Chapter 7: Complications of Pregnancy

Gestational complications include preterm labor and birth, the leading cause of neonatal mortality, managed through tocolytic medications and antenatal corticosteroids to accelerate fetal lung development. Premature rupture of membranes significantly increases infection risk and requires careful management balancing expectant observation against delivery timing. Cervical insufficiency, characterized by painless dilation, may be managed with cerclage placement, while multiple gestations introduce compounded risks including twin-to-twin transfusion syndrome. Hyperemesis gravidarum and intrahepatic cholestasis represent metabolic and hepatic complications requiring specific pharmacological interventions. Diabetes mellitus in pregnancy encompasses pregestational disease, which carries teratogenic risks from early hyperglycemia, and gestational diabetes, which threatens fetal macrosomia and neonatal hypoglycemia despite lacking congenital anomaly risk. Hypertensive disorders, including preeclampsia, eclampsia, and HELLP syndrome, represent multisystem emergencies originating from placental insufficiency and endothelial dysfunction, managed with magnesium sulfate and antihypertensive therapy. Placental abnormalities such as previa, abruption, and accreta spectrum present hemorrhagic crises requiring emergency intervention and cesarean delivery. Early pregnancy loss, ectopic pregnancy, and gestational trophoblastic disease address complications before viability. Maternal infections, particularly TORCH pathogens and group B streptococcus, pose severe teratogenic and neonatal sepsis risks. Finally, preexisting cardiovascular disease, venous thromboembolism, and substance use disorders demand careful risk stratification and targeted management to prevent maternal decompensation and fetal harm.