Pregnancy Complications

What is premature labor?

Premature or pre-term labor is labor that begins more than three weeks before you are expected to deliver your baby. Contractions (tightening of the muscles in the uterus) cause the cervix (lower end of the uterus) to open earlier than normal.

Pre-term labor may result in the birth of a premature baby. However, labor often can be stopped to allow the baby more time to grow and develop in the uterus. Treatments to stop premature labor may include bed rest, fluids given intravenously (in your vein), and medications to relax the uterus.

If born prematurely, a baby would likely survive after the seventh month, but might need to stay for a short time in the neonatal intensive care unit (NICU) of the hospital. If the baby is born earlier than the seventh month, he or she may be able to survive with specialized care in the NICU.

What are the signs of premature labor?

It is important for you to learn the signs of premature labor so that you can get help to stop it and prevent your baby from being born too early. Premature labor is usually not painful, but there are several warning signs, including:

Six or more contractions or tightening of the muscles in the uterus in one hour
Regular tightening or low, dull pain in your back that either comes or goes or is constant (but is not relieved by changing positions or other comfort measures)
Lower abdominal cramping that may feel like gas pain (with or without diarrhea)
Increased pressure in the pelvis or vagina
Menstrual-like cramps
Increased vaginal discharge
Leaking of fluid from the vagina
Vaginal bleeding
Flu-like symptoms such as nausea, vomiting and diarrhea
Decreased fetal movements (the baby does not kick as often as it usually does)

When should I call?

Call the office if you have:

Leaking of fluid from the vagina
Vaginal bleeding
Sudden increase of vaginal discharge
Lie down and check for contractions if you have any of the following signs of premature labor:

Menstrual-like cramps or abdominal cramps
Low, dull backache
Pelvic or vaginal pressure
Vaginal discharge changes
To check for contractions, place your fingertips on your abdomen. If you can feel your uterus tightening and softening, you can then record how often the contractions are happening.

If you have four or more contractions in one hour that do not go away after changing your position or relaxing, call your health care provider. Also call your health care provider if the warning signs listed above do not go away in one hour or if pain is severe and persistent.

Timing your contractions

Write down the time at the beginning of one contraction and again at the beginning of the next contraction.

What are false labor pains?

The muscles in your uterus will contract from about the fourth month of pregnancy. Irregular, infrequent contractions are called Braxton-Hicks contractions (also known as “false labor pains”).

Sharp, shooting pains on either side of your abdomen (called round ligament pain) that travel into the groin may result from the stretching ligaments that support your growing uterus.

To ease your discomfort:

Try changing your position or activity
Make sure you are drinking enough liquids (at least 6 to 8 glasses of water, juice or milk per day)
Try to rest

What happens if I have to go to the hospital?

After talking to your doctor about your signs of premature labor, he or she may tell you to go to the hospital. Once you arrive:

You will be asked to wear a hospital gown.
Your pulse, blood pressure and temperature will be checked.
A monitor will be placed on your abdomen to check the baby’s heart rate and evaluate uterine contractions.
Your cervix will be checked to see if it is opening.
If you are in premature labor, you may receive medication to stop labor so your baby has more time to develop in the uterus. If the labor has progressed and cannot be stopped, you might need to deliver your baby. If you are not in premature labor, you will be able to go home.

What is high blood pressure?

Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels) that carry the blood throughout the body. High blood pressure, also called hypertension, means that the pressure in the arteries is above the normal range.

What is pregnancy-induced hypertension?

Pregnancy-induced hypertension—which may also be called pre-eclampsia, toxemia, or toxemia of pregnancy—is a pregnancy complication characterized by high blood pressure, swelling due to fluid retention, and protein in the urine.

Who is affected by PIH?

Pregnancy-induced hypertension (PIH) affects approximately one out of every 14 pregnant women. Although PIH more commonly occurs during first pregnancies, it can also occur in subsequent pregnancies. PIH is also more common in pregnant teens and in women over age 40. Many times, PIH develops during the second half of pregnancy, usually after the 20th week, but it can also develop at the time of delivery or right after delivery.

Who is at risk of developing PIH?

A woman is more likely to develop PIH if she:

Is under age 20 or over age 35
Has a history of chronic hypertension
Has a previous history of PIH
Has a female relative with a history of PIH
Is underweight or overweight
Has diabetes before becoming pregnant
Has an immune system disorder, such as lupus or rheumatoid arthritis
Has kidney disease
Has a history of alcohol, drug, or tobacco use
Is expecting twins or triplets

What are the symptoms of PIH?

