{"id":272,"date":"2021-05-28T13:56:49","date_gmt":"2021-05-28T13:56:49","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/child\/?post_type=chapter&#038;p=272"},"modified":"2024-07-11T18:39:17","modified_gmt":"2024-07-11T18:39:17","slug":"complications-of-pregnancy-and-delivery-2","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/child\/chapter\/complications-of-pregnancy-and-delivery-2\/","title":{"raw":"Complications of Pregnancy and Delivery","rendered":"Complications of Pregnancy and Delivery"},"content":{"raw":"[caption id=\"attachment_750\" align=\"alignright\" width=\"259\"]<img class=\"wp-image-750 \" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/15195536\/PregnantWoman-195x300.jpg\" alt=\"Pregnant Woman\" width=\"259\" height=\"398\" \/> <strong>Figure 1.<\/strong>\u00a0Pregnancy affects women in different ways; some notice few adverse side effects, while others feel high levels of discomfort, or develop more serious complications.[\/caption]\r\n\r\nThere are a number of common side effects of pregnancy. Not everyone experiences all of these nor do women experience them to the same degree. And although they are considered \"minor\" these problems are potentially very uncomfortable. These side effects include nausea (particularly during the first 3-4 months of pregnancy as a result of higher levels of estrogen in the system), heartburn, gas, hemorrhoids, backache, leg cramps, insomnia,\u00a0constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on the abdomen). What is the cure? Delivery!\r\n<h2><strong>Major Complications\u00a0<\/strong><\/h2>\r\nThe following are some serious complications of pregnancy that can pose health risks to mother and child and that often require special care.\r\n<ul>\r\n \t<li><span id=\"Gestational_diabetes\" class=\"mw-headline\">Gestational diabetes\u00a0<\/span>is when a woman without\u00a0diabetes\u00a0develops\u00a0high blood sugar\u00a0levels during\u00a0pregnancy.<sup id=\"cite_ref-7\" class=\"reference\"><\/sup><\/li>\r\n \t<li>Hyperemesis gravidarum\u00a0is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common\u00a0morning sickness.<\/li>\r\n \t<li>Preeclampsia\u00a0is gestational hypertension. Severe preeclampsia involves blood pressure over 160\/110 with additional signs.\u00a0<sup id=\"cite_ref-11\" class=\"reference\"><\/sup>Eclampsia\u00a0is a seizure in a pre-eclamptic patient.<sup id=\"cite_ref-12\" class=\"reference\"><\/sup><\/li>\r\n \t<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\">Deep vein thrombosis is the formation of a\u00a0blood clot\u00a0in a\u00a0deep vein, most commonly in the legs.<\/span><\/li>\r\n \t<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\"><\/span>A pregnant woman is more susceptible to\u00a0infections. This increased risk is caused by an increased\u00a0immune tolerance in pregnancy\u00a0to prevent an immune reaction against the fetus.<\/li>\r\n \t<li>Peripartum cardiomyopathy\u00a0is a decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy.<\/li>\r\n<\/ul>\r\n<h3><strong>Maternal Mortality<\/strong><\/h3>\r\n<span style=\"color: #333333;\">Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303,000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The high number of maternal deaths in some areas of the world reflects inequities in access to health services and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one-third occur in South Asia.\u00a0<\/span>\r\n\r\n<span style=\"color: #333333;\">Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income.\u00a0[footnote]<\/span>Maternal mortality (<span class=\"timestamp\">February 2018). World Health Organization. Retrieved from\u00a0<\/span><span style=\"color: #333333;\">https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality[\/footnote]<\/span>\r\n\r\n[caption id=\"attachment_3503\" align=\"aligncenter\" width=\"687\"]<img class=\"wp-image-3503 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17022628\/Screen-Shot-2019-06-16-at-10.24.59-PM.png\" alt=\"Maternal mortality fel by almost half between 1990 and 2015. Bar graphs showing declining rates in al the major world regions, and rates falling in least developed countries from 903 in 1990 to 436 in 2015.\" width=\"687\" height=\"579\" \/> <strong>Figure 2.<\/strong>\u00a0This graph shows declining maternal mortality rates, as measured by the number of deaths per 100,000 live births. in 1990, 903 out of 100,000 live births resulted in death in the least developed countries, but that number has improved to 436 out of 100,000 births in 2015. Globally, there were 216 deaths for every 100,000 live births in 2015. Source: UNICEF, https:\/\/data.unicef.org\/topic\/maternal-health\/maternal-mortality\/.