Complications of Pregnancy and Delivery

Figure 1. Pregnancy affects  women in different ways; some notice few adverse side effects, while others feel high levels of discomfort, or develop more serious complications.

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 “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, constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on the abdomen). What is the cure? Delivery!

Major Complications 

The following are some serious complications of pregnancy which can pose health risks to mother and child and that often require special care.

• Gestational diabetes is when a woman without diabetes develops high blood sugar levels during pregnancy.
• Hyperemesis gravidarum is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common morning sickness.
• Preeclampsia is gestational hypertension. Severe preeclampsia involves blood pressure over 160/110 with additional signs. Eclampsia is seizures in a pre-eclamptic patient.
• Deep vein thrombosis is the formation of a blood clot in a deep vein, most commonly in the legs.
• A pregnant woman is more susceptible to infections. This increased risk is caused by an increased immune tolerance in pregnancy to prevent an immune reaction against the fetus.
• Peripartum cardiomyopathy is a decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy.

Maternal Mortality

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. 

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. ^[1]

Figure 2. This graph shows declining maternal mortality rates, as measured as 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/.

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 pregnancy-related death as the death of a woman while pregnant or within 1 year of the end of a pregnancy–regardless of the outcome, duration, or site of the pregnancy–from 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?

The data below shows percentages of the causes of pregnancy-related deaths in the United States during 2011–2014:

• Cardiovascular diseases, 15.2%.
• Non-cardiovascular diseases, 14.7%.
• Infection or sepsis, 12.8%.
• Hemorrhage, 11.5%.
• Cardiomyopathy, 10.3%.
• Thrombotic pulmonary embolism, 9.1%.
• Cerebrovascular accidents, 7.4%.
• Hypertensive disorders of pregnancy, 6.8%.
• Amniotic fluid embolism, 5.5%.
• Anesthesia complications, 0.3%.

The cause of death is unknown for 6.5% of all 2011–2014 pregnancy-related deaths.^[3]

Miscarriage

Spontaneous abortion is experienced in an estimated 20-40 percent of undiagnosed pregnancies and in another 10 percent of diagnosed pregnancies. Usually, the body aborts due to chromosomal abnormalities and this typically happens before the 12th week of pregnancy. Cramping and bleeding result and normal periods return after several months. Some 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).