The document discusses common problems experienced during pregnancy such as heartburn, morning sickness, fatigue, frequent urination, constipation, back pain, stretch marks, gestational diabetes, high blood pressure, dental issues, headaches, severe vomiting, pelvic pain, piles, swollen ankles and fingers, tiredness, vaginal bleeding, discharge and cramping. It provides information on causes and treatments for these issues. Specific conditions covered in more detail include indigestion, morning sickness, hyperemesis gravidarum (severe nausea and vomiting), frequent urination, constipation, back pain, stretch marks, gestational diabetes and high blood pressure.

1. Common problems
associated with
pregnancy

2.  While
a few lucky women sail through their
pregnancies without even a twinge of
morning sickness, most of us have to contend
with a few (or maybe quite a few)
pregnancy-related issues. Here's how to cope
with some of the most common pregnancy
problems.

3. 
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Heartburn
Morning sickness
Fatigue
Frequent urination
Constipation
Sore back
Stretch marks and
itchy belly
Gestational diabetes
High blood pressure
(pregnancy-induced
hypertension)
Teeth and gums
problems in pregnancy
Headaches
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Severe vomiting
Pelvic pain
Piles
Swollen ankles, feet and
fingers
Tiredness
Vaginal bleeding
Vaginal discharge
Cramp
Feeling faint
Feeling hot
Incontinence
Skin and hair changes
Varicose veins

4.  Indigestion
– also known as dyspepsia – in
pregnancy is partly caused by hormonal
changes, and in later pregnancy by the
growing womb pressing on your stomach.
 As many as eight out of 10 women
experience indigestion at some point during
their pregnancy. The symptoms of indigestion
can include feeling full, feeling sick or
nauseous, and burping. The symptoms
usually come on after eating food.

5. 
Heartburn is a strong, burning pain in the chest that is caused
by stomach acid passing from your stomach into your
oesophagus (the tube that leads from your mouth to your
stomach).
 Here
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are some ways to put out the fire:
Eat small, frequent meals (this will also help with morning
sickness).
Stay away from greasy or fried food, coffee, cola, and smoking
(which you should avoid during pregnancy anyway).
Avoid alcohol to ease indigestion.
Eat slowly and chew your food well.
Drinking a glass of milk may relieve heartburn
Don't lie down for at least half an hour after meals.
Prop up your head and shoulders while you're asleep.
Try calcium carbonate, an antacid that's also used as a calcium
supplement. Don't take more than the dose recommended on
the package, and don't treat yourself with any other over-thecounter medications (including other antacids) before checking
with your doctor or pharmacist.
Antacids & Alginates usuage.

6. 
It’s thought that hormonal changes in the first 12weeks are
probably one of the causes of morning sickness or a lack of
vitamin B6 in the diet.
 Risk
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factors for morning sickness
A number of different factors may mean you are more likely to
have NVP. These include:
Nausea and vomiting in a previous pregnancy
Your unborn baby being a girl
A family history of NVP or morning sickness
A history of motion sickness, for example in a car
A history of nausea while using contraceptives that contain
oestrogen
Obesity – where you have a body mass index (BMI) of 30 or
more
Stress
Multiple pregnancies, such as twins or triplets
First pregnancy

7. 
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Morning sickness: As any pregnant woman knows, "morning
sickness" should really be called "all-day sickness." It usually gets
better after the first trimester, but an unlucky few suffer right up
until they deliver their baby. Here are a few ways to help that easy
stomach:
Have small, frequent meals. Don't let yourself get too hungry.
Have small amounts of fluids several times a day. But don't drink
fluids during or just before or after a meal.
Before you get out of bed in the morning, eat a small nutritious
snack like crackers or a granola bar (keep it by your bed), then
rest in bed for 15 minutes.
If certain scents or foods turn your stomach, steer clear! The most
common offenders are fried, spicy, or fatty foods.
If you're having trouble finding foods you can keep down, try
bread, noodles, watermelon, crackers, cereal, mashed
potatoes, clear soup, apple slices, pretzels, or pickles.
Try having your food cold instead of hot to take away some of the
smell.
Try smelling lemons or ginger to calm your stomach.
Have a few salty potato chips to ease nausea before your meal.
Take your prenatal vitamin with food so it doesn't upset your
stomach.

