As one of Los Angeles’ preeminent high-risk pregnancy specialists, Dr. Steve Rad is an expert overseeing potential pregnancy complications and conditions.
It should be noted that the chances of birth defects may increase if existing or developing conditions are not addressed immediately. By reviewing and understanding the conditions listed below, you and Dr. Rad can take any measures needed to ensure a safe and healthy pregnancy.
AMNIOTIC FLUID ISSUES
Amniotic fluid is the liquid that surrounds and protects an unborn baby inside the uterus. It plays a crucial role in the baby’s development. However, there can be issues related to the amniotic fluid during pregnancy. Here are a few:
Amniotic band syndrome (ABS)
Amniotic Band Syndrome (ABS) is a rare condition where amniotic bands wrap around the baby’s arm, leg, fingers, or toes — restricting blood flow. The condition causes severe deformities in babies.
Oligohydramnios is a condition where there is insufficient amniotic fluid in the uterus. This causes fetal distress and can result in premature labor or miscarriage.
Polyhydramnios is a condition where amniotic fluid builds up in the uterus. Most causes are mild and do not require treatment; however, severe cases can result in premature delivery.
Fetal bladder issues refer to problems related to the development and function of the bladder in an unborn baby. These can be detected during routine prenatal ultrasound scans. One such issue is:
Lower urinary tract obstructions
A lower urinary tract obstruction (LUTO) is a blockage of the fetus’s urinary tract. Urine build-up can lead to permanent organ damage.
Fetal brain issues refer to a range of conditions that can affect the development and function of a baby’s brain during gestation. These conditions can be due to genetic abnormalities, infections, trauma, or other unknown causes.
Absent cavum septum pellucidum
The absence of the cavum septum means the cerebrospinal fluid has leaked out of the ventricles into the space between the brain and the surrounding membrane. This condition is called hydrocephalus.
Agenesis of corpus callosum
The corpus callosum is a bundle of nerve fibers connecting the left and right hemispheres of the brain. It plays a vital role in interhemispheric communication, allowing us to coordinate our actions across both sides of the body.
Dandy-Walker Malformation (DWM) is a rare congenital disorder characterized by enlargement of the fourth ventricle. The condition is also known as Dandy-Walker Syndrome or Cerebellar Hypoplasia. DWM is characterized by underdevelopment (small size and abnormal position) of the middle part of the cerebellum, cystic enlargement of the fourth ventricle, and enlargement of the base of the skull.
Holoprosencephaly is a rare genetic disorder characterized by incomplete development of the brain and face. The condition occurs in approximately 1 out of every 16,000 births. HPE is caused by gene mutations in neural tube closures during fetal development.
Ventriculomegaly is the enlargement of the brain ventricles (the fluid-filled cavities inside the skull). This condition occurs when there is too much fluid in the brain — or the ventricles look large because the surrounding brain is too small.
CERVICAL ABNORMALITY ISSUES
The cervix is the bottom part of the uterus that opens into the vagina. During pregnancy, the cervix should be long and firm to hold the fetus safely inside the womb. Unfortunately, several cervical problems can arise during pregnancy, such as:
Cervical insufficiency / cervical incompetence
Also known as cervical incompetence, cervical insufficiency is characterized by premature dilation of the cervix during pregnancy. If untreated, this results in early pregnancy loss.
During pregnancy, the cervix lengthens and then shortens again in preparation for delivery. A short cervix can become too short too early in pregnancy, resulting in early labor or pregnancy loss.
FACIAL ABNORMALITY ISSUES
Fetal facial abnormalities are conditions that affect the development of the face in the unborn baby. They can range from minor and easily treatable to more serious conditions that can cause significant functional challenges.
Cleft lip / cleft palate
A cleft lip or palate is a birth defect where the upper lip and roof of the mouth don’t fully close during fetal development. Babies and children with cleft palate can have food or liquids pass through the nose if the condition is not treated or managed.
Micrognathia is a congenital malformation of the jawbone. The lower jawbone is smaller than normal, which can cause feeding or breathing problems. It may get better on its own or may require intervention.
