INTRODUCTION

Pregnancy is the carrying of one or more embryos or foetuses by female mammals, including humans, inside their bodies. Human pregnancy is the most studied of all mammalian pregnancies. A pregnancy complication is any condition or illness that threatens the mother and/or fetus during pregnancy. Common pregnancy complications include pre-eclampsia, premature labour, gestational diabetes and depression. Pregnancy complications may result from a number of possible factors, including pre-existing disorders

or diseases (e.g. diabetes, high blood pressure) or abnormalities of the m or sperm or egg. Complications may also result from sexually transmitted diseases, abnormalities in the amniotic fluid, placental abnormalities and viral, bacterial or parasitic infections. Most pregnant women only experience minor complications of pregnancy, but for a minority more serious problems occur for the mother and/or fetus. In addition, a number of complications may result in death of the mother or loss of the fetus. These problems range from failure of the embryo to implant in the womb, leading to miscarriage, to the rupture of the placenta. The fetus can also develop problems in the womb, including congenital defects.

ECTOPIC PREGNANCY

An ectopic pregnancy is one which occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in a fallopian tube, and are thus sometimes called tubal pregnancies. The fallopian tubes are not designed to hold a growing embryo. The fertilized egg in a tubal pregnancy cannot develop normally and must be treated. An ectopic pregnancy occurs in 1 out of 60 pregnancies.

CAUSES OF ECTOPIC PREGNANCY

Ectopic pregnancies are caused by one or more of the following: An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked. Scar tissue left behind from a previous infection or an operation on the tube may also impede the eggs movement. Previous surgery in the pelvic area or on the tubes can cause adhesions. An abnormality in the tubes shape can be caused by abnormal growths or a birth defect.

WOMEN AT A RISK OF HAVING ECTOPIC PREGNANCY

Women who are more at risk for having an ectopic pregnancy include the following: Are 35-44 years of age Have had a previous ectopic pregnancy Have had pelvic or abdominal surgery Have Pelvic Inflammatory Disease(PID) Have had several induced abortions Women who get pregnant after having a tubal ligation or while an IUD is in place

SYMPTOMS OF AN ECTOPIC PREGNANCY

Sharp or stabbing pain that may come and go and vary in intensity. The pain may be in the pelvis, abdomen or even the shoulder and neck (due to blood from a ruptured ectopic pregnancy gathering up under the diaphragm). Vaginal bleeding, heavier or lighter than normal period Gastrointestinal symptoms Weakness, dizziness, or fainting Pain when urinating or defecating.

DIAGNOSIS OF ECTOPIC PREGNANCY

Ectopic pregnancies are diagnosed first by a pelvic exam to locate pain, tenderness or a mass in the

abdomen. An ultrasound is used to determine whether the uterus contains a developing fetus. The measurement of hCG levels is also important. An h CG level that is lower than what would be expected is one reason to suspect an ectopic pregnancy. Low levels of progesterone may also indicate that a pregnancy is abnormal. A process called Culdocentesis is also done, which is a procedure that involves inserting a needle into the space at the very top of the vagina, behind the uterus and in front of the rectum. The presence of blood in this area may indicate bleeding from a ruptured fallopian tube.

TREATMENT OF ECTOPIC PREGNANCY

An ectopic pregnancy may be treated in any of the following way: Methotrexate may be given, which allows the body to absorb the pregnancy tissue and may save the fallopian tube, depending on how far the pregnancy has developed. If the tube has become stretched or it has ruptured and started bleeding, all or part of the fallopian tube may have to be removed. Bleeding needs to be stopped promptly, and emergency surgery is needed. Laparoscopic surgery under general anaesthesia may be performed. This procedure involves a surgeon using a laparoscope to remove the ectopic pregnancy and repair or remove the affected fallopian tube. If the ectopic pregnancy cannot be removed by a laparoscope procedure, then another surgical procedure called a laparotomy may be done.

MISCARRIAGE

Miscarriage is the term used for a pregnancy that ends on its own, within the first 20 weeks of gestation. The medical name for this is spontaneous abortion (SAB). If the baby is lost after 20 weeks of pregnancy, it is called Stillbirth. Miscarriage is the most common type of pregnancy loss. 50-75% of all miscarriages occur when a pregnancy is lost shortly after implantation resulting in bleeding that occurs around the time of the expected period of the mother (first trimester).

