Complications of pregnancy

Source: Wikipedia, the free encyclopedia.
(Redirected from
Risk factors in pregnancy
)
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

Complications of pregnancy are health problems that are related to, or arise during

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.

Common complications of pregnancy include anemia, gestational diabetes, infections, gestational hypertension and pre-eclampsia.[1] Presence of these types of complications can have implications on monitoring lab work, imaging, and medical management during pregnancy.[1]

Severe complications of pregnancy, childbirth, and the puerperium are present in 1.6% of mothers in the US,[2] and in 1.5% of mothers in Canada.[3] In the immediate postpartum period (puerperium), 87% to 94% of women report at least one health problem.[4][5] Long-term health problems (persisting after six months postpartum) are reported by 31% of women.[6]

In 2016, complications of pregnancy, childbirth, and the

obstructed labor, and unsafe abortion.[7][8]

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

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

Gestational diabetes

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.[10]

Hyperemesis gravidarum

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.[11][12] 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.[13]

Pelvic girdle pain

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.[14][15] 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.[15]

High blood pressure

Main article: Hypertensive disease of pregnancy

Potential severe hypertensive states of pregnancy are mainly:

  • Pre-eclampsia – gestational hypertension, proteinuria (>300 mg), and edema. Severe pre-eclampsia involves a BP over 160/110 (with additional signs). It affects 5–8% of pregnancies.[16]
  • Eclampsia – seizures in a pre-eclamptic patient, affect around 1.4% of pregnancies.[17]
  • Gestational hypertension can develop after 20 weeks but has no other symptoms, and later rights itself, but it can develop into pre-eclampsia.[18]
  • liver enzymes and a low platelet count. Incidence is reported as 0.5–0.9% of all pregnancies.[19]
  • Acute fatty liver of pregnancy is sometimes included in the pre-eclamptic spectrum. It occurs in approximately one in 7,000 to one in 15,000 pregnancies.[20][21]

Women who have chronic hypertension before their pregnancy are at increased risk of complications such as premature birth, low birthweight or stillbirth.[22] 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.[23][24]

Venous thromboembolism

venous thromboembolism (VTE), 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.[25]

Anemia

Main article: Anemia in pregnancy

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.[26]

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.[9]

Infection

Main article: Susceptibility and severity of infections in pregnancy
Further information: Neonatal infection

A pregnant woman is more susceptible to certain

varicella.[27] Mastitis, or inflammation of the breast, occurs in 20% of lactating individuals.[28]

Some infections are vertically transmissible, meaning that they can affect the child as well.[29]

Peripartum cardiomyopathy

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.[30]

Hypothyroidism

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.[31] 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.[32] 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.[33] 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.[31][33] This complication is treated by iodine supplementation, levothyroxine which is a form of thyroid hormone replacement, and close monitoring of thyroid function.[33]

Fetal and placental problems

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

Ectopic pregnancy

Ectopic pregnancy is implantation of the embryo outside the uterus

  • 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.[34]
  • 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.[35]

Miscarriage

Miscarriage is the loss of a pregnancy prior to 20 weeks.[36][37] In the UK, miscarriage is defined as the loss of a pregnancy during the first 23 weeks.[38]

Approximately 80% of pregnancy loss occurs in the first trimester, with a decrease in risk after 12 weeks gestation. 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

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.[39]

  • Epidemiology: There are over 2 million stillbirths a year and there are about 6 stillbirths per 1000 births (0.6%)[40]
  • 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[39]
  • Treatment: If fetal passing occurs before labor, treatment options include induced labor or cesarean section. Otherwise, stillbirths can pass with natural birth.

