Complications are the last thing any parent-to-be wants to consider. However, it is crucial to know what the unexpected might bring, and what can be done should it occur.

Whilst everyone hopes for a smooth pregnancy, complications can get in the way and affect both mother and baby. These range from mild to life-threatening. As Dr Liana Koe, consultant obstetrician & gynaecologist at Mount Alvernia Hospital shares, risk factors vary as well. Advanced maternal age, smoking, alcohol and drug abuse. as well as a low or high body mass index (BMI), are associated with most pregnancy complications.

In this article, we outline several common pregnancy complications, their possible causes, and the preventive measures and treatment options available for expectant mothers.

1. First trimester bleeding and miscarriage

Also known as bleeding and pregnancy loss in the first 12 weeks of pregnancy, this condition is common and affects about I in 4 pregnancies. “Certain causes include cervical lesions like polyps (benign growths on the cervix), sexual intercourse and subchorionic haemorrhage (bleeding near the pregnancy sac),” notes Dr Koe.

She also assures that the majority of patients have the bleeding resolve spontaneously by 12 weeks, going on to have healthy pregnancies. However, pregnancy loss or miscarriage occurs in some patients, and the most common cause is aneuploidies (non-inherited chromosomal disorders) that occur by chance. Even in these cases, subsequent pregnancies are usually healthy and uneventful.

“Avoid strenuous activities and sexual intercourse in the event of bleeding in pregnancy, seek obstetric advice early for more frequent scans, and consider progesterone supplementation (more useful for women with previous pregnancy loss and subchorionic haemorrhage, or previous cervical trauma),” Dr Koe advises.

2. Antepartum haemorrhage (APH)

This refers to bleeding in pregnancy after 24 weeks of pregnancy. Common causes include placenta praevia (low-lying placenta), placental abruption (early separation of the placenta) and vaginal infections like yeast and bacterial vaginosis.

“Bleeding that is recurrent or heavy can lead to blood loss, low blood count, and in severe cases, risk to maternal and fetal life,” warns Dr Koe. “Severe APH that is endangering the mother or child’s life may need early delivery via Caesarean section.

However, in most cases, bleeding is not life-threatening and resolves spontaneously, especially if due to vaginal infections. Bacterial vaginosis, if untreated, can increase the risk of preterm labour.

If bleeding occurs, Dr Koe recommends bed rest and minimising excessive exertion like exercising and standing for long periods. Progesterone supplementation is useful if there is threatened preterm labour. If blood loss causes anaemia, iron supplementation or blood transfusions may needed.

3. Gestational hypertension and pre-eclampsia

Gestational hypertension (high blood pressure) may develop after 20 weeks of pregnancy. Pre-eclampsia is gestational hypertension complicated with protein detected in the urine. The underlying cause is not fully understood, but current theories suggest improper development of the placenta from early stages of pregnancy due to problems with supplying blood vessels. “Uncontrolled high blood pressure can lead to stroke, brain bleeds, cardiac arrest, heart failure and seizures (eclampsia) in expectant mothers. Multi-organ damage involving the liver, kidney. and changes in blood clotting resulting in bleeding disorders can also occur in severe pre-eclampsia and eclampsia,” observes Dr Koe.

Treatment options include anti-hypertensive medications to control the blood pressure. usually by the oral route. Intravenous medications are used in severe cases, and anti-seizure medications may be needed in the event of severe pre-eclampsia or eclampsia. Early delivery may be necessary in severe cases, as removal of the placenta lowers blood pressure.

4. Gestational diabetes mellitus (GDM)

Diabetes that is not pre-existing may also develop in the second or third trimester. Risk factors include previous gestational diabetes, having a large baby and known polycystic ovarian syndrome. “Asians are at higher risk of diabetes, hence universal screening is advocated in Singapore for all pregnant women,” recommends Dr Koe.

GDM also increases perinatal complications like preeclampsia, macrosomia (large baby) and associated complications like shoulder dystocia and increased caesarean and assisted delivery. Management options include adopting a low carbohydrate diet and exercise. About one in 10 patients may need oral medications or insulin injections.

5. Preterm labour

Defined as delivery before 37 weeks of pregnancy preterm labour can occur due to vaginal infections like bacterial vaginosis, sexually transmitted infections and risk factors like APH and preeclampsia,

“With bacterial vaginosis, there is an overgrowth of bacteria due to imbalance of vaginal flora and pH levels. It presents with excessive watery or greenish vaginal discharge, coupled with a typical “fishy” odour,” describes Dr Koe.

She adds that women with previous cervical trauma or surgery need frequent follow-ups and scans to check their cervical length during pregnancy, and take progesterone supplements to reduce their risk of preterm labour.

If preterm labour progresses and delivery is imminent, tocolytics (medications to stop contractions and relax the uterus) are given to halt or delay the labour process. For the baby, intramuscular injections of steroids to the mother prior to delivery helps to reduce the incidence of neonatal ICU stays and respiratory complications.

Article contributed by Dr Liana Koe, accredited doctor from Mount Alvernia Hospital.

This article is taken from our MyAlvernia Magazine Issue #50. Click here to read the issue on our website.