Pregnancy is generally an exciting time filled with anticipation and joy. Sometimes complications can arise during pregnancy, labour or birth. The reasons behind these are usually complex and may require further investigations and monitoring. Whatever the problem, it’s important that you and your baby are monitored throughout your pregnancy.
High blood pressure is also called hypertension. In pregnancy it can develop because of the pregnancy or you may already have high blood pressure.
It may occur after 20 weeks gestation and be a one-off event, or be part of a more complex condition such as preeclampsia.
Treatment includes rest, monitoring your blood pressure, monitoring your baby and your wellbeing and may require medication.
Preeclampsia is one of the more common complications of pregnancy and can happen at any time during the second half of pregnancy or the first few days after the birth.
Preeclampsia can cause circulation problems, which can affect the blood supply to the placenta and limit the baby’s supply of nutrients and oxygen. This can reduce the baby’s ability to grow.
Preeclampsia affects one in ten pregnancies and for most women the illness remains mild. In some cases it can become serious and affect other parts of the body such as liver and blood clotting system (HELLP syndrome) and can also lead to convulsions (eclampsia).
Preeclampsia can get worse very quickly, which is dangerous for both mother and baby. Women with preeclampsia are closely monitored. In the case of severe preeclampsia, you will need to be monitored in hospital and may have to have your baby early.
HELLP syndrome is the severe form of preeclampsia and requires urgent medical attention for both the mother and baby.
Drugs may be used to control your blood pressure and prevent convulsions.
However, if your preeclampsia becomes severe, the cure is to deliver the baby and placenta.
This could mean that your baby is born early and may be at risk of developing complications due to prematurity.
The risk of having preeclampsia again in future pregnancies is usually small. Your risk will increase if you have other medical disorders such as hypertension, kidney disease, diabetes, or lupus.
During pregnancy, your baby moves around constantly, and may changes positions many times.
Toward the end of pregnancy, the baby’s head usually settles into the pelvis, and stays ‘head down’, and usually facing toward your back, in readiness for birth.
If your baby stays facing your tummy or side, this is called posterior or lateral positions. When you commence labour, it is not a concern but you may experience increased back pain or a longer labour. Getting into an upright or hands and knees position may assist with the progress of your labour.
A breech position means the baby presents bottom or feet first, rather than head first.
During pregnancy, many babies are in the breech position. However, most babies turn before 37 weeks.
If your baby is still breech at 37 weeks, the chances of your baby turning by itself are low.
Your doctor or midwife will discuss the implications of this for your birth plan and what options are available.
Your options may include:
ECV is a commonly practiced procedure with a low risk of complications.
ECV can reduce the need for a caesarean birth. The success rate is approximately 40% for first time mothers and 60% for others. If you choose to have an ECV, the procedure is done in hospital.
A trained doctor gently turns the baby by placing their hands on your abdomen and gently coaxing the baby around so it can be born head first.
This procedure is done at around 37 weeks, using ultrasound to help see the baby, cord and placenta.
What you need to know:
At your pregnancy care visits, your midwife or doctor will measure the size of your growing baby by measuring your tummy using a tape measure.
The number of centimetres generally equals the number of weeks of pregnancy, to within about 2 cm.
If you are measuring less than expected for your pregnancy, it is important to check that your baby is still growing well. This usually means you will have an ultrasound scan to check your baby’s growth and the amount of fluid around your baby.
Around 80% of babies are born between 38 and 42 weeks of pregnancy. This is often called ‘at term’. Babies born after 40 weeks are described as ‘post term’.
It’s OK to feel frustrated or disappointed if your pregnancy has gone past its due date. Try not to worry, soon you’ll hold your baby in your arms and the long wait will be over.
While you are waiting, stay in touch with your midwife or doctor. You’ll need frequent check-ups until your baby is born.
Take advantage of the extra time. You may want to:
If your labour hasn’t started by 41 weeks, your midwife or doctor will likely offer you a 'membrane sweep’.
A membrane sweep involves a vaginal (internal) examination that stimulates the cervix (neck of your womb) to produce hormones that may trigger natural labour.
If your labour still doesn’t start naturally after this, your midwife or doctor will discuss with you a date to have your labour induced.
Your doctor or midwife will probably recommend regular tests to check on your health and your baby’s health. After 42 weeks, there is a higher risk of stillbirth or fetal compromise.
These tests might include an ultrasound to check the amniotic fluid index and an ultrasound to check the biophysical profile.
Any bleeding in later pregnancy is most likely to indicate a problem with your placenta. If you are bleeding, you will need medical attention.
Placental abruption is the most common cause of bleeding during the second half of pregnancy and is often associated with abdominal pain or tenderness.
Placental abruption is when part, or all, of the placenta separates from the wall of the uterus before the birth of your baby.
The amount of bleeding varies and the cause is not always known. Sometimes, there is no bleeding but you will have sudden and severe abdominal pain.
Treatment may involve monitoring you and your baby, bed rest and in more serious cases, the birth of your baby.
A placental abruption is an emergency that requires immediate medical attention as the placenta is your baby’s food and oxygen source. Please call the maternity ward or maternity assessment unit if you experience any sudden and severe abdominal pain and/or bleeding.
The placenta develops together with the baby in your uterus during pregnancy. It attaches to the wall of your uterus and provides a connection between you and your baby. Oxygen and nutrients pass from your blood through the placenta into your baby’s blood. The placenta is delivered shortly after the baby is born and it is sometimes called the afterbirth.
In some women, the placenta attaches low down in the uterus and may cover part of or all of the cervix (the neck of the womb).
In most cases, the placenta moves upwards and out of the way as the uterus grows during pregnancy.
For some women, however, the placenta continues to lie in the lower part of the uterus as the pregnancy continues.