[\/caption]\r\n\r\nEven though maternal mortality in the United States is relatively rare today because of advances in medical care, it is still an issue that needs to be addressed. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. The Centers for Disease Control and Prevention define a<strong>\u00a0pregnancy-related death<\/strong> as the death of a woman while pregnant or within 1 year of the end of a pregnancy\u2013regardless of the outcome, duration, or site of the pregnancy\u2013from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The reasons for the overall increase in pregnancy-related mortality are unclear. What do you think are some reasons for this surprising increase in the United States? What can be done to change this statistic?\r\n<div class=\"textbox examples\">\r\n<h3>Watch It: Maternal Mortality in the United States<\/h3>\r\n<strong>Video 1.\u00a0<\/strong>In the United States, black women are disproportionately more likely to die from complications related to pregnancy or childbirth than any other race; they are three or four times more likely than white women to die due to pregnancy-related death and are more likely to receive worse maternal care.[footnote] Black Women\u2019s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (April 2018). National Partnership for Women and Families. Retrieved from\u00a0http:\/\/www.nationalpartnership.org\/our-work\/health\/reports\/black-womens-maternal-health.html.[\/footnote] Black women from higher income groups and with advanced education levels also have heightened risks\u2014even tennis superstar <a href=\"https:\/\/www.cnn.com\/2018\/01\/10\/health\/serena-williams-birth-c-section-olympia-bn\/index.html\">Serena Williams had near-deadly complications during the birth of her daughter, Olympia<\/a>.\u00a0Why is this the case in our modern world? Watch this video to learn more:\r\n\r\nhttps:\/\/youtu.be\/VYc-Eq-vDuA\r\n\r\n<\/div>\r\n<span style=\"color: #333333;\">The data below shows percentages of the causes of pregnancy-related deaths in the United States during 2011\u20132014:<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #333333;\">Cardiovascular diseases, 15.2%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Non-cardiovascular diseases, 14.7%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Infection or sepsis, 12.8%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Hemorrhage, 11.5%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Cardiomyopathy, 10.3%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Thrombotic pulmonary embolism, 9.1%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Cerebrovascular accidents, 7.4%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Hypertensive disorders of pregnancy, 6.8%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Amniotic fluid embolism, 5.5%.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Anesthesia complications, 0.3%.<\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #333333;\">The cause of death is unknown for 6.5% of all 2011\u20132014 pregnancy-related deaths.<\/span>\r\n<h3><strong>Miscarriage<\/strong><\/h3>\r\nSpontaneous abortion\u00a0is experienced in an estimated 20-40 percent of undiagnosed pregnancies and in another 10 percent of diagnosed pregnancies.\u00a0Usually, the body aborts due to chromosomal abnormalities and this typically happens before the 12th\u00a0week of pregnancy.\u00a0Cramping and bleeding result and normal periods return after several months.\u00a0Some women are more likely to have repeated miscarriages due to chromosomal, amniotic, or hormonal problems; but miscarriage can also be a result of defective sperm (Carroll et al., 2003).","rendered":"<div id=\"attachment_750\" style=\"width: 269px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-750\" class=\"wp-image-750\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/15195536\/PregnantWoman-195x300.jpg\" alt=\"Pregnant Woman\" width=\"259\" height=\"398\" \/><\/p>\n<p id=\"caption-attachment-750\" class=\"wp-caption-text\"><strong>Figure 1.<\/strong>\u00a0Pregnancy affects women in different ways; some notice few adverse side effects, while others feel high levels of discomfort, or develop more serious complications.<\/p>\n<\/div>\n<p>There are a number of common side effects of pregnancy. Not everyone experiences all of these nor do women experience them to the same degree. And although they are considered &#8220;minor&#8221; these problems are potentially very uncomfortable. These side effects include nausea (particularly during the first 3-4 months of pregnancy as a result of higher levels of estrogen in the system), heartburn, gas, hemorrhoids, backache, leg cramps, insomnia,\u00a0constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on the abdomen). What is the cure? Delivery!