Rare complications of pregnancy

Dystocia

This literally means difficult or abnormally slow labour, and it is the result of a combination of one or more factors that can involve either mother or baby. Signs and symptoms include:

• Abnormalities of the uterine contractions, which may be too weak or uncoordinated to open the cervix during the first stage of labour or too weak to continue the expulsive processes during the second stage.
• Abnormalities of the baby's presentation or position in the birth canal - anything other than head first increases the probability of dystocia - or alternatively there may be other problems with the baby with regard to abnormal growth of parts or overall size - a weight of 4.5 Kg or more, particularly, may lead to a shoulder dystocia, where the shoulders get stuck.
• Abnormalities of the mother's bony pelvis or the birth canal itself can lead to a retarded progress of the baby through the birth canal.

Dystocia can be associated with increased problems in the mother and/or baby during the stage of labour, delivery and afterwards. Some of these problems are a direct result of the treatments, which may be:

• Medical - using drugs to encourage uterine contractions during various stages in labour.
• Surgical - using forceps or vacuum extraction techniques to either adjust the baby's position or assist with delivery, or Caesarean section for delivery.

Complications can also occur in the form of infection - to the mother or baby - as a result of both the delay in labour itself as well as infection associated with the manipulative treatments needed.

Intrahepatic Cholestasis of Pregnancy(ICP)

This condition, also known as obstetric cholestasis, icterus gravidarum and cholestatic jaundice of pregnancy, is caused by a temporary dysfunction of the mother's liver during pregnancy, which resolves shortly after delivery.

The exact cause is not known, but it is widely accepted that in those affected, the high oestrogen level in the blood has in someway altered the functioning of the liver cells, causing various bile chemicals that would normally pass into the gut to build up in the blood instead.

It is generally not regarded as harmful to the mother - and there are no long-term problems - but it can be associated with an increased risk of stillbirth or premature death of the baby if the ICP is not recognised and treated.

ICP is a relatively rare condition, apparently with some hereditary links (grandmother, mother and sisters, but it sometimes skips generations), occurring in less than one in 1,000 pregnancies.

However, it is up to four times as common in multiple rather than single pregnancies. If it does appear in a pregnancy, there is a 60-70 per cent chance that it will recur in a future pregnancy, often with increased intensity.