FETAL BLOOD ISSUES
Fetal blood issues can range from relatively common conditions, such as blood type incompatibilities between mother and fetus, to more rare and serious conditions, like fetal anemia.
Fetal anemia is a condition where the fetus has low levels of red blood cells or hemoglobin. This occurs during pregnancy because not enough red blood cells are being produced or because they are being destroyed faster than they’re being replaced. The condition can cause serious health problems for both mother and baby.
Also known as alloimmunization, isoimmunization is when the baby and carrier have different blood types. The mother’s immune system reacts to the baby’s incompatible blood proteins by attacking them.
Fetal issues during pregnancy encompass a range of conditions and complications that can affect the development and health of the unborn baby. They can be caused by various factors, including genetic abnormalities, maternal health conditions, infections, and exposure to certain medications or harmful substances, and can affect multiple systems.
Fetal congenital birth defects
A congenital condition is one you’re born with. They include conditions such as heart defects, cleft lip and palate, spina bifida, genetic disorders, and more. Genetic testing and proper monitoring can sometimes catch these problems early.
Fetal growth restriction or IUGR
Fetal growth restriction is a condition where the baby does not grow at a normal rate during pregnancy. This can be caused by problems with the placenta, maternal health problems, chromosomal defects, or multiple gestation.
Recurrent pregnancy loss or recurrent miscarriages
Recurrent Pregnancy Loss occurs when a woman has three or more consecutive losses before 20 weeks of gestation. Recurrent miscarriage makes you more likely to have a miscarriage in the future.
Stillbirth is fetal death after 20 weeks of pregnancy before or during birth. This may occur due to maternal health conditions, pregnancy complications, or several other pregnancy or delivery problems.
GENETIC ABNORMALITY ISSUES
Prenatal genetic abnormalities refer to genetic disorders or conditions that can be identified in a developing fetus during pregnancy. These abnormalities occur due to changes or mutations in the fetus’s genetic material (DNA). Some common prenatal genetic abnormality issues include:
Cystic hygroma is a benign tumor that develops from the lymphatic system. They usually appear at birth or during infancy. The cyst is filled with fluid and can cause swelling and discomfort.
Down syndrome is a genetic condition caused by having three copies of chromosome 21 instead of two. This causes problems with brain development, muscle tone and coordination, vision, hearing, speech, learning, memory, and other functions.
Trisomy 18 is a rare chromosomal disorder that occurs during pregnancy. The baby has three copies of chromosome 18 instead of two. Babies with this condition are usually born small with some physical deformities and intellectual disabilities.
Fetal gastrointestinal (GI) issues refer to a group of conditions that affect the development and function of an unborn baby’s digestive system. Some of these conditions are minor and can be managed after birth, while others may require immediate attention and even surgery after the baby is born.
A bowel obstruction is something blocking (obstructing) the bowels. This can be caused by the improper formation of the bowels or by twisting or improper rotation of the bowels during fetal development. Babies born with a bowel obstruction need immediate intervention.
Echogenic bowel is a condition where the intestines appear bright or white on ultrasound. This can be perfectly normal, however, there are several medical problems that could also cause white bowels on an ultrasound.
Gastroschisis is a rare birth defect where part of the intestines protrude through the abdominal wall and extends outside the body. The baby needs surgical intervention after birth to move the intestines inside the body. Even after treatment, babies with gastroschisis have trouble eating, digesting, and absorbing nutrients.
Omphalocele is a rare congenital defect in which part or all of the abdominal wall fails to close during fetal development. Some of the baby’s organs end up outside of the body, enclosed in a protective membrane. Other birth defects usually accompany this condition.
Fetal heart issues cover a range of conditions that can impact the development and function of an unborn baby’s heart. These can include structural defects, rhythm disturbances, or functional problems, all varying in severity. Some issues can have minor implications and require little or no intervention, while others can be life-threatening and necessitate immediate medical attention or even surgery after birth.
Coarctation is a narrowing or blockage of blood vessels that occurs during fetal development. The condition usually affects the aorta (the main artery from the heart). Newborns with this condition experience chest pain, shortness of breath, fatigue, dizziness, fainting, and leg swelling.
