Maternal and Fetal Complications

According to the March of Dimes, birth defects occur in one of every 28 births and are the leading cause of infant death. Not all defects are this serious; many babies born with birth defects live a full and active life. Birth defects may be caused by heredity, genetic and chromosomal abnormalities, infections, drugs and medicines, alcohol, smoking, nutrition, and environmental factors. Many birth defects are detected through routine ultrasound and blood tests, and treating the fetus during pregnancy is no longer an insurmountable task. Treatment may be as basic as the mother taking medication or as sophisticated as surgery on the developing fetus.

Maternal Complications

Gestational Diabetes occurs when a non-diabetic woman develops diabetes during pregnancy. Placental hormones, which promote growth in the fetus, cause the mother's body to become resistant to insulin, which is required for the break down of blood sugar (glucose) into energy. Resulting high glucose levels are then transferred to the fetus and the baby puts on extra fat, developing a condition called macrosomia. Gestational diabetes may cause breathing problems in infants, obesity in childhood, and non-insulin dependent (type II) diabetes in adulthood. Treatment includes a special meal and exercise plan, and occasional daily blood glucose testing and insulin injections. Usually the diabetes disappears following the birth of the baby.

Preeclampsia is defined as the occurrence of high blood pressure in the presence of substantial protein in the urine, and swelling. Preeclampsia is defined as either mild or severe, and if left untreated, can progress to eclampsia, resulting in maternal seizures and increased risk of mortality. In the fetus, eclampsia may delay growth and increase the risk of distress and death. Treatment may include bed rest or hospitalization, IV fluids, and antihypertensive and antiseizure medications. If the fetus is mature, delivery may be the best option.

Bleeding/Spotting commonly occurs during pregnancy and may or may not be a cause for concern.

Blighted Ovum: egg is fertilized but development stops at an early stage and the embryo never develops.
Miscarriage: products of conception are prematurely expelled from the uterus.
Implantation Hemorrhage: bleeding occurs at the time of the expected period and may be a natural condition.
Ectopic Pregnancy: fertilized egg fails to implant in the uterine cavity. In 95% of the cases, implantation occurs within the fallopian tube.
Placental Previa: placenta attaches abnormally low on the uterine wall, partially or totally covering the uterine opening.
Placental Abruption: separation of any part, or all, of the placenta after 20 weeks of pregnancy.

Infant Complications

Placental Treatment is a procedure in which the mother takes a medication that crosses the placenta into the fetus' blood system to treat a condition in the fetus.

• Medication for fetal heart defects and abnormal heart beats will either correct the condition or maintain the health of the fetus until delivery, at which time surgery or medical treatment may be performed.
• Corticosteroids given to the mother may prevent fetal respiratory distress syndrome and intraventricular hemorrhage when given prior to the delivery of a preterm infant.
• Thyroid goiter disorders can develop in the fetus when the mother has Graves Disease (a thyroid disorder). By injecting thyroid medication into the amniotic fluid, the fetal goiter will be reduced or eliminated.

Closed Fetal Corrective Surgery (Shunt Placement) is used to decrease an excessive accumulation of fluid in the fetus, which may result in organ damage. Shunts have been used to decrease fluid in the heart (ventriculomegaly), kidney (obstructive uropathy), and lung (hydrothorax). Shunts are placed into the fetus through a needle inserted through the uterine wall.

Open Fetal Corrective Surgery is considered when a condition, if left untreated, could cause organ damage or interfere with normal development. During this procedure, the mother is anesthetized, ultrasound is used to locate the fetus, an incision is made in the uterus, and corrective surgery on the fetus is performed.

• Congenital Diaphragmatic Hernias: abdominal organs (stomach, bowel, and liver) may protrude into the chest cavity due to a failure of the diaphragm to close during fetal development.
• Urinary Tract Obstruction: blockage within the urinary tract which may cause an accumulation of urine within the kidneys or bladder.
• Congenital Cystic Adenomatoid Malformation: cystic mass within the lung cavity which impedes lung and heart development.

Date last updated:  January 27, 2003