Complications Associated with a Single Pregnancy

Complications associated with a single pregnancy vs. multiple pregnancy. Single Pregnancy • High blood pressure (gestational hypertension). - Usually after week 20. - Hormonal changes: ✓ Increased progesterone and estrogen -> affect blood vessel functions -> increased blood pressure. - Blood volume changes: ✓ CO and BV increase to be able to support the foetus. - First time pregnancy: ✓ Vascular changes to accommodate for foetus. ✓ Immune tolerance -> immune system to a customised to having a developing foetus in the mother which can contribute to vascular changes and vascular problems. (Due to production of reactive oxygen species). - When the blood pressure rises this can make it hard for the blood to reach the placenta. - This causes less nutrients and oxygen reaching the placenta which slows down and affects the growth of the developing foetus. - These can risk the risk of pre-mature birth and pre-eclampsia. • Gestational diabetes. - - • Placenta hormones especially beta hCG opposes the action of insulin. This is because this hormone can cause: ✓ Insulin resistance. Combined with estrogen and progesterone these will decrease insulin sensitivity. ✓ Stimulates the corpus luteum in the ovary to make more progesterone -> stimulates more glucose production. ✓ Increased carbohydrates demand and thus increase insulin requirements. ✓ Initially the beta pancreatic cells will try to work more to meet demands, but over time become tired and unable to keep up with demands. Genetic pre-disposition. Women over 35. This is because: ✓ Insulin sensitivity decreases with age. ✓ Greater hormone fluctuations. ✓ More prone to weight gain. ✓ Decreased beta cell function. ✓ Higher prevalence of pre-existing conditions Preeclampsia • Iron deficiency anaemia - • Due to an increased blood volume so the iron demands also increase. Infections - Immune suppression to prevent the immune system. Vaginal pH becomes more alkaline during pregnancy due to hormonal fluctuations. • Miscarriage Causes: - Uterine or cervical problems. - Invasive prenatal tests - Previous miscarriages - Age - Smoking - Alcohol Complications - Heavy bleeding - Infection is the uterus cannot fully expel the pregnancy tissue of the vaginal canal is contaminated. - Asherman’s syndrome: rarely a scar tissue can form in the uterus following a miscarriage -> this can cause menstrual flow and infertility issues. - Infertility Complications of multiple pregnancies • Twin to twin transfusion syndrome - • C delivery - • Excess amniotic fluid which can cause cord to prolapse. Cord prolapse is when the umbilical cord ends up being positioned over the presenting part such that it comes out of the uterus first, with the risk being that the foetus can compress the cord and give itself hypoxia – in the case of polyhydramnios, there is more fluid for the cord to float around in, which can predispose it to drifting over the presenting part. Vanishing twin syndrome: - • • More likely to need to delivery via a c-section. Polyhydramnios - • Twins sharing the same placenta, blood flow imbalances can occur where on of the twin receives too much blood and the other not much. One of the twins disappears but the other twin remains. Antepartum haemorrhage – due to placenta praevia or placental abruption Prematurity Teratogens Infections • Toxoplasmosis Drugs • ACE Inhibitors - • Alcohol - • Disturb embryo development. Craniofacial Abnormalities Neural Tube Defects: Cardiac Abnormalities heart defects Limbs and Skeletal Defects Central Nervous System Effects Warfarin - • Mania, bipolar diseases, depression, and other mood disorders. Crosses the placenta. Cardio, neuro, thyroid, renal abnormalities. Retinoids - • Used in the prevention of malaria. Causes deafness. Cardiac abnormalities Crosses the placenta Interfere with folate metabolism so the neural tube will not close well so there will be congenital abnormalities as the skull, scalp and the brain do not fully develop. Lithium - • Crosses the placenta since it is small and polar can easily fuse from the maternal blood to the fetal blood through the interstitial space of the placenta. Disturb cellular processes. Neurological effects such as fetal alcohol spectrum syndrome which affects cognition, social skill, behaviour, memory, attention etc. Physical malformations such as fetal alcohol syndrome which is the more severe form of fetal alcohol spectrum syndrome. Chloroquine - • Decreased angiotensin II production. Affect heart and kidney development. Maybe also affect CNS development Blood clotting and vascular development abnormalities. Haematological and metabolic effects. Valproic acid - Anti-seizures medications, migraines, bipolar and anxiety medication. (act as GABA) • Tetracycline - • Neural tube defects Other developmental abnormalities. Antibiotic Can accumulate in developing teeth and bones. Skeletal abnormalities. Inhibited growth. Streptomycin - Antibiotic Hearing loss, balance and coordination problems.