8. 
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Get plenty of rest and fresh air.
Try acupressure wrist bands (available at your local
pharmacy).
Ask
your
doctor
about
taking
Diclectin®
(doxylamine/pyridoxine), a prescription antinausea
medication for pregnant women.
avoiding foods or smells that make you feel sick
avoiding drinks that are cold, tart (sharp) or sweet
asking the people close to you for extra support and
help – it helps if someone else can cook but if this
isn’t possible, go for bland, non-greasy foods, such as
baked potatoes or pasta, which are simple to prepare
distracting yourself as much as you can – often the
nausea gets worse the more you think about it
wearing comfortable clothes without tight waistbands

9. When to see a doctor for morning sickness
 If you are vomiting and can’t keep any food or
drink down, there is a chance that you could
become dehydrated or malnourished. Contact
your GP or midwife immediately if you:
 have very dark-coloured urine or do not pass
urine for more than eight hours
 are unable to keep food or fluids down for 24
hours
 feel severely weak, dizzy or faint when standing
up
 have abdominal (tummy) pain
 have a high temperature (fever) of 38°C
(100.4°F) or above
 vomit blood


10. 

Some pregnant women experience excessive nausea and
vomiting. This condition is known as hyperemesis
gravidarum and often needs hospital treatment.
Hyperemesis gravidarum isn’t common but it can be
severe. It's much worse than morningsickness. If you're
being sick all the time and can't keep food down, tell
your midwife or doctor as soon as possible.
 Symptoms
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of hyperemesis gravidarum
Excessive vomiting in pregnancy is much worse than the
nausea and vomiting of morning sickness. Signs and
symptoms of hyperemesis gravidarum include:
Prolonged and severe nausea and vomiting
Dehydration
Ketosis – a serious condition that is caused by a raised
number of ketones in the blood and urine (ketones are
poisonous acidic chemicals that are produced when your
body breaks down fat, rather than glucose, for energy)
Weight loss
Lowblood pressure (hypotension) when standing up

11. 

The symptoms not only make your life a misery but
may lead to further health complications, such as
depression.
The nausea and vomiting are usually so severe that it's
impossible to keep any fluids down, and this can cause
dehydration and weight loss. Dehydration is when you
don’t have enough fluids in your body.
Causes
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
of hyperemesis gravidarum
It is thought that a lack of vitamin B6 in the diet may be
a cause hyperemesis gravidarum.
You should be able to get enough vitamin B6 through a
healthy, balanced diet. It's present in lots of foods
including cereals, wholemeal bread, cod, potatoes, milk
and bananas.
Vitamin B6 supplements may ease your symptoms, but
don't take them without speaking to your doctor first as
it's not clear how safe it is to take vitamin B6
supplements during pregnancy.

12.  Treating


Hyperemesis
gravidarum
needs
specialist
treatment, and you will usually need to be admitted
to hospital so that doctors can assess your condition
and give you the right treatment. This can include
intravenous fluids given through a drip to treat the
ketosis and treatment to stop the vomiting.
Hyperemesis gravidarum is unpleasant with dramatic
symptoms, but the good news is it's unlikely to harm
your baby. However, if it causes you to lose weight
during pregnancy there is an increased risk that your
baby may be born smaller than expected.
 Blood

hyperemesis gravidarum
clots and hyperemesis gravidarum
Because
hyperemesis
gravidarum
can
cause
dehydration, there's also an increased risk of having
deep vein thrombosis (a blood clot).

13. 
Considering the enormous amount of work
your body is doing right now, it's not unusual
to feel completely exhausted. The best
solution: rest! Give yourself permission to
get the sleep you need, even if this means
adjusting your schedule and asking for help
with household chores.

14.  In
the first trimester, those frequent
bathroom trips are due to the pregnancy
hormone human chorionic gonadotropin
(hCG), which causes increased urination. In
the second trimester, you usually get a bit of
a break from bathroom time. But in the third
trimester, bathroom breaks are back with a
vengeance as the growing uterus puts
pressure on the bladder.

