Chapter 14: Gestational Complications & High-Risk Pregnancy

Gestational Complications & High-Risk Pregnancy differentiates between pre-existing chronic hypertension and gestational hypertension, specifically detailing the pathophysiology of pre-eclampsia as a multisystem, vasospastic disease characterized by reduced organ perfusion and endothelial damage. The discussion extends to the life-threatening HELLP syndrome—identified by hemolysis, elevated liver enzymes, and low platelet counts—and the critical management of eclamptic seizures using magnesium sulphate for neuroprotection and seizure prophylaxis. Gestational diabetes mellitus is presented as a significant metabolic concern requiring universal screening for all pregnant patients between 24 and 28 weeks, with management strategies emphasizing the maintenance of euglycemia through dietary modifications, exercise, and pharmacological interventions like insulin or metformin to mitigate risks such as fetal macrosomia and future maternal type 2 diabetes. The text also explores hyperemesis gravidarum, an extreme form of pregnancy-related vomiting that leads to severe dehydration, ketonuria, and electrolyte imbalances requiring intensive fluid and nutritional support. Early pregnancy bleeding is addressed through the study of spontaneous miscarriage, ectopic pregnancy—where implantation occurs outside the uterine cavity—and gestational trophoblastic disease, such as hydatidiform moles. Later in pregnancy, the focus shifts to major hemorrhagic events including placenta previa and placental abruption, emphasizing the necessity of rapid hemodynamic stabilization and continuous fetal health surveillance. Furthermore, the chapter investigates disseminated intravascular coagulation (DIC) as a secondary consumptive coagulopathy and examines the impact of urinary tract infections, nonobstetrical abdominal surgeries, and physical trauma on maternal-fetal outcomes. It highlights that in emergency scenarios like trauma or cardiac arrest, the primary clinical priority is maternal resuscitation and stabilization, incorporating specialized modifications to cardiopulmonary resuscitation such as lateral uterine displacement to prevent aortocaval compression and ensure the best possible survival outcomes for both the parent and the fetus.