A woman’s body typically undergoes a wide range of changes during pregnancy, which often leads to complaints about discomfort and pain (1). As your body adapts to accommodate your growing baby, you can, unfortunately, expect to experience various discomforts such as leg cramps, constipation, heartburn, hemorrhoids, morning sickness or nausea, mood changes, feeling faint or tired, swollen hands, feet or ankles, wrist pains, abdominal pains and back pains. Many of these symptoms are benign and temporary and can be alleviated by adopting a suitable routine of rest, nutrition, exercise and relaxation (2). However, there are seven pregnancy warning signs that you should not ignore, and if you experience them, you should seek medical attention immediately.
Although most women experience relatively uneventful and predictable pregnancies and childbirth, each expectant mother is at risk of experiencing abrupt and unexpected complications (3). Each expectant mother and her family should thus be able to differentiate between pregnancy symptoms that require immediate medical attention and those that can be addressed during the upcoming prenatal visit. A clear understanding of what is normal, what is unusual and what constitutes a danger sign is crucial in preventing any adverse outcomes to the expectant mother and unborn child.
Family members should have a shared understanding of a clear emergency plan (which includes a transport plan to the nearest health facility) that can be acted upon if any of the following pregnancy warning signs emerge:
Pregnancy Warning Signs
Bleeding in a relatively common occurrence in many pregnancies; The Royal Women’s Hospital in Australia estimates that one in four women will bleed in early pregnancy, with a majority of them eventually giving birth to a healthy baby (4). Any bleeding during pregnancy can nevertheless be a dangerous sign. As such, you should always contact a health professional once bleeding occurs, so that a suitable investigation and treatment plan can be initiated.
During the very early stages of your pregnancy, it is common to experience harmless light bleeding (known as ‘spotting’), which occurs when the developing embryo plants itself in the wall of your womb (i.e. implantation bleeding) (5). This typically occurs at the time that your first period after conception should have begun. Any early bleeding that did not lead to a miscarriage would not have caused any harm on your baby. The bleeding may also be caused by factors that are unrelated to the pregnancy, such as benign polyps, an infection or changes in the cervix.
Vaginal bleeding that occurs within the first 12 weeks of pregnancy may be a sign of miscarriage or ectopic pregnancy. If a miscarriage is the cause of the bleeding, no course of treatment or therapy can prevent it from taking place. Meeting a health professional is nevertheless required; urgent care may be necessary is the bleeding is heavy, and if it is accompanied by large clots and crampy pains (6).
Another possible cause of vaginal bleeding is an ectopic pregnancy. This occurs when the fetus is growing outside the uterus (commonly in the fallopian tube) (7). Ectopic pregnancies are very rare (between one to two percent of all pregnancies), but can significantly harm your health and fertility. As such, any experience of severe pain and vaginal bleeding should be followed by a consultation with a health professional.
The presence of vaginal bleeding and painful contractions during the third trimester could also be symptoms of a placental abruption, which occurs when the placenta detaches from the wall of the uterus too early (8). The amount of bleeding depends on the extent to which the placenta separates from the uterus wall; heavy bleeding and belly pains often ensues when more than half of the placenta detaches. Placenta abruption can cause serious complications for the baby (e.g. growth restriction due to the lack of oxygen and nutrients), and can even be fatal. The mother, on the other hand, can suffer from significant blood loss.
- Severe Nausea and Vomiting
Nausea and vomiting are common symptoms during pregnancy; an estimated 70–80% of pregnant women experience it, typically during the first trimester (9). However, a much smaller percentage of pregnant women (0.3–2%) experience prolonged nausea and vomiting until delivery, which may be caused by hyperemesis gravidarum (HG): a pregnancy complication that can lead to dehydration, nutritional deficiency, fluid, electrolyte and acid-base imbalance, weight loss and significant maternal and fetal morbidity if left untreated (10).
Studies have also found an increased risk for intrauterine growth retardation in women with severe nausea and vomiting during pregnancy, alongside an increased risk for low birth weight in women (this is likely due to the adverse effects of nausea and vomiting on maternal nutrition).
- Reduced Fetal Movement
A mother’s perception of fetal movement is one of the initial indicators of fetal life, and a sign of the health and wellbeing of the fetus’ central nervous and musculoskeletal systems. Fetal movement usually becomes perceivable during 18 and 20 weeks of gestation, as a discrete kick, flutter, swish or roll (11). A sudden change or significant reduction in the pattern of fetal movement can be a major clinical sign – possibly indicating an impending fetal death.
