Severe Pregnancy Symptoms And When To Seek Help

  • Stephanie Leadbitter MSc Cancer Biology & Radiotherapy Physics, BSc (Hons) Biomedical Science, University of Manchester, UK

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Introduction

Is it normal to experience days when your body feels out of control during pregnancy? According to the American College of Obstetricians and Gynecologists, pregnancy can bring uncomfortable symptoms due to hormone changes and the pressure of a growing baby. Should you call the doctor if you experience these symptoms?

Common pregnancy symptoms

Pregnancy brings various challenges and symptoms, often concerning expectant mothers. These symptoms, including nausea, vomiting, pelvic pain, girdle pain, back pain, sleep disturbances, and depression, are common yet sometimes underreported and undertreated, possibly due to their frequent occurrence or the perception that they are normal, self-limiting aspects of pregnancy.

It's crucial to recognize that every pregnancy is unique, with individuals experiencing different symptoms at various times. Comparing one person's pregnancy to another's isn't advisable because pregnancy symptoms can vary significantly.

Here are some common early pregnancy symptoms:

  1. Missed Period: A missed period is a primary indicator of pregnancy. Conception triggers hormonal changes that halt ovulation and menstruation. However, it's worth noting that missed periods can also result from stress, excessive exercise, dietary factors, hormone imbalances, and other causes of irregular menstruation.
  2. Increased Urination: Pregnancy leads to a greater blood volume in your body. This extra blood prompts your kidneys to filter waste, which is eliminated as urine. Consequently, you may find yourself needing to urinate more frequently.
  3. Fatigue: Early pregnancy often brings extreme tiredness due to elevated levels of the hormone progesterone. While fatigue tends to improve in the second trimester, it may return in the third trimester for some individuals.
  4. Morning Sickness: Despite its name, morning sickness can occur at any time of the day or night. Nausea can start as early as two weeks into pregnancy. While not everyone experiences vomiting, about half of pregnant individuals do. Severe nausea and dehydration, known as hyperemesis gravidarum, may require medical attention.
  5. Breast Changes: During pregnancy, your breasts may become sensitive to touch, similar to premenstrual tenderness but more pronounced. The areolas around your nipples might darken and enlarge. This soreness is temporary and diminishes as your body adjusts to increased hormones. You may also notice breast enlargement and tighter bras.

Remember that the only definitive way to confirm pregnancy is through a pregnancy test or an ultrasound conducted by your healthcare provider.1

Less common signs of early pregnancy

In addition to the more typical symptoms, there are some less obvious signs and symptoms of pregnancy that you might encounter during the first trimester:

  1. Moodiness: The influx of hormones in early pregnancy can lead to heightened emotions, making you more emotional and prone to mood swings.
  2. Bloating: Hormonal changes during early pregnancy can result in a bloated feeling akin to how you might feel at the onset of your menstrual period.
  3. Light Spotting: Light spotting could be among the initial signs of pregnancy. Referred to as implantation bleeding, it occurs when the fertilized egg attaches to the uterine lining, typically about 10 to 14 days after conception. This spotting often coincides with the expected time of a menstrual period but is not experienced by all women.
  4. Cramping: Some women may experience mild uterine cramping early in their pregnancy.
  5. Constipation: Hormonal shifts can slow down your digestive system, potentially leading to constipation.
  6. Food Aversions: Pregnancy can heighten your sensitivity to certain odours and alter your sense of taste. These changes in food preferences are attributed to hormonal fluctuations.
  7. Nasal Congestion: Rising hormone levels and increased blood production can cause the mucous membranes in your nose to swell, dry out, and become more susceptible to bleeding. This can result in a stuffy or runny nose.2

Pregnancy symptoms can vary widely from person to person, and not everyone will experience these less common signs. If you suspect you may be pregnant or are experiencing unusual symptoms, consult with your healthcare provider for guidance and confirmation.

Monitoring during pregnancy

Throughout your pregnancy, your healthcare provider may recommend various screenings, tests, and imaging procedures to assess the health of your baby and ensure optimal prenatal care and development.3

Genetic screening:

Genetic testing is advised during pregnancy if you or your partner has a family history of genetic disorders or if there's been a previous case of genetic abnormalities in your family. Examples of disorders that can be diagnosed include cystic fibrosis, Duchenne muscular dystrophy, haemophilia A, polycystic kidney disease, and sickle cell disease. Screening methods include the Alpha-fetoprotein (AFP) test, amniocentesis, chorionic villus sampling, cell-free foetal DNA testing, percutaneous umbilical blood sampling, and ultrasound scans.