15.  How
to reduce the need to pass urine
avoid caffeine
 avoid fluids in the early evening and before bedtime
– drink more fluids during the rest of the day to
make up for this
 go to the bathroom when you feel the urge
 when you urinate, lean forward to help the bladder
empty more

 When to get help
 If you have any pain while passing water or you pass
any blood in your urine, you may have a urine
infection, which will need treatment. Drink plenty of
water to dilute your urine and reduce pain. You
should contact your GP within 24 hours of first
noticing these symptoms.

16.  During
pregnancy, food moves more slowly
through the body to give you a better chance
to absorb nutrients. Iron supplements can
also make you constipated.
 What
 Eat
can you do to stay regular?
high-fibre foods like
fruit, vegetables, beans, and whole grains
 Get plenty of fluids
 Stay active
 Go to the bathroom when you feel the urge –
don't wait

17. Piles, also known as haemorrhoids, are enlarged
and swollen veins in or around the lower rectum
and anus. Anyone can get piles – they don't just
happen in pregnancy. When you're pregnant, piles
can occur because hormones make your veins
relax.
 Piles may itch, ache or feel sore. You can usually
feel the lumpiness of piles around your anus. They
may also bleed a little and can make going to the
toilet uncomfortable or painful. You may also
notice
pain
when
passing
a
stool
(faeces,
poo)
and
a
discharge
of
mucus afterwards. Sometimes you may feel as
though your bowels are still full and need
emptying.


18. How
to ease piles
Constipation can cause piles and if this is the case
try to keep your stools soft and regular.
 You can help ease piles, and prevent them, by
making some changes to your diet and lifestyle:
 Eat
plenty of food that is high in fibre, like
wholemeal bread, fruit and vegetables, and drink
plenty
of
water
–
this
will
prevent
constipation, which can make piles worse (find
out more about healthy eating in pregnancy)
 Avoid standing for long periods
 Take regular exercise to improve your circulation
 You may find it helpful to use a cloth wrung out
in iced water to ease the pain – hold it gently
against the piles


19. If the piles stick out, push them gently back
inside using a lubricating jelly
 Avoid
straining to pass a stool as this may
make your piles worse
 After
passing a stool, clean your anus with
moist toilet paper instead of dry toilet paper
 Pat , rather than rub, the area
 There are medicines that can help soothe
inflammation around your anus. These treat
the symptoms but not the cause of piles. Ask
your doctor, midwife or pharmacist if they can
suggest a suitable ointment to help ease the
pain. Don't use a cream or medication without
checking with them first.


20. 
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A growing uterus, a shifting center of gravity, and
loosening ligaments add up to back pain for many
pregnant women, especially in the third trimester. Here
are a few ways to ease back pain:
Choose your shoes wisely. Opt for a low heel with good
arch support.
Lift with your legs, not your back. And don't lift heavy
objects – ask for help.
If you have to stand for a long time, put one foot up on a
step stool or box.
When picking things up, squat down and keep your back
straight instead of bending from the waist.
When getting up, roll onto your side first, then use your
hands to push up.
Apply a heating pad or ask for a back rub.
Choose chairs with good lumbar support or put a little
pillow behind the small of your back when sitting.
Stay active – try water exercises and walking.

21. There's no sure-fire way to prevent or get rid of
stretch marks. But you can reduce your risk by
trying to gain no more than a healthy amount of
weight: 25 to 35 pounds (11 kg to 16 kg) for most
women. Use lotion to keep your skin well hydrated
and to avoid "itchy belly." After the baby is
born, the stretch marks will likely fade.
 Stretch marks are narrow pink or purplish streaklike lines that can develop on the surface of the
skin. They're also known as stria or striae. If you
get them, they usually appear on your tummy or
sometimes on your upper thighs and breasts as
your pregnancy progresses. The first sign you
notice might be itchiness around an area where the
skin is becoming thin and pink.


22. What causes stretch marks?
 Stretch marks are very common in the general
population and don't just affect pregnant
women. They can happen whenever the skin is
stretched, for example when we're growing
during puberty or when putting on or losing
weight, but hormonal changes in pregnancy
can affect your skin and make you more likely
to get stretch marks.
 Our skin is made up of three main layers – the
epidermis (the outer layer), the dermis (the
middle layer) and the sub cutis (the inner
layer). Stretch marks happen in the middle
layer, when the skin is stretched quite a bit
over a short time. This stretching can break
the dermis in places, forming stretch marks.

