This page examines some early pregnancy symptoms that indicate serious disease.

So you just found out you are pregnant – what could go wrong?? Hopefully, nothing – but let’s look at four common early pregnancy events, their causes, treatments and outcomes for the pregnancy.

Hyperemesis Gravidarum

Excess vomiting in early pregnancy.

It is not just morning sickness or bad morning sickness. 

First, what is Morning sickness? 

One of the common symptoms of early pregnancy is nausea and vomiting. However, not all women get it. It usually begins by the 4th – 7th week, and by week 16/20, will have settled.

Please remember that other conditions can cause vomiting in pregnancy and not just hormone changes.

Hyperemesis is severe vomiting – a severe condition that could lead to harm for both mum and baby. 

This is what it looks like:

• You may have prolonged, persistent and severe nausea and vomiting unrelated to other causes.
• Weight loss (usually at least 5% of pre-pregnancy body weight).
• Dehydration and electrolyte imbalance.

Ladies who are more likely to suffer from nausea and vomiting in pregnancy may fall into one of these groups:

• molar pregnancy (abnormal cells grow in the womb instead of a baby)
• multiple pregnancies
• first pregnancy
• if you had HG in a previous pregnancy
• if family members have had HG
• if you are overweight

Symptoms of Hyperemesis

Profuse vomiting, weakness, dizziness, unable to keep food/water down are at the top of the list.

The doctor’s assessment will check how severe this condition is, whether your electrolyte balance may be compromised and if you need hospital care.

• At the GP surgery, we would check your vital signs looking for signs of dehydration we can detect from your blood pressure and pulse.
• We would get a urine sample to check for further signs of dehydration. The urine sample can also show us problems like urine infection, excess sugar (Diabetes) or bleeding. 

When to see a Dr:

The most important indicator of dehydration is the presence of very high levels of ketones which reveals the possibility of severe dehydration.

If the doctor feels your condition is severe, you will be admitted to the gynae team to monitor, treat and ensure you and the baby do well.

 If the symptoms are less severe, you are clinically stable or do not want admission; options are available.

• You can be treated with anti-sickness medicines to control vomiting and encourage recovery.
• Other valuable measures are knowing what to eat and avoid when you have nausea/vomiting during pregnancy.
  • Ginger, peppermint tea or aromatherapy, lemon slices, acupuncture if available, citrus smells from lemon slices. Gentle exercise can be helpful for some people.

 Other tips for managing nausea and vomiting:

1. Avoid spicy or fatty foods:
2. Avoid large meals
3. Stay upright after you eat
4. Try not to drink while eating to avoid a full tummy which increases the risk of nausea.
5. Avoid strong smells
6.  Don’t use Iron supplements unless you need them – can make nausea worse.

If untreated, pregnant women may progress to have the following:

• Electrolyte imbalance can lead to acute kidney injury, nutritional and vitamin deficiencies, 
• gastro-oesophageal reflux disease from persistent vomiting, venous thromboembolism, 
• Effect on a woman’s morale, spirit and mood from pain and psychosocial upset at what is going on.

What of the baby?

• Possible fetal complications if there is hyperemesis gravidarum include preterm delivery, low birth weight, and small-for-gestational-age.

Vaginal Bleeding In Early Pregnancy

The next symptom is vaginal bleeding, which can happen in pregnancy from several causes:

• Implantation bleeding (photo)
• Infection – STIs, UTIs
• Cervical Ectropion
• Miscarriage and
• Ectopic Pregnancy

Cervical Ectropion

Cervical ectropion is a change to the cervix. The soft cells we find inside the cervical canal spread to the outer surface of your cervix. (which usually has different types of ‘hard’ or epithelial cells). 

This change is also known as cervical ectopy. 

The cervix is the “neck” of your uterus, where your uterus connects to your vagina. Please check out this video on our video channel, where we talk about your cervix, including cervical ectropion.

This condition is sometimes referred to as cervical erosion. That term is old and slightly misleading. You can rest assured that your cervix isn’t really eroding.

Cervical erosion is common in women of childbearing age and on the combined pill.

Some women are born with it; others develop it along the way – it may be from hormone changes; some may develop it during pregnancy. 

It’s not a disease – it doesn’t affect fertility or cause cancer. 

But if present, it can be problematic for some ladies. 

Symptoms of Cervical Ectopy

Many ladies with cervical ectopy have no symptoms

For those who do get them, symptoms include:

• a mucus discharge that is not heavy
• bleeding between periods – most often spotting
• pain and Bleeding during or after sex
• Bleeding with pain can also happen during or after a pelvic exam.

Mostly they are nuisance symptoms, and in some ladies, they can be severe.

But cervical ectropion can cause early pregnancy bleeding, making you worry until the diagnosis is established. And it is the most common cause of Bleeding during the last months of pregnancy.

How we detect and treat it

1. A pelvic exam can tell if a lady has an ectopy of the cervix. Here, the cervix appears much redder and less smooth than usual.
2.  If we are not very clear, we do a colposcopy. This is the test where a little camera with very bright light is used to look closely into the cervix to allow us to examine it better.
3. Treatment depends on how troublesome the symptoms are. If it’s not causing any problems, we leave it alone.
4. It may go away on its own if it’s due to hormones – from stopping the pill or after having the baby.
5. Otherwise, we can use treatment to burn away the top layer – heat/cold or chemicals (Silver Nitrate) applied to the cervix for treatments are possible.

Treatment usually as a day case – it should heal after about 4 weeks, and all the trouble symptoms disappear. 

