Complications of pregnancy refers to the problems that occur during pregnancy, which may involve the mother’s health, the baby’s health or both. For this episode of AskMeDoctor!, we welcomed Dr. Timothy, an Obstetrician & Gynaecologist currently based in Tung Shin Hospital and Sunway Medical Centre Velocity. Here are the answers to your concerns and worries regarding complications of pregnancies.

Q1: What are the common complications in pregnancy?

Dr. Timothy: Complications can happen during the early phase of pregnancy, as well as the later phase of pregnancy.

During the early phase, some pregnant women may experience morning sickness, or the more severe form which we call Hyperemesis Gravidarum (HG), miscarriages, as well as ectopic pregnancy (pregnancy outside the womb).

The common complications during the later phase of pregnancy are high blood pressure during pregnancy (gestational hypertension), gestational diabetes, more sever form of high blood pressure or also known preeclampsia, preterm labour, and infections – like urine infections, infections after rupture of membranes when the water bag breaks early (prelabour rupture of membranes (PPRM)), and Chorioamnionitis (inflammation of the fetal membranes).

Q2: Who is at risk for pregnancy complication?

Dr. Timothy: There are many risk factors that can contribute to complications in pregnancy. When we assess women who are getting pregnant, we need to get a thorough history and physical examination in order to identify the risk.

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Basically, we need to get these information:

The age of the woman: woman who are very young (teenagers) and women who are more than 40 years old tend to get complications such as gestational hypertension or blood pressure.
Underlying medical problems (whether they have any medical problems before they get pregnant): such as high blood pressure, diabetes, any autoimmune diseases, kidney disease,or heart disease; which can impact the pregnancy.
Was pregnant/had any complications during their last pregnancy: For example, if she had a miscarriage before, experienced any ectopic pregnancy before, or any medical conditions during pregnancy.
If they have been pregnant before: we would like to know their mode of delivery, either vaginal delivery or C-section.
Family history: information on family health history, abnormal babies, and twin pregnancy.

Q3: Is abdominal pain or cramp normal during pregnancy?

Dr. Timothy: It is quite common for pregnant women to get cramps and abdominal pain during pregnancy. It is usually because of the stretching of ligaments that support the pelvis. During pregnancy, the pregnancy hormones actually causes relaxation of these ligaments.

As the uterus/womb grows, it will stretch the pelvic area which can cause cramps and a little bit of pain. However, we need to exclude other dangerous conditions such as ectopic pregnancies, miscarriages and other known gynae-related conditions like urine infections and appendicitis which also happen during pregnancy.

Q4: During the 9th week of pregnancy, a mother felt stomach ache and bone pain. Her stomach feels hard and full and has difficulty in breathing and sleeping. Will there be anything dangerous happening to her baby?

Dr. Timothy: Yes, this is likely a complication of pregnancy. Based on the brief history here, the possible causes for this could be miscarriage, an ectopic pregnancy (if we do not know the location or the woman has not confirmed if her pregnancy occurs inside the womb), or possibly, infections such as urine infection, appendicitis or even gastritis.

Because in the early of pregnancy, most women experience nausea, constant vomiting, and poor appetite; which can lead to gastritis as well.

Based on these symptoms, we will need to get further history and physical examinations to determine what is the actual problem.

Will there be anything happen to the baby?

Of course, some of these conditions can actually be dangerous to the baby. For example, if it is an ongoing miscarriage, then YES, it is going to harm the baby.

Birth Control & Abortion

Q5: Can being on birth control potentially lead to complications in pregnancy?

Dr. Timothy: Some women may be taking birth control pills accidentally without knowing that they are pregnant. The birth control pills should NOT affect their pregnancy or cause any complications to the baby. There is very little risk of birth control pills causing birth defects or problem during pregnancy.

Q6: If a woman have had two abortions previously, will it create any potential complications for the next pregnancy?

Dr. Timothy: First of all, we need to know about these abortions, whether both happened due to miscarriage or a termination of pregnancy due to some reason. For example, because of the baby is unhealthy.

Recurrent miscarriage

If it is a recurrent miscarriage, we need to check whether this will repeat again in this current pregnancy. If it is a condition that led to the miscarriage; for example, the mother has had a previous medical problem, then we would need to correct the medical problem before she embarks on her next pregnancy.