23.  It's
thought that stretch marks affect up to
around 80% of pregnant women. Whether or
not you get stretch marks depends on your
skin type, as some people's skin is more
elastic. After your baby is born, the marks
should gradually fade and become less
noticeable, but they won't go away
completely.
Stretch marks are not harmful.
They don't cause medical problems and there's
usually no need to see your GP because there
isn't a specific treatment for them. Over
time, your skin will shrink and the stretch
marks will fade into white-coloured scars.

24. Gestational diabetes: This is a type of diabetes
that starts during pregnancy and usually
disappears after the birth. The first sign is
usually a high result on a routine pregnancy
blood sugar test, usually done between 24 and
28 weeks of pregnancy. Your doctor will do more
detailed blood sugar tests to confirm it. Being
diagnosed with gestational diabetes usually
means a few changes:
 You'll need more frequent medical tests, such as
blood sugar testing, ultrasounds, urine testing for
protein, and blood pressure measurements.
 You'll be asked to make some healthy diet
changes and exercise more frequently.


25.  You
may need to use insulin injections if
your blood sugar can't be controlled by
exercise and eating changes alone.
 Because
women who had gestational
diabetes during pregnancy are at a higher
risk of diabetes later in life, your doctor
will check your blood sugar about 6 weeks
after the birth, and then yearly.
 Gestational diabetes increases the risk of
having a large baby, a C-section, or very
low blood sugar levels in the baby after
birth. But it can be controlled to help keep
both you and your baby healthy.

26.  Some
women develop high blood pressure
during their pregnancies. Usually this happens
in the last trimester (the last 3 months), and
usually goes away after the birth. It can
increase the risk of certain complications for
both mother and baby. It may limit the blood
flow to the placenta, which means the baby
gets less oxygen and nutrients. It can also
cause serious problems for the mother, such as
seizures or decreased blood flow to the vital
organs.

27. 
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Let your doctor know if you have a severe
headache,
vision
changes,
abdominal
pain, decreased amounts of urine, or severe
swelling of your hands or feet. If you develop high
blood pressure during your pregnancy, your doctor
will test your blood pressure, weight, and urine
frequently. You may need medication, bed
rest, and healthy eating to get your blood pressure
down. If you are close to the end of your
pregnancy and your blood pressure is quite
high, you may need to deliver your baby before
your due date. Delivering the baby is the only way
to cure high blood pressure of pregnancy.
This is not a complete list of all pregnancy-related
problems. Talk to your doctor for advice of
managing these and other pregnancy issues not
listed here.

28.  Some
women get swollen and sore
gums, which may bleed, in pregnancy.
Bleeding gums are caused by a build-up of
plaque (bacteria) on the teeth. Hormonal
changes during pregnancy can make your
gums more vulnerable to plaque, leading to
inflammation and bleeding. This is also
called pregnancy gingivitis or gum disease.

29.  Keeping
teeth and gums healthy in pregnancy

It's extra important to keep your teeth and gums as clean
and healthy as possible while you're pregnant. The best
way to prevent or deal with gum problems is to practice
good oral hygiene. Go to the dentist so they can give
your teeth a thorough clean and give you some
advice about keeping your teeth clean at home.

Here's how you can help look after your teeth and
gums:

Clean your teeth carefully twice a day for two minutes –
ask your dentist to show you a good brushing method to
remove all the plaque
Brushing is best with a small-headed toothbrush with
soft filaments – make sure it's comfortable to hold
Avoid having sugary drinks (such as fizzy drinks or sweet
tea) and sugary foods too often – try to keep them only
to meal times



30.  If
you're hungry between meals, snack on
vegetables and avoid sugary or acidic foods
(get tips on healthy snacks)
 Avoid mouthwashes that contain alcohol
 Stop smoking, as it can make gum disease
worse
 If you have morning sickness and you
vomit, rinse your mouth afterwards with
plain water. This will help prevent the acid in
your vomit attacking your teeth. Do not
brush your teeth straight away as they will
be softened by the acid from the
stomach. Wait about one hour before doing
so.

31.  Headaches
in women are often caused by
hormones, and many women who are not
pregnant notice a link with their periods.
Menopause and pregnancy are also potential
triggers.
 Some pregnant women find they get a lot of
headaches. Headaches can get worse in the
first few weeks of pregnancy, but they
usually improve or stop completely during
the last six months. They don’t harm the
baby but they can be uncomfortable for you.

