The importance of symptoms

Although minor annoyances are fairly common during pregnancy, serious problems seldom arise. These rare conditions are known as complications of pregnancy. Most of them can be prevented. This is why it is so important for you to go to your doctor when you first suspect that you are pregnant and remain under his care until your baby is born.

Complications which might endanger you or your baby if they were to go undetected or untreated almost never appear suddenly or unexpectedly. Usually one or more warning signals occur in advance. Your doctor will watch for these signals or symptoms on each of your prenatal visits to him. Some can be detected during your regular physical examinations; others in the results of such simple tests as blood pressure readings, blood counts, blood typings, urine analyses, and checks on your weight.

Some symptoms may develop that you will be the first to notice. The most important of these are bleeding from the vagina, however slight; severe or continuous nausea and vomiting; continuing or severe headache; swelling or puffiness of the face or hands, or marked swelling of the feet or ankles; blurring of vision or spots before the eyes; a marked decrease in the amount of urine passed; a several pounds weight gain in a 1-week period; pain or burning on passing urine; chills and fever; sharp or continuous abdominal pain; sudden escape of water from the vagina.

Symptoms to be reported

Your doctor will give you special instructions about symptoms that should be reported to him without delay. Let him know right away if you have any of these symptoms or others which may mean that trouble is brewing. In this way, early treatment is possible and most difficulties can be avoided. Unless accompanied by one or more of these symptoms, none of the vague complaints or discomforts that may trouble you is likely to be of major consequence.

Such symptoms may or may not be significant, depending upon the circumstances under which they occur. Nevertheless, your doctor will want to know about any you have so that he can evaluate each one in the light of your particular case, even though it may not prove to be a cause of concern. For instance, slight bleeding during the first two months of pregnancy at the time a menstrual period would ordinarily have occurred, does not usually mean that you are about to have a miscarriage. Later in a pregnancy, recurrent lower abdominal pain, slight bleeding and a discharge of water from the vagina may simply indicate the onset of normal labor. In general, however, you should notify your doctor of the appearance of any of these symptoms as soon as possible. It is important for you to keep every appointment to see your physician so that he may inquire into the circumstances of any symptom or problem, decide whether or not the complaints are real danger signals, and give you treatment, if needed, at the earliest possible time.

Illnesses

Illnesses strike infrequently during pregnancy, because most young women of childbearing age enjoy good general health. It is also true that, except for a few complications most problems related to childbearing occur only once in several hundred births. This is why pregnancy is generally regarded as a normal process and one that is a happy experience for most women. Even so, to overlook the occasional problems that may arise or to neglect your responsibility of seeing to it that your doctor has ample opportunity to detect and treat them promptly would be a mistake.  

Miscarriage

The term "miscarriage" refers to the birth of the baby at a time before it has developed enough to live in the outside world, usually before the fifth month of pregnancy. At least 1 pregnancy in 10 comes to an end in this manner. About two-thirds of these occur in the first three months.

Miscarriages may be due also to factors other than abnormalities of the egg or infant, and many of these may be discovered and treated successfully before the next pregnancy occurs. Moreover, it should be understood that the chances for success in the pregnancies following one miscarriage are very good, because the cause usually does not recur. You should not count on this, however, and you should allow yourself to be checked for problems that persist. Miscarriages due to glandular or nutritional problems can sometimes be avoided by good prenatal care, but the best hope is to have these conditions studied and treated by your doctor before you undertake another pregnancy.

Miscarriage used to be blamed on a fall or blow to the abdomen, but doctors now know that this is an exceedingly rare cause. The baby is protected within a sac of fluid in the uterus and usually escapes injury even in the event of a serious accident to the mother.

A pelvic examination by your doctor will not cause a miscarriage. It is necessary for him to examine you thoroughly at the beginning of pregnancy, even if there is bleeding. Often the bleeding is not coming from within the uterus, but arises from conditions in the mouth of the womb, the vagina, or elsewhere. In very rare circumstances, the pregnancy may be found in the tube rather than the womb. This is another reason for having a careful examination, even though you may be bleeding at the time.

