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Women’s Health: Five Pregnancy Danger Signs Pre-eclampsia, Pre-term Labour, Fever in Pregnancy and Bleeding Explained

EDITOR’S NOTE: As always, the information in this post should not be a substitute for sound medical advice. With that done with, it seems counter-intuitive that women still are dying in the 21st century in child bearing. This is happening yet science has been able to simplify all that could go wrong in pregnancy with  easy to recognize surrogate markers. We detail these signs  in this post as the five pregnancy danger signs.

How fast time flies, when the special United Nations Millennium conference meet and drew up the millennium development goals, 2015 seemed ages away.

The thinking must have been that 15 years was sufficient time for the world to collectively attain the stipulated health and socioeconomic standards for every inhabitant of the world to live a life befitting the 21st century.

Informed Motherhood the Key to Value in Pregnancy Care

Several moons away from the self imposed deadline, the cheers are drowned by the tears. Yes some strides have had been made, but many more are were yet to be traveled. New challenges of the 21st century such as the ravaging effects of climate change may have slowed down the walk. On the other hand, the 21st century is about exploiting technology as the internet to quickening the pace of human development.

It is with this realization that we hope to positively impact at least as far as Millennium Development Goal 4 goes.  sustainable development goal three goes in sustaining health at all stages of life including pregnancy and lactation.

This article aims at making informed motherhood a reality as modern medicine is very much a patient-health provider partnership. An informed public translates to negation of the first delay. The delay that arises from lack of knowledge on and failure of recognition of pregnancy danger signs that leads to untoward health outcomes and contribute to maternal mortality.

Summary of Pregnancy Danger Signs

  1. Bleeding vaginally at any time is a pregnancy danger sign
  2. Fever is a pregnancy danger sign especially in the tropics where malaria remains a killer
  3. Leg swelling+/- leg pains is a pregnancy danger signs
  4. Abdominal pains when appropriately characterized by a health professional can be used as surrogate markers for life threatening conditions in pregnancy.
  5. Severe headaches during pregnancy is a danger sign
  6. Diminished/ absent baby kicks is a pregnancy danger sign that points directly to the state of the baby.
cartoon represenatation of a pregnent woman which summerizes pregnancy danger signs with the memonic G.R.A.M.P.S U.P with P for pain, A for absence of fetal movements and so on and so forth

Simple way to remember danger signs to look for when pregnant. Image Courtesy: evabalajadia.wordpress.com

Pregnancy Danger Sign: High Blood Pressure

Make no mistake of all the pregnancy danger signs, a persistently elevated/ rising blood pressure is the most complicated to deal with. In pregnancy, new onset hypertension requires urgent skilled health provider attention. Particularly when the high blood pressure arises sometime later than twenty weeks of pregnancy,  is an alarm that needs to be headed.

Granted, some women are hypertensive way before the highlighted 20 weeks, but even in such instances, monitoring of blood pressure throughout the pregnancy is of crucial importance as a rise of 10-15mmHg of pre-pregnancy levels occurring later than the stipulated 20weeks is of medical significance.

Blood pressure is the recorded value that your health provider picks on to asses the possibility of a potential killer disease exclusive to pregnancy: Pre- eclampsia.

The cause of pre-eclampsia is an area of ongoing health research. Nonetheless, it is currently thought that preeclampsia arises from defects in the interaction of fetal (placenta) and maternal (wall of the uterus) tissue. Eclampsia (convulsions) occurs when pre-eclampsia is not identified and manged effectively before hand.

The danger of pre-eclampsia lies not only in development of eclampsia (convulsions) which causes further damage to vital body organs like the kidney but also in the life threatening severe forms of the disease which often precedes full blown eclampsia.

Severe Pre-eclampsia manifests in the presence of  multiple body organ damage caused by the hypertensive state (high blood pressures) which destroys the integrity of small blood vessels in the organs leading to deranged physiology at the cell level.

Symptoms of severe pre-eclampsia include:

  1. Those related to damage of the central nervous system such as: Blurring of vision and severe headaches,
  2. While some are indicative of to damage of the liver such as: epigastric pain(heat burn like pain),easy bleeding due to low platelets in the blood
  3. Symptoms related to damage of the kidneys such as: Oedema (swelling) of the legs and feet caused by kidney leaking proteins

Pregnancy Danger Sign: Bleeding

The medical term for bleeding per vaginally in pregnancy is antepartum (before birth) haemorrhage (bleeding). Antepartum haemorrhage, the scariest of pregnancy danger signs, has varied causes.

In early pregnancy even small bleeds that cause spotting of undergarments should be reported to your health provider. These small bleeds could be the earliest signs of threatened abortion( an almost miscarriage). The good news is that sometimes, with prompt medical intervention, pregnancy loss is avoidable.

Abortion in pregnancy

In early pregnancy, when the bleeding is profuse and consisting of lumps of blood (clotted blood/ expelled products of conception) the likely diagnosis is an incomplete abortion.

Incomplete because the some of the fetal tissue still remains in the uterus. The danger here lies in continued bleeding which may cause anemia that when severe leads to life threatening health outcomes like heart failure and kidney failure.

Besides, the retained fetal tissue may get infected (puerperal sepsis) with adverse health outcomes like uterine perforation and spread of the infection into the abdominal cavity.

What is antepartum haemorrhage?

In late pregnancy, antepartum haemorrhage is often a sign of an abnormally implanted placenta (placenta previa). Placenta previa places the mother in danger from severe blood loss. This in turn puts the fetus in danger as premature birth is a likely outcome. At term or near term, emergency cesarean section in a health facility capable of handling premature births is often life saving for both the mother and baby.

