3rd trimester

Compications
 Gestational diabetes.

 Preeclampsia.

 Preterm labor.

 PROM.

 Placenta problems.

 IUGR.

 Post-term.

 Malpresentation.
Gestational Diabetes
Gestational diabetes is a type of diabetes that can
develop during pregnancy in women who don't
already have diabetes. Every year, 2% to 10% of
pregnancies in the United States are affected by
gestational diabetes. Managing gestational
diabetes will help make sure you have a healthy
pregnancy and a healthy baby.
What happens if a pregnant woman has gestational diabetes?

Diabetes that is not well controlled causes the baby's blood sugar to be high. The
baby is “overfed” and grows extra-large. Besides causing discomfort to the
woman during the last few months of pregnancy, an extra-large baby can lead
to problems during delivery for both the mother and the baby.
Warning Signs of Gestational Diabetes

Sugar in the urine.

Unusual thirst.

Frequent urination.

Fatigue.

Nausea.

Blurred vision.

Vaginal, bladder and skin infections.

Preeclampsia

Preeclampsia is one high blood pressure (hypertension)

disorder that can occur during pregnancy. Other disorders
can happen, too: Gestational hypertension is high blood
pressure that begins after 20 weeks without problems in
the kidneys or other organs. Some women with
gestational hypertension may develop preeclampsia.
What happens if you have
preeclampsia?
What happens when you have
preeclampsia? When you have
preeclampsia, your blood pressure is
elevated (higher than 140/90 mmHg),
and you may have high levels of
protein in your urine. Preeclampsia
puts stress on your heart and other
organs and can cause serious
complications.
What are the early warning signs of preeclampsia?
Symptoms can include:
High blood pressure during pregnancy.

Blurred vision.

Headache.

Swelling of the face, hands and feet.

Upper abdominal pain.

Vomiting.

Shortness of breath.

HELLP syndrome (severe form of preeclampsia)

Who is most likely to preeclampsia?
Risk factors

Being pregnant with more than one

baby. Chronic high blood pressure
(hypertension) Type 1 or type 2
diabetes before pregnancy. Kidney
disease.
 How early will they deliver a baby if you have
preeclampsia?

In most cases of pre-eclampsia, having your baby at about the 37th to

38th week of pregnancy is recommended. This may mean that labour
needs to be started artificially (known as induced labour) or you may
need to have a caesarean section.

What puts you at risk for preeclampsia?

Chronic high blood pressure or kidney disease before pregnancy. High

blood pressure or preeclampsia in an earlier pregnancy. Obesity.
Women with overweight or obesity are also more likely to have
preeclampsia in more than one pregnancy.
 What happens to baby if mom has preeclampsia?

Infants born preterm due to preeclampsia face a

higher risk of some long-term health issues,
mostly related to being born early, including
learning disorders, cerebral palsy, epilepsy,
deafness, and blindness.
 preterm labor
Preterm labor occurs when regular
contractions result in the opening of your
cervix after week 20 and before week 37 of
pregnancy. Preterm labor can result in
premature birth. The earlier premature birth
happens, the greater the health risks for
your baby.
What can trigger preterm labor?
Known causes of preterm labor are:

 Infections.

 Vaginal bleeding.

 Hormone changes.

 Stretching of the uterus. This might be from being

pregnant with more than 1 baby, a large baby, or too much
amniotic fluid.
Does preterm labor mean early delivery?

Preterm and premature mean the same thing — early.

Preterm labor is labor that begins early, before 37
weeks of pregnancy. Labor is the process your body
goes through to give birth to your baby. Preterm labor
can lead to premature birth.
Who is at high risk for preterm labor?

Women younger than age 18 are more likely to have a

preterm delivery. Women older than age 35 are also at risk
of having preterm infants because they are more likely to
have other conditions (such as high blood pressure and
diabetes) that can cause complications requiring preterm
delivery.
 Premature rupture of membranes

Premature rupture of membranes (PROM) is a rupture (breaking

open) of the membranes (amniotic sac) before labor begins. If
PROM occurs before 37 weeks of pregnancy, it is called preterm
premature rupture of membranes (PPROM). PROM occurs in
about 8 to 10 percent of all pregnancies.
What happens if you have premature rupture of
membranes?

If your doctor finds that you have PROM, you will need to

be in the hospital until your baby is born. If your
pregnancy is past 37 weeks, your baby is ready to be
born. You will need to go into labor soon. The longer it
takes for labor to start, the greater your chance of getting
an infection.
How do you know if you have premature rupture of membranes?

What are the symptoms of PPROM?

1. A sudden gush of fluid from your vagina.

2. Leaking of fluid from your vagina.

3. A feeling of wetness in your vagina or underwear.

How can I avoid PROM during pregnancy?

There is no way to stop this from happening in most pregnancies. You

should take good care of yourself during pregnancy. This means that
you should see your healthcare provider as soon as you know you're
pregnant. Keep up with your prenatal checkups.
Placenta problems

During pregnancy, possible placental problems include placental abruption,

placenta previa and placenta accreta. After delivery, retained placenta is
sometimes a concern.

Placental abruption

Placenta previa

Placenta accreta

Retained placenta
Placental abruption

occurs when the placenta separates from the inner wall of the uterus before
birth. Placental abruption can deprive the baby of oxygen and nutrients and
cause heavy bleeding in the mother. In some cases, early delivery is needed.

