~symptoms you should never ignore ~
Click here for a printer friendly version
www.birthchoices.co.uk
The majority of women will have healthy, problem free pregnancies, however, there are occasions when some women will have signs or symptoms of possible complications that should never be ignored. We have put together this useful guide to help highlight some of them. Please remember that this guide is not intended to replace any medical advice - if you have ANY concerns regarding you or your baby's health and wellbeing, always contact your midwife, doctor or local hospital.
Do not rely on this guide for a diagnosis; it is for general information only.
Speak to your midwife, doctor or local hospital as soon as possible if you experience any of the following at any time. This list is not exhaustive - there may be other causes for any of these signs and symptoms.
JUMP TO:
Vaginal bleeding in pregnancy
Abdominal pain
Back pain
A gush of fluid from the vagina
Signs & symptoms of Pre-eclampsia
Fever
Pain
Reduced foetal movements
Painful urination
Breathlessness or dizziness
Severe skin itching
Depression
First Trimester
Vaginal bleeding in pregnancy is not a normal symptom of pregnancy, however in the first trimester (first three months or so) it can be more common, but is usually known as ‘spotting' around this time. It can be caused by;
Implantation bleeding - when the fertilised embryo first embeds itself in the wall of the uterus.
Hormonal Bleeding - a very small proportion of women continue having ‘period like' bleeding in early pregnancy.
Miscarriage - the bleeding caused by a miscarriage tends to be heavier than spotting and is bright red in colour, there may also be abdominal pain and cramps. Sadly about one in every four pregnancies ends this way. A further one per cent of pregnancies are ectopic (see abdominal pain below) – that is, they start developing in the wrong place, usually in one of the fallopian tubes. If you are worried about miscarriage and are looking for further help, please see the 'support, links & resources' section of the wesbite. Then go to 'medical conditions & miscarriage'.
Later in pregnancy
Bleeding later in pregnancy should always be taken seriously. Some of the possible causes can be;
Placenta previa - this is when your placenta grows very close to or over the inside of your cervix. Potentially a very serious condition due to the high risk of heavy bleeding, not usually associated with any pain.
Placental abruption - this is when the placenta starts to separate from the wall of the uterus, a very serious and urgent condition, can have accompanying pain but not always.
Vasa previa - one of the large blood vessels in your placenta grows across your cervix, not usually accompanied by pain, also a very serious and urgent condition.
As with bleeding, pain in pregnancy doesn't always mean that there is a problem. Some women feel discomfort as ligaments stretch with the growing baby. Abdominal pain in pregnancy can also be caused by things unconnected to your pregnancy such as constipation or a stomach upset.
However, this does not mean that any pain should be ignored. If you are worried, and especially if you have severe abdominal or one-sided pain or pain in your shoulders, it might be wise to contact your midwife, GP or hospital and explain what is happening. Abdominal pain in pregnancy can be caused by;
Ligament pain - this is when the broad ligaments that support your growing uterus begin to stretch.
A urine infection - at any stage of pregnancy
Placental abruption (see above) - from the second or third trimester
Ectopic pregnancy - usually early pregnancy
Miscarriage - early pregnancy but can be any time up to around 24 weeks
Labour - regular, rhythmic contractions that get progressively longer, stronger and closer together, at any stage from the second trimester. Before 37 weeks of pregnancy this would indicate pre-term labour
Other non-pregnancy related causes - Constipation, wind, stomach upset, appendicitis, an ovarian cyst, infection and some medical conditions.
Pre-eclampsia - if the pain is on the upper right hand side of the abdomen or between the breasts
Many women experience backache, especially as the pregnancy progresses, which can be due to the effects on your posture as your belly grows and/or also the hormones produced during pregnancy. Attending yoga classes or asking to be referred to an obstetric physiotherapist might be helpful in these circumstances.
