pregnancy complications essay

Pregnancy Complications

Complications of pregnancy include physical and mental conditions that affect the health of the pregnant or postpartum person, their baby, or both. Physical and mental conditions that can lead to complications may start before, during, or after pregnancy. It’s very important for anyone who may become pregnant to get health care before, during, and after pregnancy to lower the risk of pregnancy complications.

If you are pregnant or gave birth within the last year, talk to your health care provider about anything that doesn’t feel right. If you have an urgent maternal warning sign  during or after pregnancy, get medical care immediately.

Reducing Your Risk

• Common Pregnancy Complications

Heart Conditions

High blood pressure (hypertension), hyperemesis gravidarum.

• Related Links

Living a healthy lifestyle and getting health care before, during, and after pregnancy can lower your risk of pregnancy complications.

• Before you get pregnant, eat healthy, stay at a healthy weight, take care of your mental health, avoid tobacco products, and limit or avoid alcohol. Preconception health care can also help you be as healthy as possible before you become pregnant.
• Once you’re pregnant, start prenatal care early and talk to your health care provider about health conditions you have now or had in the past. If you are being treated for a health condition or taking certain medicines, your provider might recommend changing the way your health condition is managed. Be sure to also discuss problems you had in any previous pregnancies.
• After pregnancy, see your health care provider for postpartum care. Be sure to discuss anything that doesn’t feel right, including not just physical symptoms, but also feelings of sadness, anxiety, and exhaustion that make it hard to take care of yourself, your baby, or others. You may need to see multiple different health care providers to be as healthy as possible after pregnancy.

The Hear Her campaign supports CDC’s efforts to prevent pregnancy-related complications and deaths by sharing potentially life-saving messages about urgent warning signs .

Common Complications

The following are some common conditions that can happen before, during, or after pregnancy. You can help prevent and manage them by seeing a health care provider regularly before, during, and after your pregnancy.

Anemia is having lower than the normal number of healthy red blood cells. People with anemia may feel tired and weak. You are more likely to get iron-deficiency anemia during pregnancy because your body needs more iron than normal. Your health care provider will check your number of red blood cells during your pregnancy. Treating the underlying cause of the anemia, if possible, can help restore the number of healthy red blood cells. Your provider may also recommend you take iron and/or folic acid supplements to help prevent and manage anemia.

Anxiety disorders are common before, during, and after pregnancy. If you have an anxiety disorder, you may struggle with uncontrollable feelings of anxiety, nervousness, fear, worry, and/or panic. These feelings can be intense and may last a long time. They can also interfere with relationships and daily activities, such as work or school. Anxiety disorders often occur with depression . Getting treatment for anxiety before, during, and after pregnancy is important. Talk to your health care provider as soon as possible if you think you have an anxiety disorder.

Everyone feels sad sometimes, but these feelings usually pass in a few days. Depression interferes with daily life and may last for weeks or months at a time. Some people have depression before, during, or after pregnancy. Symptoms of depression include:

• Lasting sad, anxious, or “empty” mood.
• Feelings of hopelessness or pessimism.
• Loss of energy.
• Trouble falling asleep or sleeping too much.
• Overeating or loss of appetite.
• Feelings of irritability or restlessness.
• Problems concentrating, recalling details, and making decisions.
• Feelings of guilt, worthlessness, or helplessness.
• Suicidal thoughts or suicide attempts.

If you have many of these symptoms together, and they last more than 2 weeks, you may have depression. Depression during pregnancy can make it hard for you to care for yourself and your pregnancy. Having depression before or during pregnancy is also a risk factor for postpartum depression , which is depression that occurs after pregnancy. Getting treatment is important for both mother and baby. Talk to your health care provider as soon as possible if you think you have depression. If you have thoughts of harming yourself or your baby, seek medical care immediately. More information is available at Depression During and After Pregnancy .

Diabetes is a disease that affects how your body turns food into energy. There are three main types of diabetes: type 1 , type 2 , and gestational diabetes . For pregnant people with type 1 or type 2 diabetes, high blood sugar around the time of conception increases the risk of birth defects , stillbirth , and preterm birth . Among people with any type of diabetes, high blood sugar throughout pregnancy can also increase the risk of preeclampsia , cesarean delivery, and the baby being born too large. To manage your diabetes, see your doctor as recommended, monitor your blood sugar levels, follow a good nutrition plan developed with your provider or dietician, be physically active, and take insulin, if directed. Managing diabetes can help you have a healthy pregnancy. If you have diabetes before pregnancy or develop it during pregnancy, it’s important to continue seeing your health care provider after pregnancy to monitor your blood sugar and overall health.

Heart conditions, such as coronary artery disease, heart attack, cardiomyopathy, and congenital heart defects , impact the heart and blood vessels. Making healthy food choices, limiting your alcohol intake, quitting smoking if you smoke, and managing any other chronic conditions can help reduce your risk for many heart conditions. Not everyone has symptoms, but you may feel neck, jaw, chest, belly, or back pain if you have a heart condition. Many people with heart conditions have healthy, uneventful pregnancies, but pregnancy can put stress on the heart of people with some types of heart conditions. Having a heart condition may increase the risk of severe illness and death during and after pregnancy.

If you have a heart condition, it’s important to see your health care provider, ideally before pregnancy or as soon as possible after becoming pregnant. During your first prenatal care visit, let your provider know if you have a heart condition. If you are diagnosed with a heart condition during pregnancy, you may also need to be monitored by your provider earlier or more often after pregnancy. More information can be found at Heart Health and Pregnancy .

You may be at increased risk for other heart conditions in the future if you have some heart conditions, preeclampsia , or gestational diabetes during or shortly after pregnancy. Work with your health care provider to monitor your risk or manage your heart condition before, during, and after pregnancy.

High blood pressure is a common heart condition occurring when your blood pressure is higher than normal . Chronic hypertension means having high blood pressure before you get pregnant or before 20 weeks of pregnancy. Gestational hypertension  is high blood pressure that first occurs after 20 weeks of pregnancy. Preeclampsia happens if you previously had normal blood pressure and suddenly develop high blood pressure and protein in your urine or other problems after 20 weeks of pregnancy. If you have chronic hypertension, you can also get preeclampsia.

High blood pressure increases the risk of preterm delivery, and low birth weight, plus more serious issues such as eclampsia , stroke, and placental abruption (the placenta separating from the wall of the uterus). High blood pressure may be prevented and is treatable . These 7 strategies to live a heart-healthy lifestyle , plus at-home self-measured blood pressure monitoring with support from your health care provider, can help you manage your high blood pressure. If you are at high risk for preeclampsia, your provider may recommend low-dose aspirin after 12 weeks of pregnancy. Learn more about High Blood Pressure and Pregnancy .

Many pregnant people have some nausea or vomiting, or “morning sickness,” especially in the first 3 months of pregnancy. Hyperemesis gravidarum, however, is more extreme than “morning sickness.” It refers to persistent nausea and vomiting during pregnancy. This can lead to weight loss and dehydration and may require intensive treatment. If you are concerned about your symptoms, call your health care provider. If you have severe nausea (e.g., you are unable to drink for more than 8 hours or eat for more than 24 hours), seek medical care immediately.

Infections can complicate pregnancy and may have serious consequences. Being screened and treated for infections, such as HIV and other sexually transmitted infections (STIs) and getting recommended vaccines can prevent many bad outcomes. Easy steps, including hand washing and avoiding certain foods, can also help protect you from some infections. Your health care provider can help you stay up to date with your vaccines. To learn more about different infections and how to protect your health, visit the following CDC pages:

• Pregnancy and HIV, Viral Hepatitis, STI & TB Prevention
• Vaccines During Pregnancy FAQs
• COVID-19 Vaccines While Pregnant and Breastfeeding
• Food Safety During Pregnancy
• 10 Tips for Preventing Infections Before and During Pregnancy

One common bacterial infection during pregnancy is a urinary tract infection (UTI). Your health care provider will likely test your urine early in pregnancy to see if you have a UTI and treat you with antibiotics, if necessary. Treatment will make it better, often in 1 or 2 days. Although not everyone with a UTI has symptoms, you may have a UTI if you have:

• Pain or burning when you pee.
• Fever, tiredness, or shakiness.
• An urge to pee often.
• Pressure in your lower belly.
• Pee that smells bad or looks cloudy or reddish.
• Nausea or back pain. Top of Page

Starting pregnancy at a healthy weight can help reduce the risk of preeclampsia , gestational diabetes , stillbirth , and cesarean delivery. If you are underweight [PDF – 1 MB]  or overweight, talk to your health care provider about ways to reach and maintain a healthy weight before you get pregnant. Gaining a healthy amount of weight during pregnancy is also important for your health during and after pregnancy. Learn about pregnancy weight gain recommendations and steps to help you meet your pregnancy weight gain goal .

• CDC Pregnancy Learn about tips to get ready for pregnancy, giving your baby a healthy start in life, and keeping yourself and the baby healthy after birth.
• Pregnancy Complications Learn more about conditions that may complicate pregnancy from the March of Dimes.
• Pregnancy Complications Learn more about pregnancy complications from Womenshealth.gov.
• Severe Maternal Morbidity Health care professionals and researchers interested in learning more about severe pregnancy complications may visit the CDC Severe Maternal Morbidity page.

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• Maternal and Infant Health Data and Statistics
• Preconception Care
• CDC’s National Center for Birth Defects and Developmental Disabilities

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What are some common complications of pregnancy?

Some women experience health problems during pregnancy. These complications can involve the mother's health, the fetus's health, or both. Even women who were healthy before getting pregnant can experience complications. These complications may make the pregnancy a  high-risk pregnancy .

For the latest information on COVID-19 and pregnancy, visit CDC at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html .

Getting early and regular  prenatal care  can help decrease the risk for problems by enabling health care providers to diagnose, treat, or manage conditions before they become serious. Prenatal care can also help identify mental health concerns related to pregnancy , such as anxiety and depression.

Some common complications of pregnancy include, but are not limited to, the following.

High Blood Pressure

High blood pressure, also called hypertension, occurs when arteries carrying blood from the heart to the body organs are narrowed. This causes pressure to increase in the arteries. In pregnancy, this can make it hard for blood to reach the placenta, which provides nutrients and oxygen to the fetus. 1  Reduced blood flow can slow the growth of the fetus and place the mother at greater risk of preterm labor and preeclampsia. 1 , 2

Women who have high blood pressure before they get pregnant will continue to have to monitor and control it, with medications if necessary, throughout their pregnancy. High blood pressure that develops in pregnancy is called gestational hypertension. Typically, gestational hypertension occurs during the second half of pregnancy and goes away after delivery.

Gestational Diabetes

Gestational diabetes occurs when a woman who didn't have diabetes before pregnancy develops the condition during pregnancy.

Normally, the body digests parts of your food into a sugar called glucose. Glucose is your body's main source of energy. After digestion, the glucose moves into your blood to give your body energy.

To get the glucose out of your blood and into the cells of your body, your pancreas makes a hormone called insulin. In gestational diabetes, hormonal changes from pregnancy cause the body to either not make enough insulin, or not use it normally. Instead, the glucose builds up in your blood, causing diabetes, otherwise known as high blood sugar.

Managing gestational diabetes, by following a treatment plan outlined by a health care provider, is the best way to reduce or prevent problems associated with high blood sugar during pregnancy. If not controlled, it can lead to high blood pressure from preeclampsia and having a large infant, which increases the risk for cesarean delivery. 4

Infections, including some sexually transmitted infections (STIs) , may occur during pregnancy and/or delivery and may lead to complications for the pregnant woman, the pregnancy, and the baby after delivery. Some infections can pass from mother to infant during delivery when the infant passes through the birth canal; other infections can infect a fetus during the pregnancy. 1  Many of these infections can be prevented or treated with appropriate pre-pregnancy, prenatal, and postpartum follow-up care.