CAUSES FOR MISCARRIAGES

The reason for miscarriage is varied, and most often the cause cannot be identified. During the first trimester, the most common cause of miscarriage is chromosomal abnormality. Most chromosomal abnormalities are the cause of a faulty egg or sperm cell, or are due to a problem at the time when the zygote went through the division process. Other causes of miscarriage include: Hormonal problems, infections or maternal health problems Lifestyle (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances) Implantation of the egg into the uterine lining does not occur properly Maternal age and trauma

WOMEN AT A RISK OF HAVING MISCARRIAGES

For women in childbearing years, the chances of having a miscarriage can range from 10-25%, and in most healthy women the average is about 15-20% chance. An increase in maternal age increases the chances of a miscarriage Women under the age of 35 years old have about 15% chances of miscarriage Women who are 35-45 years old have a 20-35% chance of miscarriage Women over the age of 45 can have up to a 50% chance of miscarriage A woman who has had a previous miscarriage has a 25% chance of having another

SYMPTOMS OF A MISCARRIAGE
Mild to severe back pain (often worse than normal menstrual cramps) Weight loss

 White-pink mucus True contractions (very painful happening every 5-20 minutes) Brown or bright red bleeding with or without cramps (20-30% of all pregnancies can experience some bleeding in early pregnancy, with about 50% of those resulting in normal pregnancies) Tissue with clot like material passing from vagina Sudden decrease in signs of pregnancy

TREATMENT OF MISCARRIAGE
The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal

tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure formed to stop bleeding and prevent infection is a dilation and curettage, known as D&C. Drugs may be prescribed to help control bleeding after the D&C is performed. Bleeding should be monitored closely once you are at home; if you notice an increase in bleeding or the onset of chills or fever, it is best to cal your physician immediately.

PREVENTION OF MISCARRIAGE
Since the cause of most miscarriages is due to chromosomal abnormalities, there is not much that can be done to prevent them. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur. Exercise regularly Eat healthy Manage stress Keep weight within healthy limits Take folic acid daily Do not smoke

Once the woman is pregnant, again the goal is to be as healthy as possible, to provide a healthy environment for the baby to grow in:

Keep your abdomen safe Do not smoke or be around smoke Do not drink alcohol Check with your doctor before taking any overthe-counter medications Limit of eliminate caffeine Avoid environmental hazards such as radiation, infectious disease and x-rays.

PLACENTA PREVIA

Placenta previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix. The placenta may separate from the uterine wall as the cervix begins to dilate (open during labor.

CAUSES OF PLACENTA PREVIA

The exact cause of placenta previa is unknown. However, the following can increase your risk: If over the age of 35 years Had more than four pregnancies Have a history of uterine surgery (regardless of incision type)

RISK OF HAVING PLACENTA PREVIA

Placenta previa affects about 1 in 200 pregnant women in the third trimester of pregnancy. Placenta previa is more common in women who have had one or more of the following: More than one child A caesarean birth Surgery on the uterus Twins or triplets

SYMPTOMS OF PLACENTA PREVIA

Signs and symptoms of placenta previa vary, but most common symptom is painless bleeding during the third trimester. Other reasons to suspect placenta previa would be: Premature contractions Baby is breech, or in transverse position Uterus measures larger than it should according to gestational age

TREATMENT OF PLACENTA PREVIA

Once diagnosed, placenta previa will usually require bed rest for the mother and frequent hospital visits. Depending on the gestational age, steroid shots may be given to help mature the babys lungs. If the bleeding cannot be controlled, an immediate caesarean delivery is usually done regardless of the length of the pregnancy. Some marginal previas can be delivered vaginally, although complete or partial previas would require a caesarean delivery.

