Conditions to be aware of

We have listed below some common conditions that you may come across during your pregnancy. These conditions, if undetected could become serious and could risk the health and well being of baby and/or expectant Mum. Our intention is not to scare you but by being aware of common conditions and their symptoms we aim to give you knowledge and confidence, and encourage you to speak to your healthcare provider if you ever notice a change or any signs of potential problems.

The most common sign of a problem in the later stages of pregnancy is a change in regular fetal movements.  It is essential to report any changes in your baby’s regular movements, along with any other symptoms you may be suffering, even if you feel the symptoms are very minor. Working with your midwife by reporting any symptoms is essential.

Gestational Diabetes

This is when high levels of Glucose build up in your blood. It’s diagnosed by a blood test your doctor or midwife will send you for if they think you’re at risk. Lots of women are checked for diabetes during pregnancy, including women with family history of diabetes, raised BMI, and certain ethnic groups, all factors that can increase the chance of getting it. Uncontrolled diabetes can cause babies to grow very large and can also cause heart problems. It is also a risk to Mum.

Signs & Symptoms:

Gestational diabetes doesn’t usually cause any symptoms. Your midwife or doctor would diagnose it after blood and urine tests. But sometimes you may have symptoms of high blood sugar, including:

  • Increased thirst
  • Needing to urinate often
  • Feeling tired

Who it affects?

Between 2 and 5 per cent of women in this country will have diabetes during pregnancy. Though the majority will no longer have the condition after the birth, there’s an increased risk of getting diabetes later in life.

Treatment

The majority of women who develop gestational diabetes successfully control it with exercise and a healthy diet; although a few will need injections of insulin in order to help the body break down the glucose. With close care and monitoring from the diabetic and obstetric team, it shouldn’t be a problem.

Useful websites:

www.diabetes.org.uk/gestational

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Pre-Eclampsia

This can occur anytime around 20 weeks of pregnancy, until a few days after the birth and is caused by a defect in the placenta. The Placenta is the link between mum and baby, providing her baby with oxygen and nutrients. If undetected and allowed to develop, pre eclampsia can potentially be life-threatening to mum and baby, causing eclampsia which results in seizures.

Pre-eclampsia can cause a rise in blood pressure, and protein in the urine. In extreme cases it can mean premature delivery.

Signs & Symptoms:

Some women will get symptoms of headaches, visual disturbances and general swelling (Oedema), suggesting high blood pressure, though others will have no symptoms at all so it is essential to ensure you have regular urine tests at your Midwife or doctors checkups.

Who it affects?

Pre-eclampsia affects one in 10 pregnancies in some form, but severely affects 1 in 100 first pregnancies, and can affect both mum and her unborn baby.

Treatment:

There is no treatment for pre-eclampsia, other than the birth of the baby, but if it is suspected you’ll be monitored closely with frequent checks on blood pressure, urine and blood. If the condition is mild, the doctors will aim for you to continue with your pregnancy for as long as possible though induction may be advised if the tests show that pre eclampsia is becoming more significant. Monitoring your baby’s movements is essential; if a change in regular movements occurs it is essential to be checked. Severe pre eclampsia will need immediate admission to hospital.

Useful Websites:

www.preeclampsia.org

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Placenta Praevia

This is when the placenta covers some or all of your cervix. It’s usually picked up at the anomaly scan at around 20 weeks of pregnancy. As the pregnancy progresses and the womb stretches the placenta should rise up the wall of the uterus. When it doesn’t do that you’re diagnosed with a placenta praevia. You’ll be closely monitored during the remainder of the pregnancy, and a c-section could be advised. Any fresh, painless bleeding should be reported immediately, as you might need to go to hospital. When the placenta lies low it can affect how strongly you feel your baby’s movements, if this is the case we recommend having extra private reassurance scans to ensure all is ok and to keep your anxiety levels down.

Who it affects?

Placenta praevia occurs in a very small percentage, around 0.5 per cent of pregnancies. It’s more common in women who’ve had a previous C-section, subsequent pregnancies, twin or multiple pregnancies and those who smoke.

