Red flag symptoms: Recognising pregnancy problems

Differentiate normal symptoms of pregnancy and serious conditions.

Ectopic pregnancy is the right fallopian tube (Photo: SPL)
Ectopic pregnancy is the right fallopian tube (Photo: SPL)
  • Abdominal and/or pelvic pain
  • Shoulder tip pain
  • Vomiting
  • Vaginal bleeding
  • Hypertension
  • Reduced fetal movement
  • Poor control of existing medical conditions
  • Signs of sepsis

In assessing the pregnant patient, it is important to exclude serious conditions that may warrant referral.


Miscarriage, the loss of pregnancy before 24 weeks of gestation, may present with vaginal bleeding, passage of clots and pain. Most occur in the first trimester and it may affect up to a fifth of recognised pregnancies.

Ectopic pregnancy

The symptoms of an ectopic pregnancy are initially the same as for a normal pregnancy and typically start at about the sixth week of pregnancy. Most ectopic pregnancies occur in the fallopian tubes.

Hyperemesis gravidarum

This severe intractable nausea and vomiting usually occurs between eight and 12 weeks of pregnancy in up to 2% of patients.

Abdominal pain

Pregnancy exacerbates conditions such as fibroid degeneration, ovarian cyst, UTI, adnexal masses that persist in pregnancy, gastro-oesophageal reflux and gall bladder disease.

Obstetric cholestasis

This affects up to 1.5% of women of Indian-Asian or Pakistani-Asian origin. It is diagnosed when pruritus occurs in pregnancy.


Pre-eclampsia is a multisystem disorder causing vascular endothelial dysfunction, occurring beyond the 20th week of gestation. It is associated with raised BP and proteinuria in a previously normotensive woman.

Antepartum haemorrhage

Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract that occurs from 24 weeks of pregnancy. Placenta praevia, placental abruption and local causes may cause APH.

Reflect on this article and add notes to your CPD organiser on MIMS Learning

  • Dr Kochhar is a GP principal in Bexhill, East Sussex

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