Pregnancy Danger Sign: Fever

Of the pregnancy danger signs, fever should be the one most amenable to control. This is because the most common causes for fever in pregnancy are easy to identify. Moreover, drugs that can treat these conditions are known.

However, this is not often the case as health system deficiencies that result in pregnant women not being able to access skilled healthcare persist.

In tropical malaria endemic areas, fever almost invariably points towards the killer plasmodium infection. Malaria by its own regards is a number one killer and thus the danger to the mother is plain to see.

Moreover, fever does not mean malaria but is also a key marker of other infectious processes. In pregnancy, the most common infection bay far is Urinary tract infections.

This is because of the pressure effects of the gravid uterus on the urine collecting system which potentate other anatomical reasons- like the shorter female urethra- that already make women more susceptible to urinary tract infections

Urinary tract infections have other tell tale symptoms like:

  1. frequency ( increased visits to the toilet which by itself is not a marker of urinary tract infections as it occurs even in normal pregnancy),
  2. nocturia (toilet visits at night), dysuria (pain on urination),
  3. heamaturia( bloody urine) and
  4. in more severe cases flank pains, vomiting and nausea indicating an infection that has spread up the system to involve the kidneys.

The danger to the mother arises from complication of urinary tract infection and the dangers of unscheduled delivery as fever may precipitate labor before the pregnancy is term.

Pre-term labor is the most deceptive of pregnancy danger sign as it can be taken for a normal pregnancy event. Pre-term labor is characterized by the presence of lower abdominal pains that increase in frequency and intensity.

These pains may be accompanied by show (drainage of amniotic fluid/breaking of water).

The danger to the baby from premature delivery is that it is likely to occur outside a health facility where life can be preserved in the event of medical emergencies that are common in preterm babies.

Moreover, life threatening infections can occur when a pregnant mother water breaks early. Such infections are a danger to both the mother and the unborn child.

Some cases of cerebral palsy and other congenital conditions like blindness are caused by the baby being born in conditions like this where infections are rife.

Pregnancy Danger sign: When The Baby Stops Kicking

cute baby feet peep throuh a soft baby shawl reminds us of their function as early warning systemgiven that absence of fetal kicks is a pregnancy danger sign

Few things are as adorable as ting baby feet

Feeling baby kicks is one of the divine moments of any pregnancy. Fathers-to- be even convince themselves of the sex of the baby on account of the kicking activity.

Pregnancy Tip: At times the baby might just be tired from strenuous activity such as a long journey. Sometimes the baby might be tired from inadequate nutrition. This happens commonly when the mother is dehydrated or are hungry and therefore have low blood sugars. In these cases, a quick pick-me-up like drinking a sweetened drink  or even just the mother resting might be all that is needed to get the baby kicking away again.

Strangers, family and friends can’t help themselves feeling the baby bump for kicks. This is a moment always full of oohs, aah, giggles and smiles. It is for this reason that it might be the easiest to pick once the mother is adequately educated.

Sudden quietness or diminished baby kicks may be a sign of fetal death or distress. Mothers ought be aware of sudden prolonged cessation in baby kicks. The tragedy of a mother carrying a pregnancy only to learn later that the unborn baby passed away months ago in-utero is one that words can’t suffice.

Worse, the mother may have to endure labor pains when labor is medically induced by a doctor to expel the dead fetus. Moreover, medical induction of pregnency is not fraught of risks. The most frightful of its complications is difficult to control bleeding as a result of disseminated intravascular coagulation (DIC).

What is Disseminated Intravascular Coagulation [DIC] ?

Disseminated meaning widespread simultaneous events. Intravascular means that it occurs within [intra] vessels [vascular].

DIC is a medical emergency that manifest as internal bleeding, bleeding under the skin and bleeding through orifices like nose and ears. The reason behind this being depletion of blood proteins and platelets that are responsible for blood clotting.

In a manner akin to a DoSS attack, the body’s clotting agents get depleted by disseminated clotting events. Once engaged in the clotting process, these proteins are consumed. Any other requirements for  clotting can’t be met as the body can’t replace the factors fast enough.

Pregnancy ‘Danger Sign’: Calf/leg  Pain

Calf pain does not strictly fall in what obstetricians and midwives universally term to as pregnancy danger signs. But we highlight it because of fatal nature of an associated condition.

Pregnancy is a hypercoaugable state. This means that pregnancy is a period when blood clots are likely to arise. The reason for this is in pregnancy, blood has a tendency to clot easily. However hypercoaugability by itself is not among the pregnancy danger signs.

The scientific reasons behind this are varied. One of the key contributing factor is the pressure effects of the uterus on major vessels. This causes blood flow to slow down (stasis). Stasis is an important prerequisite for blood clot formation.

The physiologic changes that occur with pregnancy affect blood volume and composition and also contribute to hypercoaguability . Hormonal changes are also an important contributor. In some women pre-existing disease states play an important role.

The reason we highlight hypercoaguability in pregnancy is the life threatening condition: Deep Vein Thrombosis.

What is deep vein thrombosis (DVT) ? What are the signs of DVT ?

Deep vein thrombosis is when blood clots form in the deeply lying veins of the lower limbs. The result is that there are local symptoms that are crucial in identifying this life threatening condition. They include: calf pain on walking, tenderness, swelling, warmth and local skin changes like color changes over the calf area.

The danger with deep vein thrombosis lies with the clot dislodging. This clot can then travel up the to the lungs and cause sudden death through pulmonary embolism. In some instances further travel to the brain causing stroke.

At this juncture, we cannot adequately emphasize on the importance of antenatal care for the pregnant woman. Focused Antenatal care under the care of a skilled health worker offers the only opportunity to address pregnancy danger signs. The World Health Organization recommends  six of such visits for a healthy pregnancy. What is important through is the concerted efforts of the pregnant woman and her health provider.

 

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