32.  Coping
with headaches in pregnancy
Changes to your lifestyle may help to prevent
headaches. Try to get more regular rest
and relaxation. You could try a pregnancy yoga
class. If you’re having problems sleeping, you
can find out more about tackling this in
tiredness and sleep in pregnancy.
 Taking paracetamol in the recommended dose
is generally considered safe for pregnant
women. However, there are some painkillers
that you should avoid in pregnancy, such as
those containing codeine.
 Speak to your pharmacist, midwife, GP, nurse
or health visitor about how much paracetamol
you can take and for how long.


33.  When to seek help for headaches
 If you often have bad headaches, tell your midwife
or doctor so that they can advise you. Severe
headaches can be a sign of high blood pressure and
you should seek urgent advice, as this could
indicate
a
serious
condition
called
preeclampsia. Pre-eclampsia is a condition that affects
some pregnant women during the second half of
pregnancy or immediately after the delivery of
their baby.
 Women with pre-eclampsia have:
 high blood pressure
 fluid retention (oedema), and
 protein in the urine (proteinuria)
 If it's not treated, it can lead to serious
complications. In the unborn baby, pre-eclampsia
can cause growth problems.

34.  Some
women develop pelvic pain in pregnancy.
This is sometimes called pregnancy-related pelvic
girdle pain (PRGP) or symphysis pubis
dysfunction (SPD).
 Symptoms of pregnancy-related pelvic pain
 PPGP is a collection of uncomfortable symptoms
caused by a misalignment or stiffness of your
pelvic joints at either the back or front of your
pelvis. PPGP is not harmful to your baby, but it
can cause severe pain around your pelvic area
and make it difficult for you to get around.
Different women have different symptoms, and
in some women PPGP is worse than in others.

35. 
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Symptoms can include:
pain over the pubic bone at the front in the centre
pain across one or both sides of your lower back
pain in the area between your vagina and anus (perineum)
Pain can also radiate to your thighs, and some women feel
or hear a clicking or grinding in the pelvic area. The pain
can be most noticeable when you are:
walking
going upstairs
standing on one leg (for example when you’re getting
dressed or going upstairs)
turning over in bed
It can also be difficult to move your legs apart, for example
when you get out of a car.
There is treatment to help, and techniques to manage the
pain and discomfort. If you get the right advice and
treatment early on, PPGP can usually be managed and the
symptoms minimised. Occasionally, the symptoms even
clear up completely. Most women with PPGP can have a
normal vaginal birth.

36. Who
gets pelvic pain in
pregnancy?
It’s estimated that PPGP, or SPD as it's sometimes
known, affects up to one in five pregnant women to
some degree. It’s not known exactly why pelvic pain
affects some women, but it’s thought to be linked to
a number of issues, including previous damage to
the pelvis, pelvic joints moving unevenly, and the
weight or position of the baby.
 Factors that may make a woman more likely to
develop PPGP include:
 a history of lower back or pelvic girdle pain
 previous injury to the pelvis, for example from a fall
or accident
 having PPGP in a previous pregnancy
 a hard physical job


37. When
to get help for pelvic pain
in pregnancy?
Getting diagnosed as early as possible can help
keep pain to a minimum and avoid long-term
discomfort. Treatment by a physiotherapist usually
involves gently pressing on or moving the affected
joint, which helps it work normally again.
 If you notice pain around your pelvic area, tell your
midwife, GP or obstetrician. Ask a member of your
maternity team for a referral to a manual
physiotherapist who is experienced in treating
pelvic joint problems. These problems tend not to
get better completely until the baby is born, but
treatment from an experienced practitioner can
significantly improve the symptoms during
pregnancy.


