1. Pregnancy Complications
A. Hypertensive Disorders of Pregnancy
Types:
- Gestational Hypertension: BP ≥140/90 mmHg after 20 weeks, no proteinuria.
- Preeclampsia: Gestational hypertension + Proteinuria (>300 mg/24h) ± End-organ damage.
- Eclampsia: Preeclampsia + Seizures (Medical Emergency).
Management:
- Mild Preeclampsia: BP monitoring, Labetalol/Nifedipine.
- Severe Preeclampsia: Magnesium Sulfate (Seizure prophylaxis), IV antihypertensives.
- Eclampsia: Immediate Magnesium Sulfate + Delivery of Baby (C-section if needed).
B. Gestational Diabetes Mellitus (GDM)
Screening: 24–28 weeks OGTT (75g
Glucose Challenge).
Complications:
- Fetal: Macrosomia, Neonatal Hypoglycemia, Shoulder Dystocia.
- Maternal: Risk of Type 2 Diabetes postpartum.
Management:
- Dietary Control First.
- Insulin if Fasting Glucose >95 mg/dL.
C. Placental Complications
Placenta Previa (Painless Bleeding)
Definition: Placenta covers cervix
→ Painless vaginal bleeding in the third trimester.
Management:
- No vaginal exam (Risk of hemorrhage).
- C-section delivery at 37 weeks.
Placental Abruption (Painful Bleeding)
Definition: Premature separation of placenta
→ Painful vaginal bleeding + Rigid uterus.
Management:
- Immediate C-section if fetal distress.
- IV fluids, Blood transfusion if needed.
D. Preterm Labor (<37 weeks)
Risk Factors:
- Infection (UTI, Chorioamnionitis).
- Multiple pregnancy, Short cervix (<2.5 cm).
Management:
- Tocolytics (Nifedipine) if <34 weeks.
- Antenatal Corticosteroids (Betamethasone).
2. Labor Complications
A. Prolonged & Obstructed Labor
Causes:
- Cephalopelvic Disproportion (CPD).
- Inefficient Uterine Contractions (Hypotonic Labor).
Management:
- Oxytocin Augmentation.
- C-section for CPD.
B. Fetal Distress in Labor
Signs:
- Abnormal CTG (Late Decelerations, Fetal Bradycardia).
- Meconium-stained liquor.
Management:
- Intrauterine resuscitation (Left lateral position, Oxygen, IV Fluids).
- Immediate C-section if distress persists.
C. Shoulder Dystocia
Definition: Fetal head delivers, but
shoulders get stuck at pubic symphysis.
Risk Factors: Macrosomia, Diabetes, Post-term
pregnancy.
Management:
- McRoberts Maneuver (Legs flexed to abdomen).
- Suprapubic Pressure (Push shoulder under pubic symphysis).
- If unsuccessful → Episiotomy or C-section.
D. Postpartum Hemorrhage (PPH)
Definition: Blood loss >500 mL (Vaginal)
or >1000 mL (C-section).
Causes (4 T’s):
- Tone (Uterine Atony - Most Common).
- Tissue (Retained Placenta).
- Trauma (Perineal Tears, Uterine Rupture).
- Thrombin (Coagulation Disorders).
Management:
- Uterine Massage + Oxytocin 10 IU IM.
- Tranexamic Acid (TXA) if bleeding persists.
- Surgical interventions (Bakri Balloon, B-Lynch Suture, Hysterectomy if needed).
3. Summary Table: Pregnancy & Labor Complications
|
Condition |
Key Features |
Management |
|
Preeclampsia |
Hypertension + Proteinuria |
Magnesium Sulfate, BP Control |
|
Eclampsia |
Seizures in pregnancy |
Immediate delivery, Magnesium Sulfate |
|
GDM |
High glucose in pregnancy |
Diet, Insulin if needed |
|
Placenta Previa |
Painless bleeding |
No vaginal exam, C-section |
|
Placental Abruption |
Painful bleeding, Rigid uterus |
Emergency C-section |
|
Preterm Labor |
<37 weeks contractions |
Tocolytics, Steroids |
|
Fetal Distress |
Abnormal CTG, Meconium |
Intrauterine resuscitation, C-section |
|
Shoulder Dystocia |
Head delivers, shoulders stuck |
McRoberts Maneuver, Suprapubic Pressure |
|
PPH |
Excessive postpartum bleeding |
Oxytocin, TXA, Surgery if needed |
4. Key Takeaways
- Preeclampsia & GDM require close monitoring & timely intervention.
- Placenta previa = Painless bleeding, Abruption = Painful bleeding.
- Fetal distress & shoulder dystocia require emergency management.
- PPH is the most dangerous postpartum complication & needs rapid treatment.