INCOMPETENT CERVIX

During pregnancy, as the baby grows and gets heavier, it presses on the cervix. This pressure may cause the cervix to start to open before the baby is ready to be born. This condition is called incompetent cervix or weakened cervix, and it may lead to miscarriage or premature delivery. However, an incompetent cervix happens in only about 1 out of 100 pregnancies. An incompetent or weakened cervix happens in about 1-2% of pregnancies. Almost 25% of babies miscarried in the second trimester are due to incompetent cervix.

CAUSES OF INCOMPETENT CERVIX

A weakened can be caused by one or more of the following conditions:

Previous surgery on the cervix Damage during a difficult birth Malformed cervix or uterus from a birth defect Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage DES (Diethylstilbestrol) exposure

SYMPTOMS OF INCOMPETENT CERVIX

Change in the amount or type of vaginal discharge, particularly a mucosy or watery discharge Vaginal spotting or bleeding Menstrual- like cramping

 Pelvic pressure or heaviness

TREATMENT OF INCOMPETENT CERVIX

The treatment for an incompetent or weakened cervix is a procedure that sews the cervix closed to reinforce that cervix. This procedure is called a cerclage and is usually performed between week 14-16 of pregnancy. These sutures will be removed between 36-38 weeks to prevent any problems when you go into labor. Removal of the cerclage does not result in spontaneous delivery of the baby. A woman would not be eligible for a cerclage if: There is increased irritation of the cervix The cervix has dilated 4 cm Membranes have ruptured Possible complications of cervical cercalge include uterine rupture, maternal hemorrhage, bladder rupture, cervical laceration, preterm labor and premature rupture of the membranes. The likelihood of these risks is very minimal, and most health care providers feel that cerclage is a life saving procedure that is worth the possible risks involved.

POLYHYDRAMNIOS

Polyhydramnios is the condition of having too much amniotic fluid. Doctors can measure the amount of fluid through a few different methods, most commonly through amniotic fluid index (AFI) evaluation or deep pocket measurements. If an AFI shows a fluid level of more than 25 centimetres (or above the 95th percentile), a single deep pocket measurement of <8, or a fluid level of 2000 ml or more, then a diagnosis of polyhydramnios would be made. About 1-2% of pregnant women have too much amniotic fluid. Most of these cases are mild, with only slightly elevated levels.

CAUSES OF POLYHYDRAMNIOS

Congenital defects- The higher the fluid level, the increased chance of a congenital defect. These birth defects hinder swallowing, which can prohibit ingestion of the amniotic fluid, resulting in buildup of fluid. Other birth defects could also include intestinal tract blockage or neurological abnormalities. Rh factor- As screening for the Rh factor has increased, this is no longer a common cause of elevated fluid levels. Maternal diabetes- Experts have found some correlation between diabetes and too much amniotic fluid. Twin-to-twin transfusion syndrome- This a complication that can affect identical twin pregnancies. This syndrome is when one baby gets too much blood flow and the other too little due to connections between blood vessels in their shared placenta. Unknown Reasons- According to the Center for Maternal Fetal Medicine, about 65% of cases of polyhydramnios are due to unknown causes.

RISK OF HAVING POLYHYDRAMNIOS

Most cases of polyhydramnios are mild and result in few, if any, complications. Those with higher levels

of fluid could experience one or more of the following risks: Premature rupture of the membranes (PROM) Placental abruption Preterm labor and delivery (approximately 26%) Growth restriction (IUGR) resulting in skeletal malformations Stillbirth occurs in about 4 in 1000 pregnancies that suffer from polyhydramnios vs. about 2 in 1000 pregnancies with normal fluid levels Caesarean delivery Postpartum hemorrhage

SYMPTOMS OF POLYHYDRAMNIOS
The woman may feel that her stomach is getting too large too quickly and that her skin is stretched and shiny. She might also feel breathless that it becomes hard to climb a flight of stairs. Other symptoms include abdominal pain, severe heartburn and constipation, swollen legs and varicose veins. Ultrasound scanning can confirm the diagnosis of polyhydramnios.

