DANGER SIGNS IN PREGNANCY (Part 4)

In the previous editions, we have been looking at the likely signs to indicate danger to a pregnant woman. This edition aims at enumerating the danger signs a pregnant women should look out for in the late or third trimester: PROM and Post Term Pregnancy.

A “trimester” is, most simply, a period of time. In terms of pregnancy, a trimester refers to three roughly equal portions of the time you are pregnant. Since pregnancy lasts, on average, 40 weeks, a trimester lasts roughly three months, or 13 1/3 weeks. The concept of the trimester is used to help health care providers and expectant moms divide the process of pregnancy up into specific portions. During each trimester, mom-to-be and her baby have specific discomforts, nutritional needs, and physiological changes that will occur.

PREMATURE RUPTURE OF MEMBRANES (PROM): Rupture of membranes is a normal part of giving birth. It is the medical term for saying your “water has broken.” It means that the amniotic sac (water sac) that surrounds the baby has broken, allowing the fluid to flow out. While it is normal for the sac to break during labor, if it happens too early, it can cause serious complications. This is called preterm / premature rupture of membranes (PROM). The cause of PROM is not always clear, but sometime genetic factor and infection of the amniotic membranes can be a cause
Treatment for PROM varies. Women are often hospitalized and given antibiotics, steroids, and drugs to stop labor (tocolytics).

When PROM occurs at 34 weeks or more, some doctors might recommend delivering the baby. At that time, the risks of prematurity are less than the infection risks. If there are signs of infection, labor must be induced to avoid serious complications.

Occasionally, a woman with PROM experiences resealing of the membranes. In these rare cases, a woman can continue her pregnancy to near term, although still under close observation. The risks associated with prematurity decrease significantly as the fetus nears term. If PROM occurs in the 32- to 34-week range and the remaining amniotic fluid shows that the fetus’ lungs have matured enough, the doctor may discuss delivering the baby in some cases.
Availability of improved intensive care nursery services, many preterm infants born in the third trimester (after 28 weeks) usually survive.

POST-TERM PREGNANCY: About 7 percent of women deliver at 42 weeks or later. Any pregnancy lasting longer than 42 weeks is considered post-term or post-dates. The cause of post-term pregnancy is unclear, although hormonal and hereditary factors are suspected. Sometimes, a woman’s due date is not calculated correctly. Some women have irregular or long menstrual cycles that make ovulation harder to predict. Early in pregnancy, an ultrasound can help to confirm or adjust the due date.

Post-term pregnancy is not generally dangerous to the mother’s health. The concern is for the fetus. The placenta is an organ that is designed to work for about 40 weeks. It provides oxygen and nutrition for the growing fetus. After 41 weeks of pregnancy, the placenta is less likely to work well, and this may result in decreased amniotic fluid around the fetus (oligohydramnios).This condition can cause compression of the umbilical cord and decrease oxygen supply to the fetus. This may be reflected on the fetal heart monitor in a pattern called late decelerations. There is a risk of sudden fetal death when the pregnancy is post-term. Once a woman reaches 40+ weeks of pregnancy, she usually has fetal heart rate monitoring and a measurement of the amniotic fluid. If the testing shows low fluid levels or abnormal fetal heart rate patterns, labor is induced. Otherwise, spontaneous labor is awaited until no more than 42 weeks, after which it is induced. These options depend on the managing physician.

PREVENTION OF MATERNAL MORTALITY

Recent studies shows that every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. Most of these deaths occur in low resource settings and most of them could have been prevented by focused antenatal care.
Maternal mortality is when a woman dies during pregnancy or up to 42days after the end of pregnancy from health problems related to pregnancy. Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy especially if not managed as part of the woman’s care. The major complications that account for nearly 75% of all maternal death are:
• Severe bleeding (mostly after child birth): causes of bleeding include placenta Previa, placenta abruption and Placenta accrete, increta and pancreta. Most of these can be can be diagnosed during routine ANC and appropriate management implemented.
• Infection (may be during pregnancy or child birth): most infections can be prevented from resulting in complication by immunization and proper treatment.
• High blood pressure during pregnancy
• Complications from delivery
• Unsafe abortion
• Other associated diseases such as Malaria and AIDS.

CONCLUSION

Most maternal deaths are preventable, as the health care solution to prevent or manage complications are well known. Every woman going through the stress of pregnancy deserves to experience the joy of parenthood. Safe motherhood is key, all women need to access antenatal care in pregnancy and all birth must be attended to by skilled health professional as timely management and treatment can make the difference between life and death for both the mother and child. Skilled care during child birth, care and support in the weeks after child birth is advocated.