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Complications of pregnancy

(Redirected from Pregnancy risks)

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.[1][2][3]

Complications of pregnancy
810 women die every day from preventable causes related to pregnancy and childbirth. 94% occur in low and lower middle-income countries.
SpecialtyObstetrics
ComplicationsNumerous biological and environmental complications
Risk factorsNumerous biological and environmental conditions

Common complications of pregnancy include anemia, gestational diabetes, infections, gestational hypertension and pre-eclampsia.[4][5] Presence of these types of complications can have implications on monitoring lab work, imaging, and medical management during pregnancy.[4]

Severe complications of pregnancy, childbirth, and the puerperium are present in 1.6% of mothers in the US,[6] and in 1.5% of mothers in Canada.[7] In the immediate postpartum period (puerperium), 87% to 94% of women report at least one health problem.[8][9] Long-term health problems (persisting after six months postpartum) are reported by 31% of women.[10]

In 2016, complications of pregnancy, childbirth, and the puerperium resulted globally in 230,600 deaths, down from 377,000 deaths in 1990. The most common causes of maternal mortality are maternal bleeding, postpartum infections including sepsis, hypertensive diseases of pregnancy, obstructed labor, and unsafe abortion.[11][12]

Complications of pregnancy can sometimes arise from abnormally severe presentations of symptoms and discomforts of pregnancy, which usually do not significantly interfere with activities of daily living or pose any significant threat to the health of the birthing person or fetus. For example, morning sickness is a fairly common mild symptom of pregnancy that generally resolves in the second trimester, but hyperemesis gravidarum is a severe form of this symptom that sometimes requires medical intervention to prevent electrolyte imbalances from severe vomiting.

Maternal problems

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The following problems originate in the mother, however, they may have serious consequences for the fetus as well.

Gestational diabetes

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Gestational diabetes is when a woman, without a previous diagnosis of diabetes, develops high blood sugar levels during pregnancy.[13][14] There are many non-modifiable and modifiable risk factors that lead to the devopment of this complication. Non-modifiable risk factors include a family history of diabetes, advanced maternal age, and ethnicity. Modifiable risk factors include maternal obesity.[14] There is an elevated demand for insulin during pregnancy which leads to increased insulin production from pancreatic beta cells. The elevated demand is a result of increased maternal calorie intake and weight gain, and increased production of prolactin and growth hormone. Gestational diabetes increases risk for further maternal and fetal complications such as development of pre-eclampsia, need for cesarean delivery, preterm delivery, polyhydramnios, macrosomia, shoulder dystocia, fetal hypoglycemia, hyperbilirubinemia, and admission into the neonatal intensive care unit. The increased risk is correlated with the how well the gestational diabetes is controlled during pregnancy with poor control associated with worsened outcomes. A multidisciplinary approach is used to treat gestational diabetes and involves monitoring of blood-glucose levels, nutritional and dietary modifications, lifestyle changes such as increasing physical activity, maternal weight management, and medication such as insulin.[14]

Hyperemesis gravidarum

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Hyperemesis gravidarum is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is similar although more severe than the common morning sickness.[15][16] It is estimated to affect 0.3–3.6% of pregnant women and is the greatest contributor to hospitalizations under 20 weeks of gestation. Most often, nausea and vomiting symptoms during pregnancy resolve in the first trimester, however, some continue to experience symptoms. Hyperemesis gravidarum is diagnosed by the following criteria: greater than 3 vomiting episodes per day, ketonuria, and weight loss of more than 3 kg or 5% of body weight. There are several non-modifiable and modifiable risk factors that predispose women to development of this condition such as female fetus, psychiatric illness history, high or low BMI pre-pregnancy, young age, African American or Asian ethnicity, type I diabetes, multiple pregnancies, and history of pregnancy affected by hyperemesis gravidarum. There are currently no known mechanisms for the cause of this condition. This complication can cause nutritional deficiency, low pregnancy weight gain, dehydration, and vitamin, electrolyte, and acid-based disturbances in the mother. It has been shown to cause low birth weight, small gestational age, preterm birth, and poor APGAR scores in the infant. Treatments for this condition focus on preventing harm to the fetus while improving symptoms and commonly include fluid replacement and consumption of small, frequent, bland meals. First-line treatments include ginger and acupuncture. Second-line treatments include vitamin B6 +/- doxylamine, antihistamines, dopamine antagonists, and serotonin antagonists. Third-line treatments include corticosteroids, transdermal clonidine, and gabapentin. Treatments chosen are dependent on severity of symptoms and response to therapies.[17]

Pelvic girdle pain

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Pelvic girdle pain (PGP) disorder is pain in the area between the posterior iliac crest and gluteal fold beginning peri or postpartum caused by instability and limitation of mobility. It is associated with pubic symphysis pain and sometimes radiation of pain down the hips and thighs. For most pregnant individuals, PGP resolves within three months following delivery, but for some it can last for years, resulting in a reduced tolerance for weight bearing activities. PGP affects around 45% of individuals during pregnancy: 25% report serious pain and 8% are severely disabled.[18][19] Risk factors for complication development include multiparity, increased BMI, physically strenuous work, smoking, distress, history of back and pelvic trauma, and previous history of pelvic and lower back pain. This syndrome results from a growing uterus during pregnancy that causes increased stress on the lumbar and pelvic regions of the mother, thereby, resulting in postural changes and reduced lumbopelvic muscle strength leading to pelvic instability and pain. It is unclear whether specific hormones in pregnancy are associated with complication development. PGP can result in poor quality of life, predisposition to chronic pain syndrome, extended leave from work, and psychosocial distress. Many treatment options are available based on symptom severity. Non-invasive treatment options include activity modification, pelvic support garments, analgesia with or without short periods of bed rest, and physiotherapy to increase strength of gluteal and adductor muscles reducing stress on the lumbar spine. Invasive surgical management is considered a last-line treatment if all other treatment modalities have failed and symptoms are severe.[19]

High blood pressure

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Main article: Hypertensive disease of pregnancy

Potential severe hypertensive states of pregnancy are mainly:

Women who have chronic hypertension before their pregnancy are at increased risk of complications such as premature birth, low birthweight or stillbirth.[26] Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing cardiovascular disease compared to women with normal blood pressure who had no complications in pregnancy. Monitoring pregnant women's blood pressure can help prevent both complications and future cardiovascular diseases.[27][28]