<\/p>\n<h2><strong>Major Complications\u00a0<\/strong><\/h2>\n<p>The following are some serious complications of pregnancy that can pose health risks to mother and child and that often require special care.<\/p>\n<ul>\n<li><span id=\"Gestational_diabetes\" class=\"mw-headline\">Gestational diabetes\u00a0<\/span>is when a woman without\u00a0diabetes\u00a0develops\u00a0high blood sugar\u00a0levels during\u00a0pregnancy.<sup id=\"cite_ref-7\" class=\"reference\"><\/sup><\/li>\n<li>Hyperemesis gravidarum\u00a0is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common\u00a0morning sickness.<\/li>\n<li>Preeclampsia\u00a0is gestational hypertension. Severe preeclampsia involves blood pressure over 160\/110 with additional signs.\u00a0<sup id=\"cite_ref-11\" class=\"reference\"><\/sup>Eclampsia\u00a0is a seizure in a pre-eclamptic patient.<sup id=\"cite_ref-12\" class=\"reference\"><\/sup><\/li>\n<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\">Deep vein thrombosis is the formation of a\u00a0blood clot\u00a0in a\u00a0deep vein, most commonly in the legs.<\/span><\/li>\n<li><span id=\"Deep_vein_thrombosis\" class=\"mw-headline\"><\/span>A pregnant woman is more susceptible to\u00a0infections. This increased risk is caused by an increased\u00a0immune tolerance in pregnancy\u00a0to prevent an immune reaction against the fetus.<\/li>\n<li>Peripartum cardiomyopathy\u00a0is a decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy.<\/li>\n<\/ul>\n<h3><strong>Maternal Mortality<\/strong><\/h3>\n<p><span style=\"color: #333333;\">Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303,000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The high number of maternal deaths in some areas of the world reflects inequities in access to health services and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one-third occur in South Asia.\u00a0<\/span><\/p>\n<p><span style=\"color: #333333;\">Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income.\u00a0<a class=\"footnote\" title=\"Maternal mortality (February 2018). World Health Organization. Retrieved from\u00a0https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality\" id=\"return-footnote-272-1\" href=\"#footnote-272-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/span><\/p>\n<div id=\"attachment_3503\" style=\"width: 697px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3503\" class=\"wp-image-3503 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2014\/09\/17022628\/Screen-Shot-2019-06-16-at-10.24.59-PM.png\" alt=\"Maternal mortality fel by almost half between 1990 and 2015. Bar graphs showing declining rates in al the major world regions, and rates falling in least developed countries from 903 in 1990 to 436 in 2015.\" width=\"687\" height=\"579\" \/><\/p>\n<p id=\"caption-attachment-3503\" class=\"wp-caption-text\"><strong>Figure 2.<\/strong>\u00a0This graph shows declining maternal mortality rates, as measured by the number of deaths per 100,000 live births. in 1990, 903 out of 100,000 live births resulted in death in the least developed countries, but that number has improved to 436 out of 100,000 births in 2015. Globally, there were 216 deaths for every 100,000 live births in 2015. Source: UNICEF, https:\/\/data.unicef.org\/topic\/maternal-health\/maternal-mortality\/.<\/p>\n<\/div>\n<p>Even though maternal mortality in the United States is relatively rare today because of advances in medical care, it is still an issue that needs to be addressed. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. The Centers for Disease Control and Prevention define a<strong>\u00a0pregnancy-related death<\/strong> as the death of a woman while pregnant or within 1 year of the end of a pregnancy\u2013regardless of the outcome, duration, or site of the pregnancy\u2013from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The reasons for the overall increase in pregnancy-related mortality are unclear. What do you think are some reasons for this surprising increase in the United States? What can be done to change this statistic?<\/p>\n<div class=\"textbox examples\">\n<h3>Watch It: Maternal Mortality in the United States<\/h3>\n<p><strong>Video 1.\u00a0<\/strong>In the United States, black women are disproportionately more likely to die from complications related to pregnancy or childbirth than any other race; they are three or four times more likely than white women to die due to pregnancy-related death and are more likely to receive worse maternal care.