Chapter 25: Pregnancy-Related Complications

Early pregnancy hemorrhagic conditions include spontaneous abortion, which is classified into threatened, inevitable, incomplete, complete, missed, and recurrent presentations, with recurrent loss sometimes managed through cervical cerclage when cervical insufficiency is identified. Ectopic pregnancy, the abnormal implantation of a fertilized ovum outside the uterine cavity most commonly in the fallopian tubes, is addressed with attention to causative factors such as pelvic inflammatory disease and treatment options ranging from pharmacological management with methotrexate to surgical removal via salpingectomy. Gestational trophoblastic disease, particularly the hydatidiform mole, involves abnormal trophoblastic proliferation producing characteristic grape-like vesicles with markedly elevated beta-human chorionic gonadotropin levels, necessitating urgent evacuation and prolonged monitoring to prevent transformation into choriocarcinoma. Late pregnancy hemorrhage distinguishes between placenta previa, presenting as painless bleeding from low placental positioning, and abruptio placentae, which manifests with painful bleeding and uterine rigidity due to premature placental separation, potentially progressing to disseminated intravascular coagulation, a consumptive coagulopathy depleting clotting factors. Hyperemesis gravidarum represents severe pregnancy-related nausea and vomiting resulting in dehydration, weight loss, and critical electrolyte imbalances including hypokalemia. The chapter extensively covers hypertensive disorders of pregnancy, differentiating between chronic hypertension, gestational hypertension, preeclampsia characterized by generalized vasospasm and endothelial dysfunction, and eclampsia involving seizure activity. Management of preeclampsia emphasizes magnesium sulfate for seizure prevention, with calcium gluconate as the specific antidote, along with antihypertensive agents such as hydralazine. Hemolysis, elevated liver enzymes, and low platelets syndrome represents a severe variant requiring immediate intervention. Immunological complications focus on Rh incompatibility where maternal sensitization to fetal Rh-positive blood results in erythroblastosis fetalis, preventable through administration of Rho(D) immune globulin, as well as ABO incompatibility which typically produces milder clinical consequences.