However, on occasion back pain in pregnancy can be a sign or symptom of a complication. Persistent back pain in pregnancy can be caused by;
Kidney or bladder infection - both can be serious and must be treated to prevent long term damage and to decrease the chance of premature labour.
Poor posture - ask to see an obstetric physiotherapist.
Labour - many women experience back pain in labour.
Miscarriage - back pain can also be present with a miscarriage.
Pre-eclampsia - this can be felt as severe pain between the shoulder blades, on the upper right hand side of the abdomen or between the breasts.
A gush of fluid from the vagina
Vaginal discharge is normally increased in pregnancy, but a gush of any fluid from the vagina - unless you are in labour or about to go into labour - is a sign/symptom of a potential problem. Some women experience lots of pressure on their bladder that can cause urine leakage that can be mistaken for ‘waters' breaking. If there is ANY uncertainty always talk to a midwife or doctor.
Fluid loss from the vagina can be caused by;
Membrane rupture (waters breaking) - this of course is normal in a full term pregnancy just before or during labour, some babies are even born with the membranes intact until they come out completely! Some women may go into labour a short while after membranes have ruptured, others may take 3 or 4 days.
Pre-term membrane rupture - this is when the membranes rupture before 37 weeks. It can happen when the mother is group B Strep positive, or if she has some other infection. Sometimes there is no apparent reason and not all women in this situation will go into premature labour, although some will.
Coloured fluid - that is thick and dark green, light green, blood stained, brown, yellow and thick etc... Amniotic fluid is not normally coloured, any change in colour could indicate;
Meconium - baby has opened it's bowels before birth. ‘Fresh' meconium is sometimes a sign of foetal distress. In babies born at 41 or 42 weeks, ‘old' meconium can also be a sign that the baby's gut is mature. Your midwife will know by looking at the fluid if it is ‘fresh' or ‘old'
Infection - yellow/brown/thick amniotic fluid.
Abruption - bright red coloured amniotic fluid.
Show - this is when the mucous plug that was sealing up your cervix comes out of your vagina. It is usually ‘jelly like' and can be greyish with small streaks of red blood in it - this is normal in a full term pregnancy before labour.
Signs & Symptoms of Pre-eclampsia
Hypertension or high blood pressure is the most common medical problem that is encountered in pregnancy. In general gestational hypertension complicates 10-15% of all pregnancies. Mild pre-eclampsia affects up to 10% of first time pregnancies with severe pre-eclampsia affecting about 1 or 2 in a hundred pregnancies.
The word ‘eclampsia' is a Greek word meaning ‘bolt from the blue' and is characterised by convulsions (fits). Before a woman suffers an eclamptic convulsion, most women have signs of pre-eclampsia, most notably high blood pressure and/or protein in the urine. Often there are one or more warning symptoms – such as restlessness, shakiness, intense headache, upper abdominal pain or visual disturbances – before the fit occurs. Although these are very common, non-specific symptoms which are usually perfectly benign.
For some sufferers, however, eclampsia is entirely unheralded, and signs of pre-eclampsia appear afterwards. (Action on Pre-eclampsia. APEC. 2007) . It is a common misconception that you need to have ALL of the signs and symptoms to be diagnosed with pre-eclampsia, this is not the case - some women will have them all, others only one or two.
Some of the signs and symptoms are;
High blood pressure - if the top number of your normal blood pressure (systolic) goes above 160 and the bottom number (diastolic) of your normal blood pressure rises more that 15 points or more, on more than one occasion. So if your ‘normal' blood pressure is 125/65 and it rises to 160/85 and stays around those numbers or goes higher - this is then classed as pregnancy induced hypertension (PIH).
Protein in your urine - on more than one occasion.