Treatment:

In more than 90 per cent of women who’ve been diagnosed with placenta praevia in the second trimester, the placenta will correct itself by the end of the pregnancy. The placenta itself doesn’t actually move, but as the uterus stretches it’s not as close to the cervix as it was earlier in the pregnancy.

If the condition is diagnosed after the 20th week, but you’re not bleeding, you’ll probably be advised to refrain from any vigorous excersize and to take life easy. If you’re bleeding heavily, you’ll be admitted to hospital so that the bleeding can be monitored, but even when it stops you might well be asked to stay in hospital until your baby is ready to be born. If the condition is undetected there is a risk to both mum and baby during birth, so it is essential that you attend all midwives, doctor and scan appointments and ensure you tell your healthcare advisor of any bleeding. Again if there is any change to your baby’s regular movements it could help to diagnose Placenta praevia.

Useful Website:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001902/

Useful Factsheet:

RCOG Low lying Placenta

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High Blood Pressure

This is also known as Gestational Hypertension. It can affect the blood flow through the placenta, potentially affecting the growth of your baby, or cause a placental abruption (see below) so it’s important to keep it under control.

Symptoms:

Many women will have no symptoms at all, but some will experience a headache or visual disturbances

Who it affects?

About one in 10 pregnant women has problems with high blood pressure.

Treatment:

If you develop high blood pressure during pregnancy, the first thing your midwife will do is check for protein in your urine, to eliminate the risk of pre eclampsia. High blood pressure can be controlled by medication but it will still need close monitoring to make sure that it stays within a normal range.

Useful Website:

http://www.patient.co.uk/health/Pregnancy-and-High-Blood-Pressure.htm

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Placental Abruption (Placental Failure)

This is when the placenta completely or partially peels off the wall of the uterus or begins to fail in function. In serious cases an emergency Caesarean would be necessary as the placenta is the baby’s life line. The only way to detect this condition is through an Ultrasound scan. In very late stages of pregnancy a private reassurance scan is recommended to ensure the placenta is functioning well, baby is growing well, this scan will help reduce anxiety in the later stages of pregnancy.

Symptoms:

Any change in regular fetal movements.

Severe abdominal pain

Uterine tenderness

Vaginal bleeding.

Long term placental problems can be apparent in scans as the baby’s growth may be affected.

Who it affects?

Nearly half the women who have this also have very high blood pressure. It can happen after some sort of trauma to the abdomen, such as a car accident, and is more common in women who smoke, drink a lot of alcohol or use drugs; women over 35 are more at risk as are women who have already had this in a previous pregnancy. It also becomes an increased risk in overdue pregnancies as the placenta begins to deteriorate and begins to fail.

Treatment:

With a mild abruption early on in the pregnancy, hospital bed rest may be recommended. If the bleeding ceases you might be able to go home. Later in pregnancy Steroid injections are sometimes recommended to develop the baby’s lungs just in case an early emergency delivery is needed.

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HELLP Syndrome

HELLP stands for H-hemolysis, which is the breaking down of red blood cells; EL- elevated liver enzymes; LP – low platelet count. In layman’s terms this means it can affect the body’s ability to clot blood and the livers ability to function.

Symptoms:

If you have HELLP syndrome you may feel tired and have pain in the upper part of your belly. Headaches, Nausea or Vomiting. Swelling especially in your face and hands.

Who it affects:

Most people who get HELLP syndrome would have blood pressure problems before pregnancy.

Treatment:

The only treatment for HELLP syndrome is to deliver your baby. This may have to be done before your due date if you’re particularly ill. Most women with this illness start to get better a couple of days after their babies are born. If you aren’t too sick, your doctor may be able to wait for a little time before delivering your baby.

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Obstetric Cholestasis (OC)

This is a liver disorder that can cause unbearable itching, particularly at night. Itching in pregnancy is very common, but Cholestosis often causes severe itching of the soles of the feet and palms of the hands. If left untreated it can be dangerous for the baby, so it’s always worth ruling the condition out if you’re showing symptoms of it.

