WHEN SHOULD I BE CONCERNED ABOUT PREGNANCY SYMPTOMS
Knowledge of the clinical spectrum of normal pregnancy is helpful when evaluating pregnant women who present with one or more similar clinical symptoms, but have an abnormal pregnancy or a coexistent medical or surgical disorder.
Vaginal bleeding : Bleeding in early pregnancy that is heavier than spotting or accompanied by any pain may represent an ectopic pregnancy or impending miscarriage; however, any amount of bleeding is worrisome. The approach to evaluation and management of women with bleeding in early pregnancy is discussed in detail separately.
Nausea and vomiting : The onset of nausea and vomiting after about 10 weeks of gestation should prompt an evaluation, because this is after the typical period expected for onset of pregnancy-related nausea and vomiting. A cause other than pregnancy should be considered if nausea and vomiting are accompanied by pain, fever, vertigo, diarrhea, headache, or abdominal distension.
Hyperemesis gravidarum is considered the severe end of the spectrum of nausea and vomiting of pregnancy, and is commonly defined as persistent vomiting accompanied by weight loss exceeding 5 percent of prepregnancy body weight .Alternatively, the diagnosis can be made in women with pregnancy-related vomiting that occurs more than three times per day with weight loss greater than 3 kg or 5 percent of body weight.
Urinary frequency : Cystitis or an upper urinary tract infection should be suspected if pregnancy-related urinary frequency is accompanied by dysuria, hematuria, pyuria, fever, or flank pain.
Dyspnea : Pregnancy-related dyspnea is usually mild, of gradual onset, and not associated with other pulmonary signs. If dyspnea occurs acutely, or is associated with any of these symptoms, then the patient should be evaluated for pulmonary embolism or other cardiopulmonary disease.
Light-headedness : Pregnancy related light-headedness typically occurs when the woman has been standing, especially in a warm environment. It should resolve when she lies on her left side. Light-headedness is of concern when associated with an abnormal heart rate/rhythm or signs suggestive of a seizure, and when it does not resolve in the lateral or head-down position.
Pelvic discomfort : The round ligaments begin near the uterine cornua, pass through the abdominal inguinal ring and along the inguinal canal, and end in the labia majora. Pain in the location of the round ligaments has been termed "round ligament pain;" it is common and a diagnosis of exclusion. The pain is typically on the right side of the abdomen/pelvis and often occurs upon waking, suddenly rolling over in bed, or other vigorous activity. The pain is believed to be caused by irritation of nearby nerve fibers or spasm of the ligament
An ectopic pregnancy ruptured ovarian cyst and ovarian torsion should be excluded when the pain is moderate or severe, persistent or progressive, or accompanied by vaginal bleeding or peritoneal signs.)
Midline pelvic pain and vaginal bleeding are the cardinal signs of impending or ongoing spontaneous abortion After 20 weeks of gestation, preterm labor and abruptio placentae should be excluded in women with these symptoms.
Chest pain : Chest pain not due to gastrointestinal reflux is not a normal finding in pregnancy. The evaluation of women with chest pain is the same as in non-pregnant women of similar age