Friday, February 15, 2013

Pregnancy Complications in a Postapocalyptic World

My futuristic story is set in a post-apocalyptic primitive world, sort of like in the seventeen hundreds. No electricity. I have an eighteen year-old pregnant woman, and I need a complication of late pregnancy that is likely to kill her but not her child (who is the future hero).
Here are a few:
1) Eclampsia-- a condition of severe high blood pressure, kidney and liver issues. More common in first pregnancies, but can occur with any pregnancy. Very dangerous, and can be fatal.
2) Cardiomyopathy-- the heart muscle becomes weak during the pregnancy, and the woman goes into heart failure. It can happen with any pregnancy. Once it does happen, further pregnancies are not recommended.
3) Heart valve issues, especially narrowed heart valves (specifically the mitral and aortic valves). Rheumatic fever would be a cause of valve disease in a woman without access to antibiotics for a childhood strep throat.
4) High blood pressure in the lungs (pulmonary hypertension). This is most common in women between ages 20 and 40. It may be autoimmune. It causes terrible shortness of breath, swelling of legs, and patients can have a bluish color due to low blood oxygen. Pregnancy is not recommended in women with this problem, as it is often fatal.
5) Blood clots in the legs, breaking off and going to the lungs (pulmonary embolus). Can be fatal. A clot in the leg was known as “milk leg.”
6) Placenta forming over the cervix (the exit to the uterus). Known as placenta previa, it causes bleeding, and can kill both the mother and child.
7) Placenta pulling loose--bleeding, fetal distress. Known as abruptio placenta; the mother can bleed to death.
8) Failure during delivery: baby gets stuck coming out. As C-section wouldn't be an option, mother and child would both likely die.
9) Uterus won't contract after delivery-- severe bleeding. Can be fatal.
10) Twins, triplets-- higher chance of injury to or loss of the babies and the mother.
11) Breech birth-- baby tries to come out feet first. May get stuck, may have fetal distress.
12) Gallbladder disease-- more common during pregnancy. In extreme cases, a stone can get stuck and lead to pain, infection, inflammation of the pancreas. Death can ensue.
13) Appendicitis--an old fashioned killer, but not uncommon when medical care (especially surgical care) is not available.
14) Pneumonia--another old fashioned infectious disease that can turn fatal.

If you want something showy, plague is a possibility. Spread by lice in unclean conditions, this infectious disease scourged Europe in the Middle Ages. Infants sometimes survived when their mothers didn't.

Hope this helps clarify the situation. If you need more help, please leave a question in the comments!
Cheers, Kelly

Questions? Comments?
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
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  1. Another great post, Kelly, which reminded me of a scene in my current WIP, where a young woman is only about four weeks pregnant and gets washed into the sea by a freak wave. She's uninjured but in 20°C/68°F cold water for 2-3 hours, swimming, trying to get back to shore against the current until she is rescued. How dangerous is this for the baby?

    1. Hello, Edith.
      At this stage of the game, the baby is fine. A normal human body temp is 98.6 degrees Fahrenheit. Nature's response to cold exposure is to centralize blood flow (ie, keep blood going to the vital organs and brain versus the extremities—arms and legs) placental blood flow will be well-maintained. Shivering on the mother's part helps to maintain body temperature.
      As the mother becomes hypothermic and the body temp drops below 95 degrees, she can develop fatigue, confusion, slower heart rate (which in a young healthy heart is generally well tolerated) and decreased breathing. As the temp approaches 91 degrees, cardiac arrest may ensue.
      There are cases of maternal cardiac arrest where hypothermia is utilized to keep the pregnancy and vital organs going. As long as the mother’s circulation is maintained with CPR, blood will get to the placenta.
      A rare syndrome known as hyperhidrosis (excessive sweating) and hypothermia (low body temp) of pregnancy can present with temperatures in the low 90’s. It’s thought to be a failure of the hypothalamus, the part of the brain responsible for body temp regulation. The inappropriate profound sweating cools the body unnecessarily. The prognosis for this condition is good.
      Hope this helps!
      Cheers, Kelly

    2. Thank you, Kelly. This helps very much. You've got a great blog here.

    3. Thanks, Edith! Appreciate the support. ;~)

  2. On Downton Abbey, a young mother died of eclampsia at the end of Season Two. There were two doctors arguing about her condition--one who diagnosed the eclampsia and suggested getting her to the hospital for a C-section and the other, older and knighted, who argued against it. The husband was torn and let the parents argue it out and the father prevailed, listening to the knight, who was wrong. The baby was born and everyone thought all was well, but the mommy seized and stroked out a bit later.

    1. Sounds like an accurate portrayal. It's sad when the baby dies after every medical measure has been taken. Fortunately, good prenatal care has positively impacted both maternal and fetal mortality from this condition.
      Thanks for commenting, Rochelle!
      Cheers, Kelly

  3. Thanks for sharing such a good article with us. This is very helpful for me.
    Complication during pregnancy

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