An Evaluation of Complications of Pregnancy

COMPLICATIONS OF PREGNANCY

Complications of Pregnancy

Introduction

During pregnancy, there are a wide range of health problems and complications that women could experience. To a large extent, the said complications and health problems could have a negative effect/impact on the health of the mother, that of the unborn baby, or both the health of the mother and that of the baby. This text will concern itself with some of the more common complications of pregnancy. The complications that will be addressed in this context are inclusive of; bleeding disorders, hypertension, psychological disorders, abruption, and cervical insufficiency. As will be indicated elsewhere in this text, pregnancy complications happen to be rather prevalent. This particular topic was selected owing to the need to develop better understanding of the various problems that could impact the health of the mother or/and the unborn child. Following this understanding, the relevant strategies can be embraced to ensure that the health of the mother and the unborn child are secured and/or further promoted.

Discussion

Part A

From the onset, it would be prudent to note that as the Centers for Disease Control and Prevention – CDC (2020) points out, pregnancy complications is an all-inclusive term for the various health concerns that could crop up during the term of the pregnancy. As it had been indicated in the introductory section, CDC (2020) is categorical that the said complications could affect not only the health and wellbeing of the mother, but also that of the child. In as far as the prevalence of pregnancy complications in the US are concerned, available data indicates that “complications during pregnancy, childbirth, and the postpartum period ranked as the 6th greatest cause of death among women aged 20 to 34 in the United States” (Collier and Molina, 2019). Thus, there is a clear indication as to the need to reign in this particular health concern/issue.

a) Hypertension

To begin with, one of the more common pregnancy complications happens to be hypertension. It is important to note that according to the CDC (2019), there are various categories of hypertensive disorders during pregnancy. These have been highlighted as gestational hypertension, preeclampsia, and eclampsia (CDC, 2019). To begin with, gestational hypertension happens to be hypertension that a woman develops in the course of the pregnancy. On the other hand, preeclampsia could be defined as “high blood pressure and signs of problems with the kidneys, liver, and other organs” (CDC, 2019). Lastly, when a pregnant woman presents with seizures and preeclampsia and does not report other health complications or issues (i.e. epilepsy), then eclampsia could be diagnosed (CDC, 2019). It would also be prudent to note that a pregnant woman could have diagnosed with hypertension before the acquisition of the pregnancy. In this particular case, the said high blood pressure is referred to as chronic hypertension.

There are a number of problems that hypertension during pregnancy could trigger. For instance, it could have a negative impact on the development of the placenta – effectively meaning that the baby would be denied ifs fair share of oxygen supply (Braunthal and Brateanu, 2019). This could result in abruption (which will be independently discussed elsewhere in this text), low birth weight, as well as early delivery. However, it should be noted that to a large extent, the kinds of hypertension highlighted above tend to affect the body differently. Their severity also varies. According to the CDC (2019), the rates of hypertension during pregnancy have been on an upward trajectory over the last few decades. This is a clear indication that more needs to be done to reign in the trend. According to Braunthal and Brateanu (2019), those who happen to be at a higher risk of hypertension in the curse of their pregnancy are those with; certain other illnesses and conditions such as kidney disease and lupus, those who are overweight or obese, those diagnosed with diabetes, those having a family history of gestational hypertension, those over the age of 40 or under the age of 20, etc.

b) Bleeding Disorders

Next, yet another crucial pregnancy complication happens to be bleeding disorders. In basic terms, these disorders essentially have an effect on the ability of the blood to clot as would be expected of a normal person following injury (internal or external). Failure by the blood to clot as would ordinarily be expected could result in severe bleeding. James, Steer, and Weiner (2017) point out that bleeding disorders could have a negative impact on the health of the mother as well as that of the baby during pregnancy. The said complications could be inclusive of severe hemorrhage (postpartum) and bleeding during the term of the pregnancy.

