Warning Signs in

In most cases, pregnancy goes smoothly and does not involve dangerous complications. There are however warning signs in pregnancy that you as an expectant mother should be aware of so you can know when to get the appropriate help.

Bleeding in Early Pregnancy

Some in early pregnancy is perfectly normal and should not concern ​ you. This includes implantation bleeding, which typically occurs within 1 to 2 weeks of the date of conception, and is simply an indication that the newly conceived baby has implanted into your . This bleeding may have a pinkish hue or be brown and spotty and should not last long. You may also experience some bleeding if you have recently engaged in sexual intercourse or if you’ve had a recent vaginal exam. If you experience a lot of bleeding (like a period or worse), this is a cause for concern and could indicate or result in several serious complications. It is important to contact your healthcare provider should you experience any form of bleeding. An occurs when the fertilized egg implants and begins to grow outside of the uterus. This condition can cause life threatening bleeding and requires medical attention immediately. Most of the time, an ectopic pregnancy will reveal itself within the first several weeks of pregnancy. Early signs include light vaginal bleeding and pelvic pain, an upset stomach and vomiting, sharp abdominal cramps, pain on one side of the body, dizziness or weakness, and pain in the shoulder, neck, or rectum. Emergency signs include major pain, with or without ​ severe bleeding. Call your doctor or midwife right away if you have heavy vaginal ​ bleeding with lightheadedness, fainting, or shoulder pain, or if you have severe belly ​ ​ ​ ​ ​ pain, especially on one side. A molar pregnancy, also known as hydatidiform mole, is a rare that ​ can occur during pregnancy if the cells that normally develop into the placenta do not grow normally and develop either completely or partially into grape cluster-like cysts. The baby cannot survive in a molar pregnancy and will most often be miscarried during the early weeks of pregnancy. At first, a molar pregnancy may appear just like a normal pregnancy, but it will soon distinguish itself by showing signs and symptoms, such as dark brown to bright red vaginal bleeding during the ​ first trimester, severe nausea and vomiting, the occasional passage of grape-like cysts from the , and pelvic pressure or pain. A threatened misscarriage occurs when you experience vaginal bleeding within the first 20 weeks of pregnancy, and the chance of miscarrying your baby increases. Another sign of a threatened is pain or cramping in your abdomen or lower back. There may be many reasons why this bleeding could occur, so it is important to contact your healthcare provider as soon as possible to uncover the reason. A miscarriage is the spontaneous loss of a baby before the 20th week of pregnancy, although the majority occur before the 12th week. Miscarriage occurs in about 10 to 20% of all , most often because the baby is not developing properly. Signs and symptoms of a miscarriage might include vaginal spotting or bleeding, pain or cramping in your abdomen or lower back, and fluid or tissue passing from your vagina.

Bleeding in Late Pregnancy

As with bleeding in early pregnancy, bleeding in late pregnancy can occur after sexual intercourse, a vaginal exam, or changes to the . Small amounts of spotting could be normal, especially if any of the above events have occurred. However, heavy bleeding is not considered to be normal and could also indicate that something is wrong with the placenta. Near the very end of pregnancy, that is mucusy could mean that you are losing your mucus plug and that labor is starting soon.