Some infections in pregnancy can cause or contribute to: 1

• Pregnancy loss/miscarriage (before 20 weeks of pregnancy)
• Ectopic pregnancy (when the embryo implants outside of the uterus, usually in a fallopian tube)
• Preterm labor and delivery  (before 37 completed weeks of pregnancy)
• Low birth weight
• Birth defects , including blindness, deafness, bone deformities, and intellectual disability
• Stillbirth (at or after 20 weeks of pregnancy)
• Illness in the newborn period (first month of life)
• Newborn death
• Maternal health complications

If you are planning to get pregnant, talk with your health care provider about getting vaccines and vaccine boosters for chicken pox (also called varicella) and rubella (also called German measles) before you conceive. You can also get some vaccines, such as the flu shot, while you are pregnant. If you know you have an infection, such as an STI, talk with your health care provider about it before you conceive to increase your chances of a healthy pregnancy.

Early prenatal testing for STIs and other infections can determine if the infection can be cured with drug treatment. Or, if you know you have an infection, tell your pregnancy health care provider about it as early as possible in your pregnancy. Early treatment decreases the risk to the fetus and infant. 2 Even if the infection can't be cured, you and your health care provider can take steps to protect your health and your infant's health.

Learn more about infections that can affect pregnancy .

Preeclampsia

Preeclampsia  is a serious medical condition that can lead to preterm delivery and death. Its cause is unknown, but some women are at an increased risk. Risk factors include: 5

• First pregnancies 5
• Preeclampsia in a previous pregnancy 5
• Existing conditions such as high blood pressure, diabetes, kidney disease, and systemic lupus erythematosus 1
• Being 35 years of age or older 1
• Carrying two or more fetuses 1

Preterm Labor

Preterm labor  is labor that begins before 37 weeks of pregnancy. Any infant born before 37 weeks is at an increased risk for health problems, in most cases because organs such as the lungs and brain finish their development in the final weeks before a full-term delivery (39 to 40 weeks).

Certain conditions increase the risk for preterm labor, including infections, developing a shortened cervix, or previous preterm births. 6

Progesterone, a hormone produced naturally during pregnancy, may be used to help prevent preterm birth in certain women. A 2003 study led by NICHD researchers found that progesterone supplementation to women at high risk for preterm delivery due to a prior preterm birth reduces the risk of a subsequent preterm birth by one third. 7

Depression & Anxiety

Research shows that as many as 13% of U.S. women reported frequent symptoms of depression after childbirth, and that anxiety co-occurs in up to 43% of depressed pregnant and postpartum women, making pregnancy-related depression and anxiety among the more common pregnancy complications. 8 These medical conditions can have significant effects on the health of the mother and her child. But the good news is that these are treatable medical conditions. The NICHD-led  Moms’ Mental Health Matters  initiative is designed to educate families and health care providers about who is at risk for depression and anxiety during and after pregnancy, the signs of these problems, and how to get help. 

Pregnancy Loss/Miscarriage

Miscarriage is the term used to describe a  pregnancy loss  from natural causes before 20 weeks. Signs can include vaginal spotting or bleeding, cramping, or fluid or tissue passing from the vagina. However, bleeding from the vagina does not mean that a miscarriage will happen or is happening. 9  Women experiencing this sign at any point in their pregnancy should contact their health care provider.

The loss of pregnancy after the 20th week of pregnancy is called a stillbirth . In approximately half of all reported cases, health care providers can find no cause for the loss. However, health conditions that can contribute to stillbirth include chromosomal abnormalities, placental problems, poor fetal growth, chronic health issues of the mother, and infection.  Read more about health conditions and lifestyle factors that can increase the risk for stillbirth.

Other Complications

Other complications of pregnancy may include the following:

• Severe, persistent nausea and vomiting.  Although having some nausea and vomiting is normal during pregnancy, particularly in the first trimester, some women experience more severe symptoms that last into the third trimester. The cause of the more severe form of this problem, known as hyperemesis gravidarum (pronounced  HEYE-pur-EM-uh-suhss grav-uh-DAR-uhm ), is not known. Women with hyperemesis gravidarum experience nausea that does not go away, weight loss, reduced appetite, dehydration, and feeling faint. 10 Affected women may need to be hospitalized so that they can receive fluids and nutrients. Some women feel better after their 20th week of pregnancy, while others experience the symptoms throughout their pregnancy. 10
• Iron-deficiency anemia.  Pregnant women need more iron than normal for the increased amount of blood they produce during pregnancy. Iron-deficiency anemia—when the body doesn't have enough iron—is somewhat common during pregnancy and is associated with preterm birth and low birth weight. Symptoms of a deficiency in iron include feeling tired or faint, experiencing shortness of breath, and becoming pale. ACOG recommends 27 milligrams of iron daily (found in most prenatal vitamins) to reduce the risk for iron-deficiency anemia. Some women may need extra iron through iron supplements. 12 Your health care provider may screen you for iron-deficiency anemia and, if you have it, may recommend iron supplements. 13
• Leeman, L., & Fontaine, P. (2008). Hypertensive disorders of pregnancy.  American Family Physician , 78, 93–100. PMID: 18649616
• Centers for Disease Control and Prevention. (2015). Births: Final data for 2014. Supplemental table I-6. National Vital Statistics Report, 64 (12). Retrieved May 31, 2016, from https://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12_tables.pdf (PDF 867 KB)
• Hernandez-Diaz, S., Toh, S., & Cnattinguis, S. (2009). Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study.  British Medical Journal , 338, b2255. Retrieved July 31, 2012, from  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269902/?tool=pubmed
• Office on Women's Health. (2010). Pregnancy: pregnancy complications. Retrieved May 31, 2016, from  https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-complications
• Meis, P. J., Klebanoff, M., Thom E., Dombrowski, M. P., Sibai, B., Moawad, A. H., et al. (2003). Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.  New England Journal of Medicine , 348, 2379–2385. PMID: 12802023
• Le Strat, Y., Dubertret, C., & Le Foll, B. (2011). Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. Journal Of Affective Disorders, 135(1-3), 128-138. doi: 10.1016/j.jad.2011.07.004.

Pregnancy complications and later life women's health

Affiliations.

• 1 UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
• 2 Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland.
• PMID: 36799269
• PMCID: PMC10072255
• DOI: 10.1111/aogs.14523

There has been increasing recognition of the association between various pregnancy complications and development of chronic disease in later life. Pregnancy has come to be regarded as a physiological stress test, as the strain it places on a woman's body may reveal underlying predispositions to disease that would otherwise remain hidden for many years. Despite the increasing body of data, there is a lack of awareness among healthcare providers surrounding these risks. We performed a narrative literature review and have summarized the associations between the common pregnancy complications including gestational hypertension, pre-eclampsia, gestational diabetes, placental abruption, spontaneous preterm birth, stillbirth and miscarriage and subsequent development of chronic disease. Hypertensive disorders of pregnancy, spontaneous preterm birth, gestational diabetes, pregnancy loss and placental abruption are all associated with increased risk of various forms of cardiovascular disease. Gestational diabetes, pre-eclampsia, early miscarriage and recurrent miscarriage are associated with increased risk of diabetes mellitus. Pre-eclampsia, stillbirth and recurrent miscarriage are associated with increased risk of venous thromboembolism. Pre-eclampsia, gestational diabetes and stillbirth are associated with increased risk of chronic kidney disease. Gestational diabetes is associated with postnatal depression, and also with increased risk of thyroid and stomach cancers. Stillbirth, miscarriage and recurrent miscarriage are associated with increased risk of mental health disorders including depression, anxiety and post-traumatic stress disorders. Counseling in the postnatal period following a complicated pregnancy, and advice regarding risk reduction should be available for all women. Further studies are required to establish optimal screening intervals for cardiovascular disease and diabetes following complicated pregnancy.

Keywords: chronic disease; maternal health; noncommunicable disease; post-pregnancy health; postnatal care.

© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Publication types

• Abortion, Habitual*
• Abruptio Placentae*
• Cardiovascular Diseases*
• Diabetes, Gestational* / epidemiology
• Infant, Newborn
• Pre-Eclampsia* / diagnosis
• Pre-Eclampsia* / epidemiology
• Pre-Eclampsia* / etiology
• Pregnancy Complications* / diagnosis
• Pregnancy Complications* / epidemiology
• Premature Birth* / etiology
• Risk Factors
• Women's Health

Why black women face a high risk of pregnancy complications

Black women are three to four times more likely to die from pregnancy-related complications than white women, according to the Centers for Disease Control and Prevention—and a big reason for the disparity may be racism, say experts.

“It’s basically a public health and human rights emergency because it’s been estimated that a significant portion of these deaths could be prevented,” said Harvard T.H. Chan School of Public Health’s Ana Langer in a February 20, 2019 American Heart Association article.

Lack of access to care and poor quality of care play a role in the disparity, particularly among women at lower socioeconomic levels, according to the article. But Langer, professor of the practice of public and director of the Women and Health Initiative , thinks there’s a bigger problem. “Basically, black women are undervalued,” she said. “They are not monitored as carefully as white women are. When they do present with symptoms, they are often dismissed.”

For instance, tennis star Serena Williams experienced a pulmonary embolism after giving birth to her daughter via cesarean section last year, but medical employees initially dismissed her concerns.

Langer said that publicizing cases such as Williams’ could help. “It’s important to illustrate what’s happening and make the public aware because it can encourage the health establishment to take on this crisis much more seriously,” she said.

Read the American Heart Association article: Why are black women at such high risk of dying from pregnancy complications?

America is failing its black mothers ( Harvard Public Health magazine )

Complications During Pregnancy

It is not unusual for pregnant mother to develop complications during their pregnancy period. But for mothers with certain preexisting conditions such as mothers with diabetes or cancer, the chances of developing complications is always high as compared to other normal women. This is why pregnant women are always advice to see a doctor as soon as they conform they are pregnant so as to allow for the doctors to perform certain test such as Maternal screening and ultra sound which will shade more light on the status of their pregnancy. The earlier the chances of the mother developing complication during the pregnancy is detected the better it is as it will give the doctors ample time to figure out the next line of action.

The lack of folic acid means that a mother can easily give birth to a child that has neural tube defect. The lack of folic acid is more than often implicated with neural tube defects such as anencephaly, spinal bifida, and encephalocele. But having said that, the chances of pregnancy being affected by neural tube defect is less common with one out of 100 pregnancies ending up being affected by neural tube defect (Czeizel, 2011). During the first three months of pregnancy, if the mother does not take a diet that has folic acid and especially in the case of Felicity who has diabetes, the chances of her child being affected by neural tube defect could be high. The defect could develop as a result of the failure of the embryonic neural tube failing to close by the fourth week of pregnancy which will, in turn, result in malfunctions of the spine and brain (Czeizel, 2011). Intake of folic acid goes a long way in preventing up to 70% of the development of the neural tube defect and that is why the doctor was very keen to advice felicity to ensure that she takes 600 μg of folic acid daily.

A teratogen can be understood as an agent which has the ability of causing a birth defect. It ranges from something in the environment that a mother has taken during her pregnancy to the health of the woman during the pregnancy. The fetus is always vulnerable to teratogens during the first three weeks of the pregnancy as it is that this stage that teratogen work by trying to kill the embryo rather than cause malformations.  Once the egg is fertilized, it always take up to 9 days for implantation to take place. But as soon as the fertilized egg is connected to the uterus, a common blood vessel connects the embryo to the mother. It is at this stage that a foreign object in the mother’s blood can easily cause much damage as it can easily cross over to the developing fetus (Rasmussen, 2012). But once this stage is passed and nothing has happened, the fetus will be most vulnerable to teratogens during the first six to eight weeks of pregnancy. As a matter of fact during days 21 to 60, teratogen agents are more active working with the purpose of causing major congenital malformations to the fetus.

1. Czeizel, A. (2011). Periconceptional Folic Acid-Containing Multivitamin Supplementation for the Prevention of Neural Tube Defects and Cardiovascular Malformations. Annals Of Nutrition And Metabolism, 59(1), 38-40. http://dx.doi.org/10.1159/000332125

2. Hadlow, N. (2012). Overview of maternal serum screening for down syndrome. Pathology, 44, S29. http://dx.doi.org/10.1016/s0031-3025(16)32668-x

3. Rasmussen, S. (2012). Human teratogens update 2011: Can we ensure safety during pregnancy?. Birth Defects Research Part A: Clinical And Molecular Teratology, 94(3), 123-128. http://dx.doi.org/10.1002/bdra.22887

• Alzheimer Disease
• Anger Management

Pregnancy Complications

Introduction.

