Stemming the rise of childbirth complications

When things go wrong in pregnancy, they can quickly spiral out of control. The federal Centers for Disease Control and Prevention (CDC) recently reported a steep rise in childbirth complications, which affect about 52,000 women per year. During delivery, incidents of cardiac arrest, respiratory distress and kidney failure increased by 75% from 1999 through 2009, according to the new study by the CDC . After delivery, serious complications more than doubled over that same time period.  The increase is linked to mothers who are older, obese or have conditions such as diabetes and kidney disease. Ask Yale Medicine turns to Yale Ob/Gyn physician Dr. Sonya S. Abdel-Razeq to answer the following questions on how to reduce the risks of complications during and after childbirth:

AYM: Should women having a normal pregnancy be concerned about this new finding?

Dr. Abdel-Razeq: In general, women who are healthy prior to pregnancy and have not developed any medical issues during pregnancy should not be overly concerned about these findings.  The vast majority of women experience pregnancy without unexpected difficulties.

AYM: Can complications arise in pregnant women who don’t have these risk factors?

Dr. Abdel-Razeq: Unfortunately, complications may arise in any pregnant woman; however, this study has shown us that women with preexisting conditions (specifically, morbid obesity, cardiac disease, hypertension, and diabetes) are the groups of women who are overwhelmingly more likely to experience pregnancy complications.

AYM: So many things can go wrong during and after delivery, what are the highest risks?

Dr. Abdel-Razeq: Venous thromboembolic disease (including pulmonary embolism and deep venous thrombosis or DVT) is the most common cause of maternal mortality in the United States and the second most common cause of maternal mortality worldwide.  Hemorrhage is the second most common complication in the United States and the most common complication occurring worldwide.  Hypertensive disorders unique to pregnancy, specifically preeclampsia and gestational hypertension, are the next most common complications.

AYM: How can women prepare during pregnancy to increase their chances of having a complication-free delivery?

Dr. Abdel-Razeq: Women should aim to be as healthy as possible before pregnancy.  They should see their doctor(s) regularly both before and during pregnancy and openly discuss ways to become healthier.  Optimizing preexisting conditions- losing weight if obese, controlling high blood pressure and diabetes, for example- is one of the most important things a woman can do for herself.  Following a good diet and also exercising at least three times per week are measures that will lend toward not only a healthy pregnancy, but also a healthy non-pregnant life!

AYM: What can hospitals and physicians do to prevent complications from occurring?

Dr. Abdel-Razeq: Hospitals and physicians play an important role in complication prevention.  Staying abreast of, and following guidelines established by the American Congress of Obstetricians and Gynecologists (ACOG) for the care of pregnant women is vital.  Additionally, discussing health concerns with their patients, encouraging regular visits and obtaining consultation with physicians specializing in complications of pregnancy, Maternal-Fetal Medicine physicians are also good ways to ensure the safest and best care for pregnant women.

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