Rapid or sudden weight gain, high blood pressure, protein in the urine, and swelling (in the hands, feet, and face) are all signs of PIH. Some swelling is normal during pregnancy. However, if the swelling doesn’t go away and is accompanied by some of the above symptoms, be sure to see your doctor right away. Other symptoms of PIH include abdominal pain, severe headaches, a change in reflexes, spots before your eyes, reduced output of urine or no urine, blood in the urine, dizziness, or excessive vomiting and nausea.

How is PIH diagnosed?

During routine prenatal tests, your weight gain, blood pressure and urine protein are monitored. If you have symptoms of PIH, as listed above, additional blood tests may be ordered, which would show abnormal results if PIH is present.

If PIH is suspected, a non-stress test may be performed to monitor the baby. During the non-stress test, an ultrasound transducer records the baby’s heart rate, and a pressure transducer (called the toco transducer) records uterine activity. Each time you feel the baby move, you make a mark on a graph paper that displays the fetal heart rate and uterine activity.

Usually the fetal heart rate increases when the fetus moves, just as your heart beats faster when you exercise. Certain changes in the fetal heart rate are considered a sign of good health. Sometimes an ultrasound provides more information about the baby.

How is PIH treated?

If PIH is mild, it can be treated at home. If you have been diagnosed with PIH and your doctor recommends home treatment, you will need to maintain a quiet, restful environment with limited activity or bed rest on your left side.

It is important that you follow the diet and fluid intake guidelines from your health care provider and maintain your scheduled appointments. Your perception of fetal movement every three hours is also important. Any changes need to be reported to your health care provider immediately.

If PIH becomes worse, you will need to be admitted to the hospital where you can be closely monitored. Your health care provider will work with you to maintain the health of you and your baby. In severe cases, the baby may have to be delivered. High blood pressure is treated with medication, and magnesium is given through an IV to prevent seizures.

What is the danger of PIH?

PIH can prevent the placenta from receiving enough blood, which can cause low birth weight in your baby. Although these complications are rare, PIH may cause the following:

Placental abruption, a complication that occurs when the placenta pulls away from the wall of the uterus, causing maternal bleeding and fetal distress
Seizures in the mother
Temporary kidney failure
Liver problems
Blood clotting problems

When should I call my doctor?

It is important to call your health care provider right away if you notice any of the following:

Rapid weight gain (5 pounds in 1-2 days)
Swelling or puffiness in your fingers, feet, face, or eyelids
Numbness in your hands or feet
Headache that is not relieved by taking acetaminophen (Tylenol®)
Abdominal pain, especially in the upper abdomen or to the right
Blurry vision, spots before your eyes that don’t resolve
Ringing in your ears
Decrease in fetal movement
Uterine contractions
Unrelieved nausea or vomiting
Vaginal bleeding
Any other symptom that causes concern

Does PIH improve after delivery?

A woman’s blood pressure usually returns to normal after delivery. Sometimes, however, blood pressure may remain high, requiring treatment with medication. Your health care provider will work with you after your pregnancy to prescribe an appropriate medication.

What is fetal distress?

Fetal distress is a condition in which the fetus (unborn baby) develops a problem during the mother’s labor. Although fetal distress is a loosely defined medical term, it usually refers to fetal hypoxia (lack of oxygen). Babies with the condition are generally delivered in good health, but in some cases fetal distress can lead to problems such as learning disabilities, cerebral palsy, mental retardation, and seizures.

What causes fetal distress?

Fetal distress can be linked to many causes. Common causes include:

Contractions—Involuntary tightening of muscles in the uterus (womb) to deliver the baby. Contractions briefly reduce blood flow to the placenta (organ that surrounds the fetus and allows nutrients to pass from the umbilical cord to the baby), and can compress the umbilical cord and cause nutrients to be cut off.
Infections—These may include complications such as amnionitis, an infection of the organ called the amnion that surrounds the fetus.
Placental abruption—The placenta separates from the fetus too early.
Prolapsed umbilical cord—The umbilical cord (which transports nutrients to the baby from the mother) is displaced during labor.
Hypertonic uterine states—The muscles of the uterus become too tense and do not contract properly.
Use of oxytocin—A naturally occurring hormone that can be given as a drug to create contractions.
Hypotension (low blood pressure)—If the mother’s blood pressure decreases during labor, blood flow to the fetus may be reduced. Hypotension can be caused by:
–Epidural anesthesia—An injection into the back to numb the lower body
–Supine position (lying on the back)

How is fetal distress diagnosed?

