More Serious Problems During Pregnancy

Slow-growing babies

Many of the tests in pregnancy check the growth of your baby. If you have previously had a very small baby, or if you smoke heavily, the midwives and doctors will already be monitoring your pregnancy closely. Blood pressure checks may also pick up signs of trouble. If there is concern about your baby's health, further tests may be carried out and more frequent monitoring of your baby may be recommended.

In the last weeks of pregnancy you may also be asked to keep track of your baby's movements. If you notice your baby's movements becoming less frequent or slowing down, or if they stop, contact your midwife or doctor immediately.

If tests show that your baby is not growing well in the womb, early delivery by induction of labour or Caesarean section may be recommended.

High blood pressure and pre-eclampsia

During pregnancy your blood pressure will be checked at every antenatal appointment. This is because a rise in blood pressure can be the first sign of a condition known as pre-eclampsia - often called pregnancy-induced hypertension (PIH) or pre-eclamptic toxaemia (PET) - which can run in families and affects 10% of pregnancies. Your urine will also be checked for protein.

If you do have pre-eclampsia, you will probably feel perfectly well. Some women experience symptoms such as headaches, visual disturbances, swelling and abdominal pain. Pre-eclampsia can still be severe, however, without any symptoms at all. Although most cases are mild and cause no trouble, it can get worse and be serious for both mother and baby. It can cause fits in the mother (Eclampsia) and affect the baby's growth, and be life-threatening if left untreated.

That is why routine antenatal checks are so important.

Pre-eclampsia usually happens towards the end of pregnancy, but problems can occur earlier. Rarely, it can happen after the birth. The earlier in pregnancy it starts, the more severe it is likely to be. If it does get worse, the treatment ranges from rest at home or in hospital, drugs to lower the high blood pressure or, occasionally early delivery of the baby.

Vaginal bleeding

Bleeding from the vagina at any time in pregnancy can be a danger signal. In early pregnancy, bleeding may be a sign of an ectopic pregnancy or a miscarriage, (link to When pregnancy goes wrong) although many women who bleed at this time go on to have normal and successful pregnancies. If you have bleeding with pain contact your GP straight away.

Bleeding after about five months may be a sign that the placenta is implanted in the lower part of the uterus (placenta praevia) or that it has started to separate from the uterus (placental abruption). Both of these can be dangerous for you and the baby, so contact your midwife or doctor immediately.

The cells on the surface of the cervix often change in pregnancy and make it more likely to bleed, particularly after intercourse. This is called a cervical erosion. Vaginal infections can also cause a small amount of vaginal bleeding.

Some causes of vaginal bleeding are more serious than others, so it's important to find the cause straight away. The most common sort of bleeding in late pregnancy is the small amount of blood mixed with mucus, known as a 'show'. This is a sign that the cervix is changing and becoming ready for labour to start. It may happen a few days before contractions start or during labour itself. You should always report this to your doctor or midwife as soon as it occurs.

Severe itching and obstetric cholestasis

Although itching is very common in normal pregnancy, severe generalised itching, without a rash, particularly in the last four months of pregnancy, may be the only sign of an uncommon condition called obstetric cholestasis. This is a potentially dangerous liver disorder which seems to run in families, although it can occur without any family history. It is important to contact your doctor if you have troublesome itching because obstetric cholestasis may lead to premature labour, stillbirth or serious health problems for the baby, and to an increased risk of maternal haemorrhage after the delivery.

Other symptoms:

You should contact your GP if you have a sudden 'acute' illness like diarrhoea, vomiting, abdominal pain or a high fever.

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• Pregnancy, Parenting & Baby Care
• Women's Health