Each year more than 130 million births occur worldwide. A successful pregnancy requires important physiologic adaptations, such as a marked increase in cardiac output. Medical problems that interfere with the physiologic adaptations of pregnancy increase the risk for poor pregnancy outcome; conversely,in some instances, pregnancy may adversely impact an underlying medical disorder.
In pregnancy, cardiac output increases by 40 %, due to an increase in stroke volume. Blood pressure of 140/90 mmHg is considered to be abnormally elevated and is associated with an increase in perinatal morbidity and mortality.
Approximately 5-7% of all pregnant women develop preeclampsia, the new onset of hypertension and proteinuria after 20 weeks of gestation. Symptoms may include severe elevation of blood pressure, evidence of central nervous system (CNS) dysfunction(headache, blurred vision, seizure, coma), renal dysfunction, pulmonary edema, hepatocellular injury.
2. GESTATIONAL HYPERTENSION
The development of elevated blood pressure during pregnancy or in the first 24 h post-partum in the absence of preexisting chronic hypertension or proteinuria is referred to as gestational hypertension. Mild gestational hypertension that does not progress to preeclampsia has not been associated with adverse pregnancy outcome or adverse long-term prognosis.
3. RENAL DISEASE
Normal pregnancy is characterized by an increase in glomerular filtration rate and creatinine clearance. If superimposed preeclampsia develop, endothelial injury results in a capillary leak syndrome that may make management challenging.
4. MITRAL STENOSIS
This is the valvular disease most likely to cause death during pregnancy. The pregnancy-induced increase in blood volume,
cardiac output, and tachycardia can increase the transmitral pressure gradient and cause pulmonary edema in women with mitral stenosis. Women with moderate to severe mitral stenosis who are planning pregnancy and have either symptomatic disease or pulmonary hypertension should undergo valvuloplasty prior to conception.
5. GESTATIONAL DIABETES
Gestational diabetes occurs in approximately 4% of pregnancies. AII pregnant women should be screened for gestational diabetes unless they are in a low-risk group. Pregnant women with gestational diabetes are at increased risk of stillbirth， preeclampsia, and delivery of infants who are large for their gestational age, with resulting birth lacerations, shoulder dystocia, and birth trauma including brachial plexus injury. Tight control of blood sugar during pregnancy and labor can reduce these risks.
Pregnant women who are obese have an increased risk of stillbirth, congenital fetal malformations, gestational diabetes, preeclampsia, urinary tract infections, post-date delivery, and cesarean deliverγ.
7. THYROID DISEASE
In pregnancy, the estrogen causes increase in thyroxine.binding globulin increases circulating levels of total T3 and
total T4. The thyroid gland normally enlarges during pregnancy. Although pregnant women are able to tolerate mild hyperthyroidism without adverse sequel, more severe hyperthyroidism can cause spontaneous abortion or premature labor, and thyroid storm is associated with a significant risk of maternal death.
8. HEMATOLOGIC DISORDERS
Pregnancy has been described as a state of physiologic anemia. Hemoglobinopathies can be associated with increased
maternal and fetal morbidity and mortality. Thrombocytopenia occurs commonly during pregnancy.
9. GASTROINTESTINAL AND LIVER DISEASE
Up to 90% of pregnant women experience nausea and vomiting during the first trimester of pregnancy. Crohn’s disease may be associated with exacerbations in the second and third trimesters while ulcerative colitis in the first trimester and during the early postpartum period. Exacerbation of gallbladder disease is common during pregnancy.
As pregnancy is the most important and the sensitive time period in a women life. They need some extra care, attention, rest and love.