Signs and symptoms of placental abruption include:

Vaginal bleeding, although there might not be any.

Abdominal pain. Back pain.

Uterine tenderness or rigidity.

Uterine contractions, often coming one right after another.

What causes placenta abruption?

The cause is unknown in most cases, but risk factors may include
maternal high blood pressure, abdominal trauma and substance misuse.
Without prompt medical treatment, a severe case of placental abruption
can have dire consequences for the mother and her unborn child,
including death.

What are the first signs of placental abruption?

The main symptom of placental abruption is vaginal bleeding. You also

may have pain,contractions, discomfort and tenderness or sudden,
ongoing belly or back pain. Sometimes, these symptoms may happen
without vaginal bleeding because the blood is trapped behind the
placenta.
PLACENTAL ABRUPTION
Placenta previa

is a problem during pregnancy when the placenta completely or

partially covers the opening of the uterus (cervix). The placenta
is an organ that develops inside the uterus during pregnancy. It
works to provide oxygen and nutrition to the baby and to
remove waste.

What causes placenta previa?

Some of the possible causes and risk factors of placenta

previa include: Low implantation of the fertilised egg.
Abnormalities of the uterine lining, such as fibroids. Scarring
of the uterine lining (endometrium)
Who is most at risk for placenta previa?

What are the risk factors for developing placenta previa?

You smoke cigarettes or use cocaine.

You're 35 or older.

You've been pregnant several times before.

You're pregnant with twins, triplets or more.

You've had surgery on your uterus, including a C-section or a

D&C (dilation and curettage).
PLACENTA PREVIA
Placenta accreta

is a serious pregnancy condition that occurs when the placenta

grows too deeply into the uterine wall. Typically, the placenta
detaches from the uterine wall after childbirth. With placenta
accreta, part or all of the placenta remains attached. This can
cause severe blood loss after delivery.

Retained placenta

is when the placenta is not delivered within 30 minutes of the

baby's birth. It is a serious problem since it can lead to severe
infection or life-threatening blood loss. Retained placenta is not
a common condition, but because it's serious, it will need to be
managed by a medical team.
PLACENTA ACCRETA
How do I know if I have retained placenta?

Symptoms of a Retained Placenta

The most obvious sign of a retained placenta is that you don't

deliver it. The most common symptom of a retained placenta
after birth is sudden blood loss and life-threatening bleeding.
At times you might push out most of it, however, some pieces of
the placenta can be stuck inside.

Can retained placenta cause death?

Sometimes the entire placenta (also called “afterbirth”)

remains in the uterus after childbirth. A retained placenta can
lead to hemorrhaging (bleeding), severe infection or even
death.
RETAINED PLACENTA
Intrauterine Growth Restriction, or IUGR.

is when a baby in the womb (a fetus) does not grow as

expected. The baby is not as big as would be expected for the
stage of the mother's pregnancy. This timing is known as an
unborn baby's "gestational age.“

What causes IUGR pregnancy?

IUGR has various causes. The most common cause is a

problem in the placenta (the tissue that carries food and blood
to the baby). Birth defects and genetic disorders can cause
IUGR. If the mother has an infection, high blood pressure, is
smoking, or drinking too much alcohol or abusing drugs, her
baby might have IUGR.
Is IUGR a High risk Pregnancy?

IUGR increases the risk of pregnancy and newborn

complications, depending on the cause. Babies whose growth
is restricted often become more stressed during labor and C-
section delivery.

What problems can IUGR cause?

IUGR is associated with increased risk of premature birth;

increased morbidity among premature neonates, including
necrotizing enterocolitis; low Apgar score; hypoxic brain
injury and its long-term sequelae; the need for respiratory
support and chronic lung disease; retinopathy of prematurity;
prolonged neonatal ...
When do you deliver an IUGR baby?

While timing the delivery of the late preterm/early-term IUGR

fetus requires consideration of multiple factors (e.g. degree of
growth restriction, etiology, amniotic fluid volume, and
biophysical and Doppler testing), available data suggests that
delivery should occur by 37 to 38 weeks for singleton IUGR
fetuses.
Post-term Pregnancy

is one that extends beyond 42 weeks (294 days) from the first
day of the last menstrual period; as many as 10 percent of
pregnancies are postterm.

● The chance of postterm pregnancy is higher in first

pregnancies and especially in pregnant individuals who have
had a postterm pregnancy in the past.
Malpresentation

is when your baby is not facing head-first down the birth

canal as birth approaches. The most common type of
malpresentation is breech — when your baby's bottom or feet
are facing downwards.

What are the common malpresentation?

Breech presentation is the most common malpresentation,

with the majority discovered before labour. Breech
presentation is much more common in premature labour.
Approximately one third are diagnosed during labour when
the fetus can be directly palpated through the cervix.
How do you manage malpresentation?

Fetal malpresentation is a leading cause of cesarean delivery.

Breech presentation and transverse lie at term can be
managed with ECV with or without moxibustion and
acupuncture.

Is malpresentation a high risk pregnancy?

Women with deliveries complicated by malpresentation had

higher rates of morbidity and mortality. Rates of cesarean
delivery for malpresentation ranged from 27% to 87% among
regions.
 Thank you pooooo!!!!

REPORTER: BAI SAIDA KRISDALY

HARON ADAM,RM