Rare complications of pregnancy

Ants in your pants

Intense, generalised itching (pruritis) is the main (and sometimes only) feature, which is caused by the increased level of bile salts in the blood. It usually begins in the third trimester, but may occur any time after 20 weeks.

The itching, which can be very severe, is usually noticed first at night and can be most intense on the palms and the soles. Jaundice, caused by increased levels of bile chemicals in the blood, can also appear in ICP.

Confirmation of the diagnosis is usually made from laboratory test results.

The treatment has two primary objectives:

• To try and alleviate the itching, which can be very intense. This is not easy to achieve as medication is not very effective.
• To induce labour when the baby is thought to be mature enough to be safely delivered, certainly in cases where any foetal distress is noted.

Pyogenic Granuloma

A pyogenic granuloma can arise in up to five per cent of pregnancies - usually in the second or third trimester - and then the term 'pregnancy tumour,' 'granuloma of pregnancy' or 'granuloma gravidarum' is used.

It is this variant with which we are particularly concerned.

This is a relatively common, rapidly growing - and non-malignant - lesion (basically formed by an overgrowth of blood vessels) that can also occur in children and young adults as a typically solitary, glistening red nodule, prone to bleed easily.

The first appearance is as a small, pin-head sized lesion, which can grow anywhere from 2-20 mm (about the diameter of a one penny piece).

The exact cause for the appearance of a pyogenic granuloma is unknown. Many factors have been suggested, including hormonal influences, but there is little conclusive evidence for any of them.

As many of the lesions that do occur in pregnancy resolve soon after delivery, any treatment for removal is often postponed until then.

There is typically rapid growth of the lesion over a period of a few weeks, and although frequently appearing on the head and neck, it can appear elsewhere on the body.

In pregnancy, for instance, the most common site for its appearance is within the lining of the mouth - particularly on the gums or lips.

If treatment is needed (because of irritation or bleeding) it is usually in the form of a destructive technique using a laser, electro-cautery or chemical method. Surgical treatment for removal is only very occasionally used. Recurrence can be quite common.

read more:  previous | 1 |  2 |  3 | printer friendly send to a friend