Pregnancy is a natural state of women. With the onset of pregnancy, a series of physiological changes occurs in a woman's body. Complications of pregnancy arise during gestation or birth. They can occur during pregnancy, childbirth or in the postpartum period and represent a significant danger to the mother and child.

Complications can lead to premature termination of pregnancy, uterine bleeding, fetal developmental delay, and even the death of the baby. When a woman knows what complications can occur during pregnancy, it is necessary to do everything possible to avoid them by any means possible. In most cases, the risk of complications is significantly reduced due to the medical monitoring of pregnancy. Placenta previa, abruption placentae, preterm labor and prolapsed umbilical cord sometimes occur even among healthy pregnant women. Although, frequency of their occurrence is rather low, they present a serious danger to women’s and baby’s life. This paper will examine priority nursing interventions required when handling these complications during pregnancy, as well as an importance of a nurse’s role while managing such cases.

Placenta Previa

Frequency of occurrence.

In normal pregnancy, the placenta is usually located at the bottom of the uterus body or on the back wall with the transition to the side walls, i.e. in those areas where the blood supply to the uterine wall is the best. The placenta is less frequently located on the front wall since the front wall of the uterus is subjected to much greater changes than the back wall. In addition, the location of the placenta on the rear wall protects it from an accidental injury.

Placenta previa is a pathology, in which the placenta is situated in the lower uterine segment on any wall, blocking the area of the internal os partially or completely. The frequency of occurrence of placenta previa is an average of 0.1% to 1% of all births. Cases, when the placenta overlaps the region of the internal os only partially, are marked with a frequency of 70-80% of the total number of placenta previa cases. The variant when the placenta covers the area of the internal os completely occurs with a frequency of 20-30%. Also, 0.2 - 3.0% of cases occurs at around 37 - 40 weeks of gestation. In the earlier stages of pregnancy, placenta previa is noted more frequently (up to 5 - 10% of cases). However, the uterus is stretched with the growth of the fetus, and there is a high probability of migration (movement) of the placenta above to the normal location.

High infant mortality rate, which ranges from 7 to 25%, depending on the technical equipment of the maternity hospital is fixed with placenta previa. A high rate of infant mortality with placenta previa is determined by a relatively high frequency of premature birth, fetoplacental insufficiency, and malposition in the uterus. In addition to the high infant mortality, placenta previa can cause severe complications such as bleeding in women, which is the cause of about 3% of deaths of pregnant women. Placenta previa is referred to the pregnancy pathology because of the risk of infant and maternal mortality.

Risk Factors

The reasons that cause placenta previa may be related both to the condition of the mother's body, and the peculiarities of a fetal egg. The primary cause of complications is the degenerative processes in the endometrium. In this case, the fertilized egg is not able to penetrate (be implanted) in the endometrium of the bottom and / or the body of the uterus; therefore, it is forcing it to go down below. Predisposing factors can be:

• chronic inflammation of the uterus;
• multiple births;
• abortion and curettage of the uterus;
• childbirth and abortion, complicated by septic diseases;
• tumors of the uterus;
• scars on the uterus (surgical delivery, removal of fibroids); congenital malformations of the uterus;
• internal endometriosis;
• sexual infantilism;
• the first births in the 30 years or more;
• the disturbance in ovarian hormonal function;
• multiple pregnancy.

Priority Nursing Interventions

The main symptom of placenta previa is painless recurrent bleeding from the genital tract. The diagnosis of placenta previa can be based on characteristic clinical manifestations or the results of objective research (ultrasonography and bimanual pelvic examination). Currently, ultrasonography diagnosis is the most informative and safe method of detecting placenta previa. If placenta previa is found, ultrasonography should be performed periodically, at intervals of 1 - 3 weeks, in order to determine its rate of migration. In 24 weeks, if bleeding is not abundant or completely stops, the woman should receive conservative treatment aimed at the preservation of pregnancy up to 37 - 38 weeks. The treatment of placenta previa is the application of the following drugs: tocolytic and antispasmodic drugs that improve the elongation of the lower segment of the uterus; preparations for the treatment of iron deficiency and anemia; preparations for the improvement of blood supply to the fetus. The Role of Canadian Registered Nurse During Interventions

While handling the placenta praevia complication, the main role of Canadian registered nurse is to make sure of the physiological well-being of the patient and the fetus. The nurse should take and record important features; assess bleeding; monitor the shock pulse, cold moist skin and fall in blood pressure; monitor FHR; provide strict bed rest to minimize the risk to the fetus; observe further bleeding.

Nurse’s Role as an Educator

Unfortunately, the specific treatment capable of changing the place of attachment and the location of the placenta in the uterus does not currently exist. Therefore, the therapy in case of placenta previa is aimed at relieving the bleeding and preserving the pregnancy as long as possible - ideally before the date of birth. Thus, it is extremely important for the nurse to be an educator of the pregnant women with such complications. A nurse should ensure women’s knowledge about the safe behavior. Also, the nurse should inform the patient about the rules she should follow and explain their necessity and the reasons. With placenta previa during pregnancy, a woman must necessarily abide the protective regime aimed at the elimination of various factors that can provoke bleeding. It means that a woman should limit physical activity, do not jump and ride on a bumpy road, do not fly a plane, do not have sex, avoid stress, do not lift weights, etc. During the free time, she should lie on the back, lifting up her legs, for example, on the wall, a desk, a couch, etc.

Abruption Placentae

Abruption placentae is a premature detachment of the placenta, which is situated normally. It is a complication that appears untimely in the detachment of the placenta, which takes place not after the birth of the fetus, as it should be, but during pregnancy or the birth process. This complication occurs with a frequency of 0.5 - 1.5% of cases. A third case of abruption placentae is accompanied by profuse bleeding and the development of relevant complications such as hemorrhagic shock and DIC syndrome (disseminated intravascular coagulation).

There are a number of predisposing factors that increase the risk of such complications. Abruption placentae are considered to be a manifestation of the system, sometimes latent pathology. The risk increases in cases of arterial hypertension, glomerulonephritis, diabetes, antiphospholipid syndrome, the development of nephropathy and burdened anamnesis, if such has happened before. In addition, the physical effects (hit or fall) may also provoke detachment. Also, abruption placentae may be a manifestation of an allergic reaction to medication, especially the introduction of protein solutions and transfusions of donated blood.

It is not difficult to make a diagnosis of abruption placentae of a normally situated placenta with the unfolded classical symptomatology. When symptoms of premature placental abruption are not obvious (no pain factor, external bleeding, or fetal hypoxia), the diagnosis is made by excluding other diseases. Ultrasonography helps to diagnose the problem since it can determine the size of the exfoliated area of the placenta, sizes of retroplacental hematoma and others.

A therapy of abruption placentae is based on the choice of methods for the most rapid and gentle birth. In addition, the nurse must carry out the activities aimed at combating hemorrhage, shock, and to fill the factors that increase blood coagulation at the same in a timely manner. The nurse determines obstetric tactics when choosing a method of birth due to three following parameters: 1. Time of detachment (whether it occurred during pregnancy or already during delivery). 2. The intensity of bleeding and blood loss. 3. The general condition of the mother and fetus. The Role of Canadian Registered Nurse During Interventions

The major guidelines for Canadian registered nurse’s actions are the following - Estimate the vital signs of bleeding and conduct the electronic monitoring of maternal and fetal signs of shock.

• Never perform vagina or rectum examination or take any action that would stimulate uterine activity.
• Evaluate the necessity of immediate delivery; indicate the need for emergency cesarean delivery.
• Ensure proper management. Place a woman in a lateral position to prevent pressure on the vena cava.
• Insert a large caliber intravenous catheter into a large vein to replace fluids. Get a blood sample for the level of fibrinogen. Monitor FHR externally and measuring maternal vital signs every 5 to 15 minutes.

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The nurse must carefully monitor the condition of the placenta and fetus. For this purpose, the nurse needs to conduct an ultrasonography and cardiotocography regularly. It is also necessary to monitor the state of the blood coagulation system of women by means of laboratory tests. The patient is assigned to bed rest. In addition, for the treatment of placental abruption, the following drugs should be used: medicines relax the uterus (tocolytic therapy); spasmolytic (papaverine, no-spa, magnesium sulfate, metacin, etc.); hemostatic agents (ascorbic acid, menadione, detsinon); therapy aimed at combating anemia (iron supplements).

The placenta’s role is very important. It is responsible for the biological process by which the baby is developing normally. The child's life depends on the placenta. Deviations and related pathologies may lead to the baby’s death since it performs gas exchange, nutritional and excretory, hormonal, and protective functions. The placenta should not depart during pregnancy. This process is dangerous for the baby because it can deprive it of oxygen and nutrients. However, it can happen almost to every woman. Therefore, the nurse’s role is extremely important. First of all, a nurse should inform the patient about the symptoms of placental abruption, which may be bleeding, stress and pain of the uterus with placental abruption, and heart disorder in a child. The nurse should make sure that in the event of such symptoms, women would seek medical help immediately. Also, the nurse must educate pregnant women about rules, following which can prevent abruption placentae. The nurse should make the patient aware of the necessity to compulsorily attend scheduled scans, periodically undergo ultrasound examination, through which the nurse can detect even small hematoma abruption. Definitely, there are some things that the nurse cannot control; however, she/he should try to convince the pregnant women to observe a healthy lifestyle, give up alcoholic beverages, tobacco products, drugs, harmful food, protect herself from the injuries, and to be fastened in the car. In case of an exacerbation of chronic diseases or occurrence of inflammatory processes and allergic reactions, she should not ignore these symptoms but start the treatment immediately. This knowledge, being timely provided by the nurse can save the child’s and mother’s lives.

Preterm Labor

Childbirth is a natural end of pregnancy. Normally, a baby is born at a term of 38-42 weeks. The fetus has developed completely in this period, and its internal organs are ready to function in the outside world. The birth process begins when the pregnant women’s body feels ready for the child to be born. However, there are cases when labor begins early. It is an indication of the presence of some problems in the mother or child. A premature baby is not yet ready for independent living, and such situations are avoided by doctors to prolong pregnancy to a normal term. However, 6-8% of all births are premature.

Only 5-7% of this number happens in periods ranging from 22 to 27 weeks. A little more than 30% of premature babies are born in the period from 27 to 33 weeks. Over 50% of all premature births occur in 34-37 weeks.

The reasons for preterm labor are Preterm early onset of labor, premature rupture of membranes, complications of the uterus or the fetus. The Risk Factors are the following:

• drug abuse;
• consumption of any alcoholic beverage; inadequate or improper diet;
• excessive weight gain by the pregnant;
• hormonal imbalance;
• heavy physical work;
• sexual life;
• the excessive sensitivity of the uterus;
• functional failure of the pressure of the cervix;
• placenta previa;
• abnormal structure of the uterus;
• abnormal development of the fetus;
• multiple pregnancy;
• stressful situations;
• age of 17 years and more than 35 years.

Primarily, in case of the premature beginning of contractions, tocolysis are administered. These medications are taken before 37 weeks of gestation. Magnesia sulfate, 10% ethyl alcohol, and some other preparations can be also used as a means of reducing the tone of the uterus.

At the second stage of the treatment, physicians are trying to eliminate the cause of premature births. When identifying the infection, antibiotics are administered, as well as sedation drugs.

With the development of cervical incompetence in a term up to 28 weeks of pregnancy, the tightening seams are imposed on the cervix, which prevents an ovum from falling out of the uterus. For more than 28 weeks, in the case when the pregnant has the defective cervix, a special supporting Golgi ring is introduced into the vagina. It holds the fetus and does not allow it to put pressure on the cervix. The treatment complex always includes a hormonal drug dexamethasone. Its action is aimed at the stimulation of the development of the child’s lungs. The Role of Canadian Registered Nurse During Interventions

If  the preterm labor is suspected, but there are no signs or symptoms of impending delivery, a Canadian registered nurse should act as follows:

• Do not perform a digital vaginal examination;
• Perform sterile mirror examination;
• Try to exclude the premature rupture of membrane;
• Obtain a swab for fetal fibronectin;
• Perform initial assessment;
• Confirm the exact time;
• Palpate contractions;
• Start electronic fetal monitoring to assess fetal response to fight;
• Initiate access to antibiotics, hydration and other drugs.

