OB | Complications Pt 2

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First Trimester Complications

• Ectopic Pregnancy: A pregnancy that implants outside the uterine cavity, overwhelmingly in the fallopian tube. This is a critical medical emergency; a tubal rupture can cause life-threatening internal bleeding and hypovolaemic shock. Diagnosis is confirmed by lower-than-expected β-hCG levels and an empty uterus on an ultrasound. Treatment relies on methotrexate or surgical intervention.
• Hydatidiform Mole (Molar Pregnancy): An improperly fertilized egg leading to abnormal, premalignant trophoblast tissue proliferation. Patients present with excessively high β-hCG and "grape-like" structures on ultrasound. It carries a significant risk of mutating into choriocarcinoma, requiring rigorous follow-up and sometimes chemotherapy.
• Miscarriage: The expulsion of a fetus prior to 16 weeks, generally presenting with vaginal bleeding and abdominal cramping. Depending on the classification (e.g., complete, incomplete, missed, or septic), treatment ranges from watchful waiting to pharmacological induction (misoprostol) or surgical curettage.

Second Trimester Complications

• Hypertensive Disorders: A progressive and highly dangerous spectrum of conditions. Gestational hypertension is high blood pressure beginning after 20 weeks. Pre-eclampsia involves hypertension paired with proteinuria or signs of organ failure, driven by placental endothelial dysfunction and systemic inflammation. It can rapidly escalate into HELLP Syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets) or Eclampsia (life-threatening maternal convulsions). Eclampsia is treated emergently with intravenous magnesium sulfate and prompt delivery of the fetus.
• Gestational Diabetes Mellitus (GDM): Pregnancy-induced diabetes that significantly increases the risk of fetal macrosomia (overgrowth), birth trauma, and future maternal Type 2 diabetes. It is initially managed with diet and exercise, and subsequently with insulin if targets are not met.
• Cervical Insufficiency: Painless, premature dilation of the cervix without contractions, threatening mid-pregnancy loss. Management includes vaginal progesterone or placing a surgical cerclage to keep the cervix closed.

Third Trimester & Placental/Amniotic Complications

• Placental Abruption: The premature detachment of the placenta from the uterine wall. It is characterized by painful vaginal bleeding, a hard and tense abdomen, and severe fetal distress. It is an acute emergency with high risks of maternal hypovolaemic shock and Disseminated Intravascular Coagulation (DIC).
• Placenta Praevia: A condition where the placenta obstructs the internal cervical os. In stark contrast to an abruption, it presents as painless bright red vaginal bleeding. It is managed conservatively with bed rest until delivery, which typically necessitates an elective Caesarean section.
• Fetal Growth Restriction (FGR): Fetal growth dropping below the 10th percentile. Symmetrical FGR (all fetal dimensions are proportionally small) usually suggests early genetic anomalies or congenital infections. Asymmetrical FGR (head circumference is preserved while abdominal size is reduced) points to late-onset placental insufficiency or maternal chronic disease.