Remedy for a Closed Cervix

Miscarriage

Miscarriage is when a lady loses her pregnancy or baby before 24 weeks.

The most common cause of miscarriage is abnormalities within the baby, nothing you could have done or prevented. 

Other causes include infection, severe stress or trauma, other maternal illness, some drugs, etc.

What it looks like:

When a woman is pregnant – with either a positive pregnancy test or symptoms (amenorrhoea, missed period, and breast tenderness):  

• Watch for any type of vaginal bleeding. It could be spotting, scanty bleeding initially – brownish discharge to bright red bleeding. It may settle after a few hours and start again a day or two later. 
• You may experience cramping pain in the lower abdomen and backache after Bleeding begins.

When to see a doctor

Any episode of unscheduled vaginal bleeding with pain when you are pregnant or suspect you are pregnant should be reported to the doctor.

Another essential condition to consider is an ectopic pregnancy which is why we do not ignore any instance of vaginal Bleeding in women of childbearing age.

We will check your vital signs first.

This is important to be sure you do not have internal bleeding, for example, if an ectopic pregnancy in the tube has burst. 

A urine sample confirms pregnancy and checks if there is an infection that may be responsible for the bleeding.

In addition, you will have a blood test to test your HCG hormone levels which can tell us if pregnancy is progressing or not by how high it is.

Next, you will need to have a transvaginal ultrasound scan to check on the progress of the pregnancy. If there is no sign of a heartbeat, this is the definitive confirmation of a miscarriage.

What happens next depends on the mum’s well-being and can include:

• Watchful waiting – doing nothing but waiting for the pregnancy’s womb to be emptied entirely.
•  Sometimes, a woman may be given some drugs to help empty the womb.
•  Occasionally, a woman may require surgery or manual evacuation of the womb. This may be if there is an infection or you are at risk of heavy Bleeding.

What to expect after a miscarriage

The next step after we diagnose a miscarriage depends on the treatment option:

1. Expectant Waiting – 7–14 days, steady Bleeding as the womb empties – seek medical attention if heavy Bleeding, severe pain, fever or other concern. Do a PT after 3 weeks. It should be negative if the process is complete. Otherwise, you need to see the doctor again. 
2. Medical Management – This is when we use an oral or vaginal tablet to stimulate womb contraction and help empty the womb. The scan has confirmed the baby’s heart is not there. It may be suitable if the first option is not possible. Again watch for heavy bleeding/ severe pain or other symptoms of concern. 
3. Surgical – if expectant treatment or medical management has not worked after 14 days. It can be done via local or general anaesthesia. In this case, there is no waiting as the results are faster. Complications can include bleeding, pain, and infection – we should watch out for these.

Ectopic Pregnancy

An ectopic pregnancy is a pregnancy that develops outside the womb.

• Most ectopic pregnancies (93–98%) implant in the fallopian tube. The others are non-tubal and may implant in the ovary, abdomen, cervix, caesarean section scar, interstitial part of the fallopian tube, or the cornua of a unicornuate or bicornuate uterus.

Who is at RISK of an Ectopic Pregnancy?

In about 30% of cases, we cannot tell who will end up with an ectopic pregnancy.

However, other conditions that could make it likely to happen are:

• Tube damage (such as previous ectopic pregnancy or previous pelvic inflammatory disease) 
• Being over the age of 35 years and pregnant, 
• and smoking. 

• Complications include:
  • Tubal rupture (which may lead to maternal death if treatment is delayed).
  • Recurrent ectopic pregnancy.
  • Grief, anxiety, or depression.

What are the Symptoms of Ectopic Pregnancy?

• Symptoms generally appear 6–8 weeks after the last normal menstrual period (or much later for a non-tubal ectopic pregnancy).
• Common symptoms:
  • Abdominal or pelvic pain.
  • Amenorrhoea or missed period.
  • Vaginal Bleeding (with or without clots).
• Less common symptoms:
  • Breast tenderness.
  • Gastrointestinal symptoms (such as diarrhoea and/or vomiting). 
  • Dizziness, fainting, or syncope.
  • Shoulder tip pain.
  • Urinary symptoms.
  • Passage of tissue (pregnancy material) through the vagina
  • Rectal pressure or pain on defecation.

Important tests when we suspect an ectopic pregnancy include:

• Vital signs (pulse, blood pressure may quickly alert us to internal bleeding)
• Urine and blood pregnancy test (HCG)
• Transvaginal ultrasound is the diagnostic tool of choice for ectopic pregnancy.

Following diagnosis, some treatment options are available – depending on how ‘clinically stable’ you are.

An unstable condition is if there is very heavy bleeding or your pulse and blood pressure levels are abnormal.

Some ladies, however, are well (stable) at the time of diagnosis – bleeding is light, and there are no obvious complications yet.

These options are:

• Hospital treatment:
  • Vaginal hormones,
  • Watchful waiting,
  • Medication (commonly with methotrexate), or
  • Surgery.
• Whatever treatment is chosen, it’s important to follow up and receive appropriate support, information, and advice.

More Reading

• What’s An Ectopic Pregnancy – Risks, Symptoms and Treatments
• ‘I’m pregnant, not sick!’
• 4 Common Risk Conditions for Early Pregnancy Bleeding
• YOUR Risk of Bleeding During Pregnancy from Eight Conditions
• ALL about Symptoms of Ectopic Pregnancy

Editing By AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on various healthcare conditions to provide evidence-based guidance and to help promote quality healthcare. The advice in our material is not meant to replace a qualified healthcare practitioner’s management of your specific condition.
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