1. Major complications in pregnancy

2. Miscarriages Also known as spontaneus abortions
Expulsion of fetus before it reaches viabilty
pregnancy that ends on it's own, within the first 22 weeks of gestation
Reasons
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
Maternal trauma

3. Types of abortions Threatened abortions
early pregnancy uterine bleeding
The cervix remains closed
Inevitable (Incomplete) abortions
Abdominal or back pain accompanied by bleeding with an open cervix
Leads to complete & incomplete abortions

5. Complete abortions
embryo have emptied out of the uterus. Bleeding should subside quickly
Incomplete abortions
embryo have not emptied the uterus completely

6. Missed abortions experience a miscarriage without knowing it.
embryonic death has occurred
there is no expulsion of the embryo.
Signs would be a loss of pregnancy symptoms and the absence of fetal heart sounds found on an ultrasound
Recurrent abortions
Defined as 3 or more
consecutive first
trimester miscarriages

7. Therapeutic Abortion Elective Abortion
Intentional termination of pregnancy before age of viability to preserve the health of the mother
Elective Abortion
Intentional termination of pregnancy for reasons unrelated to mothers health

9. Ectopic pregnancy
in which the embryo implants outside the uterine cavity
Occur mainly in the fallopian tube, also cervix, ovaries, and abdomen
An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death

10. 95% occur in the fallopian tube
The zygote or embryo may die and be absorbed by the body, or the tube could rupture (ruptured tubal pregnancy) with bleeding into the abdominal cavity. This is a surgical emergency

11. Signs & symptoms
Lower abdominal pain, may have light vaginal bleeding
If tube ruptures:
May have sudden severe lower abdominal pain
Vaginal bleeding
Signs of hypovolemic shock
Shoulder pain may also be felt

12. Placenta previa
Abnormal implantation of the fetus in the lower uterine segment
The growing uterus completely/ partially covers the orifice
Prevent baby from delivering vaginally
Caesarian section is done
Bright bleeding occurs when cervix
dilates, resulting in painless bleeding

13. Abruptio placentae (accidental hemorrhage)
Normal implantation of placenta
Dark bleeding with pain and enlarging uterus suggest blood is accumulating within the cavity

14. Infection, because of vaginal organisms
Placenta previa
Infection, because of vaginal organisms
Postpartum hemorrhage, because if lower segment of uterus was site of attachment, then there are fewer muscle fibers so weaker contractions may occur
Abruptio placentae
Predisposing factors
Hypertension
Cocaine or alcohol use
Cigarette smoking and poor nutrition
Blows to the abdomen
Prior history of abruptio placentae
Folate deficiency

15. Cervical insufficiency (incompetent cervix)
In cervix secretions fill the canal and form a protective barrier called the mucous plug During a normal pregnancy,
the cervix remains firm, long, and closed until late in the third trimester.
At birth it usually starts to soften, efface (grow shorter), and dilate (open up) as your body prepares for labor

16. cervix is softer and weaker abnormally short
it may efface and dilate without contractions also called "incompetent cervix”
can result in
Second,trimester miscarriage
preterm premature rupture of the membranes (PPROM), or preterm delivery (before 37 weeks).

17. Antepartum Hemorrhage
Bleeding from the birth canal after 22 weeks
Fetus is visible
Main two causes,
Accidental hemorrhage - Abruptio placentae
Placenta praevia

18. Excessive amniotic fluid (hydramnios or polyhydramnios)
medical condition describing an excess of amniotic fluid in the amniotic sac
Opposite to this is oligohydramnios,
a deficiency in amniotic fluid
Causes,
Maternal hyperglycemia
Fetal abnormalities such as esophageal atresia, duodenal atresia, facial cleft, renal disoeders, chromasome abnormalities

19. uterus growing more rapidly unusual abdominal discomfort
Indications
uterus growing more rapidly
unusual abdominal discomfort
increased back pain
shortness of breath
extreme swelling in feet and ankles.
Confirm by an ultrasound. amniotic fluid index (AFI).
normal measure for the third trimester is between 5 and 25 cm
A total of more than 25 cm is considered high.

20. Placental Insufficiency
Placenta fails to transport adequate blood supply to the growing fetus
Lack of oxygen and nutrients to the fetus
Baby might be small to the date/ intrauterine death
Serial screening is important
Ultra sound examination – fetal growth
Cardiotachography – fetal heart sound
Blood & urine test

21. Increase of placental blood flow can be done
Rest
Maternal diet rich in protein
Correcting of anemia
Higher risk pregnancies such as multiple gestations should be monitored very carefully

22. False labour
When a mother reaches her due date painless/ painful infrequent contractures
Mother feels that she is close to labour
Cervix dilation does not occur
Contractions don't grow consistently longer, stronger, and closer together.

23. Pregnancy induced hypertension
Also known as pre eclampsia
After 30th week
Signs for monitor
Oedema present in ankle after a night rest / in hands ad feet
Raised diastolic blood pressure (>90Hgmm)
proteinuria

24. Thank you