This condition is known as low-lying placenta if the placenta if it is less than 20mm from the cervix or as placenta praevia if the placenta completely covers the cervix.
Placenta praevia happens when your placenta attaches in the lower part of your uterus (womb), sometimes completely covering the cervix (neck of the womb).
This can cause heavy bleeding during pregnancy or at the time of birth.
If you have placenta praevia, your baby will probably need to be born by caesarean.
Placenta praevia is more common if you have had one or more previous caesarean births, if you had had fertility treatment in order to fall pregnant, or if you smoke.
A low-lying placenta is checked for during your routine 22-week ultrasound scan. Most women who have a low-lying placenta at 22 weeks will not go on to have a low-lying placenta later in the pregnancy: 9 out of 10 women with a low-lying placenta at their 22-week scan will no longer have a low-lying placenta when they have their follow-up scan, and only 1 in 200 women overall will have placenta praevia at the end of their pregnancy.
Placenta accreta is a rare (between 1 in 300 and 1 in 2000) but serious condition when the placenta is stuck to the muscle of your womb and/or to nearby structures such as your bladder.
This is more common if you have previously had a caesarean. It may cause heavy bleeding at the time of birth.
Vasa praevia is a very rare condition affecting between 1 in 1200 and 1 in 5000 pregnancies. It is where blood vessels travelling from your baby to your placenta, unprotected by placental tissue or the umbilical cord, pass near to the cervix.
If your healthcare professional suspects that you may have vasa praevia when you go into labour or when your waters break, your baby needs to be born urgently. Usually an emergency caesarean would be recommended.
Antibiotic treatment during labour may be recommended for:
Group B Streptococcus (GBS) is a bug that commonly lives in the bowel and one in four women carry it in their vagina. Being a carrier is not harmful to you but it can cause infection in your newborn baby. GBS is not sexually transmitted. Usually, you do not know you are a carrier.
GBS is detected by a vaginal swab. GBS can come and go during your pregnancy. If it is present when you give birth, there is a chance your baby can become infected once your waters break.
Your doctor or midwife will advise you that a Group B Streptococcus (GBS) screening test is recommended at 36 weeks of pregnancy. The below fact sheet will help you decide whether to have the test and also provides information on what to expect if the test is positive.
Group B Streptococcus (GBS) Screening – The Royal Women’s Hospital
If you are known to be GBS positive, and you have additional risk factors (e.g. your waters have broken and are therefore no longer providing a protective barrier for your baby), you will be offered antibiotics to try to prevent an infection in your baby.
Pre-labour rupture of the membranes (PROM) refers to rupture of the fetal membranes (your waters breaking) prior to the onset of regular uterine contractions. It may occur at term (≥37+0 weeks of gestation) or preterm (<37+0 weeks of gestation); the latter is designated preterm PROM (PPROM).
Prolonged rupture of membranes (ROM) is any ROM that persists for more than 24 hours and prior to the onset of labour.
Approximately eight per cent of term pregnancies are complicated by rupture of membranes (ROM) before the onset of labour, with 60 per cent of these women labouring spontaneously within 24 hours.
Risk factors associated with pre-labour rupture of membranes (PROM) include:
However, PROM often occurs in the absence of any known risk factors.
Management of PROM may be expectant or active. The decision to manage PROM actively or expectantly must be made in consideration of any risk factors, the ability of the service to provide a safe level of care, and the woman’s wishes.
Active management is recommended for women with any risk factors and for those women who prefer this option.
In the absence of any complicating risk factors, women may be offered the option of expectant management. This may be as an inpatient or, if appropriate (based on individual circumstances such as travel requirements and support), at home.
Cholestasis of pregnancy is a condition that causes bile, a digestive fluid produced by the liver, to build up in the liver during pregnancy. This causes problems with liver function. Cholestasis of pregnancy most often happens during the third trimester, but it can occur at any time during pregnancy. This condition often goes away soon after giving birth.
Also sometimes known as Intra-hepatic cholestasis of pregnancy (ICP).
The most common symptom is intense itching (pruritus), especially on the palms of your hands and soles of your feet. The itching can spread to the rest of your body and is often worse at night. Other symptoms may include:
This condition is diagnosed based on:
Cholestasis of pregnancy is confirmed by a blood test. Other tests may be performed to look for other causes of abnormal liver function. Around 2 in 10 women itch during pregnancy, and only a very small number will have with cholestasis.
Cholestasis can be harmful to both you and your baby. Cholestasis may increase the risk of:
Once you have been diagnosed with Cholestasis of pregnancy you will be referred to a specialist obstetrician for planning your ongoing care. In some women, the level of bile acids may return to normal with no intervention and others will have an individualised care plan.
You will be advised:
Your cholestasis will resolve after the birth.
In the meantime, some methods can help relieve some of the discomfort.
Itching: is the hallmark symptom of cholestasis. The itching may be improved by wearing light, cotton clothing, placing towels soaked in cold water on the skin, having cool baths/showers.
A medication called ursodeoxycholic acid (URSO) that may slightly reduce the itching in a small number of women with cholestasis.
The recommended timing of your baby’s birth will depend on the level of bile acids in your blood and also whether you have any additional risk factors such as multiple pregnancy, gestational diabetes or pre-eclampsia. Your doctor will discuss your options with you depending on your individual situation.
If you are advised to have your baby early due to high bile acid levels this usually involves having your labour induced. A caesarean section is not necessary for cholestasis of pregnancy alone.
Your symptoms will get better after birth.
Usually your liver function and bile acids return to normal around 6-12 weeks.
At your 6 weeks postnatal check-up it is important that you have your blood checked again.
Very likely, yes. There is a chance that cholestasis will occur in your next pregnancy.