4 Complications of Pregnancy

Initial assessment and escalation

Pregnancy complications range from conditions detected through routine screening to emergencies requiring immediate stabilization and birth. Initial assessment considers maternal vital signs and symptoms, gestational age, relevant medical and pregnancy history, and fetal well-being when appropriate. Severe or rapidly worsening symptoms need urgent evaluation; do not delay care while trying to identify the cause at home.

Hypertensive disorders

Gestational hypertension is new high blood pressure after $20$ weeks of pregnancy in someone whose blood pressure was previously normal. Preeclampsia is new hypertension after $20$ weeks with proteinuria and/or signs of organ involvement; it can also first appear after birth. Feeling well or having no symptoms does not rule out preeclampsia.

Severe-range blood pressure is an emergency: systolic pressure of at least $160\,\text{mm Hg}$ or diastolic pressure of at least $110\,\text{mm Hg}$. Warning symptoms include persistent severe headache, visual changes, upper abdominal pain, shortness of breath, or sudden marked swelling.

Assessment includes correctly measured, repeated blood pressure; review of symptoms; urine protein assessment; and laboratory testing for platelet count, kidney function, and liver injury. Fetal growth and well-being may also be evaluated. Management depends on severity and gestational age. It may include close maternal and fetal monitoring, pregnancy-compatible medication to control severe blood pressure, and magnesium sulfate when indicated to prevent or treat seizures. Delivery is the definitive treatment for preeclampsia, but its timing and route depend on maternal and fetal condition and gestational age.

Diabetes in pregnancy

Gestational diabetes is diabetes first recognized during pregnancy. It may have no symptoms, so screening is important, typically at $24\text{–}28$ weeks, with earlier testing for some patients at higher risk. Poorly controlled glucose increases the risk of excessive fetal growth, birth complications, and low blood sugar in the newborn.

Management generally includes nutrition counseling, physical activity when safe, home glucose monitoring, and medication if glucose targets are not met. Insulin is a commonly recommended medication. The care plan may also include additional fetal surveillance and individualized delivery planning. Diabetes diagnosed before pregnancy requires coordinated care to manage glucose and assess related health risks.

Bleeding and early-pregnancy complications

Bleeding in pregnancy has many possible causes. Ectopic pregnancy is implantation outside the uterus, usually in a fallopian tube, and can cause vaginal bleeding and one-sided pelvic pain. Sudden severe abdominal or pelvic pain, shoulder pain, weakness, dizziness, or fainting may indicate rupture and internal bleeding; this is an emergency. Evaluation may include ultrasound and serial human chorionic gonadotropin (hCG) blood tests. Treatment is medication or surgery, depending on the clinical situation.

Later in pregnancy, placenta previa may cause painless bleeding. Placental abruption often causes bleeding with abdominal or back pain and uterine tenderness. It may involve serious blood loss or fetal compromise, and visible bleeding can underestimate the amount of concealed bleeding. Any bleeding warrants prompt contact with the obstetric care team; heavy bleeding or signs of instability require emergency care. Suspected placenta previa is assessed with ultrasound; avoid a digital vaginal examination until previa has been excluded. Management is guided by bleeding, maternal stability, gestational age, and fetal status, and may require urgent delivery.

Severe nausea and vomiting

Mild nausea and vomiting are common, especially early in pregnancy. Hyperemesis gravidarum is severe illness involving persistent vomiting, dehydration, weight loss, or related metabolic problems. Concerning signs include inability to keep fluids down, very little or dark urine, dizziness or fainting, and a racing heartbeat.

Assessment may include hydration status, weight change, and laboratory tests. Treatment can include pregnancy-compatible anti-nausea medication. Significant dehydration or ongoing weight loss may require hospital care, intravenous fluids, and vitamins.

Preterm labor and membrane rupture

Preterm labor begins before $37$ completed weeks and involves contractions with changes in the cervix. Symptoms can include regular tightening, pelvic pressure, menstrual-like cramps, low backache, or a change in vaginal discharge. Contact the obstetric care team or go to the hospital promptly rather than waiting to see whether symptoms stop. Assessment may include contraction monitoring, cervical evaluation, and ultrasound. Depending on gestational age and clinical findings, treatment may include medicines to support fetal maturation, briefly delay birth when appropriate, or reduce certain fetal risks. Delivery or transfer to a hospital with appropriate newborn care may be needed.

Prelabor rupture of membranes means the amniotic sac breaks before labor begins. A gush or ongoing trickle of fluid needs prompt assessment, including evaluation for infection, labor, and fetal well-being. When membranes rupture before $37$ weeks, management balances the risks of prematurity against infection and other complications. The plan depends on gestational age and the condition of the pregnant patient and fetus.

Infection and blood clots

Pregnancy increases the importance of recognizing urinary infection. A urine culture early in prenatal care screens for bacteria even when symptoms are absent. Pain or burning with urination, or other suspected urinary tract infection symptoms, should be assessed with urine testing and treated with an appropriate antibiotic. Fever of $38\,^{\circ}\text{C}$ ($100.4\,^{\circ}\text{F}$) or higher with flank pain or tenderness may indicate pyelonephritis, a kidney infection that can require hospital treatment.

Pregnancy also increases the risk of venous blood clots. One-sided leg swelling, warmth, redness, or pain needs urgent evaluation for deep-vein thrombosis. Sudden shortness of breath, chest pain, rapid breathing, or coughing blood may indicate a pulmonary embolism and requires emergency care. Assessment and treatment are clinician-directed; people with significant clotting risk may need preventive measures.

Warning signs that need urgent care

Seek urgent medical care for severe or persistent headache, visual changes, fainting, fever, trouble breathing, chest pain, severe abdominal pain, heavy vaginal bleeding, fluid leaking from the vagina, or a notable decrease or stop in fetal movement. These signs can indicate serious complications and should not be dismissed as routine discomforts.

Recognition of complications relies on symptoms, prenatal screening, vital signs, laboratory tests, imaging, and fetal assessment. Prompt escalation for warning signs, individualized treatment, and timely delivery when necessary help protect both the pregnant patient and fetus.