Venous thromboembolism

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Venous thromboembolism, consisting of deep vein thrombosis and pulmonary embolism, is a major risk factor for postpartum morbidity and mortality, especially in highly developed countries. A combination of pregnancy-exacerbated hypercoagulability and additional risk factors such as obesity and thrombophilias makes pregnant women vulnerable to thrombotic events[29] T.he prophylactic measures that include the usage of low molecular weight heparin, in fact, can significantly reduce risks associated with surgery, particularly in high-risk patients. Awareness among healthcare givers and prompt response in early identification and management of venous thromboembolism during pregnancy and the postpartum period are both crucial for prompt response. Deep vein thrombosis, a form of venous thromboembolism, has an incidence of 0.5 to 7 per 1,000 pregnancies, and is the second most common cause of maternal death in developed countries after bleeding.[30]

Anemia

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Main article: Anemia in pregnancy

Anemia is a globally recognized complication of pregnancy worldwide and is a condition with a low hemoglobin amount in one of the trimesters. Such physiological modifications are more pronounced among individuals who suffer from undernutrition as well as chronic diseases associated with hemoglobin rehoming, like sickle cell anemia. Prevention of anemia during pregnancy is complicated, and is often treated by a team effort of dietary supplementation, iron therapy, and continuous assessment of mother and fetal indices in a multidisciplinary approach.[31] As an additional measure, emphasis is placed on the astute determination of the respective triggering points, and the application of optimal prenatal care to better maternal and fetal outcome.

Levels of hemoglobin are lower in the third trimesters. According to the United Nations (UN) estimates, approximately half of pregnant individuals develop anemia worldwide. Anemia prevalences during pregnancy differed from 18% in developed countries to 75% in South Asia; culminating to a global rate of 38% of pregnancies worldwide.[1][5][32]

Treatment varies due to the severity of the anaemia, and can be used by increasing iron containing foods, oral iron tablets or by the use of parenteral iron.[13]

Infection

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Main article: Susceptibility and severity of infections in pregnancy

Pregnancy is a critical period for the expectant mom to experience additional dangers associated with infections. Moreover, a mother and baby's health is exposed to danger when she is in this condition. The prenatal physiology complexity and immunity modulation inherently increase the risk of influenza, hepatitis E, and cytomegalovirus transmission.[33] Avoidance actions like vaccines and strict infectious control protocols can be given priority in the policies aimed at limiting the risk of transmission among high-risk populations. In addition, it is early diagnosis and management of maternal infections are among the main methods to flatline vertical transmission and fetal aberrations.

Further information: Neonatal infection

A pregnant woman is more susceptible to certain infections. This increased risk is caused by an increased immune tolerance in pregnancy to prevent an immune reaction against the fetus, as well as secondary to maternal physiological changes including a decrease in respiratory volumes and urinary stasis due to an enlarging uterus.[34] Pregnant individuals are more severely affected by, for example, influenza, hepatitis E, herpes simplex and malaria.[34] The evidence is more limited for coccidioidomycosis, measles, smallpox, and varicella.[34] Mastitis, or inflammation of the breast, occurs in 20% of lactating individuals.[35]

Some infections are vertically transmissible, meaning that they can affect the child as well.[36]

Peripartum cardiomyopathy

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Peripartum cardiomyopathy is a heart failure caused by a decrease in left ventricular ejection fraction (LVEF) to <45% which occurs towards the end of pregnancy or a few months postpartum. Symptoms include shortness of breath in various positions and/or with exertion, fatigue, pedal edema, and chest tightness. Risk factors associated with the development of this complication include maternal age over 30 years, multi gestational pregnancy, family history of cardiomyopathy, previous diagnosis of cardiomyopathy, pre-eclampsia, hypertension, and African ancestry. The pathogenesis of peripartum cardiomyopathy is not yet known, however, it is suggested that multifactorial potential causes could include autoimmune processes, viral myocarditis, nutritional deficiencies, and maximal cardiovascular changes during which increase cardiac preload. Peripartum cardiomyopathy can lead to many complications such as cardiopulmonary arrest, pulmonary edema, thromboembolisms, brain injury, and death. Treatment of this condition is very similar to treatment of non-gravid heart failure patients, however, safety of the fetus must be prioritized. For example, for anticoagulation due to increased risk for thromboembolism, low molecular weight heparin which is safe for use during pregnancy is used instead of warfarin which crosses the placenta.[37]

Hypothyroidism

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Main article: Thyroid disease in women

Hypothyroidism (commonly caused by Hashimoto's disease) is an autoimmune disease that affects the thyroid by causing low thyroid hormone levels. Symptoms of hypothyroidism can include low energy, cold intolerance, muscle cramps, constipation, and memory and concentration problems.[38] It is diagnosed by the presence of elevated levels of thyroid stimulation hormone or TSH. Patients with elevated TSH and decreased levels of free thyroxine or T4 are considered to have overt hypothyroidism. While those with elevated TSH and normal levels of free T4 are considered to have subclinical hypothyroidism.[39] Risk factors for developing hypothyroidism during pregnancy include iodine deficiency, history of thyroid disease, visible goiter, hypothyroidism symptoms, family history of thyroid disease, history of type 1 diabetes or autoimmune conditions, and history of infertility or fetal loss. Various hormones during pregnancy affect the thyroid and increase thyroid hormone demand. For example, during pregnancy, there is increased urinary iodine excretion as well as increased thyroxine binding globulin and thyroid hormone degradation which all increase thyroid hormone demands.[40] This condition can have a profound effect during pregnancy on the mother and fetus. The infant may be seriously affected and have a variety of birth defects. Complications in the mother and fetus can include pre-eclampsia, anemia, miscarriage, low birth weight, still birth, congestive heart failure, impaired neurointellectual development, and if severe, congenital iodine deficiency syndrome.[38][40] This complication is treated by iodine supplementation, levothyroxine which is a form of thyroid hormone replacement, and close monitoring of thyroid function.[40]

Fetal and placental problems

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The following problems occur in the fetus or placenta, but may have serious consequences on the mother as well.

Ectopic pregnancy

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Ectopic pregnancy is implantation of the embryo outside the uterus. This form of complicated pregnancy, which is a non-implication of a normally fertilized egg at any spot other than the uterus, involves operation failure, which can cause life-threatening conditions. However, the underlying reasons for this are not exactly known. This phenomenon is often accompanied by PID (pelvic inflammatory disease) or salpingectomy (surgery).

