Warning signs

Some problems during pregnancy require immediate attention by your health professional for evaluation. These include

  • Vaginal bleeding
  • Loss of amniotic fluid
  • Severe headaches, severe upper abdominal pain, or vision change
  • Fever
  • Not feeling the baby move after 24 weeks of pregnancy
  • Contractions before 37 weeks

The warning signs are explained on the following pages.

At the end of your pregnancy, you can also contact the obstetrics department of your hospital directly.

Vaginal bleeding during the early months of pregnancy

Pregnant women often experience bleeding at the beginning of their pregnancy.

If you have bleeding during your first trimester, contact your health professional to have the situation assessed. After asking you some questions and doing an exam, he or she will be able to explain what is happening and what to do next.

However, go directly to the emergency room if you think you are pregnant and have any of the following symptoms:

  • Dizziness or loss of consciousness
  • Severe abdominal pain on one side
  • Shoulder pain
  • Heavy bleeding: vaginal bleeding that soaks two regular sanitary pads in an hour or one maxi-pad every hour for two to three hours straight

In the first trimester, light bleeding may be related to changes associated with the start of pregnancy, in which case there is no reason to worry. In many cases, the cause of this bleeding in unknown. It does not last, and the pregnancy progresses normally.

However, half of all women who bleed during this period will miscarry. In these cases, bleeding often starts a number of days after the pregnancy has ended. Bleeding may start brownish and turn red, or it may be light or dark red. More rarely, bleeding is due to an ectopic pregnancy (pregnancy outside the uterus).

A gynecological examination will be performed to determine the source of the bleeding and determine whether the size of your uterus matches the number of weeks of pregnancy.

If you are past 10 weeks, your health professional may also try to listen to your baby’s heart. Hearing the heartbeat is a good sign, as it indicates that the likelihood of miscarriage is low (2%). However, if bleeding persists, there is still a risk. Your health professional may check if an ultrasound is needed to evaluate the condition of the fetus. Examinations and treatment will depend on your particular situation.

About one in six pregnancies ends in miscarriage. Most miscarriages are caused by major genetic abnormalities that occur at random. They do not mean the woman is infertile or has a health problem.

If your pregnancy ends prematurely

It is normal for a couple to feel sad and distressed after a miscarriage and to go through a period of mourning. Some women also feel guilty about things they did or did not do early in the pregnancy because they think they caused the miscarriage. But miscarriage is not related to stress, fatigue, physical or sexual activity, diet, or lifting heavy loads.

If you and your partner don’t know how to break the news to your children or family and friends, you can talk to someone who has gone through the same situation or ask a health professional for help. Don’t hesitate to see a psychologist or social worker if you need to, as well.

If you want to get pregnant again after a miscarriage, it is best to wait until you have had at least one normal menstrual cycle. When you feel ready to try again, your odds of having a normal pregnancy will be very good. And don’t forget to keep taking your folic acid supplement.

If you have had an ectopic pregnancy, it is also normal to grieve for a time and to perhaps need help. If you are concerned about your chances of getting pregnant again, feel free to bring it up with your doctor.

Vaginal bleeding after 14 weeks

It is not normal to have vaginal bleeding after the first trimester of pregnancy. If you do, see your health professional. Bleeding does not always mean the pregnancy is at risk, but you should be evaluated to make sure everything is all right. The bleeding may be from the placenta, which can complicate the pregnancy and requires close monitoring.

If you have light red bleeding that is heavy enough that you have to wear a sanitary pad, see a health professional right away for an assessment. In some cases, an ultrasound may be needed to determine the cause of the bleeding.

Women who are Rh negative may need immunoglobulin (WinRho®).

After any gynaecological exam, you may experience light bleeding because the cervix is more sensitive during pregnancy. This type of bleeding does not require medical attention.

Loss of amniotic fluid

Some pregnant women may also have vaginal discharge during their pregnancy. Discharge can be vaginal secretions, urine, or leaking amniotic fluid. Loss of amniotic fluid can pose a risk for the baby if it occurs before 37 weeks. The table on the next page can help you determine what type of discharge you are having.

If you think you are losing amniotic fluid, or if you are unsure, call the delivery room or your midwife or go to the hospital to find out for sure.

