Pregnancy problems associated with assisted conception

-A serious condition that may occur is that of ovarian hyperstimulation syndrome. -When fertility drugs have been taken to stimulate the production of follicles - massive enlargement of the ovaries and multiple cysts can develop -Many women taking fertility drugs will experience a mild form of this syndrome, but in a considerable percentage (0.5–5%) this develops to include oliguria, renal failure and hypovolaemic shock.

-This risk increases when pregnancy has been achieved. -The condition itself subsides spontaneously, but medical support and treatment is required for those who are severely unwell. -In assisted conception, the risk of miscarriage is approximately 14.7%. This rate is probably associated with the quality and length of freezing of the oocytes or embryos that are used. - no differences in the number of chromosomal malformations when compared with spontaneous pregnancies

-The number of multiple pregnancies increases with assisted conception, with rates of 27% for twins and 3% for triplets. - there is an increase in the rate of pre-term birth, small for gestational age babies, placenta praevia, pregnancy induced hypertension and gestational diabetes.

Nausea, vomiting and hyperemesis gravidarum - onset from 4–8 weeks' gestation -lasting until 16– 20 weeks - causes: 1- hCG, 2-oestrogen and/or progesterone - ginger wrist acupuncture,

-Hyperemesis gravidarum -severest form of nausea and vomiting - a history of vomiting -weight loss - dehydration -postural hypotensiontachycardia, ketosis and electrolyte imbalance . - treatment in hospital intravenous fluids are given to re- hydrate the woman - correct the electrolyte imbalance - anti-emetics being administered to control the vomiting.

- exclude other conditions, such as 1- a urinary tract infection 2-disorders of the gastrointestinal tract 3- a molar pregnancy, where vomiting may also be excessive. -The aim of treatment is 1- stabilize the woman's condition 2- prevent further complications

NB: Continual vomiting during the pregnancy may lead to vitamin deficiencies, and/or hyponatraemia, which can present with confusion and seizures, leading to respiratory arrest if untreated . For women who are immobilized through the severity of the vomiting, deep vein thrombosis is also a potential complication due to the combination of dehydration and immobility. In cases of hyperemesis gravidarum the fetus may be at risk of being small for gestational age due to a lack of nutrients.

Pelvic girdle pain (PGP) - pregnancy hormones, especially relaxin, can cause the ligaments supporting the pelvic joints to relax, allowing for slight movement. known as symphysis pubis dysfunction, -ligaments relaxation is excessive, the pelvic bones move up and down when the woman is walking. pain in the pubic area as well as backache occurring any time from the 28th week of pregnancy.

symptoms varying from mild pain and discomfort to severe mobility diffculties. - pain and discomfort when lying down and on standing - PGP occurs without identifiable risk factors, -a history of lower back or pelvic girdle pain, -a job that is physically active.

-a referral to an obstetric physiotherapist. - The woman should be advised to rest as much as possible and undertake activities that do not cause her further pain. - movement that involves abducting the hips which increases the pain and discomfort. -A physiotherapist supplying aids such as pelvic girdle support belts and in extreme cases, crutches

-in labor -upright and kneeling -analgesia requirements. - a reduction in hip abduction -Following the birth, the ligaments slowly return to their pre-pregnant condition, but this may take some time. - Extra support may be required and physiotherapy may need to be continued beyond the postnatal period.