Pregnancy is straightforward for the majority of women, but occasionally complications arise and one may experience discomfort in varying degrees. It is important to differentiate between normal discomfort and danger signals. The aim of antenatal care is to spot problems early and hopefully resolve them. It helps to know what is happening and why, but if the problem cannot be resolved you may need extra support and help. Some of the normal discomforts include fatigue, excessive saliva, cravings, morning sickness, heartburn, backache and frequent urination. However, if you notice any of the following symptoms, see your doctor as soon as possible.
Vaginal bleeding
According to Dr. David Kiragu, an obstetrician/gynaecologist at Kam Health Services Limited based at IPS building, Nairobi, most miscarriages occur in the first three months of pregnancy and usually begin with vaginal bleeding and pain low down in the abdomen. “It is important to contact your doctor if you experience any vaginal bleeding. You may have to go to hospital for evacuation of the uterus to ensure that any remnants of placenta are removed and possible infection treated,” he advises.
Losing your baby, even early in pregnancy, can be quite upsetting and you may feel a deep sense of loss and blame the miscarriage on something you have done, but it is infact natures way of dealing with a problem that cannot be solved, so try not to feel guilty. The next time you become pregnant your risk of miscarriage is only very slightly increased but women should take things easy for the first few months. Unless your doctor advises against it, there is no reason to avoid sexual intercourse. Sometimes a threatened miscarriage occurs, meaning the baby is still alive when bleeding begins but by lying down and resting for a few days the pregnancy stabilizes and continues as normal.
Sharp abdominal pain
This could be a sign of ectopic pregnancy, a condition in which the fertilised egg begins to grow outside the uterus, usually in one of the fallopian tubes. As it grows, the tube begins to stretch, causing a sharp pain on one side of the abdomen. Other symptoms include vaginal bleeding and feeling faint or dizzy. If you have these symptoms, you should contact your doctor immediately. According to Dr. Kiragu, the pregnancy must be terminated and in most cases the fallopian tube has to be removed.
Vaginal bleeding in later pregnancy
The cervix is also known as the neck of the womb. Usually it stays tightly closed until labour begins, but some women have a weak or incompetent cervix, which cannot support the growing baby, and this can be the cause of a later miscarriage, after the third month of pregnancy. If this is discovered before you miscarry, the cervix can be closed with a stitch, which is put in place during a minor operation. The stitch is then removed, usually about a couple of weeks before the baby is due so that labour can progress normally.
High blood pressure
Dr. Kiragu says that about one in ten mothers suffers from symptoms of pre-eclampsia during late pregnancy, whose symptoms include raised blood pressure, swelling of the hands and feet, and protein in the urine. Regular and routine antenatal checks ensure that any of these symptoms are detected early and preventive action taken. For example, if your blood pressure is very high, rest is often suggested or you may be admitted to hospital for observation. Labour may have to be induced early, and your baby may be delivered by caesarean section.
Rhesus factor problems
If a rhesus negative mother has a rhesus positive first baby, it can activate her defence mechanism which deals with foreign bodies. This means that in a subsequent pregnancy, her antibodies may damage a rhesus positive baby’s blood cells. It is usual to check the blood group of a baby born to a rhesus negative mother and if necessary give the mother an injection to prevent problems arising with future pregnancies.
The Rhesus factor is a protein that is either present or absent on the surface of a person’s red blood cells. Haemolytic disease of the newborn can occur if there is rhesus incompatibility between a mother and her unborn child. In severe cases of haemolytic disease, the foetus may die without medical treatment.
Low-lying placenta
Usually the placenta embeds high up on the wall of the uterus. Occasionally it attaches low down and may cover the cervix. If this happens it is called placenta praevia. Often the first sign is bleeding, perhaps at about 28 weeks of the pregnancy. Sometimes a low-lying placenta is picked up by an ultra sound scan early on, but the condition may correct itself as the uterus grows. If it remains very low, or covers the cervix, a caesarean section will be necessary.
Existing health problems
If you have an existing health problem such as diabetes, epilepsy or asthma, your pregnancy can be problematic. It is prudent to discuss your condition with your doctor before getting pregnant, as it is likely that you will need extra care and attention during pregnancy and possibly in labour.
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