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The Fibromyalgic Pregnancy and Beyond - Less common changes and complications during pregnancy

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Category: Information Booklets

Published on Saturday, 27 August 2011 14:52

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Less common changes and complications during pregnancy

Pregnancy is a normal state for women, but sometimes complications arise that require immediate attention. Almost all complications give some kind of warning sign, and you or your partner are likely to be the first to notice a symptom that needs attention. Your blood pressure, urine, weight, position of your baby and baby’s heartbeat are checked at each appointment because changes in these vital signs could signal a problem. Problems that are caught early have the best chance of being treated and eliminated or controlled.

 Call your maternity hospital immediately if you experience any of these symptoms:

• Bleeding from breast nipples, rectum, bladder or coughing up of blood
• Vaginal bleeding, no matter how slight (unless slight spotting after an internal exam)
• Swelling of hands or face
• Dimness or blurring of vision
• Severe or continuous headaches
• Abdominal pains that don’t go away with heat and rest or a bowel movement
• Chills or fever over 40 degrees
• Persistent vomiting
• Painful or burning urination
• Decreased foetal movement
• Sudden or slow escape of fluid from the vagina

 Early pregnancy bleeding

There are many causes of bleeding during pregnancy and these vary depending upon when the bleeding occurs. If you experience bleeding early in your pregnancy, you will be sent for a scan to determine the cause. Two serious causes of early pregnancy bleeding are miscarriage and ectopic pregnancy. Two minor causes of early pregnancy bleeding are post coital (after love making) and cervical erosion (relatively painless but sounds horrid), which many women with FM have probably experienced. My gynaecologist says that us women with FM are ‘bleeders’, if there is a problem that means we will bleed, for example between period spotting, cervical erosion, endometriosis and so on, we are more likely to get it! I certainly agree with him purely from a personal perspective though I don’t know if there is any research being done into this to see if it is factual.

Miscarriage is the most common serious cause of early bleeding and occurs in 15-20 percent of all pregnancies, usually within the first three months. Most miscarriages cannot be prevented. They are nature’s way of dealing with pregnancies that are not developing properly. It is characterized by bleeding more than you would during a heavy period and is usually associated with cramping. An ectopic pregnancy, or the implantation of a fertilized egg outside the womb (usually in a fallopian tube), is another serious cause of early bleeding.

Ectopic pregnancies occur in less than one percent of all pregnancies and are almost always associated with severe pain in one side of your upper groin area. Most of the bleeding is internal, which can be life-threatening because of its hidden nature. Call your local maternity hospital immediately if you experience severe abdominal pain early in your pregnancy, or abdominal pain combined with pain in your shoulder tips. If you have FM associated discomfort that you have when not pregnant, you need not worry unless it became more painful than usual for you, comes and goes in ‘waves’ or is associated with bleeding.

Late pregnancy bleeding

Bleeding late in pregnancy can be serious, but the most common cause is “bloody show,” one of the first signs of labour. This is caused by the thinning of the cervix and is usually associated with thick mucus. Cervical irritation and pelvic exams can also cause bleeding.

 The most serious late pregnancy bleeding is caused by either placenta praevia or placental abruption. When these conditions occur, they are most often in the final three months of the pregnancy. Placenta praevia results when the placenta partially or completely covers the cervix. As your cervix thins in preparation for labour, it will stretch any placental tissue attached to it and bleeding will occur. The other serious cause of late bleeding; placenta abruption, occurs when the placenta prematurely detaches from the inner lining of the womb. This is usually accompanied by sudden severe abdominal pain. Either condition can lead to the death of your unborn baby. Do not ignore any pain that is unusual for you, sudden and/or severe in onset.  Women with FM are able to cope with large amounts of pain but you must be sensible and avoid the urge to try to be stoic if experiencing pain during pregnancy.  Let the professionals decide for you if you are not sure. That is what we are paid for!

 If you experience significant bleeding in your pregnancy, you may be hospitalized for observation and evaluation. If the bleeding is serious or if the fetal monitor shows a persistent, non-reassuring fetal heart rate pattern, a caesarean birth may be required. Please be reassured by the fact that most bleeding is the result of minor causes that require no treatment. It is important however, for you to know that bleeding can indicate serious problems. You should report all bleeding to your local maternity hospital or GP immediately so that the severity of this blood loss and the wellbeing of both you and your baby can be assessed.

