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Special Care Pregnancy


Pregnancy imposes many stresses and strains on healthy women. However, if you already have a condition such as high blood pressure, heart disease, thyroid disease or asthma, you will be naturally concerned about the effect of the condition on your pregnancy and also about the effect of your pregnancy on the condition. Discuss such problems with your midwife or obstetrician at the first opportunity.

Asthma

During normal pregnancy, the demand for oxygen increases: breathing (ventilation) increases by about 50 per cent, usually as a result of breathing more deeply rather than more quickly. As a result, you may feel slightly breathless. On the other hand, respiratory diseases, such as asthma, can also cause breathlessness, and this can lead to difficulties in diagnosis. Asthma also causes coughing, wheeziness and chest tightness, often in response to allergens, such as pollen, or after exercise. Asthma does not usually cause any significant harm to the pregnancy, although severe asthma may restrict the baby's growth or cause premature labour.

Management

Common drugs, such as inhaled or oral steroids or inhaled bronchodilators (for example, salbutamol), are safe to use during pregnancy and should be continued to ensure effective treatment.

Thalassaemia

Thalassaemia is a genetic order that causes abnormality of the proteins making up the respiratory pigment haemoglobin.There are two types: Alpha thalassaemia which is common in women from southeast Asia. Beta thalassaemia which is common in women from Cyprus and Asia. If only one of the genes for haemoglobin is faulty, this is known as a thalassaemia trait. This may be detected for the first time during pregnancy, during a routine blood test for anaemia.

Management

If you have the thalassaemia trait, you may need iron and folate supplements throughout your pregnancy, particularly if your ferritin levels (a measure of your iron levels) are low. If your partner also has the trait, you should be referred for further tests because there is a risk that your baby may have the more serious condition, known as thalassaemia major.

High blood pressure

Some women already have high blood pressure (or hypertension) when they become pregnant. Others may be diagnosed as having hypertension during the first 3 months of pregnancy. These women probably already had a blood pressure problem, such as pre-eclampsia, which does not usually present until much later in the pregnancy. In most cases, the cause of the hypertension is unknown (referred to as essential hypertension) while a minority of women have an underlying cause, for example, kidney or heart disease.

The main problems associated with hypertension during pregnancy are the increased risks of developing pre-eclampsia, reduced blood flow through the placenta, affecting the growth of your baby, or having a placental abruption.

Management

If you are already taking anti-hypertensives, your obstetrician will advise you whether to continue your medication, if you are not, he will decide whether your blood pressure is high enough to warrant starting medication. The drug that is most commonly used to treat high blood pressure in pregnancy is methyldopa, although beta blockers are also widely used. A close eye will be kept on your blood pressure throughout your pregnancy, and you will be given extra scans to monitor your baby's growth.

Deep vein thrombosis and pulmonary embolism

In a normal pregnancy, the mother's blood clots more easily.This is designed to reduce the amount of blood loss at delivery. Having slightly thicker blood puts all pregnant women at risk of clots in the legs (deep vein thrombosis, or DVT) or lungs (pulmonary embolism, or PE). Other factors, as well as pregnancy, increase the risk of blood clots. These include obesity, greater age, having a caesarean section, a history of a previous blood clot, pre-eclampsia, immobility (for example, during long-haul flights), and thicker blood caused by a tendency to excessive blood clotting (or thrombophilia).

The symptoms of a DVT are swelling, redness, pain and tenderness in the calf muscle, while breathlessness, chest pain on breathing in, a cough and coughing up blood may indicate the presence of a PE.

Management

DVTs and PEs are potentially life-threatening complications so, if you are at particular risk, your doctor may advise you to take blood-thinning drugs during and immediately after your pregnancy to prevent a clot developing. If your doctor suspects a blood clot, he will refer you to hospital for tests to confirm the diagnosis. If a clot is found, you will be given drugs (usually by an injection into the skin but sometimes through a vein) to prevent the clot worsening.

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