What to expect when you're expecting (215 page)

If the blood clot has moved to the lungs (a pulmonary embolus), there may be:

Chest pain

Shortness of breath

Coughing with frothy, bloodstained sputum

Rapid heartbeat and breathing rate

Blueness of lips and fingertips

Fever

What can you and your practitioner do?
If you’ve been diagnosed with DVT or any kind of blood clot in previous pregnancies, let your practitioner know. In addition, if you notice swelling and pain in just one leg at any time during your pregnancy, call your practitioner right away.

Ultrasound or MRI may be used to diagnose the blood clot. If it turns out that you do have a clot, you might be treated with heparin to thin your blood and prevent further clotting (though the heparin may need to be discontinued as you near labor to prevent you from bleeding excessively during childbirth). Your clotting ability will be monitored along the way.

With a clot that reaches the lungs, clot-dissolving drugs (and, rarely, surgery) may be needed, as well as treatment for any accompanying side effects.

Can it be prevented?
You can prevent clots by keeping your blood flowing—getting enough exercise and avoiding long periods of sitting will help you do this. If you’re at high risk, you can also wear support hose to prevent clots from developing in your legs.

What is it?
Placenta accreta is an abnormally firm attachment of the placenta to the uterine wall. Depending on how deeply the placental cells invade, the condition may be called placenta percreta or placenta increta. Placenta accreta increases the risk of heavy bleeding or hemorrhaging during delivery of the placenta.

How common is it?
One out of 2,500 pregnancies will have this attachment abnormality. Placenta accreta is by far the most common of these attachment problems, accounting for 75 percent of cases. In placenta accreta, the placenta digs deeply into the uterine wall, but does not pierce the uterine muscles. In placenta increta, which accounts for 15 percent of cases, the placenta pierces the uterine muscles. In placenta percreta, which accounts for the final 10 percent, the placenta not only burrows into the uterine wall and its muscles, but also pierces the outer part of the wall and may even attach itself to other nearby organs.

Your risk of placenta accreta increases if you have placenta previa and have had one or more cesarean deliveries in the past.

What are the signs and symptoms?
There are usually no apparent symptoms. The condition is usually diagnosed via color Doppler ultrasound or may only be noticed during delivery when the placenta doesn’t detach (as it normally would) from the uterine wall after the baby is born.

What can you and your practitioner do?
Unfortunately, there is little you can do. In most cases, the placenta must be removed surgically after delivery to stop the bleeding. Very rarely, when the bleeding cannot be controlled by tying off the exposed blood vessels, removal of the entire uterus may be necessary.

What is it?
Vasa previa is a condition in which some of the fetal blood vessels that connect the baby to the mother run outside the umbilical cord and along the membrane over the cervix. When labor begins, the contractions and opening of the cervix can cause the vessels to rupture, possibly causing harm to the baby. If the condition is diagnosed before labor, a C-section will be scheduled and the baby will be born healthy nearly 100 percent of the time.

How common is it?
Vasa previa is rare, affecting 1 in 5,200 pregnancies. Women who also have placenta previa, a history of uterine surgery, or a multiple pregnancy are at greater risk.

What are the signs and symptoms?
There are usually no signs of this condition, though there may be some bleeding in the second or third trimester.

What can you and your practitioner do?
Diagnostic testing, such as with ultrasound or, better yet, a color Doppler ultrasound, can detect vasa previa. Women who are diagnosed with the condition will deliver their babies via C-section, usually before 37 weeks, to make sure labor doesn’t begin on its own. Researchers are studying whether vasa previa can be treated using laser therapy to seal off the abnormally positioned vessels.

Many of the following conditions can’t be anticipated prior to labor and delivery—and there’s no need to read up on them (and start worrying) ahead of time, since they’re very unlikely to occur during or after your childbirth. They are included here so that in the unlikely event you experience one, you can learn about it after the fact, or in some cases, learn how you can prevent it from happening in your next labor and delivery.

What is it?
Fetal distress is a term used to describe what occurs when a baby’s oxygen supply is compromised in the uterus, either before or during labor. The distress may be caused by a number of factors, such as preeclampsia, uncontrolled diabetes, placental abruption, too little or too much amniotic fluid, umbilical cord compression or entanglement, intrauterine growth restriction, or simply because the mother is in a position that puts pressure on major blood vessels, depriving the baby of oxygen. Sustained oxygen deprivation and/or decreased heart rate can be serious for the baby and must be corrected as quickly as possible—usually with immediate delivery (most often by C-section, unless a vaginal birth is imminent).

How common is it?
The exact incidence of fetal distress is uncertain, but estimates range from 1 in every 25 births to 1 in every 100 births.

What are the signs and symptoms?
Babies who are doing well in utero have strong, stable heartbeats and respond to stimuli with appropriate movements. Babies in distress experience a decrease in their heart rate, a change in their pattern of movement (or even no movement altogether), and/or pass their first stool, called meconium, while still in the uterus.

What can you and your practitioner do?
If you think your baby might be in distress because you’ve noticed a change in fetal activity (it seems to have slowed down significantly, stopped, become very jerky and frantic, or otherwise has you concerned), call your practitioner immediately. Once you are in your practitioner’s office or in the hospital (or in labor), you’ll be put on a fetal monitor to see whether your baby is indeed showing signs of distress. You may be given oxygen and extra fluids via an IV to help better oxygenate your blood and return your baby’s heart rate to normal. Turning onto your left side to take pressure off your major blood vessels may also do the trick. If these techniques don’t work, the best treatment is a quick delivery.

What is it?
A cord prolapse occurs during labor when the umbilical cord slips through the cervix and into the birth canal before the baby does. If the cord becomes compressed during delivery (such as when your baby’s head is pushing against a prolapsed cord), the baby’s oxygen supply is compromised.

How common is it?
Fortunately, cord prolapse is not common, occurring in 1 out of every 300 births. Certain pregnancy complications increase the risk of prolapse. These include hydramnios, breech delivery or any position in which the baby’s head does not cover the cervix, and premature delivery. It can also occur during delivery of a second twin. Prolapse is also a potential risk if your water breaks before your baby’s head has begun to “engage,” or settle into the birth canal.

What are the signs and symptoms?
If the cord slips down into the vagina, you may actually be able to feel it or even see it. If the cord is compressed by the baby’s head, the baby will show signs of fetal distress on a fetal monitor.

What can you and your practitioner do?
There’s really no way to know in advance if your baby’s cord is going to prolapse. In fact, without fetal monitoring, you may not know until after the fact. If you suspect that your baby’s umbilical cord has prolapsed and you are not in the hospital yet, get on your hands and knees with your head down and pelvis up to take pressure off the cord. If you notice the cord protruding from your vagina, gently support it with a clean towel. Call 911 or have someone rush you to the hospital (on the way to the hospital, lie down on the back seat, with your bottom elevated). If you are already in the hospital when the cord prolapses, your practitioner may ask you to move quickly into a different position, one in which it will be easier to disengage the baby’s head and take pressure off the umbilical cord. Delivery of your baby will need to be very quick, most likely by C-section.