Medical problems in pregnancy

Abstract

The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.

Keywords: Biologics; maternal mortality; obstetric medicine; pregnancy.

Fig 1.

Selected characteristics of the mothers who died in 2011–13. Adapted from the 2015 MBRRACE report.¹

Fig 2.

Direct and indirect maternal mortality rates per 100,000 maternities in the UK, 1985–2013 (preliminary data 2011–13). Deaths from indirect causes have risen and plateaued in recent years. In contrast, deaths from direct causes are falling. Adapted from the 2015 MBRRACE report.

Fig 3.

Direct and indirect causes of maternal mortality per 100,000 maternities in the UK, 2011–13. Adapted from the 2015 MBRRACE report. *Although thrombosis and pre-eclampsia are classified as ‘direct’, they are often associated with medical risk factors and/or comorbidities.

Fig 4.

The three aspects of managing women with medical problems in pregnancy.

Fig 5.

Major complications of pre-eclampsia. DIC = disseminated intravascular coagulation; HELLP = haemolysis elevated liver enzymes low platelets