Complications in Pregnancy: Understanding the Risks and How to Manage Them in Cayman

Likelihood of Pregnancy Complications

According to data from Blue Cross Blue Shield, complications occur in nearly 1 in 5 pregnancies, based on 1.8 million pregnant women in the US aged between 18-44. And research from Johns Hopkins Medicine shows that around 8% of all pregnancies involve complications that have the potential to harm mother or baby if left untreated.

While some complications arise out of, or are increased by, pre-existing medical conditions or greater maternal age, many occur unexpectedly, reinforcing the importance of good antenatal care and monitoring. An enduring challenge is that a high-risk pregnancy can be completely uneventful, while pregnancies with no pre-existing risk factors can suffer complications. When anticipated, complications can be planned for, but unexpected complications can happen at any time, so securing your team of pregnancy experts early is crucial.

It is worth noting that the prevalence of pregnancy complications is increasing among women. The Blue Cross Blue Shield data demonstrates a 31% increase in complications between 2014 and 2018, and data from the CDC natality database, published in The Lancet, points to a significant rise in maternal risk factors—hypertensive disorders (149% rise), chronic hypertension (182% rise) and diabetes mellitis (261% rise)—from 1989 to 2018. And, of course, a higher prevalence of risk factors drives an increase in potential complications.

It's normal to be concerned about the risk of complications during your pregnancy, but what's important is to keep the data in perspective. If complications occur in around 20% of pregnancies, then they don’t in around 80% of pregnancies. Therefore, being mindful is the best approach to both being aware of and enjoying this amazing journey.

Obstetrics or Paediatrics?

This is not a straightforward answer. Mother and baby are two fundamentally connected beings; what happens to one typically can affect the other. It means that many complications of the pregnancy itself have considerations for both and will require the expert care of both your obstetrician, possibly one with fetal medicine training, and your paediatrician.

In Cayman, many paediatricians attend uncomplicated deliveries. However, when it comes to complications, depending on the stage of pregnancy, a paediatrician with a special interest in newborn problems (called a neonatologist) will have had special training and be accredited in this more complex scenario.

Mothers-to-be tend to choose their obstetrician as soon as they suspect they are pregnant. Likewise, choosing your paediatrician — or neonatologist if you have underlying risk factors — is best done early in your pregnancy.

Common Pregnancy Complications

Gestational Diabetes

Gestational diabetes occurs when a pregnant woman develops high blood sugar levels. It typically arises in the second half of pregnancy and usually goes away after the baby is born. However, it increases the risk of a new mother developing type 2 diabetes later in life.

Symptoms: Often, gestational diabetes doesn't cause noticeable symptoms, but it can be detected through routine screening tests early in pregnancy and at around 28 weeks gestation.

Management: Treatment involves dietary changes, regular physical activity, blood sugar monitoring and sometimes medications, such as metformin or insulin injections. Women with gestational diabetes are closely monitored as the baby can grow much larger, complicating the delivery. Babies born to mums with gestational diabetes require monitoring of their blood sugars after birth as they are at risk of low blood sugar.

Pre-eclampsia

Pre-eclampsia is a condition characterised by high blood pressure and protein in the urine. It usually occurs after 20 weeks of pregnancy and can lead to serious, even fatal, complications if not managed properly.

Symptoms: High blood pressure, swelling of hands and feet, severe headaches, changes in vision and upper abdominal pain.

Management: The only way to cure pre-eclampsia is delivery. Management before delivery includes bed rest, medications to lower blood pressure, and close monitoring of the mother and baby. In severe cases, preterm delivery might be necessary.

Preterm Labour

Preterm labour occurs when a woman goes into labour before 37 weeks of pregnancy. This can result in premature birth, which poses various health risks to the baby, including respiratory issues, underdeveloped organs, and long-term health problems. Babies born in Cayman will be admitted to the neonatal unit if born before 36 weeks gestation.

Symptoms: Regular contractions, lower back pain, pressure in the pelvis, changes in vaginal discharge or significant fluid leak.

Management: Treatments to delay labour include medications to stop contractions, steroids to accelerate the baby's lung development and bed rest. Talking to a paediatrician with a special interest in the newborns (known as a neonatologist) can be helpful in helping you fully understand the care your baby will need and any concerns related to being born preterm.

Placenta Previa

Placenta previa happens when the placenta covers part or all of the cervix, which can cause severe bleeding during pregnancy and delivery.

Symptoms: Painless, bright red vaginal bleeding during the second half of pregnancy.

Management: Management depends on the severity and timing of the bleeding. It often involves bed rest, avoiding activities that could trigger bleeding and planning for a C-section delivery if the condition does not resolve itself.

Less Common Complications

Ectopic Pregnancy

An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, usually in a fallopian tube. This type of pregnancy cannot proceed normally and can cause life-threatening bleeding.

Symptoms: Sharp abdominal pain, vaginal bleeding, dizziness and shoulder pain.

Management: Treatment typically involves medication to end the pregnancy or surgery to remove the ectopic tissue.

Placental Abruption

Placental abruption is the premature separation of the placenta from the uterus, which can deprive the baby of oxygen and nutrients and cause severe bleeding in the mother.

Symptoms: Sudden abdominal pain, vaginal bleeding and a tender uterus.