Electric Fetal Monitoring (EFM), also called a cardiotocograph, allows the fetus heartbeat to be viewed in relationship to the mother’s contractions. EFM is the most commonly used instrument for the diagnosis of fetal distress.

Since fetal distress is a loosely defined term, doctors have different views over what comprises fetal distress. However, signs of distress usually include:

Brachycardia—A heart rate that is too slow (usually less than 100 beats per minute for a fetus)
Tachycardia—A heart rate that is too fast (usually over 180 beats per minute). Tachycardia is usually caused by a fever in the mother.
Thick meconium (the first bowel movement of the fetus) in the amniotic fluid.
Fetal acidosis—Too much acid in the blood. A prick of blood from the fetus’ scalp is used as the sample.

How is fetal distress treated?

There are several ways fetal distress is handled, including:

Cesarean-section (C-section)—The fetus is surgically removed through an incision made in the mother’s abdomen.
Labor induction—This process accelerates the process of childbirth in order to prevent the fetus from being damaged in the uterus.
Episiotomy—An incision is made in the perineum (area between the vagina and anus) to help deliver the fetus.
Forceps delivery— Forceps are twin steel blades that the physician inserts into the vagina and around the baby’s head during a forceps delivery.
Vacuum extraction delivery— In this procedure, the physician uses an instrument called a vacuum extractor, which has a suction cup that is placed on the baby’s head. A vacuum is created using a pump, and the baby is pulled down the birth canal with the instrument and with the help of the mother’s contractions.

How common is fetal distress?

Because there are no exact measurements of what comprises fetal distress, it is difficult to say how often it occurs. However, in the United States the Cesarean-section rate is about 26 percent.

What is IUGR?

Intrauterine growth restriction (IUGR), also called fetal growth restriction, is a condition in which the fetus is smaller than expected for the number of weeks of pregnancy. Newborn babies with IUGR are often described as small for their gestational age (SGA).

What causes IUGR?

This condition has various causes. The most common cause is a problem in the placenta (the organ that connects the developing fetus to the mother’s uterus). Birth defects and genetic disorders can cause IUGR. Additional causes include infection in the mother or high blood pressure in the mother. A pregnant woman who smokes, drinks too much alcohol, or abuses drugs also might have a baby with IUGR. In some cases, a prescription medicine that the mother is taking causes IUGR.

What are the symptoms of IUGR?

Newborn babies with IUGR often appear thin, pale, and have loose, dry skin. The umbilical cord is often thin and dull-looking rather than shiny and fat. Babies with IUGR sometimes have a wide-eyed look. Some babies with IUGR do not have this malnourished appearance but are small all over.

How is IUGR diagnosed?

During pregnancy, the size of the fetus can be estimated in different ways. One means of estimating is to measure the height of the fundus (the top of a pregnant woman’s uterus) from the pubic bone. Usually, the number of centimeters in the measurement is in line with the number of weeks of pregnancy after the 20 th week. The baby might be smaller than anticipated if the measurement is low for the number of weeks. Additional diagnostic procedures include:

Ultrasound—This is a test using sound waves to create a picture of internal structures. The head and abdomen of the fetus can be measured and compared with a growth chart to estimate the weight of the fetus.
Doppler flow—This is a test that uses sound waves to measure blood flow. The sound of the moving blood produces waveforms that reflect the blood’s amount and speed as it moves through a blood vessel. Vessels in the brain of the fetus, as well as the umbilical cord blood flow, can be checked with Doppler flow studies.
Weight gain of the mother—A pregnant woman’s weight can indicate the size of her fetus. A small amount of weight gain in pregnancy might mean that the fetus will be small.

How is IUGR treated?

It is not possible to reverse IUGR, but some treatments might help slow or minimize the effects. Treatments might include:

Nutrition—According to some studies, an increase in maternal nutrition can increase fetal growth.
Bed rest—Rest in the hospital or at home can help to improve circulation to the fetus.
Early delivery—An early delivery might be necessary if IUGR places the fetus’ health in danger.

Can IUGR be prevented?

IUGR can occur even when the mother is in good health. However, some factors including cigarette smoking and the mother’s poor nutrition can increase the risks of IUGR. Adequate prenatal care can reduce the risk for developing IUGR. Early detection can help with treating IUGR.