The First Trimester: Red Flags and When to Go To The ER

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Hey mamas!

So now that we know what symptoms are normal in the first trimester and why we get them, let’s see what’s not so normal and when we need to stop and listen to our bodies! Like I mentioned in my previous post, no one knows our bodies better than we do. If you think something is wrong, get to your doctor immediately!

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You’re growing a tiny human, it’s super exciting but also really scary! So many things can happen in an instant. It is difficult to distinguish between normal symptoms and those with a cause for concern, especially for a first-time mom. I’m a doctor and I still feel myself freaking out at times!

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Let’s dive right in!

1.Vaginal bleeding.
This has to be the most common thing I’ve seen women coming to the hospital for. Women literally sit outside in the waiting room for HOURS to be seen for bleeding. Ladies bleeding is completely normal in EARLY pregnancy. Especially if it’s light bleeding, or pinkish bleeding. As mentioned in my previous post, more often than not, it’s an implantation bleed. A speck of blood on a panty shield isn’t usually an indication to go to the ER. HOWEVER, in the first trimester, if the bleeding is HEAVY, enough to even wet a liner, there are clots and it is accompanied by cramping, GO TO THE ER IMMEDIATELY.

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The intensity and severity of vaginal bleeding is typically measured by your pad count. So that weird uncomfortable question your doctor asks, ‘how many pads did you use? Fully or partially soaked?’ may seem weird to you, but it actually helps to quantify the bleeding. This is where honesty comes in. You have got to be straight up. Was it a lot or nah? The colour of the blood is important and if there were any clots and the sizes are also very important.

Was this blood associated with any cramping? Similar in nature to menstrual cramps? This can be a sign of a miscarriage. Or was it associated with severe, sharp lower abdominal pain? Did that pain move anywhere? Especially to the shoulder tip? (Late sign, but still significant to ask). These can be signs of an ectopic pregnancy, which is a pregnancy that implants outside of the uterus. (More on both of these in my next post).

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Typically, if bleeding is severe, your doctor will ask you for any symptoms of anaemia (low blood count), do a full blood count to ensure that your blood count has not dropped, a vaginal exam to see the extent of the bleeding and check the cervix and order an ultrasound once the cervix is closed.

Bleeding is also common after intercourse because it irritates the cervix. So pay attention to this as well.

2.Excessive nausea and vomiting
This is another common condition we encounter regularly in the ER and is quite the opposite of people with bleeding. Those with vomiting tend to not see it as severe and present to the hospital really late and needing admission. This is also a common symptom experienced by most women in pregnancy. When’s the right time to go to the ER? Most people try remedies such as ginger, vitamin B and even Gravol! These work in most cases, however, those that don’t respond to these treatments and are unable to keep food down for more than twelve hours, should seek care immediately. You do NOT want ketones in your urine. This is a sign of severe dehydration and electrolyte disturbance which can affect you and your baby negatively. Prolonged vomiting also causes nutritional deficiencies which can ultimately lead to growth restriction for your baby.

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When you get to the hospital, your doctor will usually give you an injection of Gravol to help stop the vomiting and possibly a shot of something to help with the acid reflux associated with vomiting. You’re then given an IV access and fluids through the IV that contains vitamin B. Blood may be drawn at this time and your urine monitored. Then it’s up to the ward for at least 24 hours observation. Be vigilant with vomiting!

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3.Vaginal discharge
Vaginal discharge is absolutely normal in pregnancy. It is a thin, white, milky, and sometimes mild smelling discharge. VERY NORMAL. You may notice really increased amounts of discharge! Like. A. LOT. It’s really gross but a normal part of your body adapting to the higher oestrogen levels and increased blood flow.

If you notice this discharge changing in colour, possibly gray or green and frothy associated with a foul smell, this could be a sign of an STI. If the discharge becomes thick and cottage-cheese like with itching, this can be a sign of a yeast infection. Any of these common conditions may cause you some mild discomfort. You are more susceptible to these infections during pregnancy because of the changes and fluctuations in your hormones.

If you experience any of these symptoms, DO NOT hesitate to visit your doctor who will examine you and take a swab sample for testing. You will also be a given a course of insertable tablets to treat the discharge. IT IS VERY IMPORTANT TO TREAT THESE INFECTIONS. If they remain untreated, there is a risk of miscarriage and preterm labour!