Who it affects?

Obstetric Cholestosis affects around one in 135 women.

Treatment:

A series of blood tests will diagnose OC. If it’s confirmed you’ll be advised to begin medication to control the itching and help to correct your liver function, or induction may be advised. Soon after the birth OC disappears and causes no long term effects.

Useful Website:

http://www.ocsupport.org.uk/

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Polyhydramnious

This is an excess of amniotic fluid. Women who have this often complain of getting breathless quickly and feeling bigger than they think they ought to be, the skin on the abdomen feeling tight and looking shiny. There can be various reasons for polyhydramnious, including diabetes, an infection acquired during the pregnancy or occasionally a problem with the baby such as an inability to swallow the amniotic fluid and pass it as urine in the usual way. Sometimes there’s no apparent reason for an excess of fluid, but be reassured that in most cases women go on to have a healthy baby, although it is essential to monitor your baby’s movements as excess fluid can sometimes give the baby more room to spin and could result in baby becoming tangled in the umbilical cord. A change in regular fetal movements would indicate any problem early on.

This condition can be easily diagnosed at a later stage reassurance scan.

Symptoms:

Breathlessness

Feeling larger than you feel you should

Stretch shiny abdomen

Who it affects:

It’s a very rare condition, occurring in less than 1 per cent of pregnancies.

Treatment:

Polyhydramnious treatment includes careful monitoring and delivering the bay as soon as your pregnancy has run its term. If necessary, amniotic fluid levels may be lowered with medication to decrease fetal urine output, or by means of what’s known as an amnioreduction, which is the removal of amniotic fluid with a needle.

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Oligohydramnios

This is the opposite of Polyhydramnios – too little fluid in the amniotic sac around the baby. It’s often picked up by the midwife when she measures that your bump feels small for your dates. Although there have been recent studies proving measurements not to be as effective as other techniques such as scanning. There are various reasons for it, such as a problem with the placenta, a health condition of the baby, or even leaking of the amniotic fluid, but often no cause is found at all. Very low levels of fluid in the first trimester can cause an increased risk of miscarriage, but later on it’s a matter of keeping a close eye on you, and making sure that your baby is still growing. Having extra private growth scan could help with anxiety. As with Polyhydramnios it is essential to monitor your baby’s movements as the lack of fluid may make it difficult for baby to untangle itself from its umbilical cord. Also some babies with low levels of fluid cannot cope as well with labour so your newborn will need close monitoring during the birth.

Who it affects:

It occurs in about 4 per cent of pregnancies.

Treatment:

Treatment depends on how far the pregnancy has progressed if the pregnancy is at term, delivery is the best treatment. If the pregnancy is not far enough along to recommend delivery, amniotic fluid infusion may be suggested, which is where amniotic fluid is injected through the amniotic membrane to raise fluid levels.

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Group B Strep

GBS can be present at any time – in a woman’s first pregnancy, or in subsequent pregnancies. It can be a threat during pregnancy, around delivery and afterwards.

There are five recognised situations which increase the chance that a baby will be exposed to GBS, if susceptible, of developing GBS infection. Each of the risk factors shown below increases the risk of GBS infection in a newborn baby:

Mothers who have previously had a baby infected with GBS – risk is increased 10 fold

  • Mothers who have been shown to carry GBS in this pregnancy or GBS has been found in the urine at any time during this pregnancy – risk is increased 4 fold

Other Clinical Risk Factors:

As well as the two carriage risk factors shown above, the following clinical risk factors will also increase the risk of a baby developing a GBS infection:

  • Labour starts or membranes rupture before 37 weeks of pregnancy is completed (i.e. preterm) – risk is increased 3 fold
  • Where there is prolonged rupture of the membranes – more than 18 hours before delivery – risk is increased 3 fold
  • Where the mother has a raised temperature* during labour of 37.8°C or higher – risk is increased 3 fold

*If a woman has an epidural, a slightly raised temperature may be of less significance than in a woman with no epidural.
Carrying GBS, combined with one or more clinical risk factor, increases the risk at least 12 times.