Placental abruption

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.[9][41]

  • 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

Placenta previa is a condition that occurs when the placenta fully or partially covers the cervix.[9] 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 diagnosed by ultrasound, either during a routine examination or following an episode of abnormal vaginal bleeding. Most diagnosis of placenta previa occurs during the second-trimester.[citation needed]

  • Risk Factors: prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, maternal age.[42]

Placenta accreta

Placenta accreta is an abnormal adherence of the placenta to the uterine wall.[43] Specifically, placenta accreta involves abnormal adherence of the placental trophoblast to the uterine myometrium.[44]

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.[45] 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.[46]

Due to abnormal adherence of the placenta to the uterine wall, cesarean delivery is often indicated, as well as cesarean hysterectomy.[44]

Multiple pregnancies

Main article: Multiple birth

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
]

Mother-to-child transmission

Further information: Vertically transmitted infection
Further information: Neonatal infection

Since the embryo and fetus have little or no

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

genito-urinary tract (e.g., Candida
) are among those commonly seen in infection of newborns.

General risk factors

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.[47] 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.[48]

Biological

Some common biological risk factors include:

Environmental

Some common environmental risk factors during pregnancy include:

  • Exposure to
    environmental toxins
  • Exposure to
    recreational drugs
  • Social and
    socioeconomic factors: Generally speaking, unmarried individuals and those in lower socioeconomic groups experience an increased level of risk in pregnancy, due at least in part to lack of access to appropriate prenatal care.[48]
  • Unintended pregnancy: Unintended pregnancies preclude preconception care and delays prenatal care. They preclude other preventive care, may disrupt life plans and on average have worse health and psychological outcomes for the mother and, if birth occurs, the child.[59][60]
  • Exposure to
    preterm delivery.[61]

High-risk pregnancy

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

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: [62]

List of complications (complete)