38.  Treatments
for pelvic pain in pregnancy
Physiotherapy aims to relieve or ease
pain, improve muscle function and improve your
pelvic joint position and stability, and may
include:
 manual therapy to make sure the joints of your
pelvis, hip and spine move normally
 exercises
to
strengthen
your
pelvic
floor, stomach, back and hip muscles
 exercises in water
 advice and suggestions including positions for
labour and birth, looking after your baby, and
positions for sex
 pain relief, such as TENS
 equipment if necessary, such as crutches or
pelvic support belts


39. Coping
with pelvic pain in
pregnancy

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Your physiotherapist may recommend a pelvic support belt to
help ease your pain, or crutches to help you get around. It can
help to plan your day so that you avoid activities that cause you
pain. For example, don’t go up or down stairs more often than
you have to.
The Association for Chartered Physiotherapists in Women’s
Health (ACPWH) also offers this advice:
Be as active as possible within your pain limits, and avoid
activities that make the pain worse.
Rest when you can.
Get help with household chores from your partner, family and
friends.
Wear flat, supportive shoes.
Sit down to get dressed – for example don’t stand on one leg
when putting on jeans.
Keep your knees together when getting in and out of the car – a
plastic bag on the seat can help you swivel.
Sleep in a comfortable position, for example on your side with
a pillow between your legs.

40. 
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Try different ways of turning over in bed, for example turning
over with your knees together and squeezing your buttocks.
Take the stairs one at a time, or go upstairs backwards or on
your bottom.
If you’re using crutches, have a small backpack to carry things
in.
If you want to have sex, consider different positions such as
kneeling on all fours.
ACPWH suggests that you avoid:
standing on one leg
bending and twisting to lift, or carrying a baby on one hip
crossing your legs
sitting on the floor, or sitting twisted
sitting or standing for long periods
lifting heavy weights, such as shopping bags, wet washing or a
toddler
vacuuming
pushing heavy objects, such as a supermarket trolley
carrying anything in only one hand (try using a small
backpack)

41. 
Ankles, feet and fingers often swell a little in pregnancy as
your body is holding more water than usual. Towards the
end of the day, the extra water tends to gather in the
lowest parts of the body, especially if the weather is hot or
if you have been standing a lot. The gradual swelling isn't
harmful to you or your baby, but it can be uncomfortable.
 Avoiding and easing swollen ankles
 There are some steps you can take to prevent swollen feet
and ankles. These can also help to ease the discomfort if
your feet and ankles are feeling swollen already. Try to:
 avoid standing for long periods
 wear comfortable shoes – avoid tight straps or anything that
might pinch if your feet swell
 put your feet up as much as you can – try to rest for an hour
a day with your feet higher than your heart, for example
propped up with cushions as you lie on the sofa.

42. 
Foot exercises


You can do foot exercises sitting or standing. They
improve blood circulation, reduce swelling in the
ankles and prevent cramp in the calf muscles:
bend and stretch your foot up and down 30 times
rotate your foot in a circle eight times one way and
eight times the other way
repeat with the other foot

When swelling can be serious

You should seek medical attention immediately if
your face, feet or hands swell up suddenly. A
pregnancy condition called pre-eclampsia can cause
sudden swelling like this, although most women with
swelling don't have pre-ecplampsia.
If it happens to you, contact your midwife, doctor or
hospital immediately. If you do have preeclampsia, you’ll need to be monitored carefully, as
the condition can be serious for both you and your
baby.




43.  Bleeding
during pregnancy is relatively
common but it can be a dangerous sign, and
you should always contact your midwife or
GP immediately if it happens to you.
 In early pregnancy you might get some
perfectly harmless light bleeding, called
'spotting'. This is when the developing
embryo plants itself in the wall of your
womb. This often happens around the time
that your first period after conception would
have been due.

44. 
Causes of bleeding in pregnancy in early
pregnancy

During the first 12 weeks of pregnancy, vaginal
bleeding can be a sign of miscarriage or ectopic
pregnancy. However, many women who bleed at this
stage of pregnancy go on to have normal and
successful pregnancies.
 Miscarriage


If a pregnancy ends before the 24th week of
pregnancy, it's called a miscarriage. Miscarriages are
quite common in the first three months of pregnancy
and around one in five confirmed pregnancies ends
this way.
Many early miscarriages (before 14 weeks) happen
because there is something wrong with the baby.
There can be other causes of miscarriage, such as
hormone or blood clotting problems. Most
miscarriages occur during the first 12 weeks (three
months) of pregnancy and, sadly, most cannot be
prevented.

45.  Ectopic
 Ectopic
pregnancy
pregnancies, when a fertilised egg
implants outside the womb for example in
the fallopian tube, can cause bleeding but
are less common than miscarriages.
 It's a dangerous condition because the
fertilised egg can't develop properly outside
the womb. The egg has to be removed – this
can be through an operation or with
medicines.

