DANGER SIGNS DURING PREGNANCY

You would be shocked to know that annually thousands of women die due to pregnancy related life threatening problems during or after childbirth. The major causes of deaths of women due to pregnancy related problem are:

• Excessive bleeding
• Infections
• Complications of abortions
• Difficult obstructed prolonged labor
• High blood pressure

This percentage of women dying of pregnancy related causes varies in different parts of world. In developed countries that have medical facilities for caesarean delivery such as antibiotics, and blood transfusion; majority of lives of women are saved.

But in underdeveloped and underprivileged areas, complications and maternal death rate is high. This is also due to the three main reasons:

• Delay in deciding to seek medical care
• Delay in reaching the appropriate medical facility
• Delay in receiving treatment at a medical facility

The purpose of this blog is to create awareness about this serious problem, educate ourselves about danger signs and save lives. You’ll be surprised to know that most of these problems are preventable and treatable, if early life threatening danger signs are picked timely and treated appropriately, we can save many lives. If you or anybody around you has any one of these problems contact a medical professional or a nearby medical facility URGENTLY for proper treatment. Always remember to give a detailed history and tell them first about your pregnancy or your delivery which occurred within last one year.

HEADACHES, DIZZINESS OR LIGHT HEADEDNESS, FAINTING OR FITS
These problems are caused by stretching, expansion or leaking of blood vessels and irritation of  coverings of brain by infections, fluid or blood collection, blood pressure change, sugar or salt imbalance or local problems of ear, nose, throat, or teeth. Sometimes brain problems, epilepsy also presents for the first time during pregnancy or after delivery. Headaches usually settle down after some time with  mild painkillers. But if it’s not going away or getting worse with time, accompanied by high blood pressure, then it could be followed by dizziness, fits, loss of consciousness and severe damage to brain, eyes, kidneys and endangers life.

BLURRY VISION OR FLASHES OF LIGHT
If you are having sudden blurring of vision or flashes of light or seeing some floaters or stars then see your doctor as these changes could affect vision and result in permanent  loss of vision. This could be due to swelling or changes in inner most layer (retina) or nerve ending (optic disc) of eye which are the earliest danger signs of conditions like infections of brain and its coverings, irritation of nerves, changes in blood supply of eye, high blood pressure, chronic illnesses like diabetes mellitus, renal diseases or even tumors of brain.

SWELLED FEET OR FACE
Mild swelling of feet could occur after prolonged standing which goes away on taking rest. But if it persists, with pit formation on pressing thumb against ankle bone, then seek a medical help as it could be due to fluid retention in body. This can be caused by low levels of protein in body by decreased formation or increased loss, diseases of kidneys, liver or heart and infections. If this occurs in pregnancy with high blood pressure, abdominal discomfort, headaches, blurry vision, swelling around nose then it could be dangerous (pre eclamptic toxemia) and seek immediate medical help.

FEVER
Fever could be due to any local or generalized bacterial viral or fungal infection. Any high grade fever more than 100 F needs urgent investigation and antibiotic treatment, as it can cause abortions, start preterm labor and in severe cases can become life threatening for mother and growing fetus.

CHEST PAIN
This could simply be a muscular pain or acid reflux, but certain serious problems of heart, lungs  and abdomen starts with chest pain.

BREATHLESSNESS
Pregnant women usually have anemia either due to increase in fluid in body or due to deficiency of iron and other nutrients but it does not affect daily life activities. If you suddenly become breathless which increases on lying down, walking, and climbing stairs, your fingers or lips become blue then it shows low oxygen in blood. Sometimes blood disorders, heart and lung diseases are also present with this complaint, if you have sudden onset of breathlessness then seek medical help.

EXTREME VOMITING
Nausea and vomiting are common in early pregnancy which gets better after first three months of  pregnancy, but if they are not settling then there could be other co-existing problems like stomach or liver problems, gall stones, thyroid disturbances and electrolyte imbalance, all of which need proper treatment.

ABDOMINAL PAIN
Any pain in abdomen needs proper evaluation on history, examination, and investigations as it could simply a heart burn due to excessive acid secretion. But there are certain other surgical emergencies like acute appendicitis, gall bladder stone or its infections, urinary tract infections, infections or irritation of gut and any other obstetrical problems like in early pregnancy. It could be a miscarriage or ectopic (pregnancy outside uterus) in tube or ovary which can become life threatening due to blood loss and it requires urgent surgery. After mid trimester bleeding behind placenta( abruption) also present with pain, similarly early labor presents with pain or pressure in lower abdomen, backache with excessive discharge, all this needs evaluation.

DECREASED BABY MOVEMENTS
Mothers start feeling baby movements usually after five months of pregnancy. Babies in uterus spend most of the time in sleeping but at least there should be 10 fetal movements in 10 to 12 hours of a day, and the easiest way for counting fetal movements is counting to ten while lying on one side, after meals. Whenever you have reduced movements, go to labor room for cardiotocography (CTG) and ultrasound biophysical profile for fetal monitoring, as it is an obstetrical emergency.

BLEEDING OR LEAKING
Sometimes pregnant women have discharge due to local vaginal infections but if there is excessive colorless watery discharge then it could be leaking of water bag of baby, which could be followed by labor pains. Spotting or bleeding with or without pain during pregnancy signifies low lying placenta or bleeding behind placental membranes, or onset of labor. Excessive bleeding with or without passage of clots after delivery or during puerperium needs evaluation for post-partum hemorrhage.

FATIGUE
It could be a pregnancy related change but conditions like anemia, thyroid disorders, diabetes mellitus, electrolytes (salts) imbalance, hormone disturbances or serious muscle problems could present with it. If its worsening and affecting daily life activities then see your doctor.

SWELLING OR REDNESS OF LEG
Some swelling of legs is common during pregnancy but in some patients, blood becomes thicker than normal and forms clots in obese, inactive women who sometimes have a coexisting heart or liver disease, blood pressure or disturbed clotting. If you notice persistent leg swelling with or without redness or any color change, pain on movement then immediately go to a hospital as it could be a life threatening condition of clot formation in legs (deep venous thrombosis).

NEGATIVE THOUGHTS OF HURTING SELF OR BABY
Patients who have a previous history of depression, have stress, anxiety, social pressures, fatigue, sleep deprivation, lack of support system and family history of psychiatric disorders are more prone to this problem, which can worsen and become life threatening for both mother and baby if not treated on time.

Let’s save lives of our women and newborn by skilled and timely medical care before, during and after childbirth. Remember life is very precious, it should not be affected by treatable illnesses.

Dr. Ayesha Azam Khan