Bleeding disorders could be attributed to a number of factors. These are inclusive of, but they are not limited to, certain obstetric complications, issues triggered by blood thinners (anticoagulants), platelet disorders, hemophilia, as well as diseases such as the Von Willebrand disease (James, Steer, and Weiner, 2017). Owing to the various serious complications that could be triggered by bleeding disorders, the authors note there is need for keen investigation of the various clinical signs and symptoms of the same. Diagnosis could in this case be done through blood tests. When a disorder of this nature is diagnosed, the relevance of close monitoring cannot be overstated. There may also be need to rope in a multidisciplinary team of specialized healthcare professionals (i.e. OB/GYN with the relevant knowledge and experience in the management of high-risk-pregnancies, an anesthesiologist, a hematologist, etc.) for specialized care. The said proper management is crucial owing to the baseline propensity to bleed for the pregnant woman in this particular case.

c) Abruption

Third, yet another complication of pregnancy that ought to be taken into consideration is abruption. In the words of James, Steer, and Weiner (2017), “placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery” (217). In this case, the authors brand it a serious yet rather uncommon, pregnancy complication. It would be prudent to note that the placenta plays a crucial role during pregnancy. This is more so the case given that in addition to riding the baby’s blood off the buildup waste, it comes in handy in the supply of oxygen and crucial nutrients to the baby. This particular organ is often attached to the wall of the mother’s uterus.

Complete or partial separation of the said placenta from the uterus wall prior to the birth of the baby essentially means that the baby is denied of it nutrient as well as oxygen supply. Further, this could trigger serious bleeding for the woman. Other complications for the woman are inclusive of organ failure and shock (as a consequence of the loss of blood), and blood clotting issues. For the baby, abruption could result in still birth or premature birth, as well as stunted/stifled growth as a consequence of lack of sufficient nutrients. Given that this pregnancy complication often occurs suddenly, the relevance of urgent intervention cannot be overstated. James, Steer, and Weiner (2017) point out that to a large extent, the exact cause of this particular complication of pregnancy remains unknown. However, according to the authors, some of the likely causes that have been speculated in the past are inclusive of sudden amniotic fluid loss, serious abdominal injury or trauma (such as that which would ordinarily be experienced following a heavy blow to the abdomen or traffic accident), etc. There is ongoing research on the same.

d) Cervical Insufficiency

This is also referred to as incompetent cervix. In basic terms, it comes by as a consequence of cervical tissue weakness. It is important to note that just before childbirth, the cervix is expected to open and thin. It therefore follows that during the entire pregnancy term, the lower end of the cervix happens to be closed. Thus, the thinning as well as opening of the cervix prior to childbirth, or too early in the pregnancy term, could be considered a pregnancy complication. In essence, this is what is referred to as cervical insufficiency. Some of the complications that could be triggered by cervical insufficiency are inclusive of, but they are not limited to, premature birth and miscarriage. Past research studies have indicated that there are a wide range of factors that could trigger cervical insufficiency. Some of the factors that have been highlighted by Li, Li, Zhao, Cheng, Burjoo, Yang, and Xu (2020) are inclusive of diethylstilbestrol exposure, uterus damage (i.e. as a result of a past complication during childbirth), short cervix (i.e. cervix measuring below 25mm in length), past surgery of the cervix, abnormal cervical or uterus formation, etc. It would also be prudent to note that past studies have also indicated that race happens to be a risk factor for the development of an incompetent cervix (James, Steer, and Weiner, 2017). In this case, the authors make an observation to the effect that those at the highest risk of this particular pregnancy complication happen to be black women. There are various interventions that could be embraced following diagnosis of cervical insufficiency. Diagnosis could in this case be done using an ultrasound as well as pelvic exam. One intervention that has been deployed in the past is cerclage (Li, Li, Zhao, Cheng, Burjoo, Yang, and Xu, 2020). According to the authors, this particular procedure comes in handy in efforts to further enhance the strength of the cervix.

e) Psychiatric Disorders

These are a number of psychiatric disorders that occur during pregnancy. The said disorders could range from mood disorders to anxiety disorders and even depression. To a large extent, these disorders ought to be taken into consideration as part and parcel of the health and wellbeing of the mother as well as the unborn child. This is more so the case given that in some instances, the said chances are taken to be related to the changes occurring during the pregnancy, i.e. in as far as maternal physiology and temperament is concerned (McLeish and Redshaw, 2017). For instance, according to McLeish and Redshaw (2017), one of the more undiagnosed psychiatric conditions during pregnancy happens to be depression – i.e. what is referred to as postpartum depression. Some of the risk factors that have been identified for postpartum depression are inclusive of poor social support and anxiety. In seeking to treat postpartum depression, some of the options that could be explored are inclusive of antidepressants and psychotherapy.

