In considering the complications of pregnancy, the nurse in training needs a reminder that hospital experience is likely to give her an exaggerated idea of the relative frequency with which they occur. This is due to the fact that most maternity patients in hospitals are there because they are known to be abnormal in some way, or because they are pregnant for the first time, and first pregnancies are more likely to end in difficult and complicated labors than later ones. The vast majority of cases run practically uncomplicated courses, for pregnancy, labor and the puerperium are normal physiological processes. It is extremely serious, however, to allow them to become abnormal.
Watchfulness throughout pregnancy, then, in the interest of preventing disaster, cannot be too insistently advocated.
Some complications that are watched for during pregnancy are peculiar to that condition alone, and these may be divided into three general groups:
1. The premature terminations of pregnancy, which are designated as abortions, miscarriages and premature labors.
2. Ante-partum hemorrhages, due to either a placenta prævia or a premature separation of a normally implanted placenta, the latter being termed “accidental hemorrhage.”
3. The toxemias, including pernicious vomiting, pre-eclamptic toxemia, eclampsia and possibly nephritic toxemia, though this condition is not invariably associated with pregnancy.
There are other conditions, not necessarily inherent to the state of pregnancy, but which should be detected and treated early, since their development coincidently with expectant motherhood may threaten the safety of the patient or the child, or both. Probably the most serious of these is syphilis, though gonorrhea, impaired kidneys, heart lesions, tuberculosis or a general state of poor nutrition also may prove to be grave.
Any chronic, organic disease is likely to be increased in severity by the strain which pregnancy puts upon the impaired organs, in common with the rest of the maternal body. But acute diseases usually run about the same course in pregnant, as in non-pregnant women, except when an infection causes an abortion, the shock of which, in turn, reduces the patient’s resistance against the complicating disease.
As we consider these various, dreaded complications which may arise during pregnancy, infrequent though they be, we feel that no amount of effort is too much to make, if we can, thereby, save one mother or one baby from their destructive effects. We are stirred by the urgency of preventing a premature ending of pregnancy, for example, when we see it, not so much as simply another obstetrical emergency, but in its true, tragic light as the loss of an infant life and the bereavement of an expectant mother.