Congenital heart defects
Congenital heart defects (CHDs) are heart conditions a baby is born with. About 1% of babies in the U.S. are born with a heart defect, the severity of which varies.
Fetal arrhythmias (VT, PAC, PVC)
Fetal arrhythmias are abnormal heart rhythms that occur during pregnancy. In most cases, a too-slow or too-fast heartbeat is temporary. Less than 2% of fetal heartbeat irregularities represent true fetal arrhythmias.
Tetralogy of Fallot
Tetralogy of Fallot is a rare condition caused by a combination of four congenital heart defects that cause oxygen-poor blood to leave the heart and move to the rest of the body. Babies with tetralogy of Fallot often have blue skin discoloration among other more serious symptoms.
Transposition of great arteries
Transposition of great arteries is a congenital heart defect where the main pulmonary artery connects to the left ventricle instead of the right ventricle. This creates a shortage of oxygen-rich blood to the body. Without treatment, serious complications or death can occur.
Ventricular septal defect
Babies with ventricular septal defects are born with a hole between the heart’s lower chambers. (An atrial septal defect is a hole between the heart’s upper chambers.) This disrupts the flow of oxygen-rich blood and may cause serious problems depending on its size.
Fetal kidney issues refer to a group of conditions affecting the development and function of an unborn baby’s kidneys. The kidneys are vital organs that filter waste products from the blood, maintain electrolyte balance, and produce urine. Many of these issues can be detected during prenatal ultrasound scans, allowing for proper planning and preparation for treatment.
Hydronephrosis is a condition where urine backs up into the kidneys causing them to swell and become enlarged. It can be caused by a blockage or an anatomical defect. Severe hydronephrosis can result in kidney damage if untreated.
Polycystic kidney disease (PKD) is a rare genetic disorder characterized by cysts growing inside the kidneys. These cysts can enlarge the kidney or impair kidney function.
Pyelectasis occurs during pregnancy; excess urine collects in the baby’s kidneys. It is more common in males.
Renal agenesis is a rare congenital condition where the kidneys fail to develop properly during gestation. In some cases, the affected kidney fails to form at all. This condition can be detected (or suspected) during a prenatal ultrasound but will be confirmed after birth.
Fetal lung issues refer to various conditions that can affect the development and function of an unborn baby’s lungs. These issues can range from minor to serious, impacting the baby’s ability to breathe and oxygenate blood after birth. Advancements in neonatal medicine have significantly improved the prognosis for many of these issues.
Bronchopulmonary sequestrations (BPS) are rare congenital anomalies characterized by an abnormal mass of nonfunctioning lung tissue that forms during fetal development. Large BPSs can lead to breathing problems and life-threatening complications.
A congenital cystic adenomatoid malformation (CCAM) is an abnormality of one or more lobes in which the lobe forms as a fluid-filled sac, called a cyst, which does not function as normal lung tissue. CCAMs develop with equal frequency on either lung, but rarely occur on both sides. Most cases of congenital cystic adenomatoid malformation (CCAM) are diagnosed via prenatal ultrasound before the child is born.
Congenital diaphragmatic hernia (CDH) refers to a hole in the diaphragm — the muscle that separates the organs in the chest from those in the abdomen. Other organs can move into the chest cavity through this hole during fetal development, and babies with CDH may have underdeveloped lungs.
MATERNAL AUTOIMMUNE DISEASES IN PREGNANCY
Autoimmune diseases refer to conditions in which a patient’s immune system mistakenly attacks their own body tissues. These conditions can pose unique challenges and risks — especially during pregnancy. Depending on the specific autoimmune disease, these risks can range from preterm birth and low birth weight to more serious complications.
APLS (or antiphospholipid antibody syndrome) is an autoimmune disorder that causes abnormal blood clotting. It can result in miscarriage, stillbirth, preterm delivery, and preeclampsia.
Inflammatory bowel disease, Crohn’s disease, ulcerative colitis
Crohn’s disease and ulcerative colitis are chronic conditions that affect the GI tract. The symptoms include abdominal pain, diarrhea, rectal bleeding, fatigue, fever, joint pain, skin rashes, and weight loss.