Preterm labor is dangerous both for a child and the mother. The nurse should identify the patient with a risk factor of preterm labor and ensure that she knows and complies with the recommendations that can prevent a dangerous situation. Also, the nurse should inform the patient about harbingers of preterm birth: pain, tightness in the lower back, the changing nature of painful ailments in the body, cramps, indigestion, a feeling of squeezing pelvis, and changes in vaginal discharge. The nurse should explain the necessity to go immediately to the hospital with the appearance of these symptoms. For pregnant women who experienced premature labor, it is often fraught with psychological problems, when the mother may blame herself for what had happened. Because of this, many suffer from the postpartum depression.

Prolapsed Umbilical Cord

Prolapsed umbilical cord is a rare complication, occurring in one out of 1,000 births, in which the appearance of the umbilical cord precedes the passage of the fetus through the birth canal. Prolapsed umbilical cord is a serious threat to life of the fetus, as pressing the part of umbilical cord to the wall of the pelvis by the fetal leads to poor circulation in the fetus, its asphyxia and death.

Risk Factors:

• preterm delivery (birth at term of 28-37 weeks);
• polyhydramnios (increased volume of amniotic fluid);
• malposition of the fetus (transverse, oblique);
• long umbilical cord (umbilical cord longer than 70 cm).

The main task here is to determine the loss of the umbilical cord loops and assess the presence of pulsation of blood vessels during the obstetric inspection. If the cord is pulsating, then circulation is not broken and the fetus is still alive. The inspection should be carried out in the intervals between contractions. Premature rupture of membranes should be prevented. Previa cord loops is a contraindication for the amniotomy - instrumental opening membranes. Management of delivery with prolapsed umbilical cord depends on the degree of maturity of the birth canal and the general condition of the fetus. With the full opening of the internal os and the absence of signs of hypoxia, birth by the vaginal route, with output forceps if necessary, can be possible. If umbilical cord prolapsed with incomplete cervical dilatation and further deterioration of the fetus, the doctor performs an emergency Caesarean section. The Role of Canadian Registered Nurse During Interventions- If the cord prolapse is suspected, perform vaginal examination;

• If the cord is palpated, determine if there is a pulsation;
• If the cord prolapse is confirmed, call for help and stay with a woman;
• Place the head of a woman down with hips raised;
• Put a gloved hand into the vagina and put pressure on the fetal presenting part to stop compression of the brain;
• Notify the attending physician and the necessary team members.

Due to modern technology, it is possible to determine the risk of prolapsed umbilical cord long before birth. For example, ultrasound during pregnancy can reveal not only the presentation of the umbilical cord but also determine its length and other features. Therefore, the educating role of the nurse involves informing those at risk about the measures which can save their and child’s life. Thus, the nurse should inform the patient in detail about her actions in case if prolapsed umbilical cord occurs. She should make the patient understand the alarming symptoms such as discharge of amniotic fluid, after which there is a feeling of a foreign body in the vagina. The nurse should consult the women on how to behave when such symptoms appear. To relieve compression of the umbilical cord during prenatal contractions, women must enter an arm into the vagina and to try to push the arm and fetal head up, hold it in this position before coming to the hospital.

Nurse’s Approach in Supporting Clients and Their Family Members

Dangerous complications during pregnancy listed above are often a severe shock to the patient and her family, so they should be treated with the utmost care and attention to provide them with the psychological support. In such cases, the duty nurse is to be honest and truthful to the patient. However, the talks about the diagnosis, the features of the complication cannot go beyond the designated physician. The same can be said about the conversations with the relatives of the patients. When people are suffering, they seek informal communication. The psychotherapeutic role of nurses is very important. At the same time, the nurse should always remember that the partnership with the patients does not have to go into familiarly. She sympathizes with the patient but does not identify herself with the patient’s feelings. The patient should always be sure that their conversations are confidential.

When the family experienced the death of a child, they pass all stages of grief. Many relatives feel guilt. The nurse should recommend books and brochures on these topics. It will help to consider the situation reasonably. If there is such a need, the parents are sent to the institution, where they receive the psychotherapeutic help. Since it is difficult to ask for help themselves, sometimes the nurse makes the first step in negotiating with a specialist about the time of admission. Also, the nurse tells the family members about the existence of support groups and asks whether they are interested in such groups. She tries to motivate them to attend.

Placenta previa, abruption placentae, preterm labor and prolapsed umbilical cord are dangerous complications that sometimes occur during pregnancy. However, in many cases, they can be prevented. The risk factors list shows that most frequently they occur in those women who do not care much about their health during pregnancy, neglect personal hygiene, do not comply with advice received from nurses. First and foremost, it impacts adversely on the state and development of the fetus. However, the frequency of their occurrence is rather low. The outcome of the pregnancy and delivery depends not only on the woman but also on the nurse that takes care of the patient during pregnancy. Thus, it is a direct responsibility of the nurse to be an educator to improve the patient’s knowledge of her condition and ensure that she knows how to behave in case of emergency.

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What Blocking Emergency Abortion Care in Idaho Means for Doctors Like Me

O n April 24, the Supreme Court will hear arguments weighing whether Idaho politicians have the power to block doctors from giving emergency medical care to patients experiencing pregnancy complications—a case that will open the door for other states to prohibit emergency reproductive care and worsen medical infrastructure for people across the board. Once again, politicians have set up a case that could have devastating impacts on the ability of doctors to provide--and for pregnant women to receive--essential reproductive health care.

I’m a family physician who’s practiced medicine in rural Idaho for more than 20 years, where I’ve had the opportunity to guide hundreds of patients through their pregnancies. It’s no exaggeration when I say that my state’s health care system is in crisis, thanks in enormous part to our near-total abortion ban. Now, instead of trying to salvage what’s left, Idaho politicians are looking to hasten our downward spiral, making it even harder for doctors like me to provide care to patients in need. I can only hope that the Court will take into account that it’s not just abortion at stake in this case—it’s the future of emergency room care and medicine altogether.  

Rural health care has always faced challenges, but in the nearly two years since the overturning of Roe v. Wade , it’s gotten exponentially worse. In Idaho, we’ve lost nearly a quarter of our obstetricians since the state’s abortion ban went into effect—colleagues and friends who got into medicine to help people are being forced out of practicing obstetrics in our state. They realized it was impossible to provide adequate care while under the thumb of politicians more interested in advancing their extremist agenda than protecting the health of their constituents.

Idaho’s abortion ban makes it a crime for anyone to perform or assist with performing an abortion in nearly all circumstances. The ban does not even include an exception for when a person’s health is at risk—only for when a doctor determines that an abortion is necessary to prevent the pregnant person’s death. Ask any doctor and they'll tell you that this "exception" leads to more questions than answers.

Read More: ‘ Am I a Felon?’ The Fall of Roe v. Wade Has Permanently Changed the Doctor-Patient Relationship

Patients need an emergency abortion for a wide range of circumstances, including to resolve a health-threatening miscarriage. But there is no clear-cut legal definition under the ban of what exactly that looks like or when we can intervene, and doctors—operating under the threat of prosecution—have no choice but to err on the side of caution.

“Can I continue to replace her blood loss fast enough? How many organ systems must be failing? Can a patient be hours away from death before I intervene, or does it have to be minutes?” These are the callous questions doctors are now forced to think through, all the while our patient is counting on us to do the right thing and put their needs first.

As a result, pregnant patients sometimes make repeated trips to the ER because they’re told time and time again that nothing can be done for them until their complications get more severe. Imagine if someone you love had a 104-degree fever but you were told nothing could be done until it spiked to 106 and your organs were failing. Requiring patients to get right up to the point of no return before administering care is not sound medical policy—it’s naked cruelty, and it’s only going to get worse as long as we allow extremism, not science, to run rampant in our statehouses and trample over our safe system of care.

It also violates a longstanding federal law—the Emergency Medical Treatment and Labor Act (EMTALA)—that requires hospitals to treat emergencies before they become life-threatening. That’s exactly why the U.S. Department of Justice sued Idaho soon after the state’s abortion ban took effect. The lawsuit argues only that Idaho must allow doctors to provide abortions in medical emergencies when that is the standard stabilizing care, but even that proved too much for state leaders.

Instead, Idaho politicians fought the DOJ all the way up to the Supreme Court. How the Supreme Court rules will have broad implications that will reverberate throughout the country. If the Court holds that federal law no longer protects pregnant people during emergencies, it will give anti-abortion politicians across the country the green light to deny essential abortion care, push providers to leave states where the choices made with their patients can be second-guessed by prosecutors, and continue this cycle of inhumanity for patients. 

As we’ve seen in Idaho, policies guided by anti-abortion extremism make health care worse for everyone. This assault on abortion has not ended with abortion—rather, it has extended to more of our rights and health care, with birth control , IVF , prescription drugs , and now emergency medical care all at risk.  

This must stop. 

For nearly 40 years, federal law has guaranteed that patients have access to necessary emergency care, including when a pregnancy goes horribly wrong. The Supreme Court must uphold this law and ensure pregnant people continue to get the care they need when they need it most. The health of my patients in West Central Idaho—and millions of other Americans across the country—deserve nothing less.

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World Malaria Day 2024: Understanding The Consequences of Malaria During Pregnancy

World malaria day is recognised globally on april 25th to spread awareness about this mosquito-borne disease..

Pregnant women are more likely to be susceptible to the illness due to their altered immune response

Malaria is a fatal disease caused by the parasites of the plasmodium genus, transmitted to humans through the infectious bites of female mosquito Anopheles. Malaria remains a substantial public health concern, specifically in tropical and sub-tropical regions, where conditions are favourable for mosquito breeding. When it comes to pregnant women, malaria poses unique challenges, risks, and threats. Pregnant women are more likely to be susceptible to the illness due to their altered immune response, and the consequences can be severe for both the mother and the unborn child.

There are five types of parasites, but the most common and deadly in pregnancy are Plasmodium falciparum and Plasmodium vivax. These parasites can cross the placenta and impact the foetal development, leading to complications. Understanding the risks and implementing preventive measures is essential for protecting the pregnant women and their babies from dangers of malaria. Malaria can have critical risks to the pregnant ladies and their child. Some of the major risks associated with malaria are:

1. Anaemia: the malaria parasites infect red blood cells, leading to their destruction. Pregnant women with malaria are at a higher risk of developing anaemia, which can result in fatigue, weakness, and a higher chance of postpartum haemorrhage.

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2. Low birth weight and preterm delivery: Infections during pregnancy can reduce foetal growth, resulting in low birth weight. Malaria is also associated with higher risk of preterm delivery, potentially causing complications in the baby's early development.

3. Miscarriage and Stillbirth: Malaria increases the risk of miscarriage, especially during the first trimester. In severe cases, it can also lead to stillbirth, where the baby is born without any signs of life.

4. Congenital Malaria: Parasites can cross the placenta and infect the baby, leading to congenital malaria. This condition cause fever, irritability, and poor feeding in newborns.

Signs and symptoms to watch out for:

• Muscle aches
• Complications like cerebral malaria (affecting the brain) or acute respiratory distress syndrome (ARDS) can occur

Prevention against malaria:

Preventing malaria during pregnancy is crucial for the health of both the mother and the baby. Some of the preventive measures that pregnant ladies can take and consider are:

1. Use of Insecticide-Treated Nets (ITNs): Sleeping under ITNs is one of the most effective ways to prevent mosquito bites and reduce the risk of Malaria. Pregnant women should ensure their nets are in good condition and properly used.

2. Indoor Residual Spraying (IRS): This involves spraying insecticides on indoor walls to kill mosquitoes and reduce their population. IRS can significantly lower the risk of malaria transmission.

3. Prophylactic Medication: In regions with high malaria transmission, pregnant women are often given antimalarial medication as a preventive measure. The specific drug and dosage depends on the local resistance patterns and trimesters of pregnancy.

4. Avoidance of Mosquito-prone areas: Pregnant women should minimize exposure to areas with high mosquito activity, especially during peak biting times (dusk and dawn).

5. Early detection and treatment: Pregnant women should seek medical attention if they experience malaria like symptoms. Early detection and appropriate treatment are critical to prevent complications.