First-trimester prenatal screening tests:

First-trimester screening combines foetal ultrasound and maternal blood tests to assess the risk of certain birth defects. It involves:

  • Ultrasound for foetal nuchal translucency.
  • Ultrasound for foetal nasal bone determination.
  • Maternal serum (blood) tests measuring pregnancy-associated plasma protein A and Human chorionic gonadotropin. Abnormal results may indicate an increased risk of chromosomal abnormalities like Down syndrome or trisomy 18.

Second-trimester prenatal screening tests:

Second-trimester screening includes multiple marker blood tests taken between 15 and 20 weeks of pregnancy. Markers include AFP screening, Estriol, Inhibin, and Human chorionic gonadotropin. Abnormal results may necessitate further testing, such as ultrasound and amniocentesis, for an accurate diagnosis.

Ultrasound:

Ultrasound scans use high-frequency sound waves to create images of internal organs. It's used during pregnancy to monitor foetal growth and confirm the due date.

Amniocentesis

Amniocentesis involves sampling the amniotic fluid around the foetus. It's used to diagnose chromosomal disorders and open neural tube defects like spina bifida.

Foetal monitoring:

In late pregnancy and during labour, your doctor may opt for foetal monitoring to assess the foetal heart rate and other vital functions. Foetal heart rate monitoring involves checking the rate and rhythm of the foetal heartbeat, which typically ranges between 120 and 160 beats per minute. This rate can fluctuate in response to conditions in the uterus. An abnormal foetal heart rate or pattern may suggest inadequate oxygen supply to the foetus or other issues, possibly necessitating an emergency caesarean delivery.

  • Methods of Foetal Heart Rate Monitoring: Foetal heart rate monitoring can be performed in various ways. The most basic method involves using a fetoscope, a stethoscope-like instrument, to listen to the foetal heartbeat. Alternatively, a hand-held Doppler device is employed during prenatal visits to count the foetal heart rate. During labour, continuous electronic foetal monitoring is commonly used. The standard procedure for electronic foetal monitoring typically involves:
    • Applying gel to your abdomen as a medium for the ultrasound transducer.
    • Attach the ultrasound transducer to your abdomen using straps to transmit the foetal heartbeat to a recorder.
    • Displaying the foetal heart rate on a screen and printing it onto paper.
    • Recording contractions during labour using an external tocodynamometer, a monitoring device placed over the top of the uterus with a belt.
  • Internal Foetal Monitoring: When Is It Necessary?: In certain cases, internal foetal monitoring becomes necessary to obtain a more precise foetal heart rate reading. To perform internal monitoring, your amniotic fluid (bag of waters) must be broken, and your cervix should be partially dilated. This procedure entails inserting an electrode through the dilated cervix and attaching it to the foetal scalp to monitor the foetal heart rate internally.

Glucose testing:

A glucose challenge test, conducted between 24 and 28 weeks of pregnancy, measures blood sugar levels. Abnormal results may suggest gestational diabetes.

These monitoring procedures are essential for ensuring a healthy pregnancy and addressing any potential issues promptly. Your healthcare provider will guide you through the necessary tests based on your individual circumstances.

Urgent maternal warning signs during pregnancy and post-delivery

Be vigilant for critical maternal symptoms during pregnancy and in the year after childbirth. Seek immediate medical attention if you experience any of the following symptoms, as they may indicate a life-threatening situation:4

Persistent or worsening headache:

  • Feels like the most severe headache you've ever had
  • Persists despite medication and adequate fluid intake
  • Begins suddenly with intense pain, often on one side of your head above your ear
  • Accompanied by blurred vision or dizziness

Dizziness or fainting:

  • You faint or lose consciousness
  • Sustained dizziness or lightheadedness over several days
  • Experiencing memory gaps or blackouts

Changes in vision:

  • Seeing flashes of light or bright spots
  • Developing blind spots or temporary loss of vision
  • Blurry vision, difficulty focusing, or double vision

Fever of 38°C (100.4°F) or higher:

  • A temperature exceeding 100.4°F (38°C)

Extreme swelling of hands or face:

