mental retardation in the Western world. It is a disorder of permanent birth defects that occurs in the offspring of women who drink alcohol during pregnancy, depending on the amount, frequency, and timing of alcohol consumption. Alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damage neurons and brain structures, and cause other physical, mental, or behavioral problems. Drinking during pregnancy should be avoided. Women who drink more than 4 or 5 drinks per day may cause permanent damage to their fetus, including behavioral problems, sight and hearing loss, deformed organs and central nervous system dysfunction.
- Smoking can cause low birth weight, still birth, birth defects, preterm births and immature lung development. It can also contribute to addiction in the child's later teen years.
- Illegal Drugs can be the most devastating. Risks include SIDS (Sudden Infants Death Syndrome), learning disorders, birth defects, uncontrollable trembling, hyperactivity, and drug dependency. Most drugs can be tested by a simple urine or blood test.
- Medications . All medication use should be discussed with your doctor. Many over the counter and prescription drugs have warning labels. Follow these precautions to help avoid birth defects or other related problems.
Miscarriage
Miscarriage, or spontaneous abortion, is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. Miscarriages are the most common complication of pregnancy. Basic Facts: 15-20% of pregnancies end in miscarriage, 70% of the time there is a chromosomal abnormality with the fetus, and one miscarriage does not increase your risk in the next pregnancy. Miscarriage is almost never the mother's fault.
If the products of conception are not completely expelled after fetal death, this is known as a missed abortion, and is usually treated surgically by a procedure known as a D&C or dilation and curettage.
After two years of trying, I finally received a positive pregnancy test. I couldn’t believe my eyes. Nothing about my journey had been easy. I identify as a lesbian, so my donor was a gay friend from San Francisco. I sent him a photo of the pregnancy test and my phone rang immediately. Neither of us could speak, we were so excited. Over the two years his mother was busy knitting outfits for the baby. I was overjoyed, but also slightly overwhelmed with the results.
The following morning I noticed light spotting. I didn’t panic, hoping it was implantation bleeding. I was at work that day, working in a client’s home. At lunchtime, I used the restroom. To my utter shock, I was gushing blood. I had the foresight to stick a tampon in my pocket. However, due to my confusion, I could not manage to use the tampon correctly. I was flustered in disbelief. I was also very conscious of how much time I spent in the restroom. I cleaned up as quickly as possible, returned down to face the client, while I got a second tampon from my purse.
I apologized to her saying, “I had a little surprise up there.” She replied “Oh don’t worry, it happened to me a million times.” I climbed up the stairs again fighting off tears. I realized there was blood all over the bathroom, her floor, sink and countertops. Even more flustered, I cleaned myself up quickly, feeling the blood drying down my legs. I couldn’t comprehend what was happening. How could I be pregnant yesterday and gushing blood today? That beautiful little baby I pictured was gone. We were back at square one.
I returned to the client and attempted to eat my lunch. I had zero appetite. I was embarrassed, confused, anxious and overall devastated. Given the amount of time I spent in her bathroom, I felt I had to say something. I blurted out, “Yesterday I received a positive pregnancy test after two years of trying, so I’m absolutely in shock over what happened just now. I’m sorry I was gone so long, I was not expecting this and feel so uncomfortable.” The client looked up from her phone and said “Oh God, I had 14 miscarriages, so this couldn’t have happened at a better place. I know all about it.” Her reaction seemed quite casual to me. I could not imagine going through that experience 14 times.
I had fully expected her to say “Go home, you poor thing. You are in shock and need time to process this.” However, that did not happen. She expected me to carry on working, which I did. I was fighting the tears while also fighting the urge to walk out. Eventually we finished up. I cried the entire hour home. I was desperate for a shower and a long sleep.
Several days later, I was at work and suddenly started vomiting. Again, I was at a clients’ home. I couldn’t understand what was making me sick. I cleaned up and resumed working. About twenty minutes later, I was back in the bathroom, on my knees, violently shaking and vomiting into the toilet. This time I told the client. She was incredibly kind and concerned. She sent me home offering any help she could. I vomited one more time in her garden before attempting the hour drive home.
During my drive, it became obvious this was a serious situation. Instead of driving home, I went straight to the ER. I pulled up outside the hospital, quickly opened my door and vomited all over the street. I was admitted immediately. I couldn’t stop shaking. I was given IV fluids and nausea medicine to stop the vomiting. After seven long hours of extensive testing in ER, doctors determined my body was having a very unusual and violent reaction to the pregnancy. My blood type is positive, while my donor’s is negative. Once the egg was fertilized, my body fought it like an infection. The doctor assured me we could one day have a healthy baby. However, if I continued to miscarry, this would be my body’s normal reaction.
During these two years we had tried fertility clinics, acupuncture, a private out-of-pocket gynecologist, and we tried at home, turkey baster style. I even tried Clomid, a drug to help me ovulate. Clomid backfired on me, causing large painful cysts. Due to our circumstances, we also had to hire a lawyer to write a contract regarding parental rights once the baby was born. It was an emotional rollercoaster for everyone involved.
By the time I left the ER, I had decided I was done trying. I didn’t have the mental or physical energy to continue this journey. It was a very painful decision. I had dedicated so much of my time to something that didn’t seem meant to be. I always felt I would make such a great parent, but I needed to accept it may not be the way I imagined. For now, I needed to heal emotionally and mentally. If I am destined to be a parent, I believe that child will appear in another form. I was adopted as a baby and was given a beautiful life. Perhaps I will get the opportunity to return the favor. I have enough life experience to know my plan is not always the grand plan. Accepting life on life’s terms is not always easy, but is often far more beautiful than I could have planned.
Bleeding During Pregnancy
Vaginal bleeding at any stage should be taken seriously. Severe bleeding in the early weeks may be a sign of miscarriage. However, 25% of pregnant patients bleed in the first trimester. After 24 weeks, the mother should seek medical advice immediately. Third trimester bleeding in pregnancy is often one of the first signs of placenta previa-placenta completely or partially covering the opening of the uterus (cervix). An ultrasound should be performed to establish the location. Other causes of late term bleeding include:
- Preterm Labor or labor that occurs before 38 weeks gestation that can have multiple causes
- Placental Abruption is a condition in which the placenta is torn away from the uterine wall causing loss of oxygen and nutrients to the baby, and hemorrhage of mother and baby from the large blood vessels in the placenta. Most women, but not all experience heavy bleeding and abdominal pain. This is a life threatening emergency, as a fetus can only survive as long as 50% of the placenta is still attached.