20 ADVANCE FOR NURSES • GREATER PHILADELPHIA • JUNE 4, 2001

P A T I E N T H A N D O U T

Warning Signs of Problem Pregnancy

BLEEDING

Bleeding at any time during the pregnancy should beimmediately reported to your health care provider. Bleed-ing can be a sign of a potential spontaneous abortion (mis-carriage) in the first trimester. In the second and thirdtrimesters, it can be a sign of abnormal placental (after-birth) implantation to the uterine wall, or premature sep-aration of the placenta. Bleeding can also occur after in-tercourse through pressure on or irritation of the vaginaand/or cervix.

EXCESSIVE VOMITING

Many women in the first trimester experience what iscommonly called “morning sickness.” This is usually dueto hormones produced/released during pregnancy influ-encing the gastrointestinal tract. Excessive vomiting canlead to weight loss and an imbalance in your electrolytesand should be reported to your health care provider sothat your weight, and possibly your blood count, can bemonitored. Do not assume that vomiting is a normal oc-currence of pregnancy if it interferes with your normal day-to-day activities.

HEADACHES, BLURRED VISION,

EPIGASTRIC PAIN AND SWELLING

Put all of these symptoms together and you may havewhat used to be called “toxemia of pregnancy.” Preg-nancy-induced hypertension, preeclampsia or toxemia, isa disease state of pregnancy that is very complicated innature and manifests itself in the late second trimester andthird trimester. It can present itself with any or all of theabove symptoms. One of the reasons that your health careprovider asks for a urine specimen every visit is to checkfor the presence of protein in the urine, which is one ofthe manifestations of pregnancy-induced hypertension.This is also why your blood pressure is monitored duringthe pregnancy.

Keep in mind that every pregnant woman experiencesa headache now and then for a variety of reasons—suchas tension, stress, allergies—just as in non-pregnant situ-ations. Many pregnant women also experience swellingin their hands and lower extremities, especially in thethird trimester. This can be due to the increased bloodvolume and the pressure that the growing fetus exerts onveins in the leg, which slows down the blood flow return-ing to the heart. Swelling can also be caused by warm

weather. Reflux and heartburn are common in pregnantwomen and can be mistaken for epigastric pain—painthat occurs right under your ribcage. Heartburn can becaused by liver congestion, a complication of pregnancy-induced hypertension. Blurred vision can occur from a varietyof reasons, including factors not related to pregnancy. Al-ways report vision problems to your health care provider.

CRAMPING, BACKACHE AND THIGH PAIN

These symptoms may occur with or without bleeding.One of the early signs of an impending pregnancy loss isthe start of abdominal cramping, a backache or pain radi-ating into the front part of your thigh. Do not assumethat the pain stems from the weight of your belly or thatbag of groceries you carried up the stairs. If any or all ofthese symptoms occur, call your health care provider.

SHORTNESS OF BREATH, HEART PALPITATIONS

Shortness of breath and heart palpitations should neverbe taken lightly. Women in their third trimester often ex-perience a shortness of breath as the growing fetus ex-pands into the ribcage. If the shortness of breath persistsbeyond climbing a flight of stairs or comes and goes, callyour health care provider. Palpitations are another reasonto pick up the phone for an appointment. The body hasone-third more blood volume when it is pregnant, whichcan tax the heart and circulatory system. The increasedblood volume and hormones can sometimes cause thepalpitations.

FLUID LEAKING FROM THE VAGINA

Urine leakage can be caused from something as simpleas the baby pressing on your bladder. Fluid leakage canalso be the result of a spontaneous rupture of the “bag ofwaters” or membranes. The membranes are a protectivemechanism for the baby—they cushion him or her andallow room for fetal movement growth and provide abarrier against infection. Fluid leakage should always bereported to your health care provider.

Pregnancy is a great time! Enjoy it, savor it, be astound-ed by the changes that are occurring every day. At the sametime, protect yourself and your baby by being aware of thewarning signs of problem pregnancies.

Compiled by Denise A. Rosa, BS, RN, nurse manager of labor anddelivery/antepartum at Hackensack (NJ) University Medical Center.

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The purpose of this patient educationhandout is to further explain or remindyou about a medical condition. Thishandout is a general guide only. If youhave specific questions, be sure to discussthem with your health care provider.This handout may be reproduced fordistribution to patients.

Pregnancy is a time of joy and great anticipation for most expectant families. However, that happiness and tremendoushope for the future can suddenly be halted by the diagnosis of a complicated pregnancy. Every expectant mothershould savor the changes that accompany the progression of her pregnancy, but at the same time be aware that certainoccurrences are not considered normal.

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