55% of pregnant mothers who experienced a stillbirth perceived a reduction in fetal movement before a formal diagnosis, while the lack of an appropriate response from clinicians to maternal reporting of reduced fetal movement was noted to be a common contributory factor in incidents of stillbirth in Norway and the UK (12).
As such, expectant mothers should be aware that while fetal movements typically plateau at 32 weeks of gestation, there is usually no reduction in the frequency of fetal movements in the late third trimester (13). They should thus be perceptive of fetal movements up to and including the onset of labor; any atypical decrease or cessation of fetal movements should be reported to a medical professional or a nurse in her maternity unit.
- High Blood Pressure
Hypertension or high blood pressure may develop after 20 weeks of gestation as a one-off event, or as a component of a more complex condition such as pre-eclampsia (14). Pre-eclampsia occurs in one in ten pregnancies (typically during the second half of the pregnancy), or during the first few days after the birth), but usually involves milder forms of its various symptoms: high blood pressure, sudden blurred vision, protein in urine and sudden excessive swelling of the face, hands and feet (15). In certain cases, however, it can lead to serious complications, such as a reduction in blood supply to the placenta (which stifles the baby’s growth) and convulsions (eclampsia). It can also aggravate and affect other parts of the body such as the liver and blood clotting system (HELLP syndrome), which calls for urgent medical attention for the mother and baby.
- Acute Abdominal Pain
Abdominal pain is very common during pregnancy (due to the enlargement of the uterus, changes in fetal position, and fetal movements), but a thorough medical evaluation is necessary if it persists past the mid-pregnancy stage. Any localized, abrupt, constant, or severe abdominal pain that is accompanied by nausea and vomiting, vaginal bleeding, or fever is a warning sign that should not be ignored (16). These symptoms should be thoroughly investigated for the possibility of pregnancy complications (e.g. placental abruption and preterm labor), as well as more severe problems that are unrelated to the pregnancy (e.g. gallbladder disease and appendicitis). An obstetric specialist should thus be consulted if acute and severe abdominal pain persists throughout the pregnancy.
- Pathological Vaginal Discharge
Vaginal discharge is a common symptom that affects 50% of pregnant women (as well as one-third of women of childbearing age). It arises from the physiological secretions of the cervical and Bartholin’s glands and desquamation of vaginal epithelial cells, as a result of bacterial action in the vagina (17). Vaginal discharge is considered to be abnormal when it is more abundant and involves an unpleasant vaginal odor; pathological vaginal discharge is often accompanied by vulval or vaginal itching, dysuria, and/or dyspareunia (18).
Pathological vaginal discharge is commonly caused by sexually transmitted infections (STIs) and can lead to serious harm to pregnant women and their children (in the form of prematurity, low birth weight, chorioamnionitis, postpartum endometritis, and postcesarean wound infection) (19). The three diseases that are frequently associated with vaginal discharge include Bacterial Vaginosis (caused by an overgrowth of bacteria normally found in the vagina), trichomoniasis (caused by T. vaginalis), and candidiasis (usually caused by Candida albicans) (20).
- Flu Symptoms
Flu is far likelier to lead to severe illness in pregnant women, since the changes in the heart, lungs, and immune system during pregnancy makes pregnant women more vulnerable (21). Pregnant women are at risk for hospitalization and even death, while their baby may become subject to premature delivery, as well as birth defects.
As such, the emergence of any flu symptoms (e.g. fever, cough, sore throat, a runny nose or stuffy nose, muscle or body aches, headaches, and fatigue) merits an immediate call to the doctor. If administered in time, antiviral drugs (e.g. oral oseltamivir) can treat the flu and prevent any serious flu complications. The Centre for Disease Control (CDC) recommends prompt treatment for pregnant women with an influenza infection (or who are suspected of an influenza infection) since they are at a high risk of serious flu complications (22).
Do’s and Don’ts
- Do have a clear plan for getting to hospital if you experience any pregnancy warning signs
- Ensure family members know the plan and are prepared
- Do contact your doctor or midwife immediately if you are bothered or concerned about any unusual or discomforting physical changes.
- Be vigilant to your body and respond promptly to any unexpected complication
- Eat well, relax, and rest
- Don’t worry too much. Most pregnancies go by without incident and you mustn’t stress too much as stress itself is bad for the baby.