Pregnancy Complications

Pregnant woman getting prenatal care
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While the vast majority of pregnancies are uncomplicated, the entire system of prenatal care is designed to screen for potential complications and to help prevent those complications that can be prevented. Through the system of checking your blood pressure, your urine, your blood, your weight, measuring your fundus (top of the uterus), and a variety of other things, we are trying to keep you and your baby healthy so that you can have the safest pregnancy and birth possible.

This also means that we are able to hopefully find and treat problems earlier before they become bigger problems.

All of this said, there are some pregnancy complications that are more common than others. While they may only affect a small percentage of pregnant women, they can be painful and potentially dangerous to both mother and/or baby. So, here is a basic list of what might be screened for in an average pregnancy, but know that your doctor or midwife is also personalizing this list to you based on your medical and familial history to provide you with the best care possible.

Rh Factor

Everyone has both a blood group type and an Rh factor. In addition to the blood group (A, B, O, AB), the Rh factor is written as either positive (present) or negative (absent). Most people (85 percent) are Rh positive. This factor does not affect your health and doesn't typically matter, except when you're pregnant.

A pregnant woman is at risk when she has a negative Rh factor and her partner has a positive Rh factor. This combination can produce a child who is Rh positive. If the mother and baby's blood mix, this can cause the mother to create antibodies against the Rh factor, thus treating an Rh positive baby like an intruder in her body.

Typically the blood from the mother and baby do not mix, there are certain times there is a slight chance, like in birth, some prenatal tests like an amniocentesis, or after a miscarriage. Rhogam is given to help prevent this sensitization.

If you and your partner are both Rh negative, this is not something that will be problematic in your pregnancy. Don't be concerned if you don't know your blood type. This is something that will be checked early on in your prenatal care.

Gestational Diabetes (GD)

Gestational diabetes (GD) is high blood sugar or glucose levels during pregnancy. About four percent of pregnant women will suffer from gestational diabetes. Most mothers will need to be screened using blood work, there are guidelines as to who needs to be screened with blood work. This is typically screened for in the twenty eighth week of pregnancy. If you need additional screening with a glucose tolerance test (GTT), it will be done at this point. If you have GD, your labor may be induced as you get closer to the forty week mark.

If you have gestational diabetes, you will need to monitor your blood sugar. You will be taught how and when to do this during your pregnancy. Then using your diet and exercise, you will try to control your blood sugar. Medications are only used if diet and exercise don't work. You will typically see a nutritionist for help with this process, in addition to your practitioner.

Preeclampsia/Pregnancy Induced Hypertension/High Blood Pressure

Preeclampsia or pregnancy induced hypertension (PIH) is a high blood pressure disorder of pregnancy. It has long been one of the major problems for mothers in pregnancy, it may also be talked about as eclampsia or preeclampsia. It affects seven percent of first-time mothers. Labor may be induced early if you suffer from severe PIH.

According to the new ACOG guidelines, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). Evidence shows organ problems with the kidneys and livers can occur without signs of protein, and that the amount of protein in the urine does not predict how severely the disease will progress. Prior to this time, most healthcare providers traditionally adhered to a rigid diagnosis of preeclampsia based on blood pressure and protein in the urine(proteinuria).

Preeclampsia is now to be diagnosed by persistent high blood pressure that develops during pregnancy or during the postpartum period that is associated with a lot of protein in the urine or the new development of decreased blood platelets, trouble with the kidney or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances.

Considering the potential grave ramifications of this complication, it is one that we start screening for from the beginning of pregnancy with your blood pressure and urine screens. The earlier it appears, the more severe it tends to be. Your doctor will monitor your blood pressure and other signs and symptoms in determining how long to allow your pregnancy to continue. There is obviously the desire to prevent having your baby be born too early, while still protecting the mother. This is the fine balance that is different for every pregnant woman.

Placenta Previa

Placenta previa is where all or part of the placenta covers the cervix or opening of the uterus. True placenta previa occurs in about one in two hundred pregnancies. Many times early ultrasounds may show a placenta previa, but later as the uterus grows, the condition resolves itself. If it is still present at the end of pregnancy a cesarean section may be performed to prevent bleeding during the birth. This bleeding occurs when the cervix opens in labor. Most mothers will not have any signs or symptoms, though some mothers may experience bleeding. This is why it's important to talk to your practitioner if you're experiencing bleeding.

Oligohydramnios (Low Amniotic Fluid Volume)

When a woman is said to have too little amniotic fluid she has oligohydramnios.  This is diagnosed through ultrasound, but that ultrasound may be ordered after your practitioner notices a difference in the growth of your uterus from the measurements taken at your prenatal visits. Though sometimes it is actually related to maternal hydration, meaning that mom hasn't been well hydrated. There is also some indication that amniotic fluid levels drop as the time of birth comes near. Many practitioners will have you drink fluids and reexamine you via ultrasound before moving to talking about an induction of labor or other interventions.