Management: Depending on the severity, treatment can range from bed rest and close monitoring to early delivery. Severe placental abruption is an obstetric emergency and a mum with significant bleeding needs to go straight to the maternity unit whilst informing the delivery unit.

Amniotic Fluid Complications

Too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid can cause complications. Polyhydramnios is often linked to gestational diabetes, while oligohydramnios can be related to fetal growth restriction or birth defects.

Symptoms: Unusually rapid growth of the abdomen or a feeling of tightness and discomfort in the case of polyhydramnios; decreased foetal movement in the case of oligohydramnios.

Management: Regular monitoring, adjustments in maternal hydration and sometimes early delivery or drainage of excess fluid.

Hyperemesis Gravidarum

Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that goes beyond typical morning sickness. It can lead to dehydration, weight loss and electrolyte imbalances.

Symptoms: Persistent nausea and vomiting, weight loss, dehydration and fatigue.

Management: Treatment includes hospitalisation for IV fluids, medications to control nausea and nutritional support.

Congenital abnormalities

Congenital abnormalities are problems that occur in the foetus as it develops and grows.

Symptoms: Sometimes the scans you have may show that your baby has a congenital abnormality such as cleft lip and palate or something more complex such as a heart problem.

Management: Some of the more complex problems will require care not available in Cayman. Your obstetrician will work closely with your paediatrician to decide whether it is better for baby to be born in Cayman or overseas, including where would provide the best care for your baby. Talking to a paediatrician with a special interest in newborns (neonatologist) can be helpful.

Pregnancy Complications in Women Over 35

Pregnancy after the age of 35, often termed as 'advanced maternal age', can carry additional risks and complications due to the natural ageing process and pre-existing health conditions. There is a higher risk of babies with chromosomal abnormalities like Down syndrome, a higher incidence of chronic health conditions such as hypertension and an increased risk of pre-eclampsia and gestational diabetes.

Management: Careful preconception planning, close monitoring and management of pre-existing conditions are essential to reduce risks. Prenatal screening (Panorama or QNatal) can help detect chromosomal problems early in pregnancy. Regular prenatal visits, lifestyle modifications and adherence to medical advice are crucial for managing any pregnancy related conditions.

Managing Pregnancy Complications

Pregnancy complications involve a collaborative approach between the pregnant woman, her obstetric team and often a neonatologist too. Approaches to ensure a safe outcome can involve:

Regular Prenatal Care

Routine prenatal visits are crucial for monitoring the health of both the mother and the baby. Regular check-ups help in early detection and management of potential complications.

Healthy Lifestyle Choices

Maintaining a healthy diet, staying physically active and avoiding harmful substances like alcohol, tobacco, and drugs can significantly reduce the risk of complications.

Education & Awareness

Being informed about potential complications and their symptoms empowers pregnant women to seek timely medical help. Prenatal classes, widely available here in Cayman, and consultations with healthcare providers can provide valuable information.

Stress Management

Pregnancy can be stressful, especially when complications arise. Techniques such as prenatal yoga, meditation and relaxation exercises, all widely available in Cayman, can help manage stress and promote overall wellbeing.

Medication & Medical Interventions

Following the healthcare provider's recommendations regarding medications and treatments is essential.

Support Systems

Emotional and practical support from partners, family and friends can make a significant difference. Support groups and counselling services are also beneficial.

Addressing Risks & Complications

While complications in pregnancy can be daunting, many can be effectively managed with proper medical care and lifestyle adjustments. Regular antenatal visits, a healthy lifestyle and being informed about potential risks are key to ensuring a healthy pregnancy and a safe delivery. If you suspect any complications or experience unusual symptoms, it is crucial to contact your healthcare provider immediately. Remember, early detection and intervention are vital for the best possible outcomes for both mother and baby.

Here in Cayman, we have access to world class obstetricians and neonatologists, with support from other specialities too, such as cardiology and endocrinology. There are complications that cannot be handled in the best way on an island of our size, and these sometimes require transfer to a major territory centre in the US that specialises in such problems.

If you know you are at risk of complications, it’s worth considering an obstetrician with experience and training in higher risk pregnancies. They will know how to monitor and manage your pregnancy so that it progresses as smoothly as possible and any considerations around delivery are discussed with your neonatologist.

Risk factors can include pre-existing health conditions or chronic diseases, being over the age of 35, obesity, previous pregnancy or birth problems, family history and certain lifestyle factors. This is why obstetricians want to take a very comprehensive history.

Try to Relax!

While complications in pregnancy are not necessarily rare, it is important to remember that a far greater majority have no complications at all and pregnancies progress smoothly. Important things to remember:

• Living a healthy lifestyle can reduce the risk and severity of complications
• Make sure to engage in good antenatal care and monitoring
• Early identification of problems is far better
• If you have risk factors, choose the right obstetric team
• Consider appointing your paediatrician (or neonatologist) earlier rather than later
• Relax, but be vigilant too!

Armed with this understanding about both the chances and what it means to develop a complication in pregnancy, the most important message is to enjoy your pregnancy in the knowledge that with a balanced, timely and sensible approach to complications or possible symptoms, you can indeed relax. And relaxation is good for you and your pregnancy.

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