75% of early-onset GBS disease and 90% of resultant deaths follow deliveries with one or more of these risk factors.

 Who it affects:

Up to a third of all men and women carry GBS. About half of the babies born to mothers colonised with GBS at the time of delivery will become colonised themselves and, of these, only around 1 in 200 will develop GBS disease, even without any preventative medicine during labour.

Treatment:

Carrying GBS during labour and delivery does not mean necessarily that you or your baby will become ill.

Simply carrying GBS previously, without a positive test result during the current pregnancy, does not mean a woman should be offered intravenous antibiotics in labour unless one or more other risk factors are also present.

Useful Website:

www.gbss.org.uk

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Other less serious but common conditions include:

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a common complaint of pregnancy characterised by pain, numbness, burning and/or tingling in the hand and wrist. The carpal tunnel is a small tunnel that runs from the bottom of the wrist to the lower palm. Several tendons and a major nerve called the he median nerve pass through the tunnel, which controls sensation and the movement of your hand.

In CTS, the space inside the tunnel shrinks – usually, in pregnancy, because of swelling caused by fluid retention. The result is pressure on the median nerve, triggering the symptoms described above. The only parts of the hand that remain unaffected are the little finger, part of the ring finger and the outside edge of the palm, as these parts aren’t served by the median nerve.

Symptoms:

Pain or stiffness in the wrists, hands and/or fingers

Swelling of the Wrist, hands and/or fingers

Treatment:

The condition can be very aggravating, and yet, as with many other medical complaints in pregnancy, cannot be treated with medicines. There are, however, some self-help measures you can try:

  • Hold your hand up in a ‘high five’ and stretch your fingers as hard as possible for a few seconds, then relax them. Repeat 10 times.
  • Ball your hand into a tight first, then relax. Repeat 10 times.
  • Make circular movements from the wrist, then shake your hand vigorously downwards as if trying to flick water off your fingers.
  • Plunge your hand alternately into ice-cold then hand-hot water.
  • Raise your hands and arms with pillows while you sleep (but avoid sleeping on your back at this stage of pregnancy).
  • Consider acupuncture – but only with a fully qualified practitioner with experience of working with pregnant women.
  • Talk to your doctor or midwife about providing you with a wrist support.
  • Consult your doctor if your symptoms don’t improve at all or get worse. A short course of ultrasound treatment might help in some cases.

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Macrosomia

Macrosomia, also known as big baby syndrome, is sometimes used synonymously with Large for gestational age, or is otherwise defined as a fetus or infant that weighs above 4000 grams (8 lb 13 oz) or 4500 grams (9 lb 15 oz) regardless of gestational age.

Predetermining factors

One of the primary risk factors is poorly-controlled diabetes, particularly gestational diabetes as well as preexisting diabetes mellitus (DM) (preexisting type 2 is associated more with macrosomia, while preexisting type 1 can be associated with microsomia). This increases maternal plasma glucose levels as well as insulin, stimulating fetal growth.

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REDUCE YOUR RISK

While no one can guarantee one or more of these conditions won’t affect you during pregnancy, there are certain things you can do to help reduce risks:

  • ATTEND ALL ANTENATAL APPOINTMENTS and make sure you reschedule ASAP if you miss one.
  • ALWAYS MENTION any Signs, Symptoms or concerns to your midwife, no matter how small.
  • STOP SMOKING
  • EAT A BALANCED DIET containing lots of wholegrain carbs, lean proteins and healthy fats.
  • LOSE EXCESS POUNDS if you’re planning pregnancy. Also if you are overweight continue to try to lose weight during pregnancy.
  • TAKE GENTLE EXERCISE Pilates of Yoga, swimming or just walking are ideal in pregnancy.

If you have experienced any other condition in pregnancy not listed above and feel it would help other expectant Mums to know the signs and symptoms please contact us.

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