Pregnancy: Risks and Complications
October is the month to talk about Pregnancy Risks and Complications
A safe pregnancy means starting your pregnancy in the best possible health, taking care of yourself, and being assisted by qualified healthcare providers.
Knowing the risk:
To achieve the Sustainable Development Goals (SDGs), we must manage pregnancy complications and adverse events at delivery as much as possible. Identifying risk factors, ideally before conception, and enacting preventative strategies is essential for reducing maternal mortality. These include:
- Pre-existing conditions: Non Communicable Diseases (NCDs) such as obesity, diabetes, hypertension, heart and kidney diseases
- uterine abnormalities, previous uterine surgery, including caesarean section, or the presence of uterine fibromas
- Adolescent pregnancy, which doubles the likelihood of developing preeclampsia and systemic infections and increase by about 5-fold the risk of uterine infections.
- Advanced maternal age increases the probability of fetus chromosomal abnormalities and the risk of developing complications during pregnancy such as gestational diabetes (50% increase) and hypertensive disorders (70% increase)
- Fetal exposure to maternal smoking triples the risk of sudden infant death syndrome, while passive smoking in the first few months of life doubles it
Strong communication between healthcare providers and pregnant women increases the likelihood of positive outcomes, however this is often not possible for women in low-resource settings. Only 59% of the births in the sub-Saharan Africa Region, where maternal mortality is highest, are attended by skilled health personal.
The World Health Organization (WHO)’s antenatal care model is recommended to identify personal risk profiles, conduct appropriate and preventative strategies, and engage multispecialty advice in referral centres in case of abnormalities:
- Prenatal screenings include ultrasound examinations and blood samples to screen for specific chromosome abnormalities, although invasive tests (villocentesis or amniocentesis) are the only valid methods to obtain a definite diagnosis
- Ultrasound investigations evaluate fetal wellbeing, especially the second trimester morphology ultrasound to assess fetal organ development
- Vaginal-rectal swab and urine culture towards the end of pregnancy are advisable to check for Group B Streptococcus
- Mothers can actively contribute to a healthy pregnancy, with lifestyle factors including optimal nutritional intake, adequate exercise and avoidance of toxins
Safe Delivery Choices:
Even a woman with an uneventful pregnancy and no detectable risk factors may have sudden complications during labour.
- Prompt contact with a healthcare provider or hospital is essential if the mother begins losing blood or amniotic fluid
- A planned or emergency caesarean section is indicated in specific conditions such as placenta previa, abnormalities of the maternal pelvis, abnormal fetal presentations, or sever maternal / fetal complications
- Immediately after birth it is important to check the mother’s blood loss, heart rate and blood pressure to promptly diagnose any haemorrhage
- Favour early contact between mother and newborn