Complication in 2nd
trimester:
For most women, the 2nd trimester
is relatively problem free period. The hormonal changes are setting
and you still may fit into your pre pregnancy clothes. This period usually involves antenatal visits, routine tests,Link to Investigations and tests, and maintaining healthy
lifestyles. But, some complications do
occur. It is important to recognize them early and treat them effectively so that it will
benefit you and your baby. Some of these problems are
Bleeding:
Although miscarriage is
less common in the 2nd trimester than in the 1st, a risk still
exists. Any kind of bleeding should be reported to the obstetrician immediately.If
bleeding is spotty, there is no cause for concern as it may be due
to local vaginal or cervical infections. Moderate to severe bleeding is a
cause of concern probably as it can be a sign of impending abortion.
Link to abortion in in Complication in pregnancy.
Also known, as ‘painless abortion’ is a
well-recognised cause of pregnancy loss in late 2nd trimester. The mouth of the
uterus (cervix) begins to open (dilate) and thin out (effacement) before a pregnancy has
reached full and nine months (full term). This occurs in the absence of pain and uterine
contractions and without much pain or uterine contractions.
How
often does this occur?
It is
relatively uncommon, occurring in 1 - 2 % of all pregnancies.
However as it leads to repeated miscarriages, it is important to
identify and treat it.
Causes:
The premature opening of the mouth of uterus with its thinning is primarily due to
weakness in the cervical musculature. The sphincter, which is closed normally, is not able
to withstand the pressure of growing pregnancy.
The incompetent cervix could be a result of cervical
trauma,
Due to overzealous
mechanical dilatation of the cervix.
Deep cervical laceration
during delivery.
Extensive conisation of
cervix for the treatment of cervical dysplasia (early cervical carcinoma).
Other women who are at the risk are women with
polyhydramnios (excessive amount of amniotic fluid, more than 2 – 5 liters), multiple
pregnancy (causing excessive stretching of uterine musculature).
Structural
defects of the genital tract.
What
do you feel?
The
process is relatively painful and onset may be marked by:
Excessive mucus discharge
through the vagina followed by spotting and bleeding.
A sensation of pressure or
heaviness in the lower abdomen, surprisingly no pain.
How
to arrive at a diagnosis?
The
typical history of repeated midtrimester miscarriage is often
enough to diagnose the condition. In pregnancy, some tests may be
useful for confirmation, such as:
Ultrasonography: It will
show opening of the mouth of uterus (internal os) with funneling and bulging of the foetal
membranes (sac) into the cervix.
Vaginal swab for culture of
bacteria to rule out infection and treat it if present.
Urine
and blood examination for general condition.
Treatment:
Treatment of vaginal
or cervical infection.
Cervical cerclage
operation: This is a small procedure by which a stitch is taken at the mouth of uterus for
mechanical closure. This stitch must be removed at 37 completed weeks of pregnancy or at
the time of initiation of labour, whichever is earlier. The ideal time to do the operation
is around 18 – 20 weeks of pregnancy. However, the placement of circlage stitch
doesn’t completely protect women from ‘incompetent os’ or preterm labour.
Additional treatment such
as bed rest and tocolytic agent (medication which prevents uterine contraction) may also
be needed. Link to preterm labour in
Complication in Pregnancy.
Preterm Labour:
Preterm labour involves progressive pain and uterine contractions causing opening of the
mouth of uterus (cervix) before 37 weeks of pregnancy. Babies who are born this early often
have low birth weight, prematurity and various other problems, which put them into
numerous health risks. Now, the majority of babies born after 28 – 30 weeks do
survive. However, 10% of them suffer from permanent major handicap. The financial and
emotional costs of newborn intensive care is staggering. Higher still are the costs of
long-term care for the handicapped children.In order to avoid this, women must understand
the warning signals and report to the obstetrician immediately.
How
often does this happen?
Why
does preterm labour occur?
The exact cause is unknown yet. But, the factors that seem to increase a woman’s
risk of early labour have been identified. These factors include the following:
Previous preterm birth.
Pregnancy with twins,
triplets or more. Link to twins in
Abnormal Delivery.
Repeated 2nd
trimester abortion.
Polyhydramnios (excessive
amniotic fluid around baby more than 2.5 liters).
Placenta
praevia.
Infection of the amniotic
fluid or the foetal membranes.
Abnormalities of the
mother’s uterus.
Serious illness or disease
in the mother.
Smoking, heavy working
conditions, poor socioeconomic class, etc.
What
do you feel?
It is advisable to know at this juncture who
is at risk of developing preterm labour. A Woman who has poor past reproductive performance is at risk of developing the
same.’The warning signals are given below. If you find any of these, do not hesitate
to call upon your doctor. Even if, it turns out to be a false call your doctor
wouldn’t mind it as prevention of preterm labour is far better
than attempting cure.
Warning
symptoms of preterm labour:
Cramping
lower abdominal pain like period pains either
constant or comes and goes, This is usually lower down below the umbilicus in the centre.
Low, dull, backache
(constant or comes and goes).
Pressure (feels like the
baby is pushing down, feels heavy).
Abdominal cramping (with or
without diarrhoea).
Increase or change in
vaginal discharge (may be mucous, watery, light or bloody.
Fluid leaking from the
vagina.
Uterine contractions that
are 10 minutes apart or closer (may be painless). Women are 75% accurate in their ability
to recognise warning symptoms of preterm labour.
How
to arrive at a diagnosis?
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1st Trimester
