Chapter 10: Complications of Pregnancy

Complications of Pregnancy module examines the complex pathological conditions that can arise during gestation, categorized into pregnancy-specific disorders and concurrent medical issues that are exacerbated by the physiological changes of childbearing. A significant portion of the material focuses on hemorrhagic conditions, distinguishing between early gestation losses—such as spontaneous abortions (ranging from threatened to missed), the life-threatening risks of ectopic tubal pregnancies, and gestational trophoblastic disease—and late-term emergencies like placenta previa and placental abruption, which necessitate vigilant monitoring for hypovolemic shock and disseminated intravascular coagulation (DIC). The discussion extends to the management of hyperemesis gravidarum, a severe form of nausea and vomiting that threatens maternal nutrition and electrolyte balance. Hypertensive disorders are explored in-depth, specifically the pathophysiology of generalized vasospasm in preeclampsia and the progression to eclamptic seizures, as well as the multisystemic impact of HELLP syndrome and the critical role of magnesium sulfate in seizure prophylaxis and toxicity management. Endocrine challenges are highlighted through the lens of glucose metabolism, detailing how placental hormones induce insulin resistance and lead to gestational diabetes mellitus (GDM) or complicate preexisting Type 1 and Type 2 diabetes, often resulting in fetal macrosomia and neonatal hypoglycemia. Furthermore, the chapter addresses the hemodynamic strain pregnancy places on the cardiovascular system, requiring specialized care for patients with congenital or acquired heart diseases. It also covers the implications of obesity, various nutritional and genetic anemias, and blood incompatibilities like Rh and ABO sensitization. Finally, the text evaluates the catastrophic potential of various infections, including the TORCH spectrum, Group B Streptococcus, and HIV, emphasizing the importance of screening, vertical transmission prevention, and evidence-based pharmacologic interventions to ensure optimal maternal and neonatal outcomes.