TREATMENT OF POLYHYDRAMNIOS
Many cases of polyhydramnios are easily treated and do not result in complications if the pregnancy is monitored closely. Monitoring would include

frequent sonograms measuring growth, biophysical profile and fetal assessment. Other treatments could include: Medication that can reduce fluid production and are as much as 90% effective. This treatment is not used after 32 weeks gestation because of possible complications. Amnioreduction is a procedure that can be used to drain excess fluids. This is done through amniocentesis, which may carry certain risks. There is, however, the chance that fluid could build back up even after draining. Delivery of the baby

OLIGOHYDRAMNIOS

Oligohydramnios is the condition of having too little amniotic fluid. Doctors can measure the amount of fluid through a few different methods, most commonly through amniotic fluid index (AFI) evaluation or deep pocket measurements. If an AFI shows a fluid level of less than 5 centimetres (or less than the 5th percentile), the absence of a fluid pocket 2-3 cm in depth, or a fluid fluid volume less than 500ml at 32-36 weeks gestation, then a diagnosis of oligohydramnios would be suspected. About 8% of pregnant women can have low levels of amniotic fluid, with about 4% being diagnosed with oligohydramnios. It can occur at any time during pregnancy, but it is most common during the last trimester. If a woman is past her due date by two weeks or more, she may be at a risk for low amniotic fluid levels since fluids can decrease by half once she reaches 42 weeks gestation. Oligohydramnios can cause complications in about 12% of pregnancies that go past 41 weeks.

CAUSES OF OLIGOHYDRAMNIOS
Birth defects- They refer to problems with the development of the kidneys or urinary tract which could cause little urine production, leading to low levels of amniotic fluid.

Placental problems- If the placenta is not providing enough blood and nutrients to the baby, then the baby may stop recycling fluid. Leaking or rupture of membranes- This may be a gush of fluid or a slow constant trickle of fluid. This is due to a tear in the membrane. Premature rupture of membranes (PROM) can also result in low amniotic fluid levels. Post Date Pregnancy- A post date pregnancy (one that goes over 42 weeks) can have low levels of amniotic fluid, which could be a result of declining placental function. Maternal Complications- Factors such as maternal dehydration, hypertension, preeclampsia, diabetes and chronic hypoxia can have an effect on amniotic fluid levels.

RISK OF HAVING OLIGOHYDRAMNIOS

The risks associated with oligohydramnios often depend on the gestation of the pregnancy. The amniotic fluid is essential for the development of muscles, limbs, lungs and the digestive system. In the second trimester, the baby begins to mature. The amniotic fluid also helps the baby develop muscles and limbs by providing plenty of

room to move around. If oligohydramnios is detected in the first half of pregnancy, the complications can be more serious and include: Compression of fetal organs resulting in birth defects Increased chance of miscarriage or stillbirth

SYMPTOMS OF OLIGOHYDRAMNIOS
The doctor may suspect this problem if the following takes place: The woman is leaking fluid The baby is smaller than normal at that period of pregnancy On examination the outline of the baby is easily felt The woman has had a previous baby whose growth was restricted The woman has chronic high blood pressure The woman has diabetes The woman has lupus

TREATMENT OF OLIGOHYDRAMNIOS

The treatment for low levels of amniotic fluid is based on gestational age. Tests such as non-stress and contraction stress tests may be done to monitor your babys activity. Other treatments that may be used include:

Amnio-infusion during labor through an intrauterine catheter. This added fluid helps with padding around the umbilical cord during delivery and is reported to help lower the chances of a caesarean delivery. Injection of fluid prior to delivery through amniocentesis. The condition of oligohydramnios is reported to often return within one week of this procedure, but it can aid in helping visualize fetal anamtomy and make a diagnosis. Maternal re-hydration with oral fluids or IV fluids has shown to help increase amniotic fluid levels.

LISTERIA

Listeria monocytogenes is a type of bacteria that is found in water and soil. Vegetables can become contaminated from the soil and animals can also be carriers. Listeria has been found in uncooked meats, uncooked vegetables, unpasteurized milk, foods from unpasteurized milk and processed foods. Listeria is killed by pasteurization and cooking. There is a chance that contamination may occur in ready-to-eat foods such as hot dogs and deli meats because contamination may occur after cooking and before packing.