Malaria in pregnancy is a serious yet preventable concern. By adopting preventive measures and seeking early diagnosis, pregnant women can significantly reduce the risk of complications for themselves and their babies. Remember, knowledge and preventive measures are the best weapons in this fight. If you're planning a pregnancy or live in a malaria-prone area, talk to your doctor about creating a customized prevention plan.

(Dr. Ravi N Sangapur, MD (Internal Medicine), Consultant Physician, HCG Hospital, Hubli)

Disclaimer: The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

DoctorNDTV is the one stop site for all your health needs providing the most credible health information, health news and tips with expert advice on healthy living, diet plans, informative videos etc. You can get the most relevant and accurate info you need about health problems like diabetes , cancer , pregnancy , HIV and AIDS , weight loss and many other lifestyle diseases. We have a panel of over 350 experts who help us develop content by giving their valuable inputs and bringing to us the latest in the world of healthcare.

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Guest Essay

The Looming Decision That Could Get Pro-Choice Voters to the Polls

By Mary Ziegler

Ms. Ziegler is a law professor at the University of California, Davis, and the author of “Roe: The History of a National Obsession.”

If you had asked me at the start of this Supreme Court term what the blockbuster abortion case would be, I would have focused on the one that could limit access to mifepristone, a drug used in a majority of U.S. abortions . But oral arguments last month suggested strongly that the justices might not even think that case has standing — which is to say, that decision is likely not to make much of a difference.

But a decision in the second case, on access to emergency abortions, may have much more profound consequences, both for November’s election and the ongoing struggle over reproductive rights. The case centers on the Emergency Medical Treatment and Labor Act, known as EMTALA, a federal law that was passed in the 1980s to prevent hospitals from turning away emergency-room patients who could not afford to pay. At issue is whether EMTALA requires physicians to offer emergency abortions even when state abortion bans — including those enacted after the overturning of Roe — do not permit them. The Biden administration brought suit against Idaho in federal court, arguing that federal law does pre-empt state policy on the matter.

Listening to Wednesday’s oral arguments, it was hard to say with certainty which side will prevail. But given the questions asked by the court’s conservative majority, and the fact that the court had allowed the state’s law to remain in effect during the litigation, the strongest possibility is that the court will side with Idaho. If that happens, pregnant women facing medical emergencies will be more likely to be refused care, and the Biden administration will face a searing reminder of the risks of litigating before the conservative Supreme Court supermajority. Such a loss for the Biden administration could, at the same time, provide a political opportunity for the Biden campaign — and that could matter deeply in the long term, given the high stakes of this election, not least for abortion access.

The decision will affect more than people seeking abortions. Just last week, The Associated Press detailed the stories of a wide range of patients experiencing pregnancy-related complications, including miscarriage, who were turned away by hospital emergency departments in states with criminal abortion laws. In such states, emergency rooms “are so scared of a pregnant patient, that the emergency medicine staff won’t even look. They just want these people gone,” Sara Rosenbaum, a health law and policy professor at George Washington University, told The A.P.

The Biden administration tried to prevent incidents like these around the country from snowballing by looking to EMTALA, issuing guidance just weeks after Roe was overturned asserting that the federal law pre-empts state law on this matter. The administration then took Idaho to court, arguing that EMTALA’s mandate to provide “necessary stabilizing treatment” required doctors to provide abortions to patients in medical emergencies — and that the federal statute trumps Idaho’s law, which makes it a crime to perform abortion except in cases of rape or incest or when “necessary to prevent the death of the pregnant woman.”

This move was a gamble, and not one the administration takes very often: Sooner or later, the case was likely to land the administration before the Supreme Court’s conservative supermajority, with its demonstrated hostility to abortion rights. And indeed, if the court sides with Idaho, that will serve as a powerful reminder that until the Supreme Court’s composition changes, being in federal court may blow up in any pro-choice president’s face.

If Idaho does win this case, there’s a question of how broad that opinion would be — or on what foundation the court will rely. That was difficult to parse on Wednesday. At a few points, Justices Samuel Alito and Neil Gorsuch cited language in EMTALA that refers to the “unborn child” — seeming to suggest that EMTALA does not require access to abortion in emergencies because it treats both fetuses and pregnant people as patients deserving of stabilizing treatment. This was a nod toward fetal personhood — the anti-abortion movement’s ultimate goal , to secure full legal rights for fetuses. But it seems unlikely the court will issue a decision that significantly advances the personhood cause in this case.

More likely is that the court rules on whether EMTALA creates a standard of care that requires physicians to protect the health of pregnant patients, as the Biden administration argues — or whether the statute imposes no limit at all on states like Idaho.

What is certain is that there will be more uncertainty for physicians and patients until the court hands down a decision, most likely in June.

An irony is that the politics of a loss in the Supreme Court could ultimately swing in President Biden’s favor, even as it compounds the dangers facing pregnant patients in states across the country. Donald Trump’s campaign strategy has been to cast abortion as an issue that has largely been resolved, at least at the federal level. That strategy makes sense: Most Americans disagree with the strict abortion bans Republicans have championed, and Mr. Trump would prefer the electorate focus on anything but abortion. Losing the EMTALA case could help Mr. Biden remind voters that overturning Roe was not the end of the anti-abortion movement’s project. It will be made clear once again that the Right may be able to keep turning to the Supreme Court to further roll back reproductive rights.

Such a loss would also be a reminder of the stakes of this election. Some of Mr. Trump’s supporters are hoping that if he is re-elected, he will lean on the Comstock Act — a 150-year-old law that criminalizes the mailing or receiving of a wide range of items deemed to be obscene — to effectively ban abortions nationwide. (That’s because all abortions in the United States involve instruments and other items sent by mail or common carrier.) If the Supreme Court holds that the Comstock Act can indeed be used in such a way — ignoring nearly a century of precedent — Mr. Trump’s Department of Justice will decide whether to initiate prosecutions against drug companies, providers, or even women who mail or receive abortion-related items.

A second Biden administration may be more cautious about defending reproductive rights if it loses the EMTALA case. But the impact of losses like the one that seems to be coming in this case will sting less for reproductive rights supporters if Mr. Biden remains in office. In the case of the Comstock Act, for example, Mr. Biden’s Department of Justice would almost certainly not prosecute abortion providers and patients, regardless of how the court interprets the 1873 obscenity statute.

A loss in the EMTALA case may not convince some voters to overcome the skepticism with which they view Mr. Biden. But it will make abundantly clear that whatever Mr. Trump may suggest, the abortion struggle at the federal level is not over by a long shot.

Mary Ziegler is a law professor at the University of California, Davis, and the author of “Roe: The History of a National Obsession.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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Reproductive rights in America

What's at stake as the supreme court hears idaho case about abortion in emergencies.

Selena Simmons-Duffin

The Supreme Court will hear another case about abortion rights on Wednesday. Protestors gathered outside the court last month when the case before the justices involved abortion pills. Tom Brenner for The Washington Post/Getty Images hide caption

The Supreme Court will hear another case about abortion rights on Wednesday. Protestors gathered outside the court last month when the case before the justices involved abortion pills.

In Idaho, when a pregnant patient has complications, abortion is only legal to prevent the woman's death. But a federal law known as EMTALA requires doctors to provide "stabilizing treatment" to patients in the emergency department.

The Biden administration sees that as a direct conflict, which is why the abortion issue is back – yet again – before the Supreme Court on Wednesday.

The case began just a few weeks after the justices overturned Roe v. Wade in 2022, when the federal Justice Department sued Idaho , arguing that the court should declare that "Idaho's law is invalid" when it comes to emergency abortions because the federal emergency care law preempts the state's abortion ban. So far, a district court agreed with the Biden administration, an appeals court panel agreed with Idaho, and the Supreme Court allowed the strict ban to take effect in January when it agreed to hear the case.

Supreme Court allows Idaho abortion ban to be enacted, first such ruling since Dobbs

The case, known as Moyle v. United States (Mike Moyle is the speaker of the Idaho House), has major implications on everything from what emergency care is available in states with abortion bans to how hospitals operate in Idaho. Here's a summary of what's at stake.

1. Idaho physicians warn patients are being harmed

Under Idaho's abortion law , the medical exception only applies when a doctor judges that "the abortion was necessary to prevent the death of the pregnant woman." (There is also an exception to the Idaho abortion ban in cases of rape or incest, only in the first trimester of the pregnancy, if the person files a police report.)

In a filing with the court , a group of 678 physicians in Idaho described cases in which women facing serious pregnancy complications were either sent home from the hospital or had to be transferred out of state for care. "It's been just a few months now that Idaho's law has been in effect – six patients with medical emergencies have already been transferred out of state for [pregnancy] termination," Dr. Jim Souza, chief physician executive of St. Luke's Health System in Idaho, told reporters on a press call last week.

Those delays and transfers can have consequences. For example, Dr. Emily Corrigan described a patient in court filings whose water broke too early, which put her at risk of infection. After two weeks of being dismissed while trying to get care, the patient went to Corrigan's hospital – by that time, she showed signs of infection and had lost so much blood she needed a transfusion. Corrigan added that without receiving an abortion, the patient could have needed a limb amputation or a hysterectomy – in other words, even if she didn't die, she could have faced life-long consequences to her health.

Attorneys for Idaho defend its abortion law, arguing that "every circumstance described by the administration's declarations involved life-threatening circumstances under which Idaho law would allow an abortion."

Ryan Bangert, senior attorney for the Christian legal powerhouse Alliance Defending Freedom, which is providing pro-bono assistance to the state of Idaho, says that "Idaho law does allow for physicians to make those difficult decisions when it's necessary to perform an abortion to save the life of the mother," without waiting for patients to become sicker and sicker.

Still, Dr. Sara Thomson, an OB-GYN in Boise, says difficult calls in the hospital are not hypothetical or even rare. "In my group, we're seeing this happen about every month or every other month where this state law complicates our care," she says. Four patients have sued the state in a separate case arguing that the narrow medical exception harmed them.

"As far as we know, we haven't had a woman die as a consequence of this law, but that is really on the top of our worry list of things that could happen because we know that if we watch as death is approaching and we don't intervene quickly enough, when we decide finally that we're going to intervene to save her life, it may be too late," she says.

2. Hospitals are closing units and struggling to recruit doctors

Labor and delivery departments are expensive for hospitals to operate. Idaho already had a shortage of providers, including OB-GYNS. Hospital administrators now say the Idaho abortion law has led to an exodus of maternal care providers from the state, which has a population of 2 million people.

Three rural hospitals in Idaho have closed their labor-and-delivery units since the abortion law took effect. "We are seeing the expansion of what's called obstetrical deserts here in Idaho," said Brian Whitlock, president and CEO of the Idaho Hospital Association.

Since Idaho's abortion law took effect, nearly one in four OB-GYNs have left the state or retired, according to a report from the Idaho Physician Well-Being Action Collaborative. The report finds the loss of doctors who specialize in high-risk pregnancies is even more extreme – five of nine full time maternal-fetal medicine specialists have left Idaho.

Administrators say they aren't able to recruit new providers to fill those positions. "Since [the abortion law's] enactment, St. Luke's has had markedly fewer applicants for open physician positions, particularly in obstetrics. And several out-of-state candidates have withdrawn their applications upon learning of the challenges of practicing in Idaho, citing [the law's] enactment and fear of criminal penalties," reads an amicus brief from St. Luke's health system in support of the federal government.

"Prior to the abortion decision, we already ranked 50th in number of physicians per capita – we were already a strained state," says Thomson, the doctor in Boise. She's experienced the loss of OB-GYN colleagues first hand. "I had a partner retire right as the laws were changing and her position has remained open – unfilled now for almost two years – so my own personal group has been short-staffed," she says.

ADF's Bangert says he's skeptical of the assertion that the abortion law is responsible for this exodus of doctors from Idaho. "I would be very surprised if Idaho's abortion law is the sole or singular cause of any physician shortage," he says. "I'm very suspicious of any claims of causality."

3. Justices could weigh in on fetal "personhood"

The state of Idaho's brief argues that EMTALA actually requires hospitals "to protect and care for an 'unborn child,'" an argument echoed in friend-of-the-court briefs from the U.S. Conference of Catholic Bishops and a group of states from Indiana to Wyoming that also have restrictive abortion laws. They argue that abortion can't be seen as a stabilizing treatment if one patient dies as a result.