Treatment of a miscarriage

Slight bleeding may mean that a miscarriage is only threatening and that the baby may yet be saved. More severe bleeding, especially with cramps, usually means that a miscarriage is actually happening. The doctor will want to know if the mouth of the womb is opening, indicating that loss of the baby is very likely to occur. He can make this judgment only if he does a pelvic examination. If he finds the mouth of the womb closed, the outlook is much more favorable, and he may prescribe bed rest and other measures to prevent the miscarriage. If, on the other hand, he finds that some tissue has already been passed, he may advise scraping of the womb, commonly called a D&C (dilation and curetage), to remove the remaining bits of "afterbirth" (placenta) in an effort to stop bleeding and prevent infection.

If you notice bleeding at any time during pregnancy, go to bed at once and have someone notify your doctor. He will want to know when bleeding began, how much bleeding there is, whether or not you have passed clots or tissue, and whether or not you have had pain or cramps in your abdomen. You should save all clots and tissue for the doctor so that he may look for pieces of the afterbirth. The finding of tissue in the material you have saved may influence his treatment.

Miscarriages which start of their own accord and are managed promptly by the doctor are rarely dangerous to the mother, and recovery is usually rapid. On the other hand, miscarriages brought about by illegal means, either self-induced or carried out by some illicit practitioner or midwife, are often disastrous because of infection, severe hemorrhage or puncturing of the womb.

A miscarriage deliberately caused by entrance of unsterile instruments or other unclean objects into the uterus, or done by an unqualified person, can lead only to a grave risk of death to the mother. Even if she escapes death, she may require prolonged hospitalization to combat shock, infection, and abscesses in the pelvis. She may also lose her ability to bear children.

Therapeutic abortions

Occasionally it may be necessary for medical reasons to stop a pregnancy. If this decision is made, the operation must be done by a qualified doctor with the advice and consultation of several other doctors. These miscarriages, called "therapeutic abortions" by doctors, can be safely performed only in the operating room of a hospital under the strict, sterile precautions required for all other surgical operations. However, medical advances have made it one of the rarest operations performed today.

Prolonged vomiting

Mild nausea and vomiting, usually in the morning, are common complaints, but prolonged and persistent vomiting is an unusual complication. This complaint should be reported to your doctor immediately, especially if you are unable to keep down fluids; and it may be a problem of special concern if it comes on suddenly after the third month of pregnancy. If abdominal pain is present with vomiting at any stage of pregnancy, your doctor should be notified at once. Although the problem may be due to a virus or a temporary intestinal upset, your doctor should evaluate the symptoms in the light of your individual circumstances. Rarely, there may be an obstruction of your bowel or other serious problems requiring immediate treatment.

Although few women experience prolonged vomiting, it may occur in the absence of disease in some "high-strung" mothers with serious personal or family worries. Talk with your doctor if anything is troubling you. He may be able to help straighten things out or arrange for you to talk to someone who can give you the kind of assistance you need.

Toxemia of pregnancy

Toxemia is a complicated disorder which may be associated, in its extremely advanced stages, with high blood pressure, marked swelling, marked weight gain, albumin in the urine, and symptoms of headache, dizziness, blurred vision, spots before the eyes, nausea, vomiting, pain in the abdomen, and, in rare cases, convulsions and coma. The important thing to remember is that in the early stages no harm comes to the mother or her child if the condition is properly treated.

This is why your doctor will ask you about swelling of your face and fingers, rapid weight gain, and any persistent headaches or eye symptoms. Likewise, it is understandable that he should emphasize diet, salt restriction, and adequate rest, if you begin to show any of these danger signals.

If you report for your checkups faithfully, the trend of your weight, blood pressure, and urinary findings may point up the need for restrictive measures before you are in real trouble. The doctor may even want you to go into the hospital for special care although, as far as you can tell, you may feel perfectly well. Most of the time, corrective home measures will suffice, if you are cooperative in carrying out your doctor's instructions at the earliest sign of trouble.

Certain conditions increase the likelihood of developing toxemia and may lead your doctor to give you special care throughout pregnancy. He may ask you to report for checkups more frequently than you had expected. You should not be alarmed by this, because your doctor is trying to see to it that your pregnancy proceeds normally. This may be the case if you are known to have had toxemia previously or if you have high blood pressure when you are not pregnant. Patients with diabetes, kidney disease or heart trouble are entitled to this special consideration.