RISK OF HAVING LISTERIA

According to research, pregnant women account for 27% of these cases. The Centers for Disease Control

and Prevention (CDC) claims that pregnant women are 20 times more likely to become infected than non-pregnant healthy adults. SYMPTOMS OF LISTERIA Symptoms of Listeriosis may show up 2-30 days after exposure. Symptoms in pregnant women include mild flu like symptoms, headaches, muscle aches, fever, nausea and vomiting. If the infection spreads to the nervous system it can cause stiff neck, disorientation or convulsions. Infection can occur at any time during pregnancy, but it is most common during the third trimester when your immune system is somewhat suppressed. You could also experience: Miscarriage Premature delivery Infection to the new born

TREATMENT OF LISTERIA

Listeriosis is treated with antibiotics during the pregnancy. These antibiotics, in most cases, will prevent infection to the fetus. These same antibiotics are also given to newborns with Listeriosis. Following these guidelines can greatly reduce chances of contracting Listeriosis: Eat hard cheeses instead of soft cheeses Do not eat refrigerated pates or meat spreads Do not eat hot dogs, luncheon meats or deli meats unless they are cooked properly Do not eat refrigerated smoked seafood unless it is contained in a cooked dish, such as a casserole Practise safe handling of food: a. Wash all fruits and vegetables b. Keep everything clean, including your hands and preparation surfaces c. Keep your refrigerator thermometer at 40 degrees or below d. Clean your refrigerator often e. Avoid cross contamination between raw and uncooked foods f. Cook foods at proper temperatures and reheat all foods until they are steaming hot.

MOLAR PREGNANCY

A molar pregnancy is the result of genetic error during the fertilization process that leads to growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, and the growth of this material is rapid compared to normal fetal growth. It has the appearance of a large and random collection of grape-like cell clusters. Molar pregnancies are also called gestational trophoblastic disease (GTD), hydatidiform mole or simply referred to as mole. There are two types of molar pregnancies: Complete molar pregnancies: They have only placental parts (there is no baby), and form when the

sperm fertilizes an empty egg. Since the egg is empty, no baby is formed. The placenta grows and produces the pregnancy hormone, hCG. An ultrasound will show that there is no fetus, only a placenta. Partial mole: It occurs when the mass contains both, the abnormal cells and an embryo that has severe defects. In this case the fetus will be overcome by the growing abnormal mass rather quickly. An extremely rare version of a partial mole is when twins are conceived but one embryo begins to develop normally while the other is a mole.

RISK OF HAVING A MOLAR PREGNANCY

White women in the US are at a higher risk than black women Women over the age of 40 years Women who have had a prior molar pregnancy Women with a history of miscarriage

SYMPTOMS OF MOLAR PREGNANCY

Vaginal spotting or bleeding Nausea and vomiting Develop rare complications like thyroid disease

 Early preeclampsia (high blood pressure) Increased hCG levels No fetal movement or heart tone detected

TREATMENT OF MOLAR PREGNANCY

Most molar pregnancies will spontaneously end and the expelled tissue will appear grape-like. Molar pregnancies are removed by suction evacuation, dilation and curettage (D&C), or sometimes through medication. General anesthetic is normally used during these procedures. Approximately 90% women who have a mole removed require no further treatment. Follow-up procedures that monitor the hCG levels can occur monthly for 6 months or as your physician prescribes. Follow-up is done to ensure that the mole has been removed completely. Traces of the mole can begin to grow again and may possess a cancerous-type threat to other parts of the body. Pregnancy should be avoided for one year after a molar pregnancy. Any birth control method is acceptable with the exception of an intrauterine device.

Conclusion
Despite all its possible complications, difficulties and discomforts, pregnancy is a boon. It is the birth of a new life and along with it, the birth of the most cherished experience of a woman- motherhood. A mothers joy begins when a new life is stirring inside, when a tiny heartbeat is heard for the very first time, and a playful kick reminds her that she is never alone. Great care, a healthy diet and exercise help to ensure a healthy pregnancy. So, despite the risk of complications, pregnancy is one of the most wonderful phases of a womans life because as they say:
Being fat lasts nine months, but the joy of motherhood lasts forever.

BIBLIOGRAPHY

WEB: www.google.co.in, www.wikipedia.org BOOKS: Cherry and Merkatzs Complication of Pregnancy