Early ante-natal care critical in predicting and preventing serious pregnancy complications

3/21/2016 obstetrics and gynaecology

Every expectant mother has concerns about different complications that can occur during the nine months of pregnancy. While some of them like nausea and vomiting are common and pass by the first trimester, others are serious and can be life threatening to either the mother, baby or even both. Dr Sikolia Wanyonyi, a Consultant Obstetrician and Gynaecologist, and a Fetal Medicine Specialist at Aga Khan University Hospital says that 80 per cent of pregnancies will be free of any major complications and only about 20 per cent of expectant mothers suffer serious problems that will involve intervention by a doctor. Dr Wanyonyi explains, “Women should go for ante-natal visits as early as 12 weeks of pregnancy. During the first visit, the doctor asks the patient various questions including family medical history, previous pregnancies and runs various tests. This helps to identify patients who may be at risk of various complications and develop a plan to help them cope throughout the pregnancy.” “For instance, chronic high blood pressure which is poorly-controlled before and during pregnancy makes a pregnant woman and her baby likely to have problems. It is associated with an increased risk of maternal complications such as pre-eclampsia (a potentially fatal condition characterised by kidney and liver failure and could also lead to seizures and brain damage) and placental abruption (when the placenta separates prematurely from the uterus wall.” “It is important that during ante-natal visits, the blood pressure of the mother is taken together with urine tests to detect protein in the urine. Pre-eclampsia is among the top five causes of maternal deaths and is common among teenage mothers, women over 40 years of age and those with a family history of hypertension. The doctor can prescribe medication to control high blood pressure in pregnancy.” In May 2014, Christine Wanjiku, a first time mother of one during an ante-natal clinic visit to Aga Khan University Hospital was found to have elevated blood pressure with proteins in her urine. Blood tests were subsequently ordered which revealed that she had a HELLP syndrome (a life-threatening complication considered to be a variant of pre-eclamsia) at 32 weeks pregnant. The obstetric scan at that point also showed that the baby was being affected by this condition and delivery was highly recommended. “Dr Sikolia told me the complication was severe and they had to deliver the baby immediately. Although I had not experienced any problems before, at this time I was vomiting, one kidney was failing, the liver was not working well and by the time I went to theatre for a caesarian section, my platelets were too low and at risk of blood clotting.” “My baby was delivered at 32 weeks weighing 1.7 kilogrammes but the lungs had not fully formed and was admitted at the hospital’s Neonatal Intensive Care Unit for a month.” “My daughter is now well and turning two years on May 21. Ante-natal clinic visits are very critical in diagnosing these complications and expectant mothers should have them right from week one of their pregnancy,” advices Christine. Vaginal bleeding at any time during pregnancy should be taken serious. In early pregnancy, it may be a sign of miscarriage or ectopic pregnancy. Bleeding that occurs in the second and third trimester of pregnancy can often be a sign of a major complication. Causes of such bleeding may also include ectopic pregnancy (pregnancy that develops outside the womb), cervical cancer, molar pregnancy (the growth of abnormal tissue instead of an embryo), placenta previa (placenta sits low in the uterus) and placenta abruption. Because vaginal bleeding in any trimester is a bad sign, it is important to see the doctor immediately. The doctor will carry out an ultrasound to identify the underlying cause of the bleeding. Vaginal and abdominal ultrasounds are often performed together as part of a full evaluation. Miscarriage is another major pregnancy complication. This is the loss of a fetus before the 20th week of pregnancy. Usually, most miscarriage cannot be prevented and often occurs because the pregnancy is not normal. This can be as a result of the baby’s chromosomal abnormality, problems with the uterus, or cervix, or thrombophilia (tendency to form clots in small vessels). Dr Sikolia Wanyonyi advices, “Any woman who suffers two consecutive first trimester miscarriages should see a doctor to test for the root cause of the miscarriages. If a specific problem is identified, then treatment options may be available. For example thrombophilia can be treated with blood thinners while an incompetent cervix can be stitched.” Infections can also cause serious complications in pregnancy. If left untreated, they can affect the baby and cause pre-term labour, miscarriages and low birth weight. Dangerous infections include malaria, flu, hepatitis, meningitis, urine infections, sexually transmitted infections and HIV. HIV positive women wishing to conceive should consult the doctor before getting pregnant to help prevent mother to child transmission. Vaccines for infections like flu and meningitis are also available. Malformations of the fetus are also a major concern in pregnancy. These can be detected early by an ultrasound scan. Ultrasounds can identify up to 70 per cent of malformations at 20 to 22 weeks including those of the heart, limbs and head development. Malformations can result from chromosomal abnormalities causing conditions like Down’s syndrome and genetic disorders. Other causes include alcohol abuse, diabetes, medication taken during pregnancy, amniotic abnormalities and infections such as Rubella and chicken pox (during the first trimester). Low levels of folic acid have been implicated in causing neural tube defects, where the spinal cord isn’t completely enclosed. There are many other complications experienced during pregnancy and delivery. But with the advancement in science and technology, a lot of them can be predicted and prevented. Visiting the doctor before conception and early pregnancy enables the specialist to give advice and closely monitor the patient as the pregnancy develops and to be prepared for any eventualities during delivery.

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Early ante-natal care critical in predicting and preventing serious pregnancy complications

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