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The pain and physiology of infertility and miscarriages

Chenai Hove* (28), mother of one,  was just over 26 weeks pregnant when she went into pre-term labour and delivered a premature baby. Doctors struggled to resuscitate the tiny baby who weighed only 1.2kg. Her baby lived for a day before succumbing. This was Chenai’s second premature baby. The previous one had been a year ago and the early labour occurred at the same time in her pregnancy. It was found that Chenai had an incompetent cervix due to injuries that occurred in her very first pregnancy and would need a cervical stitch to be put in place for subsequent pregnancies.

In our society, pregnancy and delivering a baby is the very definition of womanhood.  What happens when that seemingly straight-forward process goes wrong? How do you know if your pregnancy is high-risk? Is there anything you can do to prevent complications? What are the top signs women can look out for in their pregnancy? Although the majority of pregnancies are uneventful, sometimes complications do occur. 
“I have suffered from a still birth due to umbilical cord and I have also suffered from placenta previa and had an emergency c-section at 32weeks with my daughter,” states Elizabeth katiku*, a 36year old journalist. “There are just so many stories of women I know who have lost babies in pregnancy and this is something I would like you to bring light on because I find there is not enough available information.”
A study done in Guatemala between 1997 and 1998 showed that women who visited health clinics after finding out they were pregnant increased the likelihood of having heard of danger signs in pregnancy as compared to women who did not attend clinics. In 1999, those who had heard radio messages or participated in women's groups were, respectively, 3 times and 5 times more likely to have heard of danger signs in pregnancy. It concluded that safe motherhood programs can effectively increase knowledge of danger signs through clinic- and community-based educational strategies.
Seeing your doctor as soon as you think you may be pregnant is a good way to minimize complications. Dangers in pregnancy can happen before, during and after delivery. The following are a few of the more common pregnancy complications that occur before delivery.

Ectopic Pregnancy
In an ectopic pregnancy, the baby develops outside the uterus like in the uterine tubes, cervix, pelvis or even abdomen. The cause of an ectopic pregnancy is usually scar tissue in the fallopian tube from infection or disease. Ectopic pregnancies occur in about one out of 50 pregnancies and can be very dangerous to the mother.
What to look out for
Bleeding means different things throughout your pregnancy. “If you are bleeding heavily and have severe abdominal pain and menstrual-like cramps or feel like you are going to faint during first trimester, it could be a sign of an ectopic pregnancy,” Peter Bernstein, MD, ob-gyn professor at New York's Albert Einstein College of Medicine and Montefiore Medical Center, says. The longer an ectopic pregnancy continues, the greater the likelihood that a fallopian tube will rupture and this may be life-threatening. 
An ultrasound and blood tests may confirm the diagnosis. Treatment of an ectopic pregnancy may include medication or surgical removal of the fetus, resulting in an early termination of the pregnancy.

Miscarriage
A miscarriage is the loss of the fetus before 20 weeks. Miscarriages occur in about 15 to 20 percent of all pregnancies usually by the 12th week of gestation and are usually due to genetic or chromosomal abnormalities. 
What to look out for
Miscarriages are usually preceded by bleeding and intense cramping, but having light bleeding does not necessarily mean that a miscarriage is occurring. In fact, 30 percent of normal pregnancies may have vaginal spotting.
To confirm that a miscarriage has occurred, an ultrasound and blood tests may be performed. The fetus and contents of the uterus are often naturally expelled. If this process does not occur, a procedure called a dilation and curettage (D&C) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.
Fetal loss in the second trimester may occur when the cervix is weak and opens too early. In some of these cases, a physician can help prevent pregnancy loss by suturing the cervix closed until delivery like Chenai’s above.

Amniotic Fluid
Too much or too little amniotic fluid in the membranes surrounding the fetus may indicate a problem with the pregnancy.
Too much fluid can put excessive pressure on the mother's uterus, leading to preterm labor. It can also cause pressure on the mother's diaphragm, leading to breathing difficulties. Fluids tend to build up in cases of uncontrolled diabetes, multiple pregnancy, incompatible blood types, or birth defects. Too little fluid may indicate birth defects, growth retardation, or stillbirth.
What to look out for
If your belly is bigger than expected for date this may be a sign of too much amniotic fluid. The only sure way to confirm this is by ultrasound. This is why clinic visits are important as the doctor will recommend one after physical exam.

Bleeding
“Bleeding is always serious,” women’s health expert Donnica Moore, MD, says. Any bleeding during pregnancy needs immediate attention. Call your doctor or go to the emergency room. Bleeding in late pregnancy may be a sign of placental complications or a vaginal or cervical infection. Women who bleed in late pregnancy may be at greater risk of losing the fetus and hemorrhaging (bleeding excessively). 

Hypertensive Disorders in Pregnancy/Pre-eclampisa
Pre-eclampsia is thought to happen when the placenta isn't working properly. It can cause severe disease if not treated. Pre-eclampsia occurs in the second half of pregnancy, most likely develop in the third trimester. The diagnosis is made by tests which confirm high blood pressure and protein in urine during antenatal clinics. These are things a woman may be unaware of therefore the danger signs below are important to note.
What to look out for
  • headache 
  • burning epigastric(centre below ribs) pain 
  • blurred vision
  • generalised body swelling (involving the back, abdominal wall, hands and face)
  • decreased urine output

Early Labour
Contractions could be a sign of preterm labour. “But a lot of first-time moms may confuse true labour and false labour,” Dr Ruddock of Florida Hospital says. False labor contractions are called Braxton-Hicks contractions. They’re unpredictable, non-rhythmic, and do not increase in intensity. “They will subside in an hour or with hydration,” Ruddock says. “But regular contractions are about 10 minutes apart or less and increase in intensity.”
If you're in your third trimester and think you're having contractions, call your doctor right away. If it is too early for the baby to be born, your doctor may be able to stop labour.

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