Lupus is an autoimmune disease that affects the body’s connective tissue (skin, joints, blood vessels, lungs, kidneys). The symptoms include fatigue, fever, joint pain, skin rashes, mouth sores, kidney problems, and hair loss.
Rheumatoid arthritis (RA) is an autoimmune disease that causes your immune system to attack your joints, resulting in inflammation.
MATERNAL HEMATOLOGIC ISSUES
Maternal hematologic issues refer to disorders affecting a pregnant woman’s blood and blood-forming tissues. These can encompass a variety of conditions and can have varying degrees of impact on the mother and baby’s health.
Antithrombin deficiency is a rare hereditary disorder that increases the risk of abnormal blood clots. Patients are at higher risk of thrombosis (blood clots in the veins), pulmonary embolism, and fetal death.
Factor V Leiden mutation
Factor V Leiden Mutation (FVL) is a genetic condition that increases your risk of developing abnormal blood clots in your legs or lungs.
History of blood clots
Blood clots occur when platelets stick together and form a plug or clot. The improper formation of these plugs can cause serious health problems such as heart attacks, strokes, deep vein thrombosis, pulmonary embolism, and even death.
Methylenetetrahydrofolate reductase (MTHFR) is an enzyme that breaks down the amino acid homocysteine. The MTHFR gene that codes for this enzyme has the potential to mutate, which can either interfere with the enzyme’s ability to function normally or completely inactivate it.
Prothrombin gene mutation
Prothrombin gene mutation (PGM) is a genetic condition that causes abnormal blood clotting.
Thrombocytopenia is a condition where your platelet count is too low. This causes bleeding problems as platelets are responsible for stopping bleeding.
Venous thromboembolic disease (VTE)
Venous thromboembolic is a condition where blood clots form inside veins or arteries. This can happen in the legs, arms, pelvis, lungs, or abdomen. The risk of developing VTE increases after surgery, childbirth, trauma, cancer, or pregnancy.
MATERNAL NEUROLOGICAL ISSUES
Maternal neurological issues during pregnancy refer to disorders affecting the nervous system, which includes the brain, spinal cord, and peripheral nerves. These conditions can impact a woman’s health and well-being and the course and outcome of her pregnancy.
Brain tumors are cancerous growths inside the brain. Pregnant women should be aware of the symptoms of brain tumors and seek medical attention immediately if they experience them.
MS is a chronic disease that affects the central nervous system and leads to neurological symptoms such as vision problems, muscle weakness, fatigue, numbness or tingling, and difficulty walking.
Opioids are synthetic drugs derived from opium. They include prescription medications such as oxycodone, hydrocodone, and codeine. These drugs are often prescribed for chronic pain or severe injuries but can be dangerous when used improperly.
Seizures are sudden episodes of abnormal electrical activity in the brain. They can cause convulsions, muscle contractions, or loss of consciousness.
Seizure disorder in pregnancy
Some patients without a seizure disorder may experience seizures during pregnancy. These can cause serious complications for both mother and baby.
MATERNAL PREGNANCY CONDITIONS
Pre-existing maternal medical conditions can impact pregnancy outcomes. In addition, pregnancy can cause new medical complications for the pregnant parent. These conditions can affect various body systems and have diverse implications for the mother and baby’s health.
Advanced Maternal Age
Women who give birth after 35 years of age are more likely to experience complications such as gestational diabetes, preeclampsia, eclampsia, placental abruption, placenta previa, premature rupture of membranes, and postpartum hemorrhage. These complications can cause serious health problems for both mother and baby.
Bleeding in pregnancy
Bleeding during pregnancy can occur for several reasons, such as placenta previa, placental abruption, uterine fibroids, or cervical incompetence. New or irregular bleeding during pregnancy should always be investigated.
Gestational Diabetes is when pregnant women develop high blood sugar levels during pregnancy. This usually happens after 20 weeks of pregnancy. If left untreated, gestational diabetes can cause complications such as miscarriage, premature birth, or even death.
Gestational hypertension (GH) is a condition that occurs during pregnancy where blood pressure rises above 140/90 mmHg. This is usually temporary and resolves after delivery.