46.  Causes
of bleeding in late pregnancy
Cervical changes - can lead to bleeding, particularly
after sex.
 Vaginal infections
 A 'show' - when the plug of mucus that has been in the
cervix during pregnancy comes away signalling that
the cervix is becoming ready for labour to start. It
may happen a few days before contractions start or
during labour itself.
 Placental abruption - a serious condition in which the
placenta starts to come away from the womb wall.
Placental abruption usually causes stomach pain, and
this may occur even if there is no bleeding.
 Low-lying placenta (or placenta praevia) - when the
placenta is attached in the lower part of the
womb, near to or covering the cervix. Bleeding from
a low-lying placenta can be very heavy and put you
and your baby at risk. You may be advised to into
hospital for emergency treatment and usually a
caesarean will be recommended.


47.  Vasa
praevia - a rare condition where the baby's
blood vessels run through the membranes
covering the cervix. Normally the blood vessels
would be protected within the umbilical cord
and the placenta. When your waters
break, these vessels may be torn and cause
vaginal bleeding. The baby can lose a lifethreatening amount of blood. It is very difficult
to diagnose vasa praevia, but it may
occasionally be identified before birth by an
ultrasound scan. Vasa praevia should be
suspected if there is bleeding and the baby's
heart rate changes suddenly after the rupture of
the membranes.

48.  Finding
out the cause of bleeding in pregnancy
To work out what is causing the bleeding, you may
need to have a vaginal or pelvic examination, an
ultrasound scan or blood tests to check your hormone
levels. Your doctor will also ask you about other
symptoms, such as cramp, pain and dizziness.
Sometimes the cause of bleeding cannot be found.
 If your symptoms are not severe and your baby is not
due for a while, you will be monitored and, in some
cases, kept in hospital for observation. How long you
need to stay in hospital depends on the cause of the
bleeding and how many weeks pregnant you are.
Being in hospital enables staff to keep an eye on you
and your baby so that they can act quickly if there
are any further problems.


49.  All
women, whether they’re pregnant or
not, have some vaginal discharge starting a
year or two before puberty and ending after
the menopause. How much discharge you
have changes from time to time and it
usually gets heavier just before your period.

50.  Is
it normal to have vaginal discharge in
pregnancy?




Yes. Almost all women have more vaginal discharge in
pregnancy. This is quite normal and happens for a few
reasons. During pregnancy the cervix (neck of the
womb) and vaginal walls get softer and discharge
increases to help prevent any infections travelling up
from the vagina to the womb.
Towards the end of pregnancy, the amount of
discharge increases and can be confused with urine.
In the last week or so of pregnancy, your discharge
may contain streaks of thick mucus and some blood.
This is called a 'show' and happens when the mucus
that has been present in your cervix during pregnancy
comes away. It's a sign that the body is starting to
prepare for birth, and you may have a few small
'shows' in the days before you go into labour.
Increased discharge is a normal part of
pregnancy, but it's important to keep an eye on it and
tell your doctor or midwife if it changes in any way.

51. When
GP







to see your midwife or
Tell your midwife or doctor if:
the discharge is coloured
it smells strange
you feel itchy or sore
Healthy vaginal discharge should be clear and white and
should not smell unpleasant. If the discharge is coloured
or smells strange, or if you feel itchy or sore, you may
have a vaginal infection.
The most common infection is thrush, which your
doctor can treat easily. You should not use
some thrush medicines in pregnancy.
Always talk to your doctor, pharmacist or midwife if you
think you have thrush. You can help prevent thrush by
wearing loose cotton underwear, and some women find
it helps to avoid perfumed soap or perfumed bath
products.

52.  Find
out
more
about
vaginal
discharge, preventing thrush and treating
thrush.
 You should also tell your midwife or doctor if
your vaginal discharge increases a lot in later
pregnancy.
 If
you have any vaginal bleeding in
pregnancy, you should contact your midwife or
doctor. Lots of women lose a small amount of
blood during pregnancy, and this is usually
nothing to worry about. However, it can
sometimes be a sign of a more serious problem
such as a miscarriage or a problem with the
placenta.