The two most serious dangers in toxemia are death of the baby before birth and the possibility of the mother's developing convulsions or "eclampsia." These complications are much less common today than they used to be, because most patients now receive good prenatal care. They are more likely to develop in the women who do not have the benefit of good prenatal care or who do not heed the advice of their doctor. In moderately advanced cases of toxemia, the doctor now has available certain drugs to lower the blood pressure and to ward off convulsions. Even these treatments are unnecessary, if the earliest signs are noted and simple precautions are taken. After the birth of the baby, the mother's circulation and kidney function usually return to normal.

Urinary infection

A pregnant woman is somewhat more likely to develop an infection in the bladder or kidney than one who is not pregnant. Certain changes in the urinary tract occur in pregnancy that hinder proper drainage of urine and make it susceptible to infection. These infections are serious only if they go unrecognized and proper treatment is not given early in the disease and continued until a complete cure is achieved.

The usual early symptoms of bladder infection are burning on urination, and an urge to urinate often. The urine may be cloudy or tinged with blood. There may also be a low-grade fever and chilliness.

When the kidneys are involved, a series of sharp elevations and drops in temperature may occur within a few hours, usually to a higher level than that noted in bladder infections, sometimes as high as 104°. The fever is often accompanied by shaking chills, backache, and tenderness in the back at the junction of the last rib with the spinal column.

If you notice such symptoms at any time during pregnancy or after you have returned home following the birth of your baby, call the doctor, go to bed, and drink plenty of water. The doctor will be able to prescribe a drug that will clear up this infection and make certain that it does not linger on in mild form to cause permanent damage. Even though you may no longer have symptoms following a course of treatment, your urine will need to be checked to be certain that all the bacteria are dead.

Anemia

Anemia is a condition of the blood resulting from a reduction either in the number of red blood cells or in the amount of hemoglobin. Hemoglobin is the red colored substance in the red blood cells which carries oxygen to the body tissues. If the amount of hemoglobin is below normal, or if there are too few red blood cells, not enough oxygen will get to the tissues. In pregnancy, it is particularly important to prevent anemia, since both the mother's body and the baby need a good supply of oxygen.

Anemia may develop from loss of blood or from a lack of sufficient iron in the diet. Iron and protein are important materials for forming hemoglobin. Lean meats, especially liver, and eggs are good sources of iron and protein. A pregnant woman may become anemic, because it is often difficult for her to get enough iron from food alone to take care of her own and her baby's needs. The baby must store iron during the months before birth so that he will have enough to carry him through the early months after birth before he can take solid foods. Often some kind of iron compound, in the form of pills or capsules, will help to supply the extra needed during pregnancy. Your doctor can decide about this by checking the amount of hemoglobin in your blood from time to time.

Some types of anemia in pregnancy are due to more complicated causes and may be harder to treat. Fortunately they are much less common.

Premature birth

Birth of the baby before it has reached a weight of 5 1/2 pounds is referred to as a premature birth. It occurs in only about 10 percent of all births that go beyond the fifth month. Because these small babies are not as strong as full-term ones, they must be given special care immediately after birth in order to live.

Premature birth is ordinarily not a great problem among healthy, well-nourished mothers. Those who are malnourished or suffer from some chronic illness are more susceptible. It occurs more frequently in twin pregnancies than in single births. Usually, in these circumstances, these babies are relatively mature in spite of their small size and may be expected to do better than a single baby of the same size. In other cases, early birth occurs as a result of syphilis, toxemia, or other serious problems; but this risk is much less when proper treatment is given early.

Many premature births may not be associated with obvious disease. It is important, therefore, for you to think of this possibility when crampy, labor-type, rhythmical, abdominal pains develop. If these persist for a period of time, you should report them to your doctor, even though in most instances it will be part of the normal contracting action of the womb. A sensation of tenseness in the womb may be a frequent occurrence in the last weeks before your baby is due. When you are resting quietly or you have been under an emotional strain, these contractions may be more noticeable. If you have doubts about their true nature, you should notify your doctor.

A sudden gush of water from the vagina several weeks before the baby is due usually means that premature birth of the baby is likely. The gush of water results from breaking of the bag of waters and is often the first sign of premature labor. In this instance, you will continue to drain fluid even though your bladder is empty.

If the bag of waters breaks, let your doctor know at once. He may want you to come to the hospital to await labor even if it has not yet started. Under no circumstances should you take a tub bath or a douche, or otherwise allow contamination of the birth tract, because these practices may lead to serious infection. The protective bag of waters is lost, and bacteria may spread directly to the baby from the vagina and lower tract.

