Common Minor Symptoms
Pregnancy can cause a variety of complaints. A woman may feel frustrated when these are dismissed as ‘minor’. Reassurance and self-help are key to dealing with many of these symptoms (see Figure 31). Many women find it useful to hear that symptoms such as morning sickness and breast tenderness are worse when the pregnancy is doing well.
More Serious Problems
Hypertensive disorders of pregnancy include gestational hypertension and pre-eclampsia. Gestational hypertension complicates up to 15% of pregnancies. Pre-eclampsia is a multi-system disorder that comes on after 20 weeks (usually 3rd trimester). It affects 5–10% of pregnancies and is severe in around 2%. In the UK, pre-eclampsia kills around 1000 babies a year, and about 10 women.
Some women are more prone to it: those over 40, in their first pregnancy, expecting twins or more, or with a previous/family history of pre-eclampsia.
Assessment early in pregnancy aims to spot women at higher risk so they can have more frequent fetal monitoring. Even so, it is impossible to predict who will develop it, so you should have a high level of awareness and know what to do.
Refer her to hospital without delay for any of these:
Diastolic BP is ≥90 mmHg, or systolic BP is ≥160 mmHg
Urine shows 2+ protein or more.While there are usually no symptoms, these are very significant and should also trigger immediate referral:
Severe headache with or without vomiting
Visual problems such as blurred vision or flashing lights
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