  • Caused by: Unknown, but risk factors include smoking, advanced maternal age, and prior surgery or trauma to the fallopian tubes.
  • Risk factors include untreated pelvic inflammatory disease, likely due to fallopian tube scarring.[41]
  • Treatment: In most cases, keyhole surgery must be carried out to remove the fetus, along with the fallopian tube. If the pregnancy is very early, it may resolve on its own, or it can be treated with methotrexate, an abortifacient.[42]

Miscarriage

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Miscarriage is the loss of a pregnancy prior to 20 weeks.[43][44] In the UK, miscarriage is defined as the loss of a pregnancy during the first 23 weeks.[45] Comprehensive support, consists of the consultation of the genomics as well as the provision of the medical or surgical operations required. The psychological relevance of family members, relatives, and friends to the bereaved ones is also a necessity. The most effective tools that can be used to minimize the psychological implications of the mourners include autopsy and bereavement counseling.

Approximately 80% of pregnancy loss occurs in the first trimester, with a decrease in risk after 12 weeks gestation. Some variables, such as the mother's being older or chromosomal abnormalities, possess a higher likelihood of causing multiple miscarriages.[46] Spontaneous abortions can be further categorized into complete, inevitable, missed, and threatened abortions:[citation needed]

  • Complete: Vaginal bleeding occurs followed by the complete passing of conception products through the cervix.  
  • Inevitable: Vaginal bleeding occurs; the cervical os is closed indicating that conception products will pass in the near future.
  • Missed: Vaginal bleeding occurs and some products of conception may have passed through the cervix; the cervical os is closed and ultrasound shows a nonviable fetus and remaining products of conception.
  • Threatened: Vaginal bleeding occurs; the cervical os is closed and ultrasound shows a viable fetus.

Stillbirth

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Stillbirth is defined as fetal loss or death after 20 weeks gestation. Early stillbirth is between 20 and 27 weeks gestation, while late stillbirth is between 28 and 36 weeks gestation. A term stillbirth is when the fetus dies 37 weeks and above.[47] This phenomenon can go beyond grief and can lead to worries about strange maternal feelings or postpartum treatment regarding complications of childbirth.[48] Such parents would require more than empathy; generally, adequate medical programs should be considered for parents having such unbearable grief. Along with psychiatric help, counseling, and peer support, which should be useful in the process of assisting parents who have lost their children.

  • Epidemiology: There are over 2 million stillbirths a year and there are about 6 stillbirths per 1000 births (0.6%)[49]
  • Clinical presentation: Fetal behavioral changes like decreased movements or a loss in fetal sensation may indicate stillbirth, but the presentation can vary greatly.
  • Risk factors: Maternal weight, age, and smoking, as well as pre-existing maternal diabetes or hypertension[47]
  • Treatment: If fetal passing occurs before labor, treatment options include induced labor or cesarean section. Otherwise, stillbirths can pass with natural birth.

Placental abruption

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Placental abruption defined as the separation of the placenta from the uterus prior to delivery, is a major cause of third trimester vaginal bleeding and complicates about 1% of pregnancies.[13][50] Symptomatic presentations are variable: Some women can entirely ignore the symptoms, while others have mild bleeding or abdominal discomfort and pain. Hence, though symptom severity variance and precipitous placental separation are not relevant, they can still cause the diagnosis and clinical management to be complicated.

Several contributors may result in placental abruption. This includes: pre-existing maternal factors (e.g., smoking, hypertension, advanced age),[51] as well as pregnancy-related factors such as multiple pregnancies or the presence of in-utero infections. Identifying risk factors beforehand in order to take steps and make quick reactions to minimize the likelihood of unfavorable outcomes for the mother or the fetus is essential. The therapy techniques of placental rupture are based on the fetal gestation age and the status of both the mother and the baby. Instant delivery should be medically warranted for full-term babies (36 weeks or more) and in case of distress. Milder cases with immature embryos being monitored closely, any necessary intervention is done in time after careful observation.

The implementation of preventive measures, which include pre-conception counseling to deal with the modifiable risk factors, can significantly contribute to the reduction of incidents of placental abruption. Knowing the long-term impacts on the mother and the baby after giving birth is essential. Continuous research and evidence-based approaches help in providing management that works. Collaboration between healthcare providers and patients is the core of the outcomes of placenta abruption.

  • Clinical Presentation: Varies widely from asymptomatic to vaginal bleeding and abdominal pain.
  • Risk factors: Prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of membranes, intrauterine infections, and hydramnios.
  • Treatment: Immediate delivery if the fetus is mature (36 weeks or older), or if a younger fetus or the mother is in distress. In less severe cases with immature fetuses, the situation may be monitored in hospital, with treatment if necessary.

Placenta previa

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Placenta previa is a condition that occurs when the placenta fully or partially covers the cervix.[13] Placenta previa can be further categorized into complete previa, partial previa, marginal previa, and low-lying placenta, depending on the degree to which the placenta covers the internal cervical os. Placenta previa is primarily diagnosed by ultrasound, either during a routine examination or following an episode of abnormal vaginal bleeding, often in the second trimester of pregnancy. Most diagnosis of placenta previa occurs during the second-trimester.[citation needed]

Treatments are adapted according to their severity and the mother's state of health, from strict monitoring to cesarean section.

  • Risk Factors: prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, maternal age.[52]

Placenta accreta

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Placenta accreta is an abnormal adherence of the placenta to the uterine wall.[53] Specifically, placenta accreta involves abnormal adherence of the placental trophoblast to the uterine myometrium.[54]

Placenta accreta risk factors include placenta previa, abnormally elevated second-trimester AFP and free β-hCG levels, and advanced gestational parent age, specifically over the age of 35.[55][56] Furthermore, prior cesarean delivery is one of the most common risk factors for placenta accreta, due to the presence of a uterine scar leading to abnormal decidualization of the placenta.[57]

Due to abnormal adherence of the placenta to the uterine wall, cesarean delivery is often indicated, as well as cesarean hysterectomy.[54]

Multiple pregnancies

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Main article: Multiple birth

Multiple births may become monochorionic, sharing the same chorion, with resultant risk of twin-to-twin transfusion syndrome. Monochorionic multiples may even become monoamniotic, sharing the same amniotic sac, resulting in risk of umbilical cord compression and entanglement. In very rare cases, there may be conjoined twins, possibly impairing function of internal organs.[citation needed] Control of multiple pregnancies, such as special prenatal care and birth plans, can help in the control of placenta accreta.[58] Moreover, early detection and response to the health problems arising from multiple pregnancies can help both the expectant parents and medical care providers deal with this particular aspect of reproductive health consciously.