Swelling - Swelling or puffiness (also called oedema) of the hands, face and eyes
Severe intense headache - that lasts more than a couple of hours
Blurred vision - Vision disturbances, such as double vision, blurring, dimming, flashing spots or lights that last for more than two hours
Pain - Severe or sharp upper- to mid-abdominal pain, with or without nausea, or severe pain between the shoulder blades or just below the ribs, especially accompanied by vomiting
Feeling ‘odd' - some women report feeling generally unwell, nervous, suddenly frightened or become aggitated
A temperature above 37.5 c. Fever is a sign and symptom of infection, either viral, like flu, or bacterial, like an infected cut or wound. If you have any fever in pregnancy it is always wise to be checked over to establish the cause of the underlying infection. Bacterial infections can be treated with antibiotics but a viral one can't. Fever is a sign that the body's immune defences are working to try and clear the infection
Common signs and symptoms of bacterial infection include:
An elevated body temperature
Sweating
Chills
Confusion
Increased pulse rate
Fast breathing
In addition, people who have bacterial infection often have elevated numbers of circulating white blood cells in their blood stream. People may also have other symptoms of infections depending on the location of the infection. The most dangerous result of an untreated bacterial infection is septaceamia (blood poisoning) which can be fatal.
Pain in pregnancy can be caused by a number of different things - some benign and some serious. We have already discussed abdominal pain and back pain, now we will look at pain in other places!
Pain in the lower leg - this could be caused by a deep vein thrombosis (DVT) which is a clot in one of the veins in your leg. This is a serious condition and should not be ignored if you have the following signs and symptoms;
Pain in the leg
Tenderness in the calf (this is one of the most important signs)
Leg tenderness
Swelling of the leg
Increased warmth of the leg
Redness in the leg
Bluish skin discoloration
Discomfort when the foot is pulled upward
The most serious complication of DVT occurs when a clot becomes dislodged from a vein, travels to the lung, and blocks or partially blocks the pulmonary artery leading from the heart to the lungs. This condition is called pulmonary embolism (PE) .
If the clot is small, only one or more portions of the lung may be deprived of blood and damaged. This condition can result in:
Shortness of breath
Chest pain with breathing
Bloody sputum (coughing up blood from the lungs)
You should have regular movements from your baby from around 22 weeks onwards - some women feel movement before this and some a little later. If your placenta is anterior (attached to the front of your uterus towards the front of your body) you may feel movements that are more ‘muffled'. If this is the case, then this is consistent throughout your pregnancy.
You will become used to the patterns of your baby's movements as your pregnancy progresses. It is important for you to take notice of any sudden or unusual change in movements - either much less than normal or conversly much more than normal.
Towards the end of the pregnancy the pattern of movements may change. Instead of feeling kicks and punches it may feel more like the baby is wriggling or shuffling. This is completely normal as the baby is getting bigger.
When to seek help?
If you're worried about the lack of fetal (baby) movement, try things like drinking a cold or hot drink, having a bath or shower or gently massaging your tummy to stimulate some movement.
If the movement seems to have suddenly reduced or you feel no movements - then you should let your midwife, GP or local maternity unit know and they will arrange for you to go to the hospital for assessment.
Passing urine should not be painful at any time during pregnancy - this includes stinging, burning or abdominal or lower back pain when passing urine. Pregnant women are more prone getting a urinary tract infection (UTI) and they should be taken seriously.
If left untreated a UTI can leed to a kidney infection that could result in permament damage to the kidneys, and/or premature labour. See your GP if you have any symptoms of a urine infection including;
Pain, discomfort, or burning when urinating; pelvic discomfort or lower abdominal pain (often just above the pubic bone)
A frequent or uncontrollable urge to pee, even when there's very little urine in the bladder Urine that has a very strong smell
Cloudy, frothy urine
Blood in the urine - can make your urine appear a rusty colour What are the symptoms of a kidney infection?
Signs that the infection has spread to your kidneys (and that you need medical attention immediately) may include:
A high fever (often with shaking, chills, or sweats)
Pain in your lower back or in your side just under your ribs, on one or both sides, and possibly in your abdomen
Nausea and vomiting
Blood in the urine
With a kidney infection you may also have some of the symptoms of a UTI/cystitis. A kidney infection is a serious medical complication of pregnancy. It can lead to premature labour, so you need to be seen and treated right away.