<a class=\"footnote\" title=\"Black Women\u2019s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (April 2018). National Partnership for Women and Families. Retrieved from\u00a0http:\/\/www.nationalpartnership.org\/our-work\/health\/reports\/black-womens-maternal-health.html.\" id=\"return-footnote-272-2\" href=\"#footnote-272-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a> Black women from higher income groups and with advanced education levels also have heightened risks\u2014even tennis superstar <a href=\"https:\/\/www.cnn.com\/2018\/01\/10\/health\/serena-williams-birth-c-section-olympia-bn\/index.html\">Serena Williams had near-deadly complications during the birth of her daughter, Olympia<\/a>.\u00a0Why is this the case in our modern world? Watch this video to learn more:<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"U.S. Maternal Mortality is Much Higher for African-Americans\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/VYc-Eq-vDuA?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<p><span style=\"color: #333333;\">The data below shows percentages of the causes of pregnancy-related deaths in the United States during 2011\u20132014:<\/span><\/p>\n<ul>\n<li><span style=\"color: #333333;\">Cardiovascular diseases, 15.2%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Non-cardiovascular diseases, 14.7%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Infection or sepsis, 12.8%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Hemorrhage, 11.5%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Cardiomyopathy, 10.3%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Thrombotic pulmonary embolism, 9.1%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Cerebrovascular accidents, 7.4%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Hypertensive disorders of pregnancy, 6.8%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Amniotic fluid embolism, 5.5%.<\/span><\/li>\n<li><span style=\"color: #333333;\">Anesthesia complications, 0.3%.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #333333;\">The cause of death is unknown for 6.5% of all 2011\u20132014 pregnancy-related deaths.<\/span><\/p>\n<h3><strong>Miscarriage<\/strong><\/h3>\n<p>Spontaneous abortion\u00a0is experienced in an estimated 20-40 percent of undiagnosed pregnancies and in another 10 percent of diagnosed pregnancies.\u00a0Usually, the body aborts due to chromosomal abnormalities and this typically happens before the 12th\u00a0week of pregnancy.\u00a0Cramping and bleeding result and normal periods return after several months.\u00a0Some women are more likely to have repeated miscarriages due to chromosomal, amniotic, or hormonal problems; but miscarriage can also be a result of defective sperm (Carroll et al., 2003).<\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-272-1\"><\/span>Maternal mortality (<span class=\"timestamp\">February 2018). World Health Organization. Retrieved from\u00a0<\/span><span style=\"color: #333333;\">https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality <a href=\"#return-footnote-272-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-272-2\"> Black Women\u2019s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (April 2018). National Partnership for Women and Families. Retrieved from\u00a0http:\/\/www.nationalpartnership.org\/our-work\/health\/reports\/black-womens-maternal-health.html. <a href=\"#return-footnote-272-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":185983,"menu_order":6,"template":"","meta":{"_candela_citation":"[]","CANDELA_OUTCOMES_GUID":"","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-272","chapter","type-chapter","status-publish","hentry"],"part":62,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/pressbooks\/v2\/chapters\/272","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/wp\/v2\/users\/185983"}],"version-history":[{"count":3,"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/pressbooks\/v2\/chapters\/272\/revisions"}],"predecessor-version":[{"id":462,"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/pressbooks\/v2\/chapters\/272\/revisions\/462"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/pressbooks\/v2\/parts\/62"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/pressbooks\/v2\/chapters\/272\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/wp\/v2\/media?parent=272"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/pressbooks\/v2\/chapter-type?post=272"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/wp\/v2\/contributor?post=272"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/child\/wp-json\/wp\/v2\/license?post=272"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}