Mother-to-child transmission

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Further information: Vertically transmitted infection
Further information: Neonatal infection

Since the embryo and fetus have little or no immune function, they depend on the immune function of their mother. Several pathogens can cross the placenta and cause (perinatal) infection. Often microorganisms that produce minor illness in the mother are very dangerous for the developing embryo or fetus. This can result in spontaneous abortion or major developmental disorders. For many infections, the baby is more at risk at particular stages of pregnancy. Problems related to perinatal infection are not always directly noticeable.[citation needed]

The term TORCH complex refers to a set of several different infections that may be caused by transplacental infection:

  • T - Toxoplasmosis
  • O - other infections (i.e. Parvovirus B19, Coxsackievirus, Chickenpox, Chlamydia, HIV, HTLV, syphilis, Zika)
  • R - Rubella
  • C - Cytomegalovirus
  • H - HSV

Babies can also become infected by their mother during birth. During birth, babies are exposed to maternal blood and body fluids without the placental barrier intervening and to the maternal genital tract.[59] Because of this, blood-borne microorganisms (hepatitis B, HIV), organisms associated with sexually transmitted disease (e.g., gonorrhoea and chlamydia), and normal fauna of the genito-urinary tract (e.g., Candida) are among those commonly seen in infection of newborns. Furthermore, vaccination, commitment to safe birth practices, and prenatal screening and treatment of infections are also strategic measures that can help reduce the risk of newborn infections.

General risk factors

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Factors increasing the risk (to either the pregnant individual, the fetus/es, or both) of pregnancy complications beyond the normal level of risk may be present in the pregnant individual's medical profile either before they become pregnant or during the pregnancy.[60] These pre-existing factors may related to the individual's genetics, physical or mental health, their environment and social issues, or a combination of those.[61]

Biological

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Some common biological risk factors include:

Environmental

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Some common environmental risk factors during pregnancy include:

High-risk pregnancy

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Some disorders and conditions can mean that pregnancy is considered high-risk (about 6-8% of pregnancies in the USA) and in extreme cases may be contraindicated. High-risk pregnancies are the main focus of doctors specialising in maternal-fetal medicine. Serious pre-existing disorders which can reduce a woman's physical ability to survive pregnancy include a range of congenital defects (that is, conditions with which the woman herself was born, for example, those of the heart or reproductive organs, some of which are listed above) and diseases acquired at any time during the woman's life.

Absolute and relative incidence of venous thromboembolism (VTE) during pregnancy and the postpartum period
Absolute incidence of first VTE per 10,000 person–years during pregnancy and the postpartum period
Swedish data A Swedish data B English data Danish data
Time period N Rate (95% CI) N Rate (95% CI) N Rate (95% CI) N Rate (95% CI)
Outside pregnancy 1105 4.2 (4.0–4.4) 1015 3.8 (?) 1480 3.2 (3.0–3.3) 2895 3.6 (3.4–3.7)
Antepartum 995 20.5 (19.2–21.8) 690 14.2 (13.2–15.3) 156 9.9 (8.5–11.6) 491 10.7 (9.7–11.6)
  Trimester 1 207 13.6 (11.8–15.5) 172 11.3 (9.7–13.1) 23 4.6 (3.1–7.0) 61 4.1 (3.2–5.2)
  Trimester 2 275 17.4 (15.4–19.6) 178 11.2 (9.7–13.0) 30 5.8 (4.1–8.3) 75 5.7 (4.6–7.2)
  Trimester 3 513 29.2 (26.8–31.9) 340 19.4 (17.4–21.6) 103 18.2 (15.0–22.1) 355 19.7 (17.7–21.9)
Around delivery 115 154.6 (128.8–185.6) 79 106.1 (85.1–132.3) 34 142.8 (102.0–199.8)
–
Postpartum 649 42.3 (39.2–45.7) 509 33.1 (30.4–36.1) 135 27.4 (23.1–32.4) 218 17.5 (15.3–20.0)
  Early postpartum 584 75.4 (69.6–81.8) 460 59.3 (54.1–65.0) 177 46.8 (39.1–56.1) 199 30.4 (26.4–35.0)
  Late postpartum 65 8.5 (7.0–10.9) 49 6.4 (4.9–8.5) 18 7.3 (4.6–11.6) 319 3.2 (1.9–5.0)
Incidence rate ratios (IRRs) of first VTE during pregnancy and the postpartum period
Swedish data A Swedish data B English data Danish data
Time period IRR* (95% CI) IRR* (95% CI) IRR (95% CI)† IRR (95% CI)†
Outside pregnancy
Reference (i.e., 1.00)
Antepartum 5.08 (4.66–5.54) 3.80 (3.44–4.19) 3.10 (2.63–3.66) 2.95 (2.68–3.25)
  Trimester 1 3.42 (2.95–3.98) 3.04 (2.58–3.56) 1.46 (0.96–2.20) 1.12 (0.86–1.45)
  Trimester 2 4.31 (3.78–4.93) 3.01 (2.56–3.53) 1.82 (1.27–2.62) 1.58 (1.24–1.99)
  Trimester 3 7.14 (6.43–7.94) 5.12 (4.53–5.80) 5.69 (4.66–6.95) 5.48 (4.89–6.12)
Around delivery 37.5 (30.9–44.45) 27.97 (22.24–35.17) 44.5 (31.68–62.54)
–
Postpartum 10.21 (9.27–11.25) 8.72 (7.83–9.70) 8.54 (7.16–10.19) 4.85 (4.21–5.57)
  Early postpartum 19.27 (16.53–20.21) 15.62 (14.00–17.45) 14.61 (12.10–17.67) 8.44 (7.27–9.75)
  Late postpartum 2.06 (1.60–2.64) 1.69 (1.26–2.25) 2.29 (1.44–3.65) 0.89 (0.53–1.39)
Notes: Swedish data A = Using any code for VTE regardless of confirmation. Swedish data B = Using only algorithm-confirmed VTE. Early postpartum = First 6 weeks after delivery. Late postpartum = More than 6 weeks after delivery. * = Adjusted for age and calendar year. † = Unadjusted ratio calculated based on the data provided. Source: [76]

List of complications (complete)

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Obstetric complications are those complications that develop during pregnancy. A woman may develop an infection, syndrome or complication that is not unique to pregnancy and that may have existed before pregnancy. Pregnancy often is complicated by preexisting and concurrent conditions. Though these pre-existing and concurrent conditions may have great impact on pregnancy, they are not included in the following list.