4.Pain or burning on urination
Let’s face it, pregnancy makes us pee. You feel like Pissy Longstockings. Believe me girl, I feel ya. Something that took ten minutes now takes twenty because of pee breaks. It’s a WHOLE scene! However, if at any point urination is painful consider that you may have any of the following (sometimes this goes hand in hand with discharge): bacterial vaginosis, chlamydia, endometriosis, genital herpes, gonorrhea, trichomoniasis (these are all names for funky bacteria and STIs) or a urinary tract infection.These sound super scary, however, more often than not, it is a UTI.

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To be sure visit your doctor, where most likely they’d do a urine sample and a physical exam. It is imperative to treat a UTI because if left untreated, it can cause a kidney infection. We don’t want that! Pregnant or not. These infections can have serious effects on you and your baby, including preterm labour so it’s important to get it checked out ASAP! (UTIs are common in pregnancy, especially as baby grows and presses on your bladder!)

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5.High fevers
Keeping with the above topic, if you begin noticing any fevers, be it with a UTI or an isolated fever (a fever is anything above 37.8°C), take something with acetaminophen i.e Panadol. If it is associated with the flu, which we so often are exposed to in Trinidad, do not take any multi symptom tablets. It has not been approved for use in pregnancy. If high fevers persist for more than 36 hours, GO TO YOUR DOCTOR.

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Fevers can be dangerous during pregnancy and is usually a sign of a more serious underlying condition. It can restrict the growth of your baby, and in some rare cases, studies show that a fever in the first trimester can be linked to cleft palate, heart defects and neural tube defects. Should the fever be as a result of an underlying condition, such as measles, mumps, cytomegalovirus or toxoplasmosis, other serious defects may occur, especially deafness.

Always be wary of fevers in pregnancy.

6.Leg or calf pain, or swelling on one side
Leg cramps are another annoying pregnancy symptom that occurs mainly in the second and third trimester. They may be due to carrying extra weight or because of swelling in the legs from excessive fluid buildup in the legs (oedema). A certain degree of swelling is normal in the feet and ankles during pregnancy. If you notice a sudden, dramatic increase in swelling, especially of the hands and feet, this can be a sign of a condition called ‘pre-eclampsia’ which is high blood pressure in pregnancy (more on this topic later), but this is more common in the second trimester onwards.

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If you notice sudden, dramatic swelling in one leg or calf associated with strong, constant muscle pain, redness, tenderness, warmth or tightening of the skin, this may be a sign of a blood clot. Pregnancy is known as a hypercoagulable state, very fancy word for saying your blood clots easily. If this occurs, there is a chance that the clot can travel to your lungs which can lead to tremendous breathing difficulty and death or to the brain causing a stroke (you will get a severe constant headache if this occurs).

Blood clots are a medical emergency and if you experience any symptoms mentioned, seek medical care immediately.

To prevent cramps, stretch your calf muscles throughout the day. Avoid sitting or standing with your legs crossed for prolonged periods, remain active, stay hydrated and lie on your left side when sleeping. If you do experience a cramp, straighten your leg and gently flex the toes back to the shins. The pain will gradually subside. If these simple measures don’t work and the calf pain is constant. GO TO THE ER.

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7.Body swelling, blurry vision, dizziness, severe headache, epigastric pain
As mentioned in the previous point, these symptoms can indicate high blood pressure during pregnancy, aka pre-eclampsia. I will do an entire post dedicated to pre-eclampsia but it is important to note that there are many associated complications, that if left untreated can potentially be fatal.

It is completely normal to suffer with tension headaches and migraines during pregnancy, however, a persistent headache along with abdominal pain, blurred vision, swelling and nausea or vomiting can be indicative of pre-eclampsia. NEVER ignore these symptoms. Get to your doctor immediately.

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8.Ensure to control all underlying medical conditions
This one is not really a red flag, but if you have any pre-existing medical conditions, such as diabetes, high blood pressure, any thyroid dysfunction, cardiac issues etc., inform your doctor immediately as your pregnancy may be classed as ‘high-risk’ and closer monitoring will need to be done.

Ensure that all medical conditions are well controlled and that the necessary medications are complied with. In some instances, some medication may need to be switched to ensure the safety of the baby.

Tell your doctor right away and come up with a plan that works for you.

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Now that we’ve discussed some of the red flags of the first trimester, I hope you have a better idea of when to go to the hospital. NEVER ignore what your body is saying to you and if you have any doubts or concerns, always seek medical advice!

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See ya in the next post!