15.3 Pregnancy-related complications and first aid

Pregnancy-related complications can pose serious risks to both mother and baby. From hypertensive disorders like preeclampsia to emergencies during labor and delivery, understanding these conditions is crucial for providing effective first aid and ensuring the best possible outcomes.

This section explores various pregnancy complications, their symptoms, and appropriate first aid responses. By learning about these issues, first responders can better assist expectant mothers and newborns in emergency situations, potentially saving lives and preventing further complications.

Hypertensive Disorders

Preeclampsia and Eclampsia

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• Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to organ systems, most often the liver and kidneys
• Typically develops after 20 weeks of pregnancy and is accompanied by protein in the urine (proteinuria) and swelling in the legs, feet, and hands (edema)
• If left untreated, preeclampsia can lead to serious complications for both the mother and the baby, including eclampsia
• Eclampsia is a severe complication of preeclampsia that causes seizures and can be life-threatening for both the mother and the baby
  • Occurs when preeclampsia goes untreated and progresses, affecting the brain and causing seizures or coma

Gestational Hypertension and Placental Abruption

• Gestational hypertension is a form of high blood pressure that develops during pregnancy, usually after the 20th week
  • Unlike preeclampsia, gestational hypertension is not accompanied by signs of damage to other organ systems or protein in the urine
  • However, gestational hypertension can still lead to complications such as preeclampsia if left untreated
• Placental abruption is a serious complication where the placenta partially or completely separates from the inner wall of the uterus before delivery
  • Can be caused by hypertensive disorders like preeclampsia and gestational hypertension
  • Symptoms include vaginal bleeding, abdominal pain, and uterine tenderness
  • Placental abruption can lead to severe bleeding, putting both the mother and baby at risk, and may require emergency delivery

Pregnancy Complications

Miscarriage and Ectopic Pregnancy

• Miscarriage is the spontaneous loss of a pregnancy before the 20th week
  • Symptoms include vaginal bleeding, abdominal pain, and cramping
  • In most cases, the cause of miscarriage is unknown, but risk factors include advanced maternal age, certain infections, and hormonal problems
• Ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus, usually in a fallopian tube
  • As the pregnancy grows, it can cause the fallopian tube to rupture, leading to severe abdominal pain and internal bleeding
  • Ectopic pregnancies are not viable and require immediate medical attention to prevent life-threatening complications

Pregnancy-Induced Diabetes and Hyperemesis Gravidarum

• Pregnancy-induced diabetes, also known as gestational diabetes, is a type of diabetes that develops during pregnancy
  • Caused by hormonal changes that make it difficult for the body to use insulin effectively, leading to high blood sugar levels
  • Can increase the risk of complications for both the mother (preeclampsia, cesarean delivery) and the baby (macrosomia, hypoglycemia)
• Hyperemesis gravidarum is a severe form of morning sickness characterized by persistent nausea and vomiting
  • Can lead to dehydration, weight loss, and electrolyte imbalances
  • In severe cases, hospitalization may be necessary to provide intravenous fluids and nutrition

Labor and Delivery Emergencies

Emergency Delivery and Postpartum Hemorrhage

• Emergency delivery may be necessary in situations where the health of the mother or baby is at risk, such as in cases of placental abruption, prolapsed umbilical cord, or fetal distress
  • First responders should assess the situation, provide supportive care, and transport the mother to a hospital as quickly as possible
  • If delivery is imminent, first responders should assist with the delivery and care for the newborn
• Postpartum hemorrhage is excessive bleeding following childbirth
  • Can occur due to uterine atony (failure of the uterus to contract), retained placental tissue, or genital tract lacerations
  • Symptoms include heavy vaginal bleeding, decreased blood pressure, and increased heart rate
  • Treatment may include uterine massage, medications to promote uterine contractions, and blood transfusions in severe cases

Umbilical Cord Care

• After delivery, the umbilical cord should be clamped and cut about 1-2 inches from the baby's body
  • The remaining umbilical cord stump will dry up and fall off within 1-2 weeks
• To prevent infection, keep the umbilical cord stump clean and dry
  • Gently clean the area with water and pat dry with a clean cloth or cotton swab
  • Avoid covering the stump with a diaper, as this can trap moisture and increase the risk of infection
• Signs of umbilical cord infection include redness, swelling, discharge, or a foul odor around the stump and should be promptly evaluated by a healthcare provider