Some people experience health problems during pregnancy. These complications can involve their health, the fetus’s health, or both. Even if you were healthy before getting pregnant you can experience complications.
Having early and regular midwife appointments helps us to diagnose, treat, or manage conditions before they become serious.
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There are many causes of vaginal bleeding in pregnancy. Most of the time bleeding is not caused by something serious, but it is very important to check it with your midwife or GP.
Raised blood pressure and pre-eclampsia
It is very important that your blood pressure stays under control. Your midwife will check your blood pressure at every antenatal appointment.
High blood pressure (hypertension) affects around 10 to 15% of pregnancies. There are different types including:
- Chronic hypertension (where you had high blood pressure before pregnancy)
- Pregnancy-related high blood pressure (gestational hypertension)
Along with checking your blood pressure we test your urine to check for protein. Protein in your urine can be a sign of pre-eclampsia.
Your care and treatment will differ depending on the cause and severity of your raised blood pressure.
Pre-eclampsia can happen in any pregnancy, but you are at higher risk if:
- your blood pressure was already high before you became pregnant
- your blood pressure was high in an earlier pregnancy
- you have kidney problems, diabetes, or a condition that affects the immune system, such as lupus.
Pre-eclampsia can affect your baby’s growth. In mild pre-eclampsia, there may be no symptoms or signs.
Contact your midwife or doctor if you get:
- severe headaches
- problems with your vision (blurring, flashing light or spots in front of your eyes)
- upper tummy pain
- puffiness or swelling of your face, hands or feet.
If you are in the early stages of pre-eclampsia, you’ll have antenatal checks more often to make sure you and your baby stay healthy. We will also tell you to rest more and may give you medication to control your blood pressure.
Rarely, the illness can develop into severe pre-eclampsia. This can be life threatening for you and your baby. If this happens you will need immediate emergency medical care.
Obstetric cholestasis is uncommon. It affects the liver during pregnancy. This causes a build-up of bile acids in your body, which makes the skin very itchy but without a rash. The symptoms get better when your baby is born.
Itching is common in pregnancy and affects around 23% of pregnant people. Only very few will have obstetric cholestasis.
If itching is worse at night and includes the palms of the hands and soles of the feet, contact your midwife as soon as possible.
RCOG: Obstetric cholestasis
Diabetes that develops in pregnancy is known as gestational diabetes. It happens because your body cannot produce enough insulin to meet its extra needs in pregnancy. This results in high blood glucose levels. Insulin is a hormone that helps to control blood glucose. Gestational diabetes is common and affects up to 18 in 100 people in pregnancy.
If you are diagnosed with gestational diabetes, you will have specialist antenatal care.Specialist support for gestational diabetes
Placenta praevia happens when your placenta (afterbirth) attaches in the lower part of your uterus (womb), sometimes completely covering the cervix (neck of the womb). This can cause heavy bleeding during pregnancy or at the time of birth.
If you have placenta praevia, your baby will probably need to be born by Caesarean.
Placenta accreta is a rare but serious condition when the placenta is stuck to the muscle of your womb and/or to nearby structures such as your bladder. This is more common if you have previously had a Caesarean. It may cause heavy bleeding at the time of birth.
Vasa praevia is a very rare condition where blood vessels travelling from your baby to your placenta, unprotected by placental tissue or the umbilical cord, pass near to the cervix. If these blood vessels tear, this can be very dangerous for your baby.
Steroids may be recommended as part of your care if you have this condition and you baby may be born prematurely.
- Placenta praevia, placenta accreta and vasa praevia | RCOG.
- Low-lying placenta (placenta praevia) | Tommy’s (tommys.org).
- Corticosteroids in pregnancy to reduce complications from being born prematurely patient information leaflet | RCOG
Infections in pregnancy
- GBS is one of many bacteria in our bodies. Usually, it does not cause any harm. Most pregnant people who carry GBS bacteria have healthy babies. There is a small risk that GBS can pass to the baby during birth and cause serious complications in the newborn. This is rare; one in every 2,000 newborn babies in the UK are diagnosed with a GBS infection. We won’t screen you for GBS, but it is sometimes detected when we do tests for other infections.