Polyhydramnios (High Amniotic Fluid Volume)

Polyhydramnios is the opposite end of the scale from oligohydramnios, it is a diagnosis of ecessive amniotic fluid. This occurs in fewer than one percent of all pregnancies.

While some feel that polyhydramnios is a cause for preterm labor because of uterine distension, polyhydramnios in and of itself is not a predictor for preterm labor, rather the cause of the increase in fluid is predictive of whether the pregnancy will go to term.​

Polyhydramnios is more likely to occur when:

  • There is a multiple gestation.
  • There is maternal diabetes.
  • There is a congenital malformation or certain birth defects.

While some practitioners have tried to drain some of the fluid from the uterus through a needle, this is often not a long term solution, as the fluid replaces itself. This may not mean that there is much done during pregnancy, but it can increase the risk of something like a prolapsed cord when the water breaks during labor. So this will be monitored when labor begins. 

Breech and Other Malpositions

Breech babies are not in the normal head down position. This happens about three to four percent of all births at the end of pregnancy. Babies are usually in malpositions for a variety of reasons, including:

There is also a position known as transverse lie, meaning that the baby is lying sideways in the uterus. Since it would be difficult to give birth to a baby in this way, your practitioner may do an external version, where the baby is turned from the outside or recommend that you have a cesarean section for your birth. There are also some practitioners who will do vaginal breech births for certain women and babies in certain breech positions.

Preterm Labor

Preterm labor is a very serious complication of pregnancy. Early detection can help prevent premature birth and possibly enable you to carry your pregnancy to term or to give your baby a better chance of survival. There are many reasons for preterm labor including infection, problems with the uterus, multiple babies, maternal disease, etc. No matter what the cause of the preterm labor, it is important to know what the signs are so that you can get prompt care. You should call your doctor or midwife if you have any of the following signs of preterm labor:

There may be other signs your practitioner tells you to look for, be sure to call if you are concerned. This is what your practitioner is there for and they are used to getting calls outside of office hours. If you are concerned and you cannot get a hold of your practitioner, you may seek care from the emergency department.

Incompetent Cervix

An incompetent cervix is basically a cervix that is too weak to stay closed during a pregnancy. Therefore resulting in a preterm birth and possibly the loss of the baby, because of the shortened gestational length. It is believed that cervical incompetence is the cause of 20 - 25 percent of all second trimester losses. This incompetence generally shows up in the early part of the second trimester, but possibly as late as the early third trimester.

It is generally categorized as premature opening of the cervix without labor or contractions. Diagnosis can be made either manually or with ultrasonography.

If a Problem is Suspected

If you or your practitioner think that there is a problem, the next step is usually a conversation together with your medical team. This will be where you develop a plan of action. This action plan may include special tests for your specific condition or suspected condition. It may also include watchful waiting. Sometimes the watchful waiting is very difficult because you want to act, but this may not always be the best course of action. It will usually involve more frequent prenatal care visits.

What Happens If You Have a Complication

The good news is that with good prenatal care, most complications can be prevented, identified early, and/or successfully treated. Some require additional care during or after pregnancy and sometimes well into your future, while others do not. After your baby is born, it is best to schedule a time to talk to your practitioner before planning another pregnancy to see what can be done prior to pregnancy to help lower your risk of a repeat of the complication or to manage it earlier.

High Risk Specialists

Sometimes if your complication is out of the ordinary or severe enough to be labeled a high risk pregnancy, you may need a higher level of care. If you are working with a midwife, this may mean working in conjunction with a physician, or possibly even transferring your care to a physician. If you are seeing an OB/GYN, you may also wind up needing to transfer your care to a high risk specialist known as a maternal fetal medicine (MFM) specialist.


Abalos E, Duley L, Steyn D. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD002252. DOI: 10.1002/14651858.CD002252.pub3

American Diabetes Association (ADA). Before Pregnancy. November 2013.

Bain E, Crane M, Tieu J, Han S, Crowther CA, Middleton P. Diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD010443. DOI: 10.1002/14651858.CD010443.pub2

Duley L, Henderson-Smart DJ, Walker GJA. Interventions for treating pre-eclampsia and its consequences: generic protocol (Protocol). Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007756. DOI: 10.1002/14651858.CD007756.

Meher S, Abalos E, Carroli G. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003514. DOI: 10.1002/14651858.CD003514.pub2

Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006593. DOI: 10.1002/14651858.CD006593.pub2

Neilson JP. Interventions for suspected placenta praevia. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD001998. DOI: 10.1002/14651858.CD001998

Novikova N, Cluver C, Koopmans CM. Delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD009273. DOI: 10.1002/14651858.CD009273.

Obstetrics: Normal and Problem Pregnancies. Gabbe, S, Niebyl, J, Simpson, JL. Sixth Edition.

Zipursky A, Bhutani VK. Rhesus disease: a major public health problem. Lancet. 2015 Aug 15;386(9994):651. doi: 10.1016/S0140-6736(15)61498-2.

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