Pregnancy-induced hypertension (PIH), also referred to as pre-eclampsia or toxemia of pregnancy, is a state of hypertension during pregnancy in association with oliguria, proteinuria, and edema. The cause is a hormone imbalance that results in constriction of blood vessels. If untreated, PIH may lead to eclampsia with seizures, coma, and possible death.

Development of a fertilized egg outside of its normal position in the uterine cavity is termed an ectopic pregnancy. Although it may occur elsewhere in the abdominal cavity, this abnormal develop￾ment usually takes place in the oviduct, resulting in a tubal pregnancy. Salpingitis, endometriosis, and PID may lead to ectopic pregnancy by blocking passage of the egg into the uterus. Continued growth will rupture the oviduct, causing dangerous hemorrhage. Symptoms of ectopic pregnancy are pain, tenderness, swelling, and shock. Diagnosis is by measurement of the hormone HCG and ultrasonography, confirmed by laparoscopic examination. Prompt surgery is required, sometimes including removal of the tube.

For a variety of reasons, a pregnancy may terminate before the fetus is capable of surviving outside the uterus. An abortion is loss of an embryo or fetus before the 20th week of pregnancy or before a weight of 500 g (1.1 lb). When this occurs spontaneously, it is commonly referred to as a miscarriage. Most spontaneous abortions occur within the first 3 months of pregnancy. Causes include poor maternal health, hormone imbalance, incompetence (weakness) of the cervix, immune reactions, tumors, and, most commonly, fetal abnormalities. If all gestational tissues are not eliminated, the abortion is described as incomplete and the remaining tissue must be removed.

An induced abortion is the intentional termination of a pregnancy. A common method for inducing an abor￾tion is dilatation and evacuation (D&E), in which the cervix is dilated and the fetal tissue is removed by suction.

Placental Abnormalities

If the placenta attaches near or over the cervix instead of in the upper portion of the uterus, the condition is termed placenta previa. This disorder may cause bleeding in the later stages of pregnancy. If bleeding is heavy, it may be necessary to terminate the pregnancy.

Placental abruption (abruptio placentae) describes premature separation of the placenta from its point of attachment. The separation causes hemorrhage, which, if extensive, may result in fetal or maternal death or a need to end the pregnancy. Causative factors include injury, maternal hypertension, and advanced maternal age.

Mastitis

Inflammation of the breast, or mastitis, may occur at any time but usually occurs in the early weeks of breastfeeding. It is commonly caused by staphylococcus or streptococcus bacteria that enter through cracks in the nipple. The breast becomes red, swollen, and tender, and the patient may experience chills, fever, and general discomfort.

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