- If GBS is detected, either in urine or swabs, during your pregnancy we will discuss the use of intravenous antibiotics in labour with you.
- Group B streptococcus (GBS) infection in pregnancy and newborn babies (RCOG)
- Genital herpes is common infection caused by the herpes simplex virus. Genital herpes can cause problems in pregnancy.
- If you had genital herpes before becoming pregnant the risk to your baby is very low, even if you have it during pregnancy. It is still important to tell us so you can plan your care and treatment.
- If you get herpes for the first time early in pregnancy you will be referred to see a genito-urinary doctor to confirm diagnosis and plan your care.
- If you get genital herpes for the first time during the third trimester the risk of passing the virus on to your baby before or during the birth is higher. We will advise you to have a caesarean section to deliver your baby at around 39 weeks. This is because if you give birth vaginally, there is a higher risk of passing the virus on to your baby. The virus can cause serious complications in the newborn.
- View our sexual health services
- Genital herpes and pregnancy – information for you (RCOG)
- Chicken pox is highly infectious. It is spread directly via personal contact or droplets. Most people get it when they are children so 90% of the adult population in the UK is immune.
- If you think you have been with someone, who has it and have not had, or are unsure if you have had, chickenpox before please tell your midwife immediately. We will arrange a blood test to check your immunity and you may need an immunoglobulin vaccination.
- If you are diagnosed with chickenpox before 28 weeks of pregnancy you will be referred to a fetal medicine consultant.
- Chicken pox and pregnancy: information for you (RCOG)
- Parvovirus is a common, mild illness in children. It shows up as fiery red cheeks (resembling a slapped cheek) 2-5 days after feeling generally unwell.
- Most pregnant women who get parvovirus in pregnancy have healthy babies, but it can cause complications.
- If you think you have been with someone with parvovirus, tell your midwife. We will arrange a blood test to check your immunity. If you are not immune, we will make a further plan of care.
- If you are diagnosed with parvovirus you will referred to a fetal medicine consultant for extra antenatal scans.
- What are the risks of slapped cheek syndrome during pregnancy? (NHS)
Everybody’s blood falls into a number of blood groups. The four main blood groups are: Group A, Group O, Group B, and Group AB which are carried on the red blood cells. Red blood cells are the commonest cells in the blood system and their job is to carry the oxygen you breathe around your body. Usually when a mother and her baby have different blood groups, there is no problem.
But, sometimes the blood of birth parent and baby differ in a more important way. This difference is called the Rhesus D Factor (RhD Factor). The RhD Factor is the name given to a special protein attached to the red blood cells in the blood. People whose red blood cells carry the RhD Factor are called ‘RhD-Positive’ and those without are called ‘RhD-Negative’.
All pregnant women and people have their blood group tested at booking of the pregnancy. If you are Rh D-Negative, you will be offered anti-D at 29 weeks and post birth if needed. Please call maternity triage if you have any bleeding or any possible injury to your bump as you might need to have anti-D at this time as well.
- Blood groups and red cell antibodies in pregnancy.
- D-negative-mothers-blood-test-to-check-her-unborn-babys-blood-group.pdf (mft.nhs.uk)
- Rhesus Disease (NHS)
Deep Vein Thrombosis and Venous Thromboembolism
Deep Vein Thrombosis (DVT) is a clot which can develop in the veins of your leg. It can cause pain, swelling and redness, or at times have no symptoms at all.
A clot can also move to your lungs, and this is known as a pulmonary embolism (PE). Symptoms of this include chest pains and breathlessness. This is a serious condition, which can be life-threatening.
There is an increased risk of DVT and PE in women who are, or have recently been, pregnant, and the risk increases after surgery.
If you have ever experienced a DVT or VTE in your past, please contact maternity triage as soon as you know you are pregnant. We will review your health history make a care plan for you.
If you are planning a journey where you will be sat down for more than 4 hours, please tell your Community Midwife so they can do an updated risk assessment. Regular limb movements and drinking plenty of water will decrease your risk of VTE.
- DVT (deep vein thrombosis) – NHS
- Reducing the risk of venous thrombosis in pregnancy and after birth patient information leaflet | RCOG