 High blood pressure in pregnancy

Fewer than 10 percent of pregnant women develop a syndrome associated with high blood pressure, also known as Pregnancy Induced Hypertension (PIH) or pre-eclampsia. The exact cause of this potentially serious condition is unknown.

 When changes of blood pressure are detected early, you and your baby can avoid serious problems. However, with PIH you will often feel quite well except for possible headaches in the beginning.  As a sufferer of FM, you will have built up a tolerance to feeling unwell on a more or less, regular basis and this condition is sometimes ignored by women without pre-existing medical conditions until greatly advanced.  This is one of the reasons why attending regular scheduled antenatal appointments is so important. Pre-eclampsia can cause damage to multiple organs in your body if undetected. Your baby can suffer from a lack of oxygen and nutrients which can lead to growth problems, on-going health problems throughout life or even death.

 Women who are overweight, diabetic or older than 40 years are considered to be at an increased risk of developing this complication of pregnancy. Mothers with kidney disease, twins or a history of high blood pressure are also considered as likely candidates. There is no known link to FM pre-disposing you to an increased risk of PIH or pre-eclampsia.

 High blood pressure is caused when the blood vessels in the body contract, increasing the pressure and lessening the amount of blood flowing to the uterus, placenta and to your baby. Mild changes in blood pressure for a brief period are unlikely to cause problems. However, prolonged and severe spasm of the vessels can be potentially harmful and need closer monitoring, including drug treatment for some women in order to lower the blood pressure.

A sudden weight gain or noticeable swelling of the face and hands can indirectly signal high blood pressure. Some women with FM may suffer with swollen hands, ankles and feet anyway.  If this is the case with you then mention it to your midwife or obstetrician so they are aware of this fact.  What you are looking for is swelling that is not normal for you and please note that you should never have noticeable, sudden swelling in your face.

 Some women experience no distinct symptoms at all. Headaches, visual disturbances, or pain in the upper abdomen may indicate a more serious problem and you should call your local maternity unit if any other occur. By monitoring your blood pressure, weight and urine at each antenatal visit, your midwife, GP or obstetrician should be able, in most cases, to make an early diagnosis of the problem and take steps to help you avoid serious complications.

 Each case of pre-eclampsia is treated differently depending upon a variety of factors usually determined through more specialised investigations and how close you are to your due date. Reduced activity as an outpatient or hospitalisation until stabilised on medication to lower your blood pressure may become necessary, but the eventual birth of your baby will expedite your recovery from this disorder. If you have needed medicating during your pregnancy to help stabilise your blood pressure, then you may need to continue taking these tablets for an indeterminate time during your postnatal period.  Your GP will closely monitor you if this is the case.

 Fluid retention

A low-sodium diet is not generally necessary, but certain foods and liquids do contain an excessive amount of salt that promote increased fluid retention in some women. You may want to consider cutting out of your regular diet:

• Bacon, sausage, ham, pork and luncheon meats
• Canned soups, canned vegetables, canned meats and fishes
• Salted popcorn, pretzels, potato crisps, nachos, salted nuts, etc.
• Tomato juice, bouillon cubes, adding salt to meals

 Premature labour

Labour usually occurs sometime after the 37^th week of pregnancy, (37 - 42 weeks is considered full term.) A baby born before 37 weeks is considered premature. These infants may require special care in breathing and maintaining their body temperatures or they may be perfectly healthy. Although premature birth does represent the greatest risk overall to your newborn baby, each baby will be assessed as an individual at birth.

 Warning signs of premature labour

Premature labour is labour that starts before 37 weeks of pregnancy, or more than three weeks before your due date. Signs and symptoms include:

1. Uterine contractions — more than four in one hour.
2. Menstrual period type cramps — may come and go or be constant.
3. Abdominal cramps — with or without diarrhoea.
4. Low backache — comes and goes or remains constant.
5. Pelvic pressure — feels like your baby is pushing down.
6. Change in vaginal discharge — a sudden increase in amount or if it becomes more mucous-like, watery, slightly bloody, neon yellow or green tinged.

 If you have one or more of these symptoms, you might be in premature labour.  You should call your local maternity hospital immediately for advice. They will likely invite you in to check you and your baby over and observe you for a while before making a decision about what care to offer you.