Thomson is also Catholic, and she says the idea that, in an emergency, she is treating two patients – the fetus and the mother – doesn't account for clinical reality. "Of course, as obstetricians we have a passion for caring for both the mother and the baby, but there are clinical situations where the mom's health or life is in jeopardy, and no matter what we do, the baby is going to be lost," she says.

The Idaho abortion law uses the term "unborn child" as opposed to the words "embryo" or "fetus" – language that implies the fetus has the same rights as other people.

Shots - Health News

The science of ivf: what to know about alabama's 'extrauterine children' ruling.

Mary Ziegler , a legal historian at University of California - Davis, who is writing a book on fetal personhood, describes it as the "North Star" of the anti-abortion rights movement. She says this case will be the first time the Supreme Court justices will be considering a statute that uses that language.

"I think we may get clues about the future of bigger conflicts about fetal personhood," she explains, depending on how the justices respond to this idea. "Not just in the context of this statute or emergency medical scenarios, but in the context of the Constitution."

ADF has dismissed the idea that this case is an attempt to expand fetal rights. "This case is, at root, a question about whether or not the federal government can affect a hostile takeover of the practice of medicine in all 50 states by misinterpreting a long-standing federal statute to contain a hidden nationwide abortion mandate," Bangert says.

4. The election looms large

Ziegler suspects the justices will allow Idaho's abortion law to remain as is. "The Supreme Court has let Idaho's law go into effect, which suggests that the court is not convinced by the Biden administration's arguments, at least at this point," she notes.

Trump backed a federal abortion ban as president. Now, he says he wouldn't sign one

Whatever the decision, it will put abortion squarely back in the national spotlight a few months before the November election. "It's a reminder on the political side of things, that Biden and Trump don't really control the terms of the debate on this very important issue," Zielger observes. "They're going to be things put on everybody's radar by other actors, including the Supreme Court."

The justices will hear arguments in the case on Wednesday morning. A decision is expected by late June or early July.

Correction April 23, 2024

An earlier version of this story did not mention the rape and incest exception to Idaho's abortion ban. A person who reports rape or incest to police can end a pregnancy in Idaho in the first trimester.

• Abortion rights
• Supreme Court

• International

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Supreme Court hears case about emergency abortion care

By CNN's Tierney Sneed, John Fritze, Hannah Rabinowitz, Jen Christensen and Holmes Lybrand

Conservative justices press whether mental health issues can lead to abortions

From CNN's John Fritze

Though the issue was not explored deeply before the arguments, the question has long simmered in the background of the emergency abortion case: Can a woman who is pregnant receive an abortion at a hospital under the federal law by claiming a mental health illness, such as severe depression?

Conservatives are concerned about that possibility because they believe it would lead to more abortions.

"I really want a simple, clear cut answer to this question," Conservative Justice Samuel Alito asked. "Does 'health' mean only physical health or does it also include mental health?"

US Solicitor General Elizabeth Prelogar, arguing for the Biden administration, said that the federal law itself would require hospitals to stabilize a pregnant patient with "grave mental health emergencies" but said that it wouldn't lead to abortions.

"Let me be very clear about our position," she said. "That could never lead to pregnancy termination because that is not the accepted standard of practice to treat" any mental health emergencies.

See the scene outside the Supreme Court as the arguments on the abortion case kicked off

From CNN’s John Fritze

Anti-abortion activists and abortion rights advocates gathered outside the Supreme Court on Wednesday ahead of one of the most significant abortion cases since the high court overturned Roe v. Wade two years ago.

See photos from the scene:

Alito asks US solicitor general why DOJ believes it can impose restrictions on what Idaho can criminalize

From CNN's Hannah Rabinowitz

Justice Samuel Alito questioned why the Justice Department believes it can impose restrictions on Idaho state law as it relates to hospital decisions.

US Solicitor General Elizabeth Prelogar said that because hospitals are accepting federal money for programs like Medicare, they have to abide by the federal rules.

In response, Alito asked how the argument squared with Congress’ Spending Clause power.

“The theory is, Congress can tell a state or any other entity or person, ‘Look, here is some money or other thing of value, and if you want to accept it, fine, then you have to accept certain conditions,'" he said.

“But," he continued, "How does the Congress’ ability to do that, authorize it to impose duties on another party that has not agreed to accept this money?”

Roberts and Barrett appear to be key votes as US solicitor general begins arguments

From CNN's Tierney Sneed

With the first part of Idaho’s arguments wrapping it up, it appears that Justices John Roberts and Amy Coney Barrett, who are conservative, will be key votes in the case.

Justice Brett Kavanaugh, who sometimes sides with the liberals, has signaled skepticism of the Biden administration's arguments about the reach of the federal emergency care law.

Barrett, however, had several tough questions for Idaho attorney Joshua Turner and appeared to have some difficulties with how he described Idaho’s ban would apply in medical abortions.

Roberts had fewer questions during Turner’s presentation, but zeroed in on how the life-of-the-mother exemption in Idaho’s law operates and who decides whether a doctor had a “good faith” reason to perform abortion under it.

Now it's the Biden administration's turn as US Solicitor General Prelogar takes the stage

Now it’s the Biden administration’s turn to respond as US Solicitor General Elizabeth Prelogar takes the well of the ornate courtroom and begins her presentation to the justices.  

Just like Idaho’s attorney, Prelogar will speak for about two minutes uninterrupted and will then begin fielding questions in rapid succession. As the Justice Department's top appellate attorney, Prelogar’s presence underscores the significance of the case for the administration.

Prelogar will argue that federal law supplants the state’s abortion ban when women show up at an emergency room in Idaho with complications from a pregnancy that are not life threatening but that risk the health of the mother.

Kavanaugh appears to signal support for Idaho in early arguments

Justice Brett Kavanaugh, often a critical vote to watch in major Supreme Court arguments, questioned just how much of a conflict exists between the federal law at issue in the case and Idaho’s strict abortion ban.

“Is there any condition you’re aware of where EMTALA requires an abortion where Idaho law... does not?” Kavanaugh asked.

That question picks up on an argument Idaho has made throughout the case: That there is no conflict between the federal and state laws, because the state law already exempts most emergency situations.

But the Biden administration has countered there is a wide gap between Idaho’s exception — for the life of the pregnant woman – and the requirement of the Emergency Medical Treatment and Active Labor Act, also known as EMTALA, to stabilize patience to ensure the health of the pregnant woman.

Other than mental health, Kavanaugh asked, "is there any other condition identified by the solicitor general where you think Idaho law would not allow a physician" to perform an abortion.

Josh Turner, arguing for Idaho, said he did believed the answer was "no."

Gorsuch helps Idaho attorney explain when the state believes abortions are allowed

Conservative Justice Neil Gorsuch asked whether the Idaho law allowed for abortions in the case of a pregnant person suffering from a medical condition that may result in death in the future, but where death isn’t necessarily imminent.

“As I read your briefs, you thought Idaho thinks that in cases of molar and ectopic pregnancies, for example, that an abortion is acceptable,” Gorsuch asked.

“Correct,” Idaho attorney Joshua Turner said.

“It doesn’t matter whether it happens tomorrow or next week or a month from now?” Gorsuch asked.

Turner responded, saying that “there is no imminency requirement.”

Liberal female justices direct hearing to grisly details of emergency pregnancy complications

The all-female, liberal wing of the Supreme Court grilled Idaho attorney Joshua Turner on hypotheticals in which pregnancy complications pose serious health risks to women, forcing the hearing into discussion of the grisly medical emergencies at the heart of the case.

Sotomayor started the line of questioning, asking Turner point-blank whether, under Idaho’s interpretation of the federal emergency care law, states could prohibit abortions even if a woman’s life is at risk.

Justice Ketanji Brown Jackson zeroed in on the key “conflict” in the case: scenarios where an abortion is necessary to stabilize a woman but is not necessary to save her life.

Justice Elena Kagan picked up on the line of inquiry, asking Turner a situation in which a woman could lose her reproductive organs.

As Turner sought to grapple with the “difficult” situations in her question, Sotomayor jumped back in, pushing Turner on a pregnancy complication that put a woman at risk of sepsis or hemorrhaging.

She also asked about a patient experiencing complications who was denied an abortion earlier in her pregnancy. In the scenario, by the time the woman was able to deliver, the baby had died and she had been forced to get a hysterectomy in the meantime.

The extended questioning on the Idaho abortion ban's role in medical emergencies followed the hearing's drier start that focused on legal questions about federal preemption of state medical regulations.

Turner’s answers prompted some skeptical questions from Justices Amy Coney Barrett and John Roberts, who could be key swing votes in the case.

Discretion for doctors' emergency decisions is becoming a key theme

One theme emerging from the court’s conservatives early in today's arguments is how much discretion doctors have to make decisions in emergency situations without running afoul of Idaho’s ban.

In one exchange, Justice Amy Coney Barrett claimed Idaho's attorney appeared to be “hedging” on the question of borderline calls and questioned whether he was attempting to move the goal posts to suggest those circumstances could subject a doctor to prosecution.

It was a notably aggressive question from a member of the court's conservative wing.

Some context: The state, in its briefing, claimed the law exempts certain conditions, such as ectopic pregnancies, from the ban.

Chief Justice John Roberts also jumped into the fray, asking about the process for how the state determines if a doctor made the right call.

“What happens if a dispute arises with respect to whether or not the doctor was within the confines of Idaho law?” he asked.

Idaho's attorney responded by noting the doctor’s medical judgement would be based, in part, on “good faith.”

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Supreme Court hears case about emergency abortion care

By CNN's Tierney Sneed, John Fritze, Hannah Rabinowitz, Jen Christensen and Holmes Lybrand

Idaho’s attorney tells Supreme Court that state law controls medicine

From CNN's John Fritze

Joshua Turner, arguing on behalf of Idaho, told the Supreme Court in opening remarks Wednesday that nothing in the Emergency Medical Treatment and Labor Act preempts the state’s traditional power to regulate medicine.

The administration’s reading, Turner said, is “wholly untenable.”

“Licensing laws limit medical practice, that’s why a nurse isn’t able to perform open heart surgery,” he said. “The answer doesn’t change just because we’re talking about abortion.”

You will hear the acronym EMTALA mentioned a lot in today's arguments. Here's what it means 

From CNN’s Jen Christensen

A law called the Emergency Medical Treatment and Active Labor Act, also known as EMTALA, is at the heart of a Supreme Court case that is before justices on Wednesday. It became law in 1986 after studies showed that  many hospitals were trying to save money by engaging in “patient dumping” or transferring a patient — often uninsured or a member of a minority community — to a public hospital without first providing appropriate care to stabilize them. 

A study at  Cook County Hospital at the time the law passed found that “dumped” patients were twice as likely to die as those who were treated at the hospital where they initially sought care. About a quarter of patients were transferred in what was considered an unstable condition. 

EMTALA required all US hospitals that received Medicare money — essentially nearly all of them — to screen everyone who came to their emergency rooms to determine whether the person had an emergency medical condition. The law then requires hospitals, to the best of their ability, to stabilize anyone with an emergency medical condition or transfer them to another facility that has that capacity. The hospitals must also treat these patients   “until the emergency medical condition is resolved or stabilized.” 

Why this matters to the Idaho case: In 1989 , after reports that some hospitals were refusing to care for uninsured women in labor, Congress expanded EMTALA to specifically say how it included people who were pregnant and having contractions. In 2021, the Biden administration released the  Reinforcement of EMTALA Obligation , which says the doctor’s duty to provide stabilizing treatment “preempts any directly conflicting state law or mandated that might otherwise prohibit or prevent such treatment” although it did not specify whether an abortion has to be provided.

In July 2022, the Biden administration’s  guidance  clarified that EMTALA includes the need to perform stabilization abortion care if it is medically necessary to treat an emergency medical condition.

Here's a look at where abortion access stands in Idaho and across other states:

Supreme Court arguments in major abortion case are underway

The Supreme Court’s arguments in what has the potential to be the most significant abortion case since the high court overturned Roe v. Wade two years ago are now underway.

