Pregnancy Complications

During pregnancy, it is possible for the tissue surrounding the embryo to degenerate. Such degeneration typically manifests itself in hydatidiform moles and choriocarcinoma. These tumors are difficult to diagnose and are associated with an increased level of beta hCG. Treatment involves the complete removal of the tumorous growth. The characteristics of the tumors are described in more detail below.

During pregnancy, the placenta develops and adapts to the needs of the child. The placenta fulfils numerous tasks, but mainly serves the child’s oxygen and nutrients supply. Due to various causes, a malfunction is possible, whereby the child is under-supplied and can no longer grow properly. Early diagnosis with therapeutic measures is therefore important.

In the context of precocious pregnancy, flawed implantation of the placenta is possible. This can remain asymptomatic in the beginning. However, bleeding mostly occurs during the end stages of pregnancy. Also, vaginal bleeding can be the cause of premature placenta detachment. This bleeding is life threatening to both the mother and child, and is very painful. In the following article, the clinical picture of premature placenta detachment and placenta praevia are further explained together with their differential diagnosis.  

Eccyesis or tubal pregnancy refers to the implantation of the blastocyst outside the uterine cavity. Thereby, affected patients suffer from acute abdominal pain. Eccyesis or tubal pregnancy can be quickly diagnosed by means of an ultrasound and laboratory analysis. In severe cases, in the case of rupture and hemorrhage, the fastest possible action is required. Surgery should be considered as a therapeutical approach.

Abortions, or so-called miscarriages, frequently occur in the context of precocious pregnancies. Generally, the affected people consult a gynecologist since vaginal bleeding occurs during pregnancy. There are different forms of abortions, which can be very painful but also asymptomatic. Mostly, removal of the fetus is necessary to avoid infections or further bleeding.

Pre-eclampsia is a condition that is characterized by an elevated blood pressure and proteinuria and that usually happens after 20 weeks of gestation. Women with pre-eclampsia can also develop hemolysis, thrombocytopenia and elevated liver enzymes known as HELLP syndrome or microangiopathic hemolytic anemia. Due to wide-spread endothelial dysfunction, they might also develop brain edema and eclampsia. Laboratory investigations show thrombocytopenia, proteinuria > 30 mg/day, hemolysis and elevated liver enzymes. The only known curative treatment for pre-eclampsia is delivery of the fetus.

Gestational trophoblastic disease is a malignant tumorous disease of the placental trophoblasts and can be classified into partial or complete molar pregnancy. Patients with gestational trophoblastic disease are usually identified early in the disease by the detection of a markedly elevated hCG level and characteristic ultrasound findings, such as focal cysts in partial moles and extensive villi edema in complete moles. Complete evacuation of the molar pregnancy is indicated as first line therapy, while chemotherapy can be reserved for patients with recurrent disease or GTN. Future normal pregnancy is expected to be not affected by a previous history of gestational trophoblastic disease.