See also

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References

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  1. ^ a b Stevens, Gretchen A; Finucane, Mariel M; De-Regil, Luz Maria; Paciorek, Christopher J; Flaxman, Seth R; Branca, Francesco; Peña-Rosas, Juan Pablo; Bhutta, Zulfiqar A; Ezzati, Majid (2013-07-01). "Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data". The Lancet Global Health. 1 (1): e16–e25. doi:10.1016/s2214-109x(13)70001-9. ISSN 2214-109X. PMC 4547326. PMID 25103581.
  2. ^ Lozano, Rafael; Naghavi, Mohsen; Foreman, Kyle; Lim, Stephen; Shibuya, Kenji; Aboyans, Victor; Abraham, Jerry; Adair, Timothy; Aggarwal, Rakesh; Ahn, Stephanie Y; AlMazroa, Mohammad A; Alvarado, Miriam; Anderson, H Ross; Anderson, Laurie M; Andrews, Kathryn G (2012-12-15). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". The Lancet. 380 (9859): 2095–2128. doi:10.1016/s0140-6736(12)61728-0. hdl:10292/13775. ISSN 0140-6736. PMC 10790329. PMID 23245604.
  3. ^ Liu, Li; Johnson, Hope L; Cousens, Simon; Perin, Jamie; Scott, Susana; Lawn, Joy E; Rudan, Igor; Campbell, Harry; Cibulskis, Richard; Li, Mengying; Mathers, Colin; Black, Robert E (2012-06-09). "Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000". The Lancet. 379 (9832): 2151–2161. doi:10.1016/s0140-6736(12)60560-1. ISSN 0140-6736. PMID 22579125.
  4. ^ a b Obstetrics and gynecology. Charles R. B. Beckmann, American College of Obstetricians and Gynecologists (6th ed.). Baltimore, MD: Lippincott Williams & Wilkins. 2010. ISBN 978-0-7817-8807-6. OCLC 298509160.{{cite book}}: CS1 maint: others (link)
  5. ^ a b O'Toole, F.E; Hokey, E.; McAuliffe, F.M; Walsh, J.M (2024-06-01). "The Experience of Anaemia and Ingesting Oral Iron Supplementation in Pregnancy: A Qualitative Study". European Journal of Obstetrics & Gynecology and Reproductive Biology. 297: 111–119. doi:10.1016/j.ejogrb.2024.03.005. ISSN 0301-2115. PMID 38608353.
  6. ^ "Severe Maternal Morbidity in the United States". CDC. Archived from the original on 2015-06-29. Retrieved 2015-07-08.
  7. ^ "Severe Maternal Morbidity in Canada" (PDF). The Society of Obstetricians and Gynaecologists of Canada (SOGC). Archived from the original (PDF) on 2016-03-09. Retrieved 2015-07-08.
  8. ^ Glazener CM, Abdalla M, Stroud P, Naji S, Templeton A, Russell IT (April 1995). "Postnatal maternal morbidity: extent, causes, prevention and treatment". British Journal of Obstetrics and Gynaecology. 102 (4): 282–287. doi:10.1111/j.1471-0528.1995.tb09132.x. PMID 7612509. S2CID 38872754.
  9. ^ Thompson JF, Roberts CL, Currie M, Ellwood DA (June 2002). "Prevalence and persistence of health problems after childbirth: associations with parity and method of birth". Birth. 29 (2): 83–94. doi:10.1046/j.1523-536X.2002.00167.x. PMID 12051189.
  10. ^ Borders N (2006). "After the afterbirth: a critical review of postpartum health relative to method of delivery". Journal of Midwifery & Women's Health. 51 (4): 242–248. doi:10.1016/j.jmwh.2005.10.014. PMID 16814217.
  11. ^ Naghavi, Mohsen; et al. (GBD 2016 Causes of Death Collaborators) (September 2017). "Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016". Lancet. 390 (10100): 1151–1210. doi:10.1016/S0140-6736(17)32152-9. PMC 5605883. PMID 28919116.
  12. ^ Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. (June 2014). "Global causes of maternal death: a WHO systematic analysis". The Lancet. Global Health. 2 (6): e323–e333. doi:10.1016/s2214-109x(14)70227-x. hdl:1854/LU-5796925. PMID 25103301.
  13. ^ a b c d "Pregnancy complications". womenshealth.gov. 2016-12-14. Retrieved 2018-11-07.
  14. ^ a b c Lende M, Rijhsinghani A (December 2020). "Gestational Diabetes: Overview with Emphasis on Medical Management". International Journal of Environmental Research and Public Health. 17 (24): 9573. doi:10.3390/ijerph17249573. PMC 7767324. PMID 33371325.
  15. ^ Summers A (July 2012). "Emergency management of hyperemesis gravidarum". Emergency Nurse. 20 (4): 24–28. doi:10.7748/en2012.07.20.4.24.c9206. PMID 22876404.
  16. ^ Goodwin TM (September 2008). "Hyperemesis gravidarum". Obstetrics and Gynecology Clinics of North America. 35 (3): 401–17, viii. doi:10.1016/j.ogc.2008.04.002. PMID 18760227.
  17. ^ Austin K, Wilson K, Saha S (April 2019). "Hyperemesis Gravidarum". Nutrition in Clinical Practice. 34 (2): 226–241. doi:10.1002/ncp.10205. PMID 30334272. S2CID 52987088.
  18. ^ Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieën JH, Wuisman PI, Ostgaard HC (November 2004). "Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence". European Spine Journal. 13 (7): 575–589. doi:10.1007/s00586-003-0615-y. PMC 3476662. PMID 15338362.
  19. ^ a b Walters C, West S, A Nippita T (July 2018). "Pelvic girdle pain in pregnancy". Australian Journal of General Practice. 47 (7): 439–443. doi:10.31128/AJGP-01-18-4467. PMID 30114872. S2CID 52018638.
  20. ^ Villar J, Say L, Gulmezoglu AM, Meraldi M, Lindheimer MD, Betran AP, Piaggio G (2003). "Eclampsia and pre-eclampsia: a health problem for 2000 years.". In Critchly H, MacLean A, Poston L, Walker J (eds.). Pre-eclampsia. London: RCOG Press. pp. 189–207.