First up is Josh Turner, the chief of constitutional litigation and policy of the Idaho attorney general’s office.

Turner is expected to argue that the federal government cannot supplant the state’s strict ban on abortion by relying on a Reagan-era federal law that requires hospitals to “stabilize” patients who need emergency care.

Reproductive rights and anti-abortion protesters clash in front of Supreme Court ahead of arguments

From CNN's Gabe Cohen and Aileen Graef

Reproductive rights and anti-abortion activists clashed in front of the Supreme Court on Wednesday just before arguments are slated to start in Moyle v. United States.

Justices are set to hear arguments regarding a law from the 1980s protecting a person’s right to an abortion if they have a life-threatening condition.

The two groups shouted phrases, including "abortion is health care" and "abortion is oppression," while standing shoulder-to-shoulder, highlighting the tense divisions surrounding the issue.

No significant physical altercation has been seen, but they were shouting in each others' faces at times.

The key players in today's oral arguments

From CNN staff

The Supreme Court will soon hear arguments on whether Idaho’s abortion ban can be enforced in medical emergencies. Here are the key players in court today:

The justices:

• Chief Justice  John Roberts   
• Justice  Clarence Thomas   
• Justice  Samuel Alito   
• Justice  Sonia Sotomayor   
• Justice  Elena Kagan   
• Justice  Neil Gorsuch   
• Justice  Brett Kavanaugh   
• Justice  Amy Coney Barrett   
• Justice  Ketanji Brown Jackson   

Arguing in defense of the state abortion ban:

• Joshua Turner , Idaho’s chief of constitutional litigation and policy

Arguing on behalf of the Biden administration: 

• US Solicitor General Elizabeth Prelogar

Order of proceedings: Turner, representing Idaho, is expected to be up first for arguments. Then, Prelogar will respond for the Biden administration in a presentation. Finally, Turner will return to the lectern for a five-minute rebuttal. 

Pregnancy complications are a common medical emergency and childbirth is riskier than abortion

From CNN’s Deidre McPhillips

Pregnancy complications are the fifth most common reason why women age 15 to 64 seek care at emergency departments in the United States, according to  data  published by the US Centers for Disease Control and Prevention’s National Center for Health Statistics. In 2021, pregnancy complications led to about two million emergency department visits, the CDC estimates.  

Warning signs of an emergency during pregnancy can include bleeding, chest pain and dizziness. There is not sufficient data to understand how many of these emergencies require an induced termination, or abortion.  

However, experts say that abortion bans may increase the number of pregnancy-related emergencies and that restricting the option to have an abortion in emergencies can threaten the health and livelihood of the pregnant person. 

“Abortion care is part of standard and proven medical practice to reduce risk and in some cases, save lives. Tying the hands of emergency medicine healthcare workers would pose a major threat to pregnant people and public health,” Dr. Ushma Upadhyay, a professor at the University of California, San Francisco’s Bixby Center for Global Reproductive Health, said in an email. 

“Abortion care is extremely safe, safer than continuing a pregnancy to term,” she said. 

More context: One  study  from 2015 found that only 0.23% of abortions — including medication and procedural cases — resulted in a major complication that required hospital admission, surgery or blood transfusion. Meanwhile, a 2012  study  found that childbirth caused severe complications five times more often, or 1.3% of the time.

Maternal mortality in the US has increased sharply in recent years, rising from about 20 deaths for every 100,000 live births in 2020 to nearly 33 deaths for every 100,000 live births, according to a CDC  report  published last year. The latest abortion surveillance  data  from the CDC suggests that there was less than one death for every 100,000 legal abortions in the US. 

On the political front, Biden attacks Trump for "nightmare" of Dobbs decision

From CNN's Priscilla Alvarez and Nikki Carvajal

President Joe Biden on Tuesday launched one of his most forceful attacks of the 2024 campaign against presumptive Republican nominee Donald Trump – who he said was responsible for the “nightmare” caused by the overturning of Roe v Wade .

“For 50 years the court ruled that it was a fundamental constitutional right to privacy,” Biden said at a campaign stop.

“There’s one person who’s responsible for this nightmare, and he's acknowledged, and he brags about it. That’s Donald Trump.”

Democrats have seized on abortion ahead of November , hoping it could spur moderate voters – particularly women – to turn out in droves against Trump by tying the abortion bans directly to him. Biden’s campaign often cites Democratic successes in the 2022 midterms and off-year elections since Roe was overturned as examples of the issue driving voters to the polls.

Biden also poked fun at the former president for describing “the Dobbs decision as a miracle.”

“Maybe it’s coming from that Bible he’s trying to sell,” Biden joked. “I almost wanted to buy one to see what the hell’s in it."

Biden added: "Folks, it was no miracle — it was a political deal to get rid of Roe – a deal, a political deal he made with the evangelical base of the Republican Party.”

Read more on Biden and presidential abortion politics.

Lawyer for Idaho is making his debut at the Supreme Court

Arguing for Idaho is Josh Turner, a lawyer with Attorney General Raúl Labrador’s office who is making his debut at the Supreme Court.

Turner, whose title is chief of constitutional litigation and policy, joined Labrador’s office last year during a shakeup that involved several senior attorneys . He was previously a business litigation attorney at Faegre Drinker Biddle & Reath .

Turner told Law360 recently that there was “a lot of clamoring” to represent the state before the Supreme Court but that he was “thankful that the attorney general has confidence in me to deliver the argument and represent the people of Idaho.”

What to know about Solicitor General Elizabeth Prelogar, who is arguing on behalf of the Biden administration

From CNN's Tierney Sneed

For the fourth time since she became the federal government’s top Supreme Court advocate, Solicitor General Elizabeth Prelogar is arguing an abortion-related case.

The  dispute before the high court on Wednesday , about whether federal mandates for hospitals override strict state abortion bans in medical emergencies, shows how legal fights over abortion rights did not cease when the conservative majority ended a constitutional right to an abortion in 2022.

In the first two abortion-related cases Prelogar argued, the conservative majority rejected her calls that abortion rights be protected.

But she has eked out wins on other issues where the Biden administration was seemingly at odds with the court’s conservative proclivities, including in tussles over immigration policy and voting rights.

Prelogar, born in 1980, is a former Supreme Court clerk herself, having worked for both the late Justice Ruth Bader Ginsburg and Justice Elena Kagan. The Senate’s 53-36 vote confirming her as solicitor general made her the second women ever to serve in the role, with Prelogar following in the footsteps of Kagan, the solicitor general during the Obama administration.

An Idaho native, Prelogar attended Emory University and then Harvard Law School. She also clerked for her current boss, Attorney General Merrick Garland, when he was a DC Circuit judge, before her Supreme Court clerkships. She went on to litigate Supreme Court cases for private firms and worked on special counsel Robert Mueller’s investigation.

Read more about Elizabeth Prelogar's career here.

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Complication experience during pregnancy and place of delivery among pregnant women: a cross-sectional study

Bekelu teka worku.

1 Department of Population and Family Health, Jimma University, Jimma, Ethiopia

Misra Abdulahi

Merertu tsega, birtukan edilu, mahilet berhanu habte, samira awel.

2 Department of Nursing, Jimma University, Jimma, Ethiopia

Masrie Getnet

3 Department of Biostatistics, Jimma University, Jimma, Ethiopia

Yabsira Melaku

4 Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia

Radiet Kidane

Abonesh taye, meseret tamirat, associated data.

all data used to prepare this article is available within the article. If further is needed, the interested person can contact the corresponding author via [email protected] or [email protected] on a reasonable base.

Unlike other causes such as abortion, obstetric complications like hemorrhage, and hypertensive disorders of pregnancy, which are difficult to resolve for women who give birth out of health facilities are persisted or increased to be the cause of maternal mortality in Ethiopia. Direct obstetric complications resulted in the crude direct obstetric case fatality rate in this country. This study aimed to assess the relationship between Complication Experience during Pregnancy and Place of Delivery among Pregnant Women.

A community-based cross-sectional study was conducted to assess the baseline information as a part of a randomized control trial study. The sample size that was calculated for the cohort study with the assumptions to detect an increase in a minimum acceptable diet from 11 to 31%, with 95% CIs and 80% power, an intra-cluster correlation coefficient of 0·2 for a cluster size of 10 was used for this study. Statistical analysis was done using SPSS version 22.

The prevalence of self-reported pregnancy-related complications and home delivery were 79(15.9%, CI; 12.7–19.1) and 46.90% (95%CI; 42.5–51.1) respectively. Women who did not face vaginal bleeding were five times AOR 5.28(95% CI: 1.79–15.56) more like to give birth at home than those who faced this problem. Women who did not face severe headache were nearly three AOR 2.45(95%CI:1.01–5.97) times more like to give birth at home.

This study concluded that home delivery was high among the study participants whereas pregnancy-related complications such as vaginal bleeding and severe headache were identified as protective factors for facility delivery. Hence, the researchers recommended the incorporation of “storytelling” into the existing health extension program packages to improve facility delivery which shall be applied after the approval of its effectiveness by further research.

Relating to maternal health, the recent focus of the global health agenda has expanded beyond the survival of women and their babies to ensuring they thrive and achieve their full potential for health and well-being [ 1 ]. In line with this, the time of child delivery is critical for both women and babies, as the risk of morbidity and mortality could increase considerably if complications happen [ 1 , 2 ].

In less developed countries, maternal health intervention targets mostly women who can have complications during pregnancy or have other concerning issues such as distance from health facilities [ 3 , 4 ]. However, evidence shows that women without complications are also experiencing maternal death [ 1 ]. For this matter, World Health Organization (WHO) is recommending good-quality and evidence-based intrapartum care for all women irrespective of the setting or level of health care with the importance of the development of relevant national and local level health policies and clinical protocols [ 1 ].

Unlike other causes such as abortion, obstetric complications like obstructed labor/uterine rupture (36%), hemorrhage (22%), and hypertensive disorders of pregnancy (19%) that are difficult to resolve for women who give birth out of health facilities are persisted or increased to be the cause of maternal mortality in Ethiopia [ 3 , 5 ]. Direct obstetric complications resulted in the crude direct obstetric case fatality rate of 0.64% in Ethiopia where hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) are the two leading causes [ 6 ].

Despite the high prevalence of direct obstetric complications with high maternal death, and great government effort to increase skilled obstetric care [ 4 , 7 ], low institutional delivery is persisted and has shown a decreasing trend over time in some places in Ethiopia [ 8 , 9 ]. According to the data from the 2019 Ethiopian Mini Demographic and Health Survey analysis, the prevalence of institution/facility delivery was 48.58% [ 8 ]. A high fever during pregnancy (14%), severe headache (57.5%), vaginal bleeding (8.6%), blurred vision (24.2%), convulsion (10.8%), swollen hand/face (16.9%), unconsciousness (12.1%) and water breakage (7.3%) are common complications that Ethiopian women reported during pregnancy [ 10 , 11 ].

Different factors affect institutional delivery in Ethiopia. Women with a higher educational level, having antenatal care follow-up, being urban residents, community media exposure, community antenatal care coverage, lower parity, and better educational status of the husband had higher odds of giving birth at a health facility [ 7 – 9 , 12 ]. Based on these and related evidence, recommendations were being forwarded to increase institutional delivery and to contribute to saving the lives of women and newborns. However, no study had assessed the association between complications experienced during third-trimester pregnancy and place of delivery in Ethiopia.

In some settings, particularly in less developed areas too few interventions or too many interventions that the women do not need and adhere to are being provided for the purpose of improving facility delivery service quality and its utilization [ 1 ]. So, this study helps to forward specific and relevant interventions to increase facility delivery. Thus, it aims to determine the relationship between complications experienced during third-trimester pregnancy and place of delivery among pregnant women.

Study setting and period

The study was conducted in two districts of Jimma Zone named, Dedo districts and Seka Chekorsa districts in Oromia region, Southwest Ethiopia. The districts have 36 Kebeles each with a total population of 237,844 in Dedo district and 296,440 in Seka Chekorsa district in 2013 E.C (Ethiopian calendar). Based on the 2013 E.C. report, there were 8486 and 9436 pregnant women in Dedo and Seka Chekorsa districts respectively. Dedo district has One hospital, eight health centers, and nine private clinics whereas Seka Chekorsa district has one public hospital, nine public health centers, and 16 private health facilities. All information was obtained from the zonal health bureau. The study was conducted from August 20 to 24/2022GC.