Certain conditions that can lead to recurrent miscarriages are like diabetes, thyroid disorders, and even blood disorders. So we would need to examine and correct them before the next pregnancy.

Termination of pregnancy

If it was because of termination of pregnancy, then we need to know what was done previously. Was it done through a medical termination or surgical termination which is in the form of Dilation and Curettage (D&C).

Multiple D&C actually increases the risk of a woman developing Placenta Previa. Placenta Previa is a condition where the placenta is implants at the lower part of the uterus or covering the cervix. This is a very dangerous condition because it can lead to a life-threatening bleeding.

Endometriosis, Fibroid & Herpes

Q7: After suffering from endometriosis, a woman is finally pregnant. Will this health condition affect her pregnancy?

Dr. Timothy: Endometriosis is a condition where the endometrial lining (the lining of the womb) grows outside the womb. It can actually grows around the pelvic area, ovaries, and around the abdominal lining.

Women suffering from endometriosis usually experience chronic pain – chronic pelvic pain or severe form of period pain.

Women with endometriosis who are pregnant, they generally do quite well. They should progress like any other healthy pregnant women. Generally, it does not usually cause much complications in pregnancy.

Endometriosis is commonly under diagnosed because women sometimes have severe period cramps but they take that as a normal thing.

Q8: How or when you discover that someone has endometriosis?

Dr. Timothy: Usually, you diagnose endometriosis when that woman is not pregnant, they usually present chronic pelvic pain or severe period pain. Ultrasound scan can only detect endometriosis if there is a cyst on the ovary – we call it as endometriotic cyst.

If you do not have endometriotic cyst, then we will not be able to diagnose endometriosis through ultrasound. The only way is through procedure we call laparoscopy, which is actually a surgical procedure.

So, we put a camera into the woman’s tummy, to see if there is endometriosis.

Q9: If a woman has had fibroid for several years and fortunately, they have never caused her any problem, will this cause any complication when she gets pregnant?

Dr. Timothy: Fibroids are quite common among women. About 20% of woman actually have fibroids. If fibroids do not cause her any problem before, it is likely that the fibroids are small and does not distort the womb.

In this kind of cases, usually the fibroid does not cause any problems to the pregnancy. However, we do know that if you have a fibroid during pregnancy, you can potentially get certain complications. For example, miscarriages – if the fibroid is distorting your womb and you may get pain during the pregnancy due to the degeneration of the fibroid.

The fibroid can actually interfere with the growth of the baby and leads to malpresentation, where the baby’s position is not at its normal position.

Q10: If a woman has herpes, can her baby catch it from her?

Dr. Timothy: Herpes is a Sexually Transmitted Disease (STD). It is a condition where a woman develops small blisters all over the outer part of her vagina. It depends whether it is a primary herpes, meaning that the woman develops herpes for the first time, or a secondary herpes, where it is a reactivation of the previous infection.

Primary Herpes: The mother does not have any antibodies, therefore, she cannot protect the baby.
Secondary Herpes: The mother has had herpes before, but this herpes virus had remained dormant in her body and it has now been reactivated. Therefore, she developed an antibody from the previous infection. So the antibodies will actually protect her baby.

Herpes is dangerous if it develops during the time of labour or when the woman is about to deliver. This is because herpes is developed at the outer part of the vagina (vulva), where the transmission can happen during birth.

If the woman has primary herpes, we will generally advise for a C-section to avoid transmission to the baby, where the baby can develop neonatal herpes.

Q11: How can pregnant women prevent complications from developing?

Dr. Timothy: We have to identify the risk factor. We have to individualize each woman because every woman will have different risk.

One of the ways is to go for a preconception consultation with a Gynaecologist, so the Gynae can actually explore the patient’s history thoroughly – the woman’s age, previous medical history, previous surgical history, previous modes of deliveries, previous complications in previous pregnancies, and family history.

Through the physical examinations, the Gynaecologist can actually identify other problems that may not be obvious. For example, a woman may have a heart murmur.

Here is the complete interview with Dr. Timothy Lee:

All in all, pregnant mothers need to practice a healthy eating and lifestyle until after the birth of the baby. You are responsible to protect yourself and your baby. Eat nutritious foods, avoid alcohol and cigarettes, have a plenty of rest, stay hydrated, and stay tuned for our next episode of AskMeDoctor!