Multiple gestation complications
Multiple pregnancies (twins, triplets, etc.) Are associated with higher rates of maternal morbidity and mortality than single pregnancies. There is no consensus on whether the rate of adverse outcomes is increased in women who become pregnant after assisted reproductive technologies (ART).
Preeclampsia is a pregnancy condition characterized by high blood pressure and high protein levels in your urine. If the condition is not managed, it can lead to seizures or stroke.
Labor occurring before 37 weeks gestation is preterm and may result in complications or incomplete fetal development. The risk increases with advanced maternal age, multiple pregnancies, obesity, diabetes, smoking, alcohol consumption, and certain infections.
Preterm premature rupture of membranes (PPROM)
PPROM is a condition where the amniotic sac ruptures before 37 weeks of pregnancy. This results in a higher risk of infection or preterm labor.
Postpartum hemorrhage and massive bleeding
Postpartum hemorrhage (PPH or PPV) is when blood loss during childbirth exceeds 500 ml. This can occur any time after delivery but usually happens within 24 hours of giving birth.
Thyroid disorders are common in women of childbearing age. In fact, they affect nearly 2% of American women. The symptoms include fatigue, depression, hair loss, dry skin, constipation, difficulty sleeping, and menstrual irregularities.
Placental problems refer to a variety of conditions that affect the placenta. The placenta is a crucial organ that provides oxygen and nutrients to the developing fetus while removing waste products. When complications arise, they can potentially impact the health of both mother and baby, leading to issues such as preterm birth, low birth weight, and, in severe cases, stillbirth.
Chorioangioma is a benign tumor of the placenta. It is seen in approximately 0.5-1% of pregnancies.
Placenta accreta is a condition where placental tissue grows into the uterine wall. Placenta accrete occurs when the placenta attaches abnormally to the uterus.
Placenta previa is a condition where the placenta covers the cervix. This means that the baby cannot pass through the birth canal. The condition occurs in approximately 2 out of every 1,000 pregnancies and generally develops early in pregnancy.
Vasa previa is a rare pregnancy complication where fetal umbilical cord blood vessels run too close to the cervix. The vessels are at risk of rupture at the onset of labor, which usually results in stillbirth. If detected early, the survival rate for the fetus is 97%.
Fetal skeletal issues refer to conditions that can affect the development and formation of an unborn baby’s skeletal system, including bones and cartilage. These issues can range from minor anomalies to severe disorders affecting the baby’s mobility and overall health.
Achondroplasia is a genetic disorder that results in slowed skeleton growth. The primary feature of achondroplasia is dwarfism.
Clubfoot is a condition where the foot is turned inward or outward. This deformity of the foot can be detected as early as 12 weeks gestation, but diagnosis is confirmed at birth.
Spina bifida is a neural tube defect where part or all of the spinal cord does not form properly during pregnancy. Increased folic acid intake during pregnancy can help prevent the condition.
Twin complications during pregnancy refer to potential health challenges that can arise when a woman carries more than one fetus. While many twin pregnancies progress without major issues, they are inherently more complex and carry a higher risk of certain complications. These can affect the mother’s health, the babies’ development, or both.
Conjoined twins are babies born physically connected to each other. They may share one or more internal organs.
Monochorionic diamniotic twins
Monochorionic diamniotic (MCDA) twins are rare, occurring in only 0.5% of twin pregnancies. The twins share a placenta but have their own amniotic sacs. They are at higher risk of complications due to their shared blood supply.
Twin anemia polycythemia sequence
TAPS is a rare condition that occurs in twins that share a placenta. There are unequal blood counts between the twins, with one twin at risk of anemia and the other at risk of a too-high blood count (polycythemia).
Twin reversed arterial perfusion
TRAP sequence is a rare complication of twins that share a placenta. One twin has a nonexistent or improperly formed heart, forcing the other twin’s heart to provide blood for both. Only one twin will fully develop and be able to live outside the womb.
Twin-to-Twin Transfusion Syndrome
TTTS is a rare pregnancy condition affecting twins (or other multiples). These twins share one placenta but have uneven blood vessel distribution. One twin risks malnourishment and organ failure; the other is at risk of heart overwork and other cardiac complications.