Pregnancy Problems

Recurrent Pregnancy Loss 

In some cases, an underlying health problem may be the cause of multiple miscarriages. If an underlying cause is found, treatments can be recommended to reduce the risk of miscarriage in the next pregnancy.

Preterm Birth

Labor contractions that start too soon (preterm labor) or the water breaking too early  (preterm premature rupture of membranes, or PPROM: If the normal events of labor start too early, the fetus is at risk of being born before he or she is ready for the outside world. Drugs to slow preterm labor and steroid injections that jump-start the baby's biology can be given to help prepare the baby for the outside world if born early.

• Shortened Cervix – The cervix keeps the uterus closed until it is time for birth. In a condition called cervical insufficiency, the cervix starts to thin too early, which can lead to preterm birth. Cervical insufficiency can be treated with medications or surgery that may be able to reduce the risk of early birth.

• Cerclage – In some cases, surgery can strengthen a thinning cervix. In this procedure, the cervix is sewn shut, either through the vagina or through an incision in the abdomen, to prevent pregnancy loss. Some surgeons perform this procedure with minimally invasive surgical techniques, including robotic-assisted cerclage.

• Preterm Birth in a Prior Pregnancy – Multiple factors can impact the risk of giving birth too soon. In some cases, a problem can be identified, such as an abnormally shaped uterus, that can contribute to preterm birth. Based on this evaluation, therapies can be recommended to prevent preterm birth in the next pregnancy.

Blood Pressure Problems

In a healthy pregnancy, hormones lower the mother's blood pressure and direct food and oxygen to the uterus through the placenta. Sometimes, however, signals from the placenta cause the blood pressure to increase, leading to problems such as gestational hypertension, preeclampsia, HELLP syndrome, and eclampsia. The cure for these conditions is to deliver the baby, which is risky when high blood pressure develops months before a baby's due date. In these situations, the risks and benefits of continuing the pregnancy vs. giving birth to improve outcomes for mother and baby need to be carefully weighed. For those who have previously had blood pressure problems during pregnancy, a strategy to minimize risk for their next birth can be mapped out before becoming pregnant.

Bleeding

During pregnancy, the placenta delivers vital nutrients and removes waste products from the growing baby. Shortly after birth, a healthy placenta detaches from the uterus and passes out of the mother's body. If the placenta is located over the cervix, or if it begins to detach before the baby is born, bleeding can occur.

• Placenta Previa – Usually, the placenta attaches to the uterus far from the cervix. In cases of placenta previa, the placenta blocks the birth canal. During labor, placenta previa can cause bleeding. Careful monitoring can help determine a safe time for birth.

• Placenta Accreta, Increta, and Percreta – In these conditions, the placenta is attached too tightly to the wall of the uterus, and it cannot separate after the baby is born. This problem is more common after previous surgeries on the uterus, such a cesarean delivery, that scar the uterine wall, particularly if there is a placenta previa. Often, a hysterectomy (removal of the uterus) at the time of birth is needed to control life-threatening bleeding. Ultrasound can be used to estimate the risk of accreta, and MFMs and expert surgeons often work together to develop a safe birth plan for mother and baby.

• Placental Abruption – In a partial abruption, a small amount of the placenta detaches from the wall of the uterus, causing bleeding. If bleeding is mild and there are no signs of distress, the pregnancy can continue with close monitoring. In a complete abruption, most or all of the placenta detaches from the uterus before the baby is born. Urgent surgery is needed to deliver the baby and control bleeding.

Maternal Health Problems

Pregnancy can worsen existing health problems, such as high blood pressure, diabetes, or kidney disease, and these chronic conditions can affect pregnancy. Those with high-risk pregnancies often need monitoring throughout the pregnancy and may require medications to manage their medical problems with minimal risk to the baby. The following sections list some of the preexisting health conditions that may complicate pregnancy and for which the expert care of an MFM may be needed.

Heart Disorders

In some cases, an underlying health problem may be the cause of multiple miscarriages. If an underlying cause is found, treatments can be recommended to reduce the risk of miscarriage in the next pregnancy.

• Congenital heart disease

• Arrhythmias

• Valve disease

• Cardiomyopathy

• Pulmonary hypertension

• Coronary artery disease

• Heart transplant
  
  

Lung Problems

During pregnancy, the lungs work harder to bring in more oxygen and expel extra carbon dioxide. Chronic lung problems can cause an extra burden during pregnancy.