  21. ^ Abalos E, Cuesta C, Grosso AL, Chou D, Say L (September 2013). "Global and regional estimates of preeclampsia and eclampsia: a systematic review". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 170 (1): 1–7. doi:10.1016/j.ejogrb.2013.05.005. PMID 23746796.
  22. ^ "High Blood Pressure in Pregnancy". medlineplus.gov. Retrieved 28 September 2022.
  23. ^ Haram K, Svendsen E, Abildgaard U (February 2009). "The HELLP syndrome: clinical issues and management. A Review" (PDF). BMC Pregnancy and Childbirth. 9: 8. doi:10.1186/1471-2393-9-8. PMC 2654858. PMID 19245695. Archived (PDF) from the original on 2011-11-12.
  24. ^ Mjahed K, Charra B, Hamoudi D, Noun M, Barrou L (October 2006). "Acute fatty liver of pregnancy". Archives of Gynecology and Obstetrics. 274 (6): 349–353. doi:10.1007/s00404-006-0203-6. PMID 16868757. S2CID 24784165.
  25. ^ Reyes H, Sandoval L, Wainstein A, Ribalta J, Donoso S, Smok G, et al. (January 1994). "Acute fatty liver of pregnancy: a clinical study of 12 episodes in 11 patients". Gut. 35 (1): 101–106. doi:10.1136/gut.35.1.101. PMC 1374642. PMID 8307428.
  26. ^ Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS (May 2021). "Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis". Journal of the American Heart Association. 10 (9): e018494. doi:10.1161/JAHA.120.018494. PMC 8200761. PMID 33870708.
  27. ^ "Pregnancy complications increase the risk of heart attacks and stroke in women with high blood pressure". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2023-11-21. doi:10.3310/nihrevidence_60660. S2CID 265356623.
  28. ^ Al Khalaf S, Chappell LC, Khashan AS, McCarthy FP, O'Reilly ÉJ (July 2023). "Association Between Chronic Hypertension and the Risk of 12 Cardiovascular Diseases Among Parous Women: The Role of Adverse Pregnancy Outcomes". Hypertension. 80 (7): 1427–1438. doi:10.1161/HYPERTENSIONAHA.122.20628. PMID 37170819.
  29. ^ Sarkar, Monika; Brady, Carla W.; Fleckenstein, Jaquelyn; Forde, Kimberly A.; Khungar, Vandana; Molleston, Jean P.; Afshar, Yalda; Terrault, Norah A. (January 2021). "Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases". Hepatology. 73 (1): 318–365. doi:10.1002/hep.31559. ISSN 0270-9139. PMID 32946672.
  30. ^ a b c Venös tromboembolism (VTE) – Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008
  31. ^ Taher, Ali T.; Iolascon, Achille; Matar, Charbel F.; Bou-Fakhredin, Rayan; de Franceschi, Lucia; Cappellini, Maria Domenica; Barcellini, Wilma; Russo, Roberta; Andolfo, Immacolata; Tyan, Paul; Gulbis, Beatrice; Aydinok, Yesim; Anagnou, Nicholas P.; Bencaiova, Gabriela Amstad; Tamary, Hannah (August 2020). "Recommendations for Pregnancy in Rare Inherited Anemias". HemaSphere. 4 (4): e446. doi:10.1097/HS9.0000000000000446. ISSN 2572-9241. PMC 7437563. PMID 32885142.
  32. ^ Wang S, An L, Cochran SD (2002). "Women". In Detels R, McEwen J, Beaglehole R, Tanaka H (eds.). Oxford Textbook of Public Health (4th ed.). Oxford University Press. pp. 1587–601.
  33. ^ https://www.cell.com/immunity/pdf/S1074-7613(22)00184-4.pdf [bare URL PDF]
  34. ^ a b c Kourtis AP, Read JS, Jamieson DJ (June 2014). "Pregnancy and infection". The New England Journal of Medicine. 370 (23): 2211–2218. doi:10.1056/NEJMra1213566. PMC 4459512. PMID 24897084.
  35. ^ Kaufmann R, Foxman B (1991). "Mastitis among lactating women: occurrence and risk factors". Social Science & Medicine. 33 (6): 701–705. doi:10.1016/0277-9536(91)90024-7. hdl:2027.42/29639. PMID 1957190.
  36. ^ "What infections can affect pregnancy?". NIH. 27 April 2021. Retrieved March 6, 2023.
  37. ^ Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U (January 2020). "Peripartum Cardiomyopathy: JACC State-of-the-Art Review". Journal of the American College of Cardiology. 75 (2): 207–221. doi:10.1016/j.jacc.2019.11.014. PMID 31948651. S2CID 210701262.
  38. ^ a b "Thyroid Disease & Pregnancy | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-03-12.
  39. ^ Sullivan SA (June 2019). "Hypothyroidism in Pregnancy". Clinical Obstetrics and Gynecology. 62 (2): 308–319. doi:10.1097/GRF.0000000000000432. PMID 30985406. S2CID 115198534.
  40. ^ a b c Taylor PN, Lazarus JH (September 2019). "Hypothyroidism in Pregnancy" (PDF). Endocrinology and Metabolism Clinics of North America. Pregnancy and Endocrine Disorders. 48 (3): 547–556. doi:10.1016/j.ecl.2019.05.010. PMID 31345522. S2CID 71053515.
  41. ^ Lemire F (October 2021). "[Not Available]". Canadian Family Physician. 67 (10): 791. doi:10.46747/cfp.6710791. PMC 8516186. PMID 34649907. S2CID 238861265.
  42. ^ "Ectopic pregnancy – Treatment – NHS Choices". www.nhs.uk. Retrieved 2017-07-27.
  43. ^ "Pregnancy complications". www.womenshealth.gov. Archived from the original on 2016-11-14. Retrieved 2016-11-13.
  44. ^ Dugas C, Slane VH (2022). "Miscarriage". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 30422585. Retrieved 2022-09-12.
