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Maternal complications during pregnancy

Last updated: March 13, 2025

Summarytoggle arrow icon

Maternal complications during pregnancy include metabolic conditions, hemorrhage, infectious diseases, and dermatologic conditions. Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy characterized by ketonuria and weight loss and typically requires inpatient admission, IV fluid hydration, and antiemetic therapy. Pregnancy-associated liver diseases most frequently occur in the second and third trimesters and are associated with significant maternal and fetal mortality and morbidity if not managed promptly. Cervical insufficiency refers to the inability of the cervix to retain a pregnancy in the second trimester in the absence of labor, contractions, or other pathologies; cervical cerclage may be required. Pregnancy dermatoses are pruritic conditions that occur during pregnancy or in the immediate postpartum period and include gestational pemphigoid and polymorphic eruption of pregnancy. Other maternal complications of pregnancy include hypertensive pregnancy disorders and gestational diabetes.

See also “Common discomforts during pregnancy.”

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Overviewtoggle arrow icon

Metabolic complications

Hemorrhagic complications

Infectious complications

Other complications

Overview of maternal complications during pregnancy
Risk factors Clinical features Diagnostics Management
Uncomplicated nausea and vomiting of pregnancy
Hyperemesis gravidarum
Cervical insufficiency
Trauma in pregnancy Maternal
  • Almost 1 in 4 pregnant women in the US experiences intimate partner violence [1]
  • Imbalance due to the gravid abdomen (↑ risk of falls)
  • Incorrect use of seatbelts during pregnancy (↑ risk of abdominal trauma)
  • Minor trauma: obstetric surveillance
  • Major trauma: initial stabilization and resuscitation (further assessment in trauma center)
Fetal
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Hyperemesis gravidarumtoggle arrow icon

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Pregnancy-associated liver diseasestoggle arrow icon

Overview [9][10][11]

Overview of liver disease in pregnancy

HELLP syndrome Acute fatty liver of pregnancy Intrahepatic cholestasis of pregnancy Acute viral hepatitis
Trimester
  • Any trimester
Clinical features
Diagnostics
Treatment
  • Stabilization
  • Immediate delivery
  • Supportive care
Complications Maternal
Fetal

Mildly elevated ALP is normal in pregnancy. Pregnant patients with elevated transaminase and/or bilirubin levels should be evaluated for hepatocellular and biliary disease. [9][11]

Acute fatty liver of pregnancy [9][11][14]

Rule out causes of acute liver injury that are unrelated to pregnancy (e.g., acute viral hepatitis, autoimmune hepatitis, drug-induced liver injury, Wilson disease). [9]

It is often difficult to differentiate between AFLP, HELLP, and preeclampsia with severe features, and these conditions can also coexist. Renal failure, hyperuricemia, and hypoglycemia are more common and severe in AFLP than in HELLP and severe preeclampsia. [9]

Supportive care and immediate delivery are the main aspects of AFLP management. There is no role for expectant management. [9]

Intrahepatic cholestasis of pregnancy [9][10][11][13]

Elevated total serum bile acid level (> 10 mcmol/L) in a patient with pruritus in the second or third trimester (without other causes of pruritus) is diagnostic for intrahepatic cholestasis of pregnancy. Elevated transaminases are not required for diagnostic confirmation. [10]

Early initiation of therapy with ursodeoxycholic acid may reduce the risk of preterm birth and stillbirth. [13]

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Cervical insufficiencytoggle arrow icon

Definition

Cervical insufficiency is the inability of the cervix to retain a pregnancy in the second trimester in the absence of contractions, labor, or other underlying pathologies (e.g., infection, bleeding, premature rupture of membranes).

Etiology

Most cases of cervical insufficiency are idiopathic.

Risk factors [21]

Clinical features

Diagnosis

Management of cervical insufficiency and short cervical length [23]

A shortened cervical length is not sufficient to diagnose cervical insufficiency.

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Chorioamnionitistoggle arrow icon

Etiology

Clinical features

Diagnosis

Chorioamnionitis is a clinical diagnosis (fever plus ≥ 1 additional symptom). Tests support or confirm diagnosis if the clinical presentation is ambiguous (e.g., in subclinical chorioamnionitis).

  • Maternal blood tests
  • Bacterial cultures
    • Urogenital secretions
    • Amniotic fluid (most reliable, but rarely conducted)
  • Group B Streptococcus screening: cervicovaginal and rectal swabs

Management

Complications

References:[26][27][28][29]

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Pregnancy dermatosestoggle arrow icon

Pregnancy dermatoses include gestational pemphigoid, polymorphic eruption of pregnancy, and intrahepatic cholestasis of pregnancy.

Gestational pemphigoid [30]

Polymorphic eruption of pregnancy (PEP)

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