What to be Vigilant for During Pregnancy?

29th, January 2020

Whether it is your first pregnancy or your third, it can be quite a confusing time with so many things to look out for. We spoke to Dr Laura Ringland, one of our Private GP’s on what to be vigilant for during pregnancy helping you and your baby have a safe and healthy 9 months.

Signs & Symptoms to look out for during pregnancy

These can include: 

  • Sudden increase in swelling of face, hands, feet, legs and ankles
  • Excessive weight gain (due to fluid retention)
  • Upper abdominal pain
  • Severe nausea and vomiting
  • Headaches
  • Vision changes (blurred vision, flashing lights, floaters)

The above symptoms, some of which can seem benign in pregnancy can be due to preeclampsia, a condition marked by high blood pressure in women who haven't had high blood pressure before.
 
If you notice any symptoms of pre-eclampsia, get medical advice immediately. Preeclampsia can occur as early as 20 weeks of pregnancy, but that is rare; signs and symptoms usually occur later in pregnancy. In a small number of cases, the signs and symptoms may develop in the 6 weeks after birth.
 
It is important to note that you can also have preeclampsia and not have any symptoms which is why it's important to see your obstetrician/midwife at the recommended intervals when you will have routine blood pressure and urine checks. Preeclampsia initially causes high blood pressure and protein in the urine (proteinuria).
 
Risk factors for preeclampsia include;

  • Pre-existing diabetes, kidney disease, high blood pressure, lupus or antiphospholipid syndrome.
  • Previous preeclampsia (16% chance of recurrence in subsequent pregnancies).
  • First pregnancy
  • 10 years + since last pregnancy
  • Family history of pre-eclampsia e.g. in mum or sister.
  • Age < 40
  • BMI >35 (obese) at start of pregnancy
  • Multiple pregnancy (e.g. twins or triplets)

Although rare, complications can develop if pre-eclampsia isn't diagnosed and monitored and so early recognition is key. The earlier pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby.

Potential complications for the mother

These can include:
 
Fits (eclampsia) - Of those who have eclampsia, around 1 in 50 will die from the condition. Unborn babies can suffocate during a seizure and 1 in 14 may die. Thankfully eclampsia is quite rare in the UK, with an estimated 1 case for every 4,000 pregnancies.
 
HELLP syndrome - This is a rare liver and blood clotting disorder. It is most likely to occur immediately after delivery but can occur during pregnancy and if it does, the only treatment is to deliver the baby.
 
Stroke - The blood supply to the brain can be disturbed due to high blood pressure. This is known as a cerebral (brain) haemorrhage, or stroke.
 
Organ damage - Pulmonary oedema (fluid on lungs), kidney failure and liver failure can occur.
 
DIC - (disseminated intravascular coagulation) causing bleeding or blood clots.

Potential complications for the baby

These can include: 
 
Low birth weight - babies of women with pre-eclampsia may grow more slowly in the womb than normal as the condition reduces the amount of nutrients and oxygen passed on by the mother.
 
Preterm delivery by induction or c section - If pre-eclampsia is severe, a baby may need to be delivered before they are fully developed. This can lead to serious complications, such as breathing difficulties caused by the lungs not being fully developed.
 
Death - Some babies of women with pre-eclampsia can die in the womb and be stillborn.
Given the potential seriousness of this condition, do not hesitate to contact your GP / midwife / obstetrician / foetal assessment unit or emergency department urgently should you develop any or a combination of the signs and symptoms of preeclampsia. There should be a list of emergency contact numbers in your green folder.

UTI’s during pregnancy

Urinary Tract Infections are common in pregnancy (overall incidence of approximately 8%). This is partly due to physical changes which occur to our urogenital tract when pregnant. Sexual activity in women has also been established as a significant risk factor for UTIs as it results in increased bacterial invasion. UTIs can be entirely asymptomatic (without symptoms).
 
Asymptomatic bacteriuria (bacteria in urine)/UTIs during pregnancy increase the risk of developing pyelonephritis. Pyelonephritis occurs when the infection travels up to the kidney and when it occurs in pregnancy, is associated with an increased risk of foetal loss, premature delivery and low birth weight babies.
 
In order to detect asymptomatic bacteriuria/UTIs and to prevent these complications, you should have your urine checked early in pregnancy and at each of your antenatal visits. It is important that you see your midwife or GP promptly if you develop pain when you pass urine, are passing urine more often, have pain in your lower tummy, blood in your urine or a high temperature.
 
Seek urgent medical attention (attend local emergency department) if you develop the symptoms mentioned above as well as/or pain in your lower back/side over your kidney, a high temperature, nausea, vomiting, diarrhoea or blood in your urine; this can represent a more serious infection/pyelonephritis and warrants urgent antibiotics.

If you have any concerns, our team of specialist pregnancy consultants will be available to guide you through your pregnancy at our Private Pregnancy Clinic
 
If you would like to book an appointment, you can do so online or by contacting 028 9066 7878.


Dr Laura Ringland

Private GP, Kingsbridge Private Hospital, Belfast and Maypole Clinic, Holywood.


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