There are 2 common things that generally cause breathlessness in pregnancy:
1.
|
Pressure from the baby on the 'diaphragm' or muscle layer separating the lungs from the intestines. The diaphragm needs to 'pull down' to allow the lungs to inflate. Its ability to do this is made somewhat difficult by the pressure of the growing baby. Breathlessness in the second and third trimesters is fairly common. |
|
A higher level of carbon dioxide gas in the blood. This level increases because the baby is also getting rid of its own carbon dioxide gas (a waste product), through their umbilical cord and the woman. |
Breathlessness and dizziness sometimes can be signs and symptoms of aneamia in pregnancy, although they would not generally be this first indication of anaemia as extreme tiredness and being very pale usually are.
What are the symptoms of anaemia during pregnancy?
If the woman is otherwise healthy, she will rarely have any symptoms of anaemia unless her haemoglobin (red pigment) is below 8g /dl. Although if your ‘normal' haemoglobin level is 12g/dl then a drop to 9 or 10 could result in symptoms The first symptoms will be tiredness and paleness.
Palpitations - the awareness of the heartbeat, breathlessness and dizziness can occur, though they are unusual. If the anaemia is severe (less than 6g of haemoglobin per decilitre of blood), it may cause chest pain, fainting or headaches . A sudden onset of breathlessness accompanied by chest pain or upper back pain could also be an indication of other complications such as PE (see the section on pain)
Itching during pregnancy is a common symptom. It can be caused by stretching of the skin and the increased blood supply to the skin. What many women don't realize, however, is that sometimes itching can be a sign of a liver abnormality called intrahepatic (within the liver) cholestasis (pooling of bile salts) of pregnancy, also known as Obstetric choloestasis.
When associated with itching, the skin component is called pruritus gravidarum. Obstetric cholestasis occurs in about 1 in 100 pregnancies in the UK. It is more common in women carrying twins, triplets, or more. Mothers, daughters and sisters of affected women have a higher than average risk of also being affected when pregnant.
It is more common in certain parts of the world. For example, in some countries in South America, especially Chile and Bolivia, up to 1 in 20 or more pregnant women develop this condition.
About half the time it is associated with yellow jaundice. Typically symptoms occur in the last third of pregnancy when the hormone levels are at their highest. However, it sometimes develops earlier in pregnancy.
Signs and symptoms of obstetric choleostasis include;
Itch - This is the most common and typical symptom. The itch can be 'all over', but it is often worst on the hands and feet . Commonly, itch is the only symptom. It tends to get worse until you have the baby. The itch can become severe and affect sleep, concentration, mood, and can become distressing. Note: mild itching from time to time is normal in pregnancy. However, if you develop a constant itch that gets worse, tell your doctor. A blood test can confirm if you have obstetric cholestasis. Other less common symptoms include
Tiredness.
Poor appetite and feeling sick.
Mild jaundice - You may go 'yellow' and have dark urine and pale faeces (stools). This is uncommon and due to an increased level of bilirubin (a constituent of bile) leaking from the bile ducts into the bloodstream.
Ante natal depression is as serious as post natal depression and affects around 10% of women in the UK. Speak to your midwife or GP if you are experiencing any of the following:
Tired but unable to sleep - for example, due to mind over-active/worrying, feeling tired all the time
No appetite or overeating for the sake of it
Agoraphobia (fear of open spaces)
Crying more than is usual, feeling sad most of the time
Feeling isolated and lonely
Chronic anxiety/stress/feeling violent
Irritability and irrational behaviour/thoughts and/or paranoia;
Symptoms of Obsessive Compulsive behaviour e.g. repeatedly washing hands, counting or ‘checking‘ things over and over.
Lack of interest in anything/thoughts of suicide
