When things go wrong during pregnancy, the health of both mother and baby may be at risk of certain health problems associated with pregnancy.
Infertility. Infertility is defined as failure to conceive following a period of 12 months or longer of unprotected sexual intercourse. In 1988, over 8 million American women 15 to 44 years of age reported an impaired ability to have children. Major causes include endometriosis, poor sperm quality or low sperm count, failure to ovulate, and tubal damage.
Ectopic Pregnancy. An ectopic pregnancy is a pregnancy that has implanted outside of the uterus, most commonly in the Fallopian tubes, which may have been scarred from a previous infection, ectopic pregnancy, or tubal ligation. The growing pregnancy, if not surgically terminated, may rupture the tube, causing hemorrhage. Ectopic pregnancy is a leading cause of maternal deaths among African-American women.
Abortion. Abortion refers to the termination of pregnancy before the twentieth week of gestation (counting from the last menstrual period). Abortion can be spontaneous or induced. Most spontaneous abortions (miscarriages) involve some chromosomal abnormalities; the causes of the rest are not known, but some may be due to exposure to environmental toxins.
Birth Defects. Birth defects are the leading cause of infant death and the fifth leading cause of potential years of life lost. About 3.6 percent of all babies in the United States are born with major birth defects, the most common being cleft lip and palate, Down syndrome, neural tube defect, and congenital heart disease.
Low Birth Weight (LBW). LBW, defined as birth weight under 2,500 grams (5.5 pounds), is the second leading cause of infant death, and the leading cause of infant death among African Americans. Risk factors include short interpregnancy interval, low prepregnancy weight, inadequate weight gain during pregnancy, history of LBW or preterm birth, cigarette smoking, and socioeconomic factors.
Preterm Birth. Preterm birth, defined as delivery before 37 weeks of gestation, may result in major problems, including neurological damage from brain hemorrhage or respiratory distress from immature lungs.
Fetal Death. Fetal death refers to the death of a fetus after 20 weeks of gestation. Major causes include preexisting maternal conditions like diabetes mellitus or hypertension, and premature separation of the placenta from the uterus (placental abruption) as a result of drug use or trauma.
Infant Death. Infant death refers to death of a baby under one year of age. Major causes include birth defects, LBW, and sudden infant death syndrome (SIDS).
Maternal Death. Maternal death is defined as the death of a woman as a result of her pregnancy, from the first stages of gestation to within 42 days after the pregnancy has terminated. Risk factors include age greater than 35, unmarried status (owing to socioeconomic factors, including a lack of access to health care), and lack of prenatal care. The classic HIT triad (hemorrhage, infection, and toxemia or preelcampsia) contributes to about half of all maternal deaths. Approximately 300 women in the United States and 500,000 women in the world die every year from pregnancy-related causes. The maternal mortality ratio of 7.5 deaths per 100,000 live births in the United States did not changed significantly during the last 20 years of the twentieth century.
Preeclampsia. Preeclampsia, caused by high blood pressure during the latter part of pregnancy, is characterized by hypertension, protein in the urine, edema, and organ damage as a result of hypertension. Such organ damage may include seizure, stroke, kidney failure, liver damage, and fluid in the lungs. Preeclampsia is treated by effecting prompt delivery (and thereby ridding the body of the circulating toxin released by the placenta). Magnesium is commonly used to prevent seizure. Complications of severe preeclampsia can often be prevented with early diagnosis and appropriate treatment.
Obstetrical Hemorrhage. Obstetrical hemorrhage is characterized by excessive blood loss. It occurs prenatally as a result of premature separation (placental abruption) or abnormal location (placenta previa) of the placenta. It can also occur as a result of injury to the birth canal during delivery, retained placenta within the uterus after delivery, or the inability of the uterus to firm up (uterine atony) after delivery.
Puerperal Infection. Puerperal infections are those that occur during labor, delivery, or the postpartum period. The infection is typically caused by bacteria from the vagina ascending into the uterus. Risk factors include cesarean section, prolonged time from when the “water breaks” to delivery, poor nutrition, and maternal anemia. Prompt treatment with antibiotics can prevent significant morbidity associated with puerperal infections.
Embolism. An embolus is a clot. It could be a blood clot (thromboembolus), or a clot of fetal tissues (amniotic fluid embolus) that travels in maternal circulation. If it blocks off circulation in the lungs or the heart, the embolus could be fatal.
