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Pregnancy Risks

The risk of having complications of pregnancy varies depending on many factors. A medical expert can help make sense of this complicated health evaluation. Some factors to consider are:

  • the woman's general state of health
  • her age
  • the stage of her pregnancy (risk goes up as the pregnancy progresses)
  • illnesses
  • past surgeries
  • family history
  • Previous pregnancy history (number, spacing, and outcome)
  • medications currently used or potential exposures to any toxic substances
  • any problems identified in the current pregnancy

Most times, pregnancy complications can be managed so there is no lasting effect on health. Some complications will result in serious risk to health. Pregnancy related deaths are rare events. In Alaska, a woman's risk of dying from complications of pregnancy or childbirth is very low, about 10 deaths per 100,000 live births (from data for 2010-2011). This compares to the U.S. maternal death rate of 10 per 100,000 live births.

The most common possible complications of pregnancy include:

  • Ectopic pregnancy – This is a pregnancy that has implanted somewhere outside of the uterus. A frequent location is in one of the woman's fallopian tubes. There is no room in the tube for a fetus to develop. Ectopic pregnancy can become a medical emergency that can lead to death.
  • High blood pressure – A woman who has high blood pressure before her pregnancy is at higher risk of pregnancy complications. A woman who has never had high blood pressure can develop high blood pressure during pregnancy.
    A woman's blood pressure may rise dramatically in pregnancy and cause problems such as impaired functioning of the liver, kidneys or blood clotting system. Fetal growth may be slowed and the placenta damaged. If blood pressure increases out of control, with or without treatment, maternal or fetal death can occur. In late pregnancy the likelihood of high blood pressure increases. The stress of labor and delivery can send the woman with high blood pressure into crisis with seizures, kidney failure, and extreme danger to the fetus. An emergency cesarean section may be needed to save both mother and fetus. These conditions are known as Pregnancy-Induced Hypertension, Pre-eclampsia, Eclampsia, and HELLP Syndrome. (See glossary for definitions).
  • Infection, especially genital or urinary infections – Bacterial and viral infections of the genital or urinary tract can contribute to premature rupture of membranes, premature labor, or infection of the fetus or mother.
  • Diabetes – A woman with known diabetes before pregnancy can reduce the risk of her fetus having birth defects if her blood sugars are in good control. Some women (about 9%) develop diabetes as their pregnancy advances. Too high blood glucose content can contribute to causing high blood pressure and its complications as described above. Another common result of diabetes in pregnancy is a larger than average fetus, which may result in a difficult vaginal birth or the need for a cesarean section delivery.
  • Premature labor – Premature labor is defined as labor starting after the 20th week of pregnancy but before the full term of pregnancy (37 weeks). Sometimes premature labor can be stopped by medical treatment. If a premature birth results, there is a greater chance of the infant's death due to immature organ systems, particularly the respiratory system. The chances of survival of the infant improve the closer the pregnancy is to the due date.

The process of birth includes labor and delivery. The possible risks and complications of labor and delivery include:

  • Blood clot (embolus) – Blood clots can become dislodged and move to smaller vessels where they block off blood flow. If blood flow to a vital organ is blocked by an embolus, the woman's death can occur very quickly.
  • Heavy bleeding – There is always some bleeding with a birth. Heavy bleeding is more likely with a difficult vaginal delivery, the performance of a cesarean section, a large fetus, or when medical complications like high blood pressure are present. This could result in the need for a blood transfusion with its associated risks.
  • Premature birth – In Alaska, in 2011 9.2% of births were premature. Babies born before the full term of pregnancy have much greater risk of immediate health problems. Many will catch up with full term infants by the time they are one or two years old. Some will not. Some will have lasting disabilities.
  • Infection – Some infections of the birth canal can be passed to the baby as it is born through the vagina. An important source of infection of the mother is infection that travels up into the uterus after birth has occurred. Bacteria can directly enter blood vessels and spread throughout the body very quickly causing high fevers and chills. These infections can progress to shock and death without prompt medical care.
  • Injuries to the vagina, rectum or bladder – When the fetus passes through the birth canal, excessive stretching can cause damage to the vagina, rectum, or bladder.
  • Cesarean section – Cesarean section is the surgical delivery of a fetus through an incision made in the woman's abdomen and uterus. The percent of cesarean sections in Alaska in 2010 was 22.6%, the lowest rate in the United States. Commonly called "C-section", the procedure is done to relieve dangerous conditions of stress on the fetus or the woman, when the fetus is too large to pass through the birth canal, when the woman's labor is not progressing normally, and various other reasons. Any surgery poses some level of risk for problems with anesthesia, injury to the woman or fetus, bleeding or infection.
  • Rh factor incompatibility – Protein material found on the surface of red blood cells is known as the Rh factor. If a woman and her fetus have different Rh factors, the woman must receive medication to prevent the development of antibodies that would endanger future pregnancies.

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