Possible types of discharge

Type of discharge Description Amount

Vaginal secretions

  • Heavier and runnier in the final months of pregnancy
  • May wet your underwear, but not leak through
  • May soak a panty liner

The amount of discharge is another factor that can help you distinguish between leaking amniotic fluid, vaginal secretions, and urine. To estimate the amount

  • Wear a sanitary pad
  • Check the pad in 30 minutes
  • If you are really losing amniotic fluid, the pad will be soaked and heavy

Urine

  • More common after physical exertion, movement, coughing, and sneezing
  • Leaking stops when the bladder is empty

Amniotic fluid (waters)

  • Continuous loss of a clear, odourless fluid

Severe headaches, severe upper abdominal pain, or vision change

Contact your health professional right away if you are experiencing any of the following symptoms: severe headaches, severe upper abdominal pain, vision change (e.g., spotty or blurred vision), or general discomfort. Also consult your health professional if you notice that your blood pressure is high.

Fever

If you have a cold and are running a low-grade fever (about 38 to 38.4°C taken orally), you can take acetaminophen to lower your temperature and relieve pain. You can also contact an Info-Santé nurse or your health professional for advice. However, if your low-grade fever lasts more than 24 hours or you have a high fever (38.5°C or more), it could be harmful to your pregnancy or be a sign that you have an infection that needs to be treated.

See a doctor for diagnosis and proper treatment if any of the following apply:

  • You have a fever of 38 to 38.4°C, taken orally, that lasts more than 24 hours
  • You are running a fever of 38.5°C or higher, taken orally (you can take it twice to make sure)
  • Your general health is poor, you feel unwell, or you have severe chills
  • You have any concerns

Your baby doesn’t seem to be moving

Your baby is more active at certain times of day, but you may not always notice his movements because you are more active or distracted than usual. You also may not be able to feel all his movements, even if your baby is active (remember the movements you saw on the ultrasound that you couldn’t feel). At the end of your pregnancy the baby’s movements may feel different, but you will continue to feel the baby move until the delivery.

After 24 weeks of pregnancy, if you can’t feel your baby move or he is moving less than usual, rest and see what happens. If you count fewer than six separate movements over two hours, contact your birthing centre or health professional right away or go to the hospital to make sure your baby is all right.

Contractions before 37 weeks

Throughout your pregnancy, it is normal to feel contractions that are unrelated to labour. Known as Braxton Hicks contractions, they are irregular and may or may not be painful. They can be caused by sudden changes in your position, standing for long periods, or sexual activity. You may also feel small “electric shocks” in your cervix or menstrual-like cramps that last a few seconds. If this happens, these are not contractions; they are usually reactions to the baby’s movements.

However, if you feel your uterus harden regularly or are experiencing pain, you may be having real contractions. Sometimes the pain of the first contractions is similar to menstrual cramping. Real contractions last at least 20 seconds and come and go regularly.

If you are experiencing regular or frequent contractions (more than seven in one day) before 37 weeks, you may be going into premature labour, especially if you also have vaginal discharge. Contact your health professional or hospital so they can determine what is happening. Premature labour can sometimes be stopped if it is caught early enough.

After 37 weeks, the same symptoms may indicate that labour is starting. In this case everything is perfectly normal because your baby is no longer considered premature.

How to tell the difference between contractions and other abdominal pain

Problem Symptoms

Heartburn

  • Pain in the upper abdomen
  • Burning sensation caused by excess acid

Intestinal cramps

  • Pain throughout the abdomen that may be due to diarrhea or constipation

Urinary tract infection

  • Pain in the lower abdomen and sometimes the back
  • Frequent need to urinate small amounts
  • False urge to urinate and sense of urgency; leaking urine
  • Burning sensation when urinating
  • Persistent urge even after urinating
  • Blood in the urine (sometimes)

Ligament pain

  • Stretching sensation or pain in the lower abdomen, especially when you move, exert yourself physically, walk for a long time, or turn over at night (ligament pain is more common during second pregnancies and poses no danger to you or your baby)

Uterine contractions

  • Painful hardening of the uterus
  • The first contractions are sometimes like menstrual cramps
  • Pain comes and goes regularly
  • Pain lasts at least 20 seconds

Genetic abnormality: Error in the genes. Genes are located on the chromosomes of human cells. They pass along the traits of parents to their children.