  • Swelling in the hands hindering finger movement or ring-wearing
  • Facial swelling impedes eye-opening, resulting in puffiness
  • Swollen lips, mouth, or loss of sensation, distinct from typical pregnancy-related swelling

Thoughts of harming yourself or your baby:

  • Contemplation of self-harm due to feelings of extreme sadness, hopelessness, or lack of control
  • Overwhelming and persistent anxiety
  • Unwanted and distressing thoughts of harming your baby

Breathing difficulty:

  • Sudden or progressive shortness of breath, as if you can't inhale sufficiently
  • Tightness in the throat or chest
  • Breathing troubles while lying flat, necessitating propping your head with pillows

Chest pain or rapid heartbeat:

  • Chest pain, which resembles tightness or pressure in the centre
  • Pain radiating to the back, neck, or arm
  • Altered heartbeat, including rapid, irregular, or skipped beats
  • Dizziness, faintness, or disorientation during these episodes

Severe nausea and vomiting:

  • Extreme nausea beyond typical early pregnancy queasiness
  • Inability to ingest fluids for more than 8 hours or solid food for over 24 hours
  • Vomiting resulting in dehydration, dry mouth, headaches, confusion, fever, or dizziness

Persistent and severe belly pain:

  • Sharp, stabbing, or cramp-like abdominal pain which will not subside
  • Sudden, intense belly pain or worsening pain over time
  • Severe chest, shoulder, or back pain

Baby's reduced or halted movement during pregnancy:

  • Perception that your baby's movements have diminished or ceased

Vaginal bleeding or fluid leakage during pregnancy:

  • Bleeding more than spotting, resembling a period
  • Vaginal fluid leakage
  • Vaginal discharge with a foul odour

Vaginal dleeding or discharge after pregnancy:

  • Heavy bleeding, saturating one or more pads in an hour
  • Passing clots larger than an egg or passing tissue
  • Vaginal discharge with an unpleasant odour

Severe swelling, redness, or pain in leg or arm:

  • Occuring at any point during pregnancy or within 6 weeks after birth
  • Swelling, tenderness, or pain in one leg, especially the calf
  • Potential redness, warmth, and swelling in the affected area
  • Pain, tenderness, or swelling in one arm, typically on one side of the body

Overwhelming fatigue:

  • Sudden, profound weakness and fatigue, distinct from chronic fatigue
  • Inadequate energy to carry out daily activities
  • Persistent tiredness despite ample sleep
  • Difficulty tending to your baby's needs and feelings of postpartum sadness

This list isn't exhaustive. If you sense something is amiss or are unsure about the severity of your symptoms, consult your healthcare provider, informing them of your pregnancy or recent childbirth within the last year.

Summary

  • Pregnancy can bring uncomfortable symptoms due to hormonal changes and the pressure of a growing baby, which can vary widely between individuals.
  • Common early pregnancy symptoms include missed periods (though they can be caused by other factors), increased urination, fatigue, morning sickness, breast changes, and more.
  • Less common signs of early pregnancy can include moodiness, bloating, light spotting, cramping, food aversions, and nasal congestion.
  • Monitoring during pregnancy involves various tests and screenings to ensure the health of both the mother and the baby, including genetic screening, ultrasound scans, amniocentesis, glucose testing, and foetal monitoring.
  • Urgent maternal warning signs during pregnancy and post-delivery include severe headache, dizziness, changes in vision, fever, extreme swelling, thoughts of self-harm or harm to the baby, breathing difficulty, chest pain, severe nausea, severe belly pain, reduced foetal movement, vaginal bleeding or fluid leakage, severe swelling or pain in the leg or arm, and overwhelming fatigue.
  • If any of these warning signs are experienced, it is crucial to seek immediate medical attention to address potential life-threatening situations during pregnancy or post-delivery.

References 

  1. Lutterodt MC, Kähler P, Kragstrup J, et al. Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice. BJGP Open; 2019, 3. Available from: https://bjgpopen.org/content/3/4/bjgpopen19X101674.
  2. Bustos M, Venkataramanan R, Caritis S. Nausea and vomiting of pregnancy - What’s new? Auton Neurosci 2017; 202: 62–72. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107351.
  3. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract 1993; 43: 245–248. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1372422.
  4. Sapra KJ, Buck Louis GM, Sundaram R, et al. Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort. Hum Reprod 2016; 31: 887–896. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791918.

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