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

References

  1. ^
    OCLC 298509160.{{cite book}}: CS1 maint: others (link
    )
  2. ^ "Severe Maternal Morbidity in the United States". CDC. Archived from the original on 2015-06-29. Retrieved 2015-07-08.
  3. ^ "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.
  4. S2CID 38872754
    .
  5. PMID 12051189
    .
  6. PMID 16814217
    .
  7. PMID 28919116
    .
  8. PMID 25103301
    .
  9. ^ a b c d "Pregnancy complications". womenshealth.gov. 2016-12-14. Retrieved 2018-11-07.
  10. ^
    PMID 33371325
    .
  11. PMID 22876404
    .
  12. PMID 18760227
    .
  13. S2CID 52987088
    .
  14. PMID 15338362
    .
  15. ^
    S2CID 52018638
    .
  16. ^ 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.
  17. PMID 23746796
    .
  18. ^ "High Blood Pressure in Pregnancy". medlineplus.gov. Retrieved 28 September 2022.
  19. PMID 19245695. Archived
    (PDF) from the original on 2011-11-12.
  20. S2CID 24784165
    .
  21. PMID 8307428
    .
  22. PMID 33870708
    .
  23. S2CID 265356623
    .
  24. PMID 37170819
    .
  25. ^ a b c Venös tromboembolism (VTE) – Guidelines for treatment in C counties. Bengt Wahlström, Emergency department, Uppsala Academic Hospital. January 2008
  26. ^ 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.
  27. ^
    PMID 24897084
    .
  28. PMID 1957190
    .
  29. ^ "What infections can affect pregnancy?". NIH. 27 April 2021. Retrieved March 6, 2023.
  30. S2CID 210701262
    .
  31. ^ a b "Thyroid Disease & Pregnancy | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-03-12.
  32. S2CID 115198534
    .
  33. ^
    S2CID 71053515
    .
  34. S2CID 238861265
    .
  35. ^ "Ectopic pregnancy – Treatment – NHS Choices". www.nhs.uk. Retrieved 2017-07-27.
  36. ^ "Pregnancy complications". www.womenshealth.gov. Archived from the original on 2016-11-14. Retrieved 2016-11-13.
  37. PMID 30422585
    . Retrieved 2022-09-12.
  38. ^ "Miscarriage". NHS Choice. NHS. Archived from the original on 2017-02-15. Retrieved 2017-02-13.
  39. ^
    S2CID 5241108
    .
  40. S2CID 3607787
    .
  41. S2CID 960903
    .
  42. S2CID 22774083
    .
  43. PMID 23466142
    .
  44. ^
    S2CID 81685472
    .
  45. PMID 10214831
    .
  46. ^ "Placenta Accreta Spectrum". www.acog.org. Retrieved 2022-09-16.
  47. ^ "Health problems in pregnancy". Medline Plus. US National Library of Medicine. Archived from the original on 2013-08-13.
  48. ^ 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.
  49. S2CID 42701860
    .
  50. PMID 20887538
    .
  51. PMID 29978553
    .
  52. PMID 26109551
    .
  53. S2CID 22400308
    .
  54. PMID 31022164
    .
  55. ^ "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.
  56. ^ "Substance Use During Pregnancy". Centers for Disease Control and Prevention. 2009. Archived from the original on 2013-10-29. Retrieved 2013-10-26.
  57. ^ 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.
  58. PMID 19565330
    .
  59. ISBN 978-0-309-05230-6
    . Retrieved 2011-09-03.
  60. ^ "Family Planning - Healthy People 2020". Archived from the original on 2010-12-28. Retrieved 2011-08-18.
  61. PMID 19733802
    .
  62. PMID 26560059
    .
  63. ^ Leveno 2013, p. 38.
  64. ^ "Chromosome Abnormalities Fact Sheet". National Human Genome Research Institute (NHGRI). Retrieved 14 May 2017.
  65. ^ Leveno 2013, p. 13.
  66. PMID 24101604
    .
  67. ^ Leveno 2013, p. 47.
  68. ^ Leveno 2013, p. 2.
  69. ^ "Pregnancy Loss: Condition Information". www.nichd.nih.gov. Retrieved 14 May 2017.
  70. ^ Leveno 2013, p. 50.
  71. ^ Leveno 2013, p. 88.
  72. ^ Leveno 2013, p. 91.
  73. ^ Leveno 2013, p. 114.
  74. ^ Leveno 2013, p. 130.
  75. ^ Leveno 2013, p. 131.
  76. PMID 25674710
    .
  77. ^ Leveno 2013, p. 147.
  78. ^ Leveno 2013, p. 152.
  79. ^ "Uterine Rupture in Pregnancy: Overview, Rupture of the Unscarred Uterus, Previous Uterine Myomectomy and Uterine Rupture". reference.medscape.com. Retrieved 14 May 2017.
  80. ^ Leveno 2013, p. 154.
  81. ^ Leveno 2013, p. 161.
  82. ^ Leveno 2013, p. 169.
  83. ^ a b Leveno 2013, p. 171.
  84. ^ Leveno 2013, p. 180.
  85. ^ Leveno 2013, p. 188.
  86. ^ a b c d e f g h Leveno 2013.
  87. ^ Leveno 2013, p. 218.
  88. PMID 77714
    .
  89. ^ Leveno 2013, p. 223.
  90. ^ Leveno 2013, p. 225.
  91. ^ Leveno 2013, p. 232.
  92. ^ Leveno 2013, p. 236.
  93. ^ Leveno 2013, p. 241.
  94. ^ Leveno 2013, p. 247.
  95. ^ Leveno 2013, p. 250.
  96. ^ Leveno 2013, p. 252.
  97. ^ Leveno 2013, p. 260-273.
  98. ^ Leveno 2013, p. 274.
  99. ^ a b "Public Education Pamphlets". sogc.org. Archived from the original on 6 July 2018. Retrieved 15 May 2017.
  100. PMID 19398682
    .
  101. ^ Leveno 2013, p. 278.
  102. ^ Leveno 2013, p. 335.
  103. ^ Leveno 2013, p. 349.
  104. ^ Leveno 2013, p. 363.
  105. ^ Leveno 2013, p. 382.
  106. ^ Leveno 2013, p. 410.
  107. ^ Leveno 2013, p. 425.
  108. ^ Leveno 2013, p. 435.
  109. ^ a b Leveno 2013, p. 439.
  110. ^ 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

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

External links
Retrieved from "https://en.wikipedia.org/w/index.php?title=Complications_of_pregnancy&oldid=1213706867"