Part B

a) Ethical Ramifications

In as far as pregnancy complications are concerned, there are a number of ethical concerns/issues which ought to be taken into consideration. For instance, there is the ethical concern that relates to the incorporation of women who are pregnant in clinical trials. As has been indicated in Part A of this text, there are still some grey areas in as far as the cause of some pregnancy complications are concerned. For this reason, there is need for additional research so as to not only identify the risk factors, but also come up with better approaches of reigning in the complications. This effectively means that the relevance of continuous research in this realm cannot be overstated. It would, however, be prudent to note that there are those who are concerned over the impact that clinical research could have on both the mother and the unborn fetus – and whether the resulting benefits of such studies could offset any harm occasioned (Prostran, 2018). The author makes an observation to the effect that despite the fact that there are a number of research practice and design adjustments that have been made in the past and that “have led to an increase in the proportion of women included in research trials, knowledge gaps remain because of a continued lack of inclusion of women, especially those who are pregnant, in premarketing research trials” (94). There are, however, those who are of the opinion that research studies incorporating pregnant women are essential in efforts to promote future practice in this realm, and can be conducted in an ethical manner. In what appears to advance this assertion, for instance, the Food and Drug Administration (FDA) has in the past released a raft of guidelines that are meant to propose or highlight scenarios under which women who are pregnant can be incorporated in clinical studies (FDA, 2019).

b) Religious Considerations

There are also a number of religions considerations that come into play in as far as pregnancy complications are concerned. For instance, it should be noted that thanks to globalization, the US could be deemed a cosmopolitan society attracting persons from diverse locations of the world. This is to say that the citizens of this great nation are drawn from all continents of the world. One of the factors that happen to play an active role in the health and wellbeing as well as recovery of patients following illness is religious beliefs. For instance, according to Aziato, Odai, and Omenyo (2016), there are studies that have indicated that a person’s sense of wellbeing is somewhat connected to their religious beliefs. This, according to the authors, is more so with regard to the development of emotional strength and stability via prayer and meditation, as well as other religious practices embraced across diverse cultures. This is also the case during pregnancy. For instance, as has been indicated elsewhere in this text, one of the more prominent pregnancy complications happens to be depression. Religion could in this case come in handy in efforts to promote emotional wellbeing of pregnant women. This essentially means that religious beliefs ought to be part and parcel of the care program during pregnancy. For this reason, Aziato, Odai, and Omenyo (2016) are of the opinion that “religiosity should be a key component of training health care professionals so that they can understand the religious needs of their clients and provide holistic care” (77).

c) Political Relevance

One of the ways through which some of the pregnancy complications highlighted above can be reined in is via government intervention. For instance, some of the pregnancy complications highlighted above could be avoided. For instance, the risk for hypertension during pregnancy could be reduced by maintaining the ideal body weight. It is, however, possible that some persons could be unaware of this crucial fact. Thus, there is an opportunity for government intervention in this case, i.e. by way of undertaking public education initiatives to encourage future-mothers to adopt health lifestyles, i.e. in as far as engagement in physical activities and avoidance of junk food is concerned (Maybin, 2017). The government could also fund research studies meant to develop better understanding of the risk factors as well as causes of some of the pregnancy complications highlighted in this text, i.e. abruption. Next, it should also be noted that one of the major risk factors of premature delivery, which could be termed a pregnancy complication, happens to be iron deficiency anemia. One of the strategies that could be put in place to minimize the risk of maternal anemia is the administration of daily oral iron as well as folic acid. This is an area ripe for government intervention especially in ensuring that pregnant women have access to free daily oral iron as well as folic acid.