Identification of Complications during Pregnancy

Approximately 15% of all women will experience potentially life-threatening pregnancy-related complications, many of which cannot be detected in advance through risk screening. Identification of actual complications, such as infection or hypertension, is more helpful than identification of risk, especially demographic risk (e.g., too young, too old, too many, too closely spaced.) All women are at risk for complications and should receive basic care. Women with a known high-risk condition, such as multiple gestations, breech presentation, or hypertension, should receive special care for their condition(s).

Health care providers should offer services for prevention, early detection, and management of pregnancy-related problems, starting in the first trimester. Identification of complications should address only those factors for which concrete and appropriate interventions are available. If a health care provider identifies a problem that she or he is not equipped to manage, that provider must refer the woman to the next level of care. In addition, providers should educate all expectant mothers, their families, and community members about pregnancy-related danger signs and what to do if complications arise. The conditions that are the most important to address during pregnancy, and their associated preventive services should be incorporated in the ANC program:

  • Anemia: (see Nutrition TRM)
    • Nutritional counseling
    • Iron, folate supplementation
    • Helminthes treatment in endemic areas
    • Malaria prevention and case management in endemic areas
  • Pre-eclampsia:
    • Check blood pressure; treat or refer to higher level of care, if necessary
    • Instruct families to watch for danger signs, such as headache, blurry vision, abdominal pain, swelling (edema), and convulsions, and to seek help if needed
    • Treatment may vary by context; see MCHIP’s Pre-eclampsia-Eclampsia Briefer for a summary of WHO recommendations
  • Malaria:
    • Intermittent preventive treatment during pregnancy
    • Insecticide treated net (ITN) distribution and counseling on proper use
    • Testing (microscopy or rapid diagnostic tests) and case management (treatment or referral) in endemic areas
  • Reproductive tract infections (RTIs), STIs screening, treatment, and, if detected, referral of the woman and her partner:.
    • Gonorrhea and Chlamydia are particularly important to detect because they can be passed from an infected mother to her newborn in the birth canal, causing a number of conditions, including ophthalmia neonatorum (neonatal conjunctivitis), which can lead to blindness if not treated. In resource-poor settings, newborns should be given antibiotic eye drops or ointment in both eyes within an hour of delivery as the most practical intervention
    • Syphilis can cause perinatal death, mental retardation, and other neurological problems. (See the syphilis subsection later.)
    • Bacteriuria and urinary tract infection can cause pre-term births and vaginosis
  • HIV: Counseling, testing, and prevention of mother-to-child-transmission (PMTCT) services 
  • Tuberculosis: Health education, testing, and treatment and referral, if necessary