Red Flag Symptoms: Pregnancy

In March 2008, new guidance on screening for fetal anomalies and clinical conditions in the mother were included in updated NICE guidelines on antenatal care.

    * Unilateral pain in pelvis or abdomen
    * Vaginal bleeding
    * Epigastric pain
    * Rigid/tender uterus
    * Fever
    * Hypertension
    * Itching
    * Reduced fetal movements

This update serves as a useful reminder of which symptoms are worth looking into more seriously during pregnancy.

Keep in mind symptoms that are perfectly normal throughout pregnancy, such as nausea, breast tenderness and back ache. Normal pregnancy symptoms may seem alarming to first-time mothers and women may need reassurance.

Bleeding during early pregnancy occurs in one in four pregnancies and can be part of a normal pregnancy. It is most common between the ninth and 12th week of pregnancy. Bleeding can also be a sign of a miscarriage or ectopic pregnancy. A raised temperature may indicate sepsis, and a rapid pulse or lowered BP could point to shock.

A woman presenting with unilateral lower abdominal pain and vaginal bleeding should be investigated for ectopic pregnancy. A history of STIs increases risk of ectopic pregnancy.

Bleeding accompanied by continuous pain with a hard, tender uterus may indicate placental abruption. If the woman is stable, an ultrasound can be performed to confirm the status of the pregnancy.

Reading the signs
Urinalysis and an FBC may be done in primary care, depending on the urgency of the situation. Urinalysis may rule out a UTI or highlight proteinuria, which occurs in pre-eclampsia.

Hypertension or epigastric pain in the third trimester could be a sign of pre-eclampsia. The updated NICE guidance for antenatal care now states that BP measurement and urinalysis for protein should be carried out at each antenatal visit to screen for pre-eclampsia.

Itching may be a symptom of obstetric cholestasis. The itching can be treated and symptoms should resolve after the birth.

Finally, remember not to overlook labour as a cause of symptoms, especially in first-time pregnancies.

Possible causes

  • Premature labour.
  • Miscarriage.
  • Ectopic pregnancy.
  • Placental abruption.
  • Pre-eclampsia.
  • Obstetric cholestasis.


NICE guidelines for antenatal care, 2008


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