Study design

A community-based cross-sectional study design was employed to collect the data.

Study population

All pregnant women who were selected from the selected kebeles in the Dedo district and Seka Chokorsa district kebeles and who fulfil the inclusion criteria were the study population.

Inclusion and exclusion criteria

The women were included based on the inclusion criteria set for the cohort study which includes pregnant women in the third trimester who have lived in the selected kebeles for not less than six months, and were willing to be visited by data collectors and supervisors after the child delivery. Similarly, exclusion criteria were serious illness (women diagnosed with hyperemesis) or clinical complications requiring hospitalization, twin pregnancy, or any child congenital abnormality identified by experts.

Sample size determination and sampling procedure

Sample size that was calculated for the cohort study was used for this study. It was determined with the assumptions to detect an increase in a minimum acceptable diet from 11 to 31% [ 13 ], with 95% CIs and 80% power, an intra-cluster correlation coefficient of 0·2 for a cluster size of 10. It was calculated that 52 clusters were needed. Adding 20% of the sample size for loss to follow-up, the final sample size was 624 pregnant women (312 in intervention, and 312 in control groups). Being a part of baseline data, this study used the sample size calculated for the two groups as it is.

The cohort study was proposed on any pregnant women residing in the selected kebeles who fulfill the inclusion criteria. During the analysis of this baseline data, 98 women who were primigravida were excluded from the analysis since the objective of this study was on last delivery. To ensure the adequacy of the remaining number for sample size, the sample was calculated using single population proportion formula for the prevalence (15.9%) of pregnancy-related complications in Ethiopia [ 10 ] with the assumptions of a 95% confidence level, 5% degree of precision, and 10% non-response rate. Thus, n = [Zα/ 2 ] 2 *p*(1 − p)/d 2 = (1.96) 2 *0.159(1 − 0.159) / (0.05) 2 = 227. We used 497 sample which is greater than the minimum required sample.

Participant Recruitment

The study areas were clustered by kebele. All third-trimester pregnant women residing in the selected kebeles were identified and enrolled in the study using the updated Health Extension Workers’ antenatal care logbook. Pregnant women were also identified through the one-to-five network to reduce the possibility of missing them. Then, all the identified pregnant women in their third trimester were enrolled in the study.

Data collection tool, method, and personnel

The data collection tool was prepared from relevant literature [ 14 – 18 ] originally in English, translated into the local language Afan Oromo and back-translated by other language experts. The tool was tested on 5% of the sample calculated for cohort study and necessary measurement was taken before the actual data collection. Ten females, who had completed at least 10th grade were recruited, trained, and worked on data collection. The data were collected by these interviewers through a home-to-home face-to-face interview. The data collection process was strictly supervised by the research team and trained supervisors. Data collection was done using the KoboCollect mobile application.

Data analysis

Statistical analysis was done using SPSS version 22. Descriptive statistics were used to summarize the characteristics of the participants. Bivariate logistic regression analysis was done for each variable with the outcome variable to select candidate variables at p -value < 0.25. Then, multivariate logistic regression analysis was done to control for possible confounding variables and to determine the presence of a statically significant association between the predictors and the outcome variable at p -value < 0.05 and AOR with 95% CI. Multicollinearity and model fitness was checked and out-ruled.

Socio-demographic characteristics of the participants

All study participants were married and living with their partners. The mean age of the respondents was 26.78 (SD ± 4.88) years (Table  1 ).

Distribution of Socio-demographic characteristics of participants

Obstetric and maternal health service-related characteristics of the participants

The mean duration of the last child delivery for which the history was asked was 36.54(SD ± 13.44) months (Table  2 ).

Distribution of obstetric history of women who participated in the study

About 15% 79(15.9%) of women had faced pregnancy-related complications during the pregnancy of their most recently delivered child (Fig.  1 ).

Prevalence of women who faced any type of self-reported pregnancy-related complication during pregnancy of their most recent child

Vaginal bleeding and severe headache were the most common pregnancy - related complications that the women who participated in the study reported facing the complications (Fig.  2 ).

Distribution of types of self-reported pregnancy - related complications the women faced

Place of delivery

The majority of the women who participated in the study had given birth to their most recent delivery at home (Fig.  3 ).

Distribution of place of child delivery among women who participated in the study

Relationship between complication experience during pregnancy and place of delivery

A large number of women who faced pregnancy-related complications during their most recent pregnancy had gave birth at home (Table  3 ).

Self-reported pregnancy-related complications and place of delivery among women who participated in the study

The logistic regression analysis result

In bivariate logistic regression, vaginal bleeding, severe headache, persistent vomiting, face/hand swelling, and others were identified as candidate variables for multivariate analysis from the seven pregnancy-related complications. Two pregnancy-related complications; vaginal bleeding with a p -value of 0.003 and severe headache with a p -value of 0.049 were significantly associated with the outcome variable in multivariate analysis. According to this result, women who did not face vaginal bleeding were five times AOR 5.28 (CI; 1.79–15.56) more like to give birth at home than those who faced this problem. Similarly, women who did not face severe headache were nearly three AOR 2.45 (CI; 1.01–5.97) times more like to give birth at home than those who faced the problem (Table  4 ).

Logistic regression analysis output showing the association between pregnancy-related complications and place of delivery among the women who participated in the study

*Shows the statistical significance of the association at p -value < 0.05

This study established an association between pregnancy-related complications and place of delivery among women who had at least one - time history of child delivery in two districts of Jimma Zone of Oromia in Ethiopia. A large number of respondents reported that they had faced pregnancy-related complications whereas; the most frequently reported complications were vaginal bleeding and severe headache. Home delivery was also high while women who did not face pregnancy - related complications were more likely to give birth at home.

The prevalence of self-reported pregnancy - related complications among the study participants was 79(15.9%, CI; 12.7, 19.1). This finding is consistent with the study finding 372 (15.9%) from Northwest Ethiopia [ 10 ]. In both studies, the finding is high. The high prevalence of pregnancy - related complications could be associated with the physical and social characteristics of the participants where young aged women were higher in this study and young age is a risk factor for pregnancy - related complications [ 19 ].

However, this self-reported pregnancy - related complications magnitude is lower than 27.4% (78/285) the study result from Uganda [ 20 ]. The discrepancy could be due to differences in the study setting, data collection time, and study method. Our study was a community-based study, using a self - reported approach among mothers who gave birth and that of Uganda is a facility - based study where they have a chance to review the records for missed information and this can reduce recall bias. Additionally, the time of data collection can also create a difference since our study is conducted a few years after delivery where there could be the effect of recall bias [ 21 ].

In our study, home delivery among the study participants was 46.90%( 95% CI; 42.5–51.1). This result is lower (88.3%) compared to the result of the study done in Northern Ethiopia [ 22 ] and the result (73.8%) of the study conducted in Ethiopia nationally [ 23 ]. This variation could be due to the difference in sample size where the study of Northern Ethiopia had a smaller sample size, and the national data is differently high. The disparity in study time might also matter as maternal health service utilization is increasing from time to time in Ethiopia [ 24 ].

On the other hand, the prevalence of home delivery in this study was higher than the finding of a pooled analysis of home delivery in East Africa 23.68% (95% CI:23.45–23.92) [ 25 ]. The high prevalence of home delivery in this study could be due to the effect of fear of COVID-19, and poor common client satisfaction in this country [ 26 – 28 ].

Facility delivery in our study was 53.1% (95% CI: 48.9–57.5). This outcome is higher compared to the result of a study conducted in the Afar region 35.2% (95% CI: 30.5–40.1) and Gurage zone of Southern Nations, Nationalities, and Peoples’ Region of Ethiopia (31%) [ 17 , 18 ]. This difference could be due to the variation in the study setting, study period, and economical variation of the study participants. Accessibility to health institutions is more difficult in the two regions compared to our study setting [ 29 ].

However, the facility delivers in our case is lower than that of Waka town of South Nations and Nationalities of Ethiopia (89.4%), Woldia Town of Ethiopia (74.7%), and Boset Woreda, Central Ethiopia (60%) [ 14 – 16 ]. The lower magnitude of facility delivery in our study might be due to the nature of the study area where it was conducted majorly in the rural area and all maternal health service utilization in Ethiopia is lower in rural compared to urban [ 29 ].

Association of pregnancy-related complications and place of child delivery

The logistic regression analysis result of this study identified that two of the self-reported pregnancy - related complications had a statistical association with facility delivery where the women who did not face vaginal bleeding and severe headache were much more likely to give birth at home compared to those who faced these complications.

The majority of the previously conducted study in Ethiopia regarding identifying factors associated with place of delivery focused on maternal - related factors such as socio-economic and socio-cultural factors, and facility-related factors like distance and quality of service. Also, several efforts have been made to resolve these factors by the Ethiopian government to increase maternal health services utilization; particularly to increase institutional delivery service utilization. Regardless of all these efforts, skilled delivery and facility delivery utilization remained very low in this country despite the persistently high maternal death. Our study focused on the association between pregnancy complications and place of delivery which can contribute to a new way of investigating the challenges for improvement of maternal health service utilization.

The result indicated that women who did not face vaginal bleeding were five times AOR 5.28 (95% CI: 1.79–15.56) more like to give birth at home than those who faced this problem. Likewise, women who did not face severe headache were nearly three AOR 2.45 (95% CI: 1.01–5.97) times more like to give birth at home than their counter groups. Similar to these results, different studies had identified that pregnancy-related complications have a significant and positive association with child delivery in health facilities.

Pregnancy complications recognized at antenatal care was identified (OR 2.4, 95% CI 1.3–4.6) as a factor associated with health facility delivery [ 30 ] in the Philippines. Moreover, a systematic review conducted on institutional delivery in Ethiopia revealed that women who encountered problems during pregnancy (OR = 2.83, CI = 4.54, 7.39) had a higher chance of giving birth in health facilities [ 31 ]. Further, a study in Southwest Ethiopia (AOR = 3.86, 95% CI: 2.67– 7.29) and Benishangul Gumuz, West Ethiopia (AOR = 1.95, 95% CI: 1.01, 4.23,) indicated the experience of pregnancy - related danger signs had a positive association with institutional delivery.

The possible explanation for the association might be that facing complications during pregnancy initiates the women for the utilization of different maternal health services such as prenatal which could help them with birth preparedness and complication readiness that in turn can increase institutional delivery [ 27 , 32 ]. Women who had faced complications can have more practical experience in life - threatening conditions than those who did not which can motivate them to give birth under the supervision of professionals who can help them during an emergency in case it happens. In addition, experiencing complications can make women seek health care services during pregnancy and they can have a chance of being recommended facility delivery by health professionals.

Conclusion and recommendation

This study concluded that home delivery is high among the study participants whereas the happening of pregnancy-related complications such as vaginal bleeding and severe headache were identified as protective factors for facility delivery. Hence, the researchers recommended the incorporation of “storytelling” in awareness creation from the experience of pregnant women who had experienced a complication during pregnancy into the existing health extension program packages in Ethiopia to improve facility use. However, it shall be applied after the approval of its effectiveness by further research.

Limitations of the study

This study was conducted among women who gave birth in a previous period which extends to six years because we could not exclude mothers with a long delivery time as it is not ethical to exclude them from the interventions. This study also did not identify the reason for home delivery due to fear of recall bias.

Acknowledgements

Our special gratitude goes to Jimma University for funding this work, and to the health extension workers of the two districts for their unreserved support in participant identification.

Authors’ contributions

All authors contributed to the work equally. The author(s) read and approved the final manuscript.

Jimma University funded this work.

Availability of data and materials

Declarations.

The study protocol was reviewed and approved by Jimma University Institutional Review Board. Ethical clearance was obtained with JUIH/IRB/110/22 reference number. All methods were carried out in accordance with relevant guidelines and regulations of the university’s Institutional Review Board. All the study participants gave their written informed consent. Since there was no participant from minority groups, it was not important to contact their parents or legal guardians. During the data collection, all data collectors and the study participants adhered to the COVID-19 precaution methods.

not applicable.

the authors declare we have no conflict of interest.

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