Chapter 23: Risk Conditions Related to Pregnancy

Pregnancy loss includes spontaneous abortion with vaginal bleeding and tissue passage, ectopic pregnancy presenting with abdominal pain and shoulder pain if rupture occurs, hydatidiform mole characterized by abnormally high human chorionic gonadotropin levels and absence of fetal heart tones, and incompetent cervix requiring surgical cerclage. Placental disorders distinguish between placenta previa as painless bright red bleeding with a soft uterus where vaginal examination is contraindicated, and abruptio placentae as dark red bleeding with severe pain and uterine rigidity that constitutes an obstetric emergency. Abnormally invasive placental variants including accreta, increta, and percreta increase hemorrhage risk and may necessitate hysterectomy. Disseminated intravascular coagulation represents a life-threatening state of excessive clotting followed by widespread bleeding and platelet depletion. Hypertensive disorders progress from gestational hypertension through preeclampsia characterized by hypertension with facial edema and visual changes, potentially advancing to eclampsia with seizures or HELLP syndrome involving hemolysis and hepatic involvement, managed with magnesium sulfate therapy and lateral positioning. Diabetes mellitus accelerates insulin resistance in pregnancy, requiring increased doses particularly in later trimesters, with gestational diabetes screening occurring between twenty-four and twenty-eight weeks. Cardiac disease becomes problematic when pregnancy-induced increases in plasma volume and cardiac output exceed the heart's compensatory capacity. Multiple gestations and obesity increase risks for preterm labor and cesarean delivery. Infectious complications include HIV transmission prevention through three-drug antiretroviral therapy and zidovudine coverage, hepatitis B requiring neonatal immunization, TORCH infections with teratogenic effects particularly in early pregnancy, herpes simplex virus requiring cesarean delivery if active lesions present, and group B streptococcus necessitating intrapartum antibiotics. Other significant conditions include hyperemesis gravidarum causing dehydration and electrolyte loss, and tuberculosis requiring extended antibiotic regimens with pyridoxine supplementation.