Rh factor

Your doctor checks your blood type routinely as a precaution in case you need blood during pregnancy or delivery. In addition, he determines the presence or absence of the Rh factor—a substance which is present in the blood cells of a large proportion of people. If you have the Rh factor in your red blood cells, you are called Rh positive; if you do not, you are Rh negative.

This factor is found in the blood of about 85 percent of white women and in about 95 percent of Negroes. This factor is a matter of concern only if it is absent in the woman while being present in the husband's blood. In these "incompatible" couples, the infant, who may inherit the factor from the father, may cause the mother to develop antibodies against this factor. These substances (antibodies) are manufactured by the mother as her protection against new materials introduced into her blood—in this case it is the baby's red blood cells which contain the Rh factor she does not possess.

Ordinarily, the first baby who causes this reaction in the mother will not be affected by the mother's antibodies. If the mother has already developed these substances before her first pregnancy as a result of a transfusion with Rh positive blood, even the first baby might be affected by the antibodies. This rarely occurs, however, because great care is taken to check for the Rh factor before giving a blood transfusion. The question arises only in those women who may have been transfused many years ago, before anything was known about this factor.

When antibodies are present in the mother's blood, usually after one or more previous pregnancies, these substances pass over to the baby and destroy his red cells, because the antibodies are antagonistic or hostile to them. These antibodies do not endanger the mother, but they may cause severe anemia and other changes in the baby—a condition known as erythroblastosis.

If you do not have the Rh substance in your blood you are Rh negative. If your husband does have the factor he is Rh positive. Your doctor will check your blood to see if you have antibodies that might affect your baby. This is especially necessary if you either have been previously transfused with Rh positive blood or have had previous children who are Rh positive. It is well to have your children checked, because this information will be helpful to your doctor. Also, obviously, you must know the Rh type of your husband.

More attention has been paid to this condition than its frequency and seriousness justify. The truth is that even among Rh negative women who are married to Rh positive men, these antibodies appear in the blood of only about 1 such woman in 20. When they appear, the substances are readily detected in the blood, and certain measures are available to reduce the risks to the baby. Most of these cases are mild problems, and the outlook for the infant is excellent. In the rare, more severe forms, even though the outlook is not as good, the policy of bringing about labor early to cut down on the exposure of the baby to the mother's antibodies, and transfusions for the baby after birth, have led to the saving of many lives.

Chronic diseases

If you have had certain chronic illnesses or disorders before you became pregnant, you may have some difficulty during pregnancy because of them. Such illnesses as diabetes, rheumatic heart disease, chronic kidney disease, tuberculosis, and syphilis may cause special problems.

For a woman with any of these diseases, good care and continuing medical supervision are absolutely necessary during pregnancy. If you have ever had one of these illnesses, you must pay particularly close attention to your doctor's advice and recommendations.

Diabetes, heart disease, and chronic kidney disease may interfere with normal functioning of a mother's internal organs.

Tuberculosis is not inherited by the baby, but after birth a baby may catch this disease from contact with his mother. It is necessary to keep the baby of a mother with active tuberculosis away from her until she is well.

The germ of syphilis can get through the placenta and infect the baby before birth. Some State laws require every pregnant woman to have a test for syphilis. Such tests are important because it is possible for a woman to become infected with syphilis without knowing it. Her unborn child may become badly infected if the mother does not receive proper treatment. With early and adequate treatment the chances of having a normal baby are almost 100 percent, but untreated syphilis can cause the death of a baby either before or after birth. If an infected baby lives, it may be physically and sometimes mentally damaged.

Even if the mother has been previously treated for syphilis, the baby can sometimes become infected before birth. Syphilis is a complex disease, and relapse can happen. A woman who has, or has had syphilis, must be followed frequently with blood tests during her pregnancy. She should report to her doctor as early as possible in pregnancy and follow his instructions to the letter, if the baby is to be spared the disease and to develop normally.

Rubella

Rubella, commonly known as German measles, if contracted in early months of pregnancy may harm the unborn baby. Unless a complication occurs, rubella seldom requires treatment. If you have been exposed to the disease, call this to your doctor's attention immediately. Though the baby may appear normal at birth, the doctor will want to examine him regularly for any defects that might become apparent later. Since many babies born of mothers who had rubella during pregnancy are capable of spreading the infection, the doctor will probably recommend isolating the baby.

Marcus Siegel

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