  45. ^ "Miscarriage". NHS Choice. NHS. Archived from the original on 2017-02-15. Retrieved 2017-02-13.
  46. ^ du Fossé, Nadia A; van der Hoorn, Marie-Louise P; van Lith, Jan M M; le Cessie, Saskia; Lashley, Eileen E L O (2020-05-02). "Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis". Human Reproduction Update. pp. 650–669. doi:10.1093/humupd/dmaa010. PMC 7456349. PMID 32358607. Retrieved 2024-08-11.
  47. ^ a b Marufu TC, Ahankari A, Coleman T, Lewis S (March 2015). "Maternal smoking and the risk of still birth: systematic review and meta-analysis". BMC Public Health. 15 (1): 239. doi:10.1186/s12889-015-1552-5. PMC 4372174. PMID 25885887. S2CID 5241108.
  48. ^ "Stillbirth - Obstetrics and Gynecology Clinics".
  49. ^ Page JM, Silver RM (April 2018). "Evaluation of stillbirth". Current Opinion in Obstetrics & Gynecology. 30 (2): 130–135. doi:10.1097/GCO.0000000000000441. PMID 29489503. S2CID 3607787.
  50. ^ Oyelese Y, Ananth CV (October 2006). "Placental abruption". Obstetrics and Gynecology. 108 (4): 1005–1016. doi:10.1097/01.aog.0000239439.04364.9a. PMID 17012465. S2CID 960903.
  51. ^ Odendaal, Hein; Wright, Colleen; Schubert, Pawel; Boyd, Theonia K.; Roberts, Drucilla J.; Brink, Lucy; Nel, Daan; Groenewald, Coen (October 2020). "Associations of maternal smoking and drinking with fetal growth and placental abruption". European Journal of Obstetrics & Gynecology and Reproductive Biology. 253: 95–102. doi:10.1016/j.ejogrb.2020.07.018. PMID 32862031.
  52. ^ Oyelese Y, Smulian JC (April 2006). "Placenta previa, placenta accreta, and vasa previa". Obstetrics and Gynecology. 107 (4): 927–941. doi:10.1097/01.AOG.0000207559.15715.98. PMID 16582134. S2CID 22774083.
  53. ^ Wortman AC, Alexander JM (March 2013). "Placenta accreta, increta, and percreta". Obstetrics and Gynecology Clinics of North America. 40 (1): 137–154. doi:10.1016/j.ogc.2012.12.002. PMID 23466142.
  54. ^ a b Silver RM, Branch DW (April 2018). "Placenta Accreta Spectrum". The New England Journal of Medicine. 378 (16): 1529–1536. doi:10.1056/NEJMcp1709324. PMID 29669225. S2CID 81685472.
  55. ^ Hung TH, Shau WY, Hsieh CC, Chiu TH, Hsu JJ, Hsieh TT (April 1999). "Risk factors for placenta accreta". Obstetrics and Gynecology. 93 (4): 545–550. doi:10.1016/S0029-7844(98)00460-8. PMID 10214831.
  56. ^ Anuselvi, M. (May 2022). Risk Factors, Pattern and Outcome of Third Trimester Bleeding in a Tertiary Care Hospital (masters thesis). Coimbatore Medical College, Coimbatore.
  57. ^ "Placenta Accreta Spectrum". www.acog.org. Retrieved 2022-09-16.
  58. ^ Jauniaux, E.; Kingdom, J. C.; Silver, R. M. (2021). "A comparison of recent guidelines in the diagnosis and management of placenta accreta spectrum disorders". Best Practice & Research. Clinical Obstetrics & Gynaecology. 72: 102–116. doi:10.1016/j.bpobgyn.2020.06.007. PMID 32698993.
  59. ^ Kumar, Manoj; Saadaoui, Marwa; Al Khodor, Souhaila (2022). "Infections and Pregnancy: Effects on Maternal and Child Health". Frontiers in Cellular and Infection Microbiology. 12. doi:10.3389/fcimb.2022.873253. ISSN 2235-2988. PMC 9217740. PMID 35755838.
  60. ^ "Health problems in pregnancy". Medline Plus. US National Library of Medicine. Archived from the original on 2013-08-13.
  61. ^ a b c d e f Merck. "Risk factors present before pregnancy". Merck Manual Home Health Handbook. Merck Sharp & Dohme. Archived from the original on 2013-06-01.
  62. ^ Koniak-Griffin D, Turner-Pluta C (September 2001). "Health risks and psychosocial outcomes of early childbearing: a review of the literature". The Journal of Perinatal & Neonatal Nursing. 15 (2): 1–17. doi:10.1097/00005237-200109000-00002. PMID 12095025. S2CID 42701860.
  63. ^ Bayrampour H, Heaman M (September 2010). "Advanced maternal age and the risk of cesarean birth: a systematic review". Birth. 37 (3): 219–226. doi:10.1111/j.1523-536X.2010.00409.x. PMID 20887538.
  64. ^ Brouwers L, van der Meiden-van Roest AJ, Savelkoul C, Vogelvang TE, Lely AT, Franx A, van Rijn BB (December 2018). "Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis". BJOG. 125 (13): 1642–1654. doi:10.1111/1471-0528.15394. PMC 6283049. PMID 29978553.
  65. ^ Lamont K, Scott NW, Jones GT, Bhattacharya S (June 2015). "Risk of recurrent stillbirth: systematic review and meta-analysis". BMJ. 350: h3080. doi:10.1136/bmj.h3080. hdl:2164/4642. PMID 26109551.
  66. ^ Williams PM, Fletcher S (September 2010). "Health effects of prenatal radiation exposure". American Family Physician. 82 (5): 488–493. PMID 20822083. S2CID 22400308.
  67. ^ Denny CH, Acero CS, Naimi TS, Kim SY (April 2019). "Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18-44 Years - United States, 2015-2017". MMWR. Morbidity and Mortality Weekly Report. 68 (16): 365–368. doi:10.15585/mmwr.mm6816a1. PMC 6483284. PMID 31022164.
  68. ^ "Preventing Smoking and Exposure to Secondhand Smoke Before, During, and After Pregnancy" (PDF). Centers for Disease Control and Prevention. 2007. Archived from the original (PDF) on 2011-09-11.
