Puerperal Disorders

Unfortunately, the complexities of human pregnancy and birth make it a risky endeavor. The most vulnerable time for maternal death is the post-partum period during which 60% deaths and 65% deaths are reported. Around 62.3% deaths are estimated to occur in post-partum period. Unfortunately, post-partum period is the most neglected period. In the developing world, while 65% of all women have some form of antenatal care, 53% get intra-natal care; only 30% get post-partum care. Women continue to need care and support after childbirth. Postpartum checkups can make all the difference for an abnormal bleeding or infection. Living away from services or being unable to afford those services prevents a woman from acquiring the knowledge needed after birth to look after herself or to receive the life-saving antibiotics and the attention she may need after delivery.

Essentials of Normal Pregnancy

Pregnancy is physiologically and nutritionally a highly demanding period. A pregnant woman prepares herself to meet the nutritional demands by increasing her own body fat deposits during pregnancy. The fetus inside the uterus of mother is like a parasite (i.e., it takes several nutrients that it requires from the mother, regardless of whether she has enough of them or not). However, it has been observed that women's diets among poor socio-economic groups during pre-pregnant, pregnant, and lactating periods are essentially similar. Consequently, widespread maternal malnutrition results in a high prevalence of infants with low birth weight and a very high maternal mortality rate. Extra diet is needed to improve the birth weight and increase deposits of fat in the maternal body. Adequate intake of nutritious diet is reflected in optimal weight gain of 10 to 12 kg during pregnancy. Some micronutrients are especially required in extra amounts to meet the physiological needs of this period. Hence, good nutrition must be ensured for optimum growth and development of children, adolescents, and women.

Physiology of Pregnancy

Pregnancy is associated with profound anatomical, physiological, biochemical, and endocrine changes that affect multiple organs and systems. One fertilized egg cell implanted in the lining of uterus initiates countless bodily changes. Secretion of ovarian hormones increases greatly. The bone marrow produces more RBCs and blood volume increases. The heart enlarges slightly to handle an extra supply of blood and shifts its position as uterus enlarges with the growing fetus. Such changes are necessary to help women adapt to the pregnant state and to support the growth and survival of the fetus. Such anatomical and physiological changes can also create confusion during a pregnant woman's clinical review. Likewise, changes in the biochemistry of blood during pregnancy may cause difficulties in interpreting tests. Hence, there is need to understand the deviation from normal anatomical, physiological, biochemical, and endocrine changes occurring during pregnancy so as to plan appropriate strategies for better maternal and fetal health.

Management of High-Risk Pregnancies

Rarely does a pregnancy happen without any complication. The majority of these problems are minor and due to normal anatomical and physiological changes occurring during pregnancy. However, some are more serious and require medical attention. Certain conditions that are specific to pregnancy and occur during pregnancy classify it as a high-risk pregnancy. A high-risk pregnancy is closely monitored with antenatal check-ups and possibly an additional care. In labour, certain obstetric complications require an immediate intervention. A high-quality antenatal care means that potentially serious conditions are usually successfully managed, both during pregnancy and in labour. Post-delivery problems, either to baby or to mother, may also need medical attention with careful follow-up and sometimes referral. Thus, providing good antenatal care, finding appropriate ways of preventing, and dealing with consequences of unwanted pregnancies and improving the way society looks after pregnant women are the three most important ways to reduce maternal mortality in high risk pregnancies.

Labor Complications

A complication of labor is a problem that poses a risk to the mother's or baby's health that occurs during birth. There are also pregnancy complications; those are the health problems that occur in the pregnant woman or in the developing fetus before the onset of labour. Complications of birth may occur during labor or the delivery and can have serious repercussions for both mother and newborn. Some complications that women develop during pregnancy like preeclampsia (high blood pressure with protein in the urine) may lead to premature detachment of the placenta from the uterus (placental abruption) and problems in the newborn. Some other labor complications may sometimes develop spontaneously and unexpectedly. Hence, it becomes easier to anticipate such problems during pregnancy through regular antenatal check-up by a physician or a certified nurse/midwife. Thus, intrapartum care of women with a complicated labor and delivery is recommended to improve the chances of having a healthy baby and safe delivery.

High-Risk Pregnancies

Infant and child survival and their growth and development cannot be improved without good maternity care. Proper planning of births is a basic ingredient of any child survival package. Sexually transmitted diseases (STDs), and in particular HIV infections, unless adequately controlled, can impede further progress in child survival. There are great risks of neglecting sexual and reproductive health; a painful or detrimental transition from adolescence to adulthood can lead to ill effects in the long run. Early pregnancy/motherhood can be physically hazardous for girls and can jeopardize their educational attainment as well as economic potential. In particular, adolescent girls are vulnerable to HIV exposure and sexually transmitted infections (STIs), sexual coercion, violence, as well as exploitation. These have an enormous impact on the physical and mental health of an individual and have long-term implications for them, their offspring, their families, and their communities.

Reproductive Health of Women

The tragedy of maternal mortality in the developing world is not just a health concern; it should be recognized as a human rights issue. The theme for World Health Day for 1998 was “Pregnancy is Special; let's make it safe.” When this theme was adopted by the World Health Assembly, it set a principle in the health policy. Pregnancy is not a disease. Pregnancy is special. Pregnancy, a privilege for a woman, is the means for human species to survive and propagate. When women risk their lives and health in order to give birth to a new life, they have a right to safe motherhood. Pregnancy should, thus, not compete for resources with the disease conditions. It is for these reasons of disease burden, an impact that transcends national boundaries as well as a deep concern about social injustice and inequity along with the availability of cost-effective interventions, that a major investment in reproductive healthcare is justified.

Complications of Pregnancy

Although the majority of pregnancies are uneventful, sometimes complications do happen. Pregnancy complications are the conditions or pathological processes associated with pregnancy. They can occur during or after pregnancy and range from minor discomforts to serious diseases that require medical interventions. They can involve the mother's health, the baby's health, or both. Complication of pregnancy can cause maternal morbidity and mortality. The most common causes of maternal mortality are maternal bleeding, maternal sepsis, hypertensive disease, obstructed labour, and pregnancy with the consequence of abortion, which includes miscarriage, ectopic pregnancy, and medical abortion. The primary means of preventing maternal deaths is to provide rapid access to emergency obstetric care, including treatment of haemorrhage, infection, hypertension, and obstructed labour. Proper antenatal care can reduce the maternal mortality rate by reducing the number of pregnancies among women of reproductive age. Thus, adequate monitoring and appropriate intervention strategies should be provided for better maternal and fetal outcome.