• Asthma

• Pneumonia

• Restrictive lung disease

• Influenza

• Tuberculosis

• Cystic fibrosis

Obesity

Having extra body fat increases the risk of diabetes, high blood pressure, birth defects, and cesarean delivery. If you are overweight or obese at the time of pregnancy, you may benefit from expert advice on nutrition, advanced ultrasound, and expert management during labor.

Endocrine Disorders

The endocrine glands make hormones, the chemicals that control many body functions. Some hormones made in extra amounts during pregnancy (such as estrogen) change how the body responds to stress, regulate blood sugar, and control the flow of nutrients such as calcium and vitamin D. Those with endocrine conditions need expert advice to help their bodies adjust to the demands of pregnancy and to return to normal after childbirth.

• Addison's disease

• Type 1 diabetes mellitus  

• Thyroid disease

• Parathyroid disease

• Pheochromocytoma

Digestive Disorders

During pregnancy, the digestive system slows so that her body can absorb the nutrients she needs to grow a baby. These changes likely contribute to morning sickness, and they can worsen existing conditions such as gallstones and heartburn.

• Nausea and vomiting of pregnancy; hyperemesis gravidarum (severe nausea and vomiting of pregnancy)

• Eating disorders

• Intrahepatic cholestasis

• Inflammatory bowel disease (ulcerative colitis; Crohn's disease)

• Gallbladder disease (cholecystitis; cholelithiasis)

• Pregnancy after liver transplantation

• Pancreatitis

• Wilson's disease

Blood Disorders

The amount of blood in the body increases by almost 50% during pregnancy. Blood clots form more easily, most likely as a way of preventing heavy bleeding during childbirth. If you have blood problems, such as anemia or clotting problems, these changes can require special care during pregnancy.

• Maternal anemia and hemoglobinopathies

• Sickle cell disease

• Von Willebrand disease

• Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome

• Venous thromboembolism and anticoagulation

• Inherited thrombophilia

Kidney Disorders

The kidneys work overtime during pregnancy to filter out both mom's and baby's waste products. Preexisting kidney disease may require special blood pressure monitoring during pregnancy to protect the kidneys while meeting the baby's needs.

• Kidney transplant

• Nephropathy

• Chronic renal insufficiency

Brain and Psychiatric Conditions

Hormonal changes and greater blood volume can aggravate or improve neurologic problems. The stresses and hormonal changes of pregnancy can also complicate psychiatric conditions. Some medications to treat these conditions may also affect the baby's health. For both neurologic and psychiatric diseases, it is essential to plan ahead and choose treatments that keep these conditions under control while minimizing risk to the growing fetus.

Neurologic Conditions

• Seizure disorders

• Headache

• AV malformation/Berry aneurysm

• Multiple sclerosis

• Pseudotumor cerebri

• Myasthenia gravis

• Spinal cord injury

• Diabetes insipidus

Psychiatric Conditions

• Drugs of abuse

• Depression

• Other psychiatric disorders

• Domestic abuse

Immune Disorders and Infections

Pregnancy changes the immune system so that the mother's body does not reject the growing baby. These changes can increase the risk of some infections. Other infections can cause birth defects and may require specialized treatment during pregnancy. Changes to the immune system may also affect autoimmune disorders.

Infectious Disorders

• Hepatitis A

• Hepatitis B

• Hepatitis C

• HIV

• Gonorrhea

• Chlamydia

• Syphilis

• Trichomonas

• Group B streptococcus

• Rare infections

Autoimmune Disorders

• Antiphospholipid syndrome

• Systemic lupus erythematosus

Surgical Emergencies

When surgical emergencies occur in pregnancy, surgeons and MFMs work together to ensure the health of two patients at the same time.

• Trauma

• Critical care

• Non-obstetric abdominal surgery in the current pregnancy

Bone, Cartilage, and Skin Disorders

Pregnancy stretches joints and tissues, affecting bones, cartilage, and connective tissue.

• Marfan syndrome

• Maternal skeletal dysplasia

• Dermatoses

Cancer

For cancer survivors, pregnancy may stress organs that were strained by chemotherapy, requiring extra monitoring. In other cases, cancer is diagnosed during pregnancy. MFMs partner with medical and surgical oncologists to map out surgery, chemotherapy, and timing of birth to minimize risk to mother and child.