  69. ^ "Substance Use During Pregnancy". Centers for Disease Control and Prevention. 2009. Archived from the original on 2013-10-29. Retrieved 2013-10-26.
  70. ^ a b "New Mother Fact Sheet: Methamphetamine Use During Pregnancy". North Dakota Department of Health. Archived from the original on 2011-09-10. Retrieved 7 October 2011.
  71. ^ Della Grotta S, LaGasse LL, Arria AM, Derauf C, Grant P, Smith LM, et al. (July 2010). "Patterns of methamphetamine use during pregnancy: results from the Infant Development, Environment, and Lifestyle (IDEAL) Study". Maternal and Child Health Journal. 14 (4): 519–527. doi:10.1007/s10995-009-0491-0. PMC 2895902. PMID 19565330.
  72. ^ Grand-Guillaume-Perrenoud, Jean Anthony; Origlia, Paola; Cignacco, Eva (2022-02-01). "Barriers and facilitators of maternal healthcare utilisation in the perinatal period among women with social disadvantage: A theory-guided systematic review". Midwifery. 105: 103237. doi:10.1016/j.midw.2021.103237. ISSN 0266-6138. PMID 34999509.
  73. ^ Eisenberg L, Brown SH (1995). The best intentions: unintended pregnancy and the well-being of children and families. Washington, D.C.: National Academy Press. ISBN 978-0-309-05230-6. Retrieved 2011-09-03.
  74. ^ "Family Planning - Healthy People 2020". Archived from the original on 2010-12-28. Retrieved 2011-08-18.
  75. ^ Gavin AR, Holzman C, Siefert K, Tian Y (2009). "Maternal depressive symptoms, depression, and psychiatric medication use in relation to risk of preterm delivery". Women's Health Issues. 19 (5): 325–334. doi:10.1016/j.whi.2009.05.004. PMC 2839867. PMID 19733802.
  76. ^ Abdul Sultan A, West J, Stephansson O, Grainge MJ, Tata LJ, Fleming KM, Humes D, Ludvigsson JF (November 2015). "Defining venous thromboembolism and measuring its incidence using Swedish health registries: a nationwide pregnancy cohort study". BMJ Open. 5 (11): e008864. doi:10.1136/bmjopen-2015-008864. PMC 4654387. PMID 26560059.
  77. ^ Leveno 2013, p. 38.
  78. ^ "Chromosome Abnormalities Fact Sheet". National Human Genome Research Institute (NHGRI). Retrieved 14 May 2017.
  79. ^ Leveno 2013, p. 13.
  80. ^ Kirk E, Bottomley C, Bourne T (1 March 2014). "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location". Human Reproduction Update. 20 (2): 250–261. doi:10.1093/humupd/dmt047. PMID 24101604.
  81. ^ Leveno 2013, p. 47.
  82. ^ Leveno 2013, p. 2.
  83. ^ "Pregnancy Loss: Condition Information". www.nichd.nih.gov. Retrieved 14 May 2017.
  84. ^ Leveno 2013, p. 50.
  85. ^ Leveno 2013, p. 88.
  86. ^ Leveno 2013, p. 91.
  87. ^ Leveno 2013, p. 114.
  88. ^ Leveno 2013, p. 130.
  89. ^ Leveno 2013, p. 131.
  90. ^ Cluver C, Gyte GM, Sinclair M, Dowswell T, Hofmeyr GJ (February 2015). "Interventions for helping to turn term breech babies to head first presentation when using external cephalic version". The Cochrane Database of Systematic Reviews. 2015 (2): CD000184. doi:10.1002/14651858.CD000184.pub4. hdl:10019.1/104301. PMC 10363414. PMID 25674710.
  91. ^ Leveno 2013, p. 147.
  92. ^ Leveno 2013, p. 152.
  93. ^ "Uterine Rupture in Pregnancy: Overview, Rupture of the Unscarred Uterus, Previous Uterine Myomectomy and Uterine Rupture". reference.medscape.com. Retrieved 14 May 2017.
  94. ^ Leveno 2013, p. 154.
  95. ^ Leveno 2013, p. 161.
  96. ^ Leveno 2013, p. 169.
  97. ^ a b Leveno 2013, p. 171.
  98. ^ Leveno 2013, p. 180.
  99. ^ Leveno 2013, p. 188.
  100. ^ a b c d e f g h Leveno 2013.
  101. ^ Leveno 2013, p. 218.
  102. ^ Bowman JM, Chown B, Lewis M, Pollock JM (March 1978). "Rh isoimmunization during pregnancy: antenatal prophylaxis". Canadian Medical Association Journal. 118 (6): 623–627. PMC 1818025. PMID 77714.
  103. ^ Leveno 2013, p. 223.
  104. ^ Leveno 2013, p. 225.
  105. ^ Leveno 2013, p. 232.
  106. ^ Leveno 2013, p. 236.
  107. ^ Leveno 2013, p. 241.
  108. ^ Leveno 2013, p. 247.
  109. ^ Leveno 2013, p. 250.
  110. ^ Leveno 2013, p. 252.
  111. ^ Leveno 2013, p. 260-273.
  112. ^ Leveno 2013, p. 274.
  113. ^ a b "Public Education Pamphlets". sogc.org. Archived from the original on 6 July 2018. Retrieved 15 May 2017.
  114. ^ Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, et al. (July 2009). "Practice parameter update: management issues for women with epilepsy--focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society". Neurology. 73 (2): 126–132. doi:10.1212/WNL.0b013e3181a6b2f8. PMC 3475195. PMID 19398682.
  115. ^ Leveno 2013, p. 278.
  116. ^ Leveno 2013, p. 335.
  117. ^ Leveno 2013, p. 349.
  118. ^ Leveno 2013, p. 363.
  119. ^ Leveno 2013, p. 382.
  120. ^ Leveno 2013, p. 410.
  121. ^ Leveno 2013, p. 425.
  122. ^ Leveno 2013, p. 435.
  123. ^ a b Leveno 2013, p. 439.
  124. ^ a b c d e f g h "ICD-10 Version:2016". International Statistical Classification of Diseases and Related Health Problems 10th Revision. Retrieved 16 May 2017.

Further reading

edit
  • Leveno K (2013). Williams manual of pregnancy complications. New York: McGraw-Hill Medical. ISBN 978-0071765626.
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