The vast majority of pregnancies go to term without problems and a healthy baby is born at the end. Occasionally pregnant mothers develop some complications that need more intensive care or regular review by your GP, midwife or hospital obstetrician. This section describes some of these conditions so that you might recognise warning signs if they occur and seek early advice.

1. Pre-eclampsia
2. Bleeding during early pregnancy
3. Bleeding during later pregnancy
4. Bile obstruction and jaundice
5. Premature rupture of membranes ("waters breaking")
6. Foetal movements

Pre-eclampsia

Pre-eclampsia may occur in the second half of pregnancy, and is characterised by raised blood pressure, usually with protein in your urine and often with fluid accumulating in soft tissues (e.g. ankle, leg, abdominal and hand swelling). Women who are developing pre-eclampsia may experience headaches, rapid weight gain (more than 1 kg in a week or ½-1 kg per day), fever, chest or upper abdominal pains, vomiting and visual disturbances. They feel unwell, not dissimilar to a viral infection.

If untreated pre-eclampsia can develop into muscle irritability, twitching, epileptic fits and ultimately may result in a stroke. It is one of the major causes of maternal mortality and we take it very seriously. If we suspect you may be developing pre-eclampsia, you will be admitted to hospital. Pre-eclampsia settles after delivery and if you are in danger, your baby will be delivered early.

Pre-eclampsia is the principal reason that blood pressure is monitored so closely in the ante-natal period. Arbitrarily, the cut off for normal blood pressure is set at 140/90 mmHg with high blood pressure defined as being above this. However, your doctor or midwife will be taking into consideration your normal level of blood pressure at previous visits. This might vary a little from visit to visit and a difference of 10-20 mmHg may not be important but a rise of 30/20 mmHg above your booking blood pressure is probably significant. We also check your urine for protein at each visit and that is why it is important to provide us with a fresh specimen at each attendance.

Pre-eclampsia is more common in first pregnancies and if your first pregnancy was uncomplicated it is much less likely that you will develop this problem subsequently. If you had pre-eclampsia in a previous pregnancy or there is a family history of this condition you are at greater risk. Other risk factors include age less than 20 or over 35 years, previous high blood pressure or kidney disease, multiple pregnancy (e.g. you are pregnant with twins) and small stature (height less than 155cm, 5'1"). Most women, of course, have a healthy pregnancy but it is useful to be aware of the danger signs.

Bleeding during early pregnancy

Bleeding early in pregnancy may be a sign of a threatened miscarriage. Up to about 24 weeks there is nothing that can be done to save the baby if you are miscarrying. Most often it is nature's way of ending a pregnancy where there is something wrong, but may be triggered by other factors such as infection in about 10% of patients. However, some light bleeding without period like pains does not necessarily mean that your baby is unwell; 75% of threatened miscarriages settle. It is not unusual to have a small amount of bleeding early on that settles quickly. If accompanied by passing of clots and severe period like pains it is more likely to be a miscarriage.

You need to check that your blood group is Rhesus positive. This will be shown on your hospital co-op card or notes having been checked with your booking visit blood test. We will have the information on the surgery computer if the blood test has been taken. If necessary, a blood group test can be arranged quickly at the hospital. If your blood group is Rhesus negative then you will require and injection of Anti-D antibodies if you are more than 12 weeks pregnant. This is to prevent sensitisation to your baby's blood. This can cause problems in this and later pregnancies if not treated.

Having a miscarriage is never pleasant. The bleeding can be heavy and uncomfortable and it is often sensible to be admitted to hospital to ensure that the process is complete and the womb is empty. Otherwise you may have problems with continued bleeding or infection.

Bleeding within 2-3 weeks of a missed period may represent an ectopic pregnancy (a pregnancy developing outside the womb in the fallopian tube). This must be treated as an emergency and you should seek medical advice immediately.

Bleeding during later pregnancy

Bleeding later in pregnancy (28 weeks or more) may be a sign of a low lying placenta or of the placenta separating from the womb. There are other causes, such as polyps at the cervix or inflammation in the vagina or cervix. Either way you should seek medical advice so that the cause can be investigated and complications such as severe bleeding or damage to your baby avoided.

When you are ready to deliver, you may have a "show". This is the plug of mucus that has been blocking the entrance to the womb throughout the pregnancy. When the pregnancy is near to delivering this plug comes away and you may see some blood stained mucous discharge from the vagina. This is not a problem but you should mention it to your midwife or doctor.

Bile obstruction and jaundice

Itching of the skin sometimes occurs in pregnancy; it can be quite intense. Usually this is innocent and affects the abdomen and limbs. It may respond to moisturising creams. Occasionally itching may be a symptom of liver problems. You should mention any general itchiness to your doctor or midwife so that if necessary a blood test to check your liver can be arranged and if appropriate a referral to hospital made. If there is evidence of jaundice (yellow skin) then your baby may be delivered early e.g. at 37 weeks if there are signs that it is not well.

There are other, very rare causes of jaundice in pregnancy. They often are accompanied by abdominal pain, headaches and vomiting and you feel unwell. As always, if you are worried, speak your doctor or midwife to discuss any problems.

Premature rupture of membranes ("waters breaking")

If the membranes around the baby rupture you will leak fluid through the vagina. 80% of the time this happens women will go into labour. However, women whose waters have broken and have not gone into labour need to be seen at the hospital because the baby is at risk of infection from the vagina and labour may need to be induced. Do speak to your doctor or midwife if you are concerned.

Foetal movements

Women first feel the developing baby moving between 16 and 22 weeks of pregnancy. The first movements might be described like a bubbling or wind in the lower abdomen, or like having a small fish inside you. Women in second or subsequent pregnancies usually feel the movements earlier. Later on you will feel the baby kicking. Towards the end of pregnancy the kicks sometimes become less frequent. However, a sensible rule of thumb is to expect ten movements, or kicks, before 9.00PM. If necessary, keep a "Kick to ten" chart, marking off movements as they happen during the day. If you feel that your baby has not been moving during the past 12-24 hours then it is sensible to either speak to your doctor or midwife or telephone one of the midwives at the delivery suite (the number will be on your hospital co-op card). If necessary a monitoring of your baby's heart can be arranged to check that it is OK.