Placental abruption occurs when the normally implanted placenta separates either partially or completely from the uterus before the baby has been delivered. This is an extremely dangerous complication as it will deprive the baby of the nutrients and oxygen he needs to survive, and it can cause life-threatening bleeding for the mother. It often happens suddenly, most frequently in the third trimester. A woman who has a will experience signs and ​ symptoms including potential vaginal bleeding (the bleeding may be hidden inside the uterus behind a pocket of placenta), sudden and sharp abdominal and back pain, uterine tenderness or rigidity, and uterine contractions, which often come one right after another. Placenta previa occurs when the placenta implants into the uterine lining either ​ ​ partially or completely over the cervix, which is the outlet of the uterus. Bleeding often begins spontaneously and can occur all throughout pregnancy and delivery. The main sign of placenta previa is bright red vaginal bleeding without pain during the second half of pregnancy. Some women also have contractions. Most common during the 3rd trimester, placenta previa accounts for about 20% of bleeding during late pregnancy. Vasa previa occurs when the blood vessels which usually safely travel through ​ the umbilical cord from the baby to the mother actually develop and travel through a layer in the amniotic sac and overlie the space between the baby and the cervix instead. This is an extremely dangerous condition because the vessels are not protected by the umbilical cord and are thus at risk of breaking (causing the baby to bleed to death) should the amniotic sac rupture. In many cases, there are no ​ symptoms of vasa previa at all. It often goes undetected until labor, when the fetus is already distressed, or following a stillbirth. If you have any painless vaginal bleeding or bleeding that is very dark (a burgundy red), contact your healthcare provider immediately. The blood of a fetus is naturally lower in oxygen than that of the mother. So if the blood is darker than what is typical, it could indicate that it has come from the fetus and not from you.

Headache

Headaches in early pregnancy could simply be caused by the surge of changing hormones, an increased blood volume, stress, poor posture, and changes of your vision. Lack of sleep, low blood sugar, dehydration, and caffeine withdrawal are other possible causes as well. The degree to which women experience headaches or even migraines varies from woman to woman. Some may have fewer or weaker migraines while others may experience just the opposite. Headaches are not necessarily a danger sign in and of themselves, especially when they are mild and infrequent. The concern comes when headaches are severe and frequent and occur during the third trimester. While this could simply be related to poor posture and the extra weight placed on the body, it could also indicate the development of a serious condition called preeclampsia, which is high blood pressure that can lead to seizures. You should contact your healthcare provider if you experience any of the following symptoms: Headaches that become worse, more persistent, or different ​ than normal, or if your headaches are accompanied by blurry vision, sudden weight gain, pain in the upper right abdomen, and swelling in the hands and face.

Decreased Fetal Movement

As pregnancy advances, you should be feeling your baby move frequently in patterns that are unique to him. If at any point in time (but especially after the 28th week mark) you begin to observe that his patterns are becoming abnormal or are greatly reduced, this may be cause for concern. It is true that as he grows larger, there is less room for him to move around in your uterus, but he should still be moving at least 10 times every hour. If you are not sure this is happening, contact your healthcare provider to let her know. She may tell you to do (or may do it herself) “Fetal Kick Counts.” To do this, eat or drink something cold or sweet, then lie down on your left side and count the number of times you feel your baby move within an hour. Picking a time that he is normally active will help you observe his patterns better and decide whether he is moving less or not. If you don’t feel 10 movements in an hour, repeat the process for another hour. If you still are concerned, contact your healthcare provider for assistance. Decreased fetal movement could be an indication that he is not getting enough oxygen or nutrients, that he is distressed, or that there the amniotic fluid levels are low.

Contractions Prior to 37 Weeks

While Braxton Hicks or “practise” contractions are very normal to experience after 20 weeks but prior to 37 weeks, but these are not typically painful, are not regular, and do not increase in intensity, frequency, or duration at this time. If this is the case, you may be experiencing preterm labor and should contact your healthcare provider right away. Your baby is not fully developed yet, and delivery before 37 weeks increases his risk of complications. Other signs of preterm labor include a constant low, dull backache, a sensation of pelvic or lower abdominal ​ ​ pressure, mild abdominal cramps, vaginal spotting or light bleeding, preterm rupture of membranes (in a gush or a continuous trickle of fluid after the membrane around the baby breaks or tears), cervical change, and a change in type of vaginal discharge (watery, mucus-like or bloody). ​ Abdominal Pain or Tenderness or Burning with Urination

Abdominal pain during pregnancy has many causes, some very common and non-threatening, while others are definitely more serious. Round ligament pain can show itself as a sharp stabbing pain when you change positions, or it can also be an ​ achy, dull, lingering pain. It is caused when the two large ligaments that run from your uterus to your groin are stretched as the uterus grows, causing discomfort. This pain generally occurs during the second trimester, and is considered to be harmless. Gas and constipation can also cause abdominal pain during pregnancy due to increased levels of progesterone. More serious causes of abdominal pain or tenderness include ectopic pregnancy, placental abruption, , miscarriage, , or preeclampsia.

A urinary tract infection is often first noticed when a woman experiences pain, discomfort, and a burning sensation when she urinates. While easily treated during pregnancy, if ignored, a urinary tract infection can cause complications. UTIs can also produce lower abdominal pain. Should you notice pain in your lower back, the sides of your body under your rib cage or above your pelvic bone accompanied by fever, nausea, sweats, or chills, then it is possible that the UTI has spread to your kidneys. If this is the case, seek medical attention as soon as possible.

As described above, preeclampsia is a condition that can occur during pregnancy and is characterized by high blood pressure and protein in the urine after 20 weeks gestation. This can result in seizures if left untreated. Feeling pain in the upper right abdomen right under your ribs, along with nausea, vomiting, and increased pressure on your abdomen can all be signs of preeclampsia.

Swelling

While it is normal to have a small degree of swelling in the hands, feet, and ankles during pregnancy, there are situations in which it could indicate a greater problem, such as preeclampsia. You should never experience severe or rapid swelling, swelling in the morning when you wake up, or abnormal swelling in your face or hands. If swelling is accompanied by preeclampsia, you will have high blood pressure and protein in your urine, the swelling may appear suddenly and increase continually, and your swelling will be mostly concentrated in your hands and on your face. You will be able to indent the swollen areas (This is calle pitting edema.) and will also have the abdominal symptoms described in the paragraph above.

Severe Itching

About 70% of women will experience some degree of itching during pregnancy. In the majority of cases, it has relatively harmless causes, such as eczema, dry skin, or allergies. Itching can however be dangerous if it is severe and localized primarily on the palms of the hands and the soles of the feet. This kind of itching indicates that your liver is malfunctioning and allowing bile salts to accumulate in your body. These bile salts not only cause severe itching, they can cross through the placenta and cause many problems for the baby, including preterm delivery, distress and meconium stained fluid, and in some cases, stillbirth. Although the chance of developing this condition (referred to as cholestasis) is very low (about 1%), it is important to be familiar with the warning signs so that you will be able to differentiate between normal pregnancy itching and abnormal itching. If you have a rash or itching that completely resolves or occurs appears before 20 weeks, you most likely do not have cholestasis.

Ruptured Membranes Prior to 37 Weeks

The amniotic sac/membranes should not rupture before you have reached 37 weeks of pregnancy. This is because your baby’s lungs are not mature before this point, and delivery could mean that he will have more complications and need more medical interventions than if he were born closer to 40 weeks gestation. If you notice either a slow, but constant trickle of fluid or a gush of fluid leaking before you reach 37 weeks, contact your healthcare provider right away.

Blurred Vision

Although sometimes frightening, blurry vision is actually a fairly common ​ complaint during pregnancy, often due to changing hormones and fluid retention. It is important to let your doctor or midwife know about any changes to your vision, especially if you notice changes that do not go away, floaters, double vision, or flashing lights. Vision that is blurred or changed in any way could be an indication of gestational diabetes and high blood pressure or preeclampsia.

Severe Nausea and Vomiting

Although very common during the first trimester, nausea and vomiting is usually perfectly normal and harmless. However, if it becomes severe (You can’t hold any food or drink down, are vomiting more than 20 times a day, or are losing rather than gaining weight.) or persists into the 3rd or 4th month, the risk for complications rises. This kind of nausea and vomiting is called hyperemesis gravidarum, and is not something to be ignored. You are at risk for developing dangerous electrolyte imbalance and malnourishment, and your baby’s growth and development will be hindered if you do not get help or are unable to get nourishment into you some other way. It is very important that you let your doctor or midwife know if you are experiencing debilitating nausea and vomiting.