53. 
Cramp is a sudden, sharp pain, usually in your
calf muscles or feet. It is most common at night.
Nobody really knows what causes it, but there
are some ideas about causes of cramp and why it
can happen in pregnancy.
 Avoiding
cramp
Regular,
gentle
exercise
in
pregnancy,
particularly
ankle
and
leg
movements, will improve your circulation and
may help to prevent cramp occurring. Try these
foot exercises:
 Bend and stretch your foot vigorously up and
down 30 times
 Rotate your foot eight times one way and eight
times the other way
 Repeat with the other foot


54.  How
 It
to ease cramp
usually helps if you pull your toes hard up
towards your ankle or rub the muscle hard.
You can find out more about treatment of
cramp, but remember always to consult your
midwife, GP or pharmacist before taking
painkillers in pregnancy.

55.  Pregnant
women often feel faint. This is
because of the hormonal changes occurring
in your body. Fainting happens if your brain is
not getting enough blood and therefore not
enough oxygen.
 You are most likely to feel faint if you stand
too quickly from a chair or out of a bath, but
it can also happen when you are lying on
your back.

56. Avoiding feeling faint
 Here are some tips to help you cope:
 Try to get up slowly after sitting or lying
down
 If you feel faint when standing still, find a
seat quickly and the faintness should pass – if
it doesn’t, lie down on your side
 If you feel faint while lying on your
back, turn on your side
 It’s better not to lie flat on your back in later
pregnancy or during labour. Find out more
about the symptoms that might mean you're
going to faint, such as a sudden, clammy
sweat, ringing in your ears and fast, deep
breathing.

57.  During
pregnancy you’re likely to feel
warmer than normal. This is due to hormonal
changes and an increase in blood supply to
the skin. You’re also likely to sweat more. It
helps if you:
 Wear
loose clothing made of natural
fibres, as these are more absorbent and
breathe more than synthetic fibres
 Keep
your room cool – you could use an
electric fan to cool it down
 Wash frequently to help you feel fresh

58.  Incontinence
is a common problem both during
and after pregnancy. Sometimes pregnant
women are unable to prevent a sudden spurt of
urine or a small leak when they cough, laugh or
sneeze, or when they move suddenly, or just
get up from a sitting position. This may be
temporary, because the pelvic floor muscles
(the muscles around the bladder) relax slightly
to prepare for the baby's delivery. You can help
to prevent incontinence by doing pelvic floor
exercises.

59.  When
to get help
 In many cases incontinence is curable. If you
have got a problem, talk to your
midwife, doctor or health visitor.

60.  Urinating
a lot in pregnancy
 Needing to urinate (pass water, or pee) often
may start in early pregnancy. Sometimes it
continues throughout pregnancy. In later
pregnancy it is the result of the baby’s head
pressing on your bladder.
 How to reduce the need to pass urine
 If you find that you need to get up in the night
to pass urine, try cutting out drinks in the late
evening. But make sure you drink plenty of nonalcoholic, caffeine-free drinks during the day.
Later in pregnancy, some women find it helps to
rock backwards and forwards while they are on
the toilet. This lessens the pressure of the womb
on the bladder so that you can empty it
properly.

61.  When
 If
to get help
you have any pain while passing water or
you pass any blood in your urine, you may
have a urine infection, which will need
treatment. Drink plenty of water to dilute
your urine and reduce pain. You should
contact your GP within 24 hours of first
noticing these symptoms. You can find out
more about:
 Medicines
without
asking
your
midwife, doctor or pharmacist whether they
are safe in pregnancy.

62.  Hormonal
changes taking place in pregnancy
will make your nipples and the area around
them go darker. Your skin colour may also
darken a little, either in patches or all over.
 Birthmarks, moles and freckles may also
darken. Some women develop a dark line
down the middle of their stomach. These
changes will gradually fade after the baby is
born, although your nipples may remain a
little darker.

63.  If
you sunbathe while you are pregnant, you
may find you burn more easily. Protect your
skin with a high-factor sunscreen and don’t
stay in the sun for a long time. Find out more
about keeping skin safe in the sun.
 Hair
growth
can
also
increase
in
pregnancy, and your hair may be greasier.
After the baby is born, it may seem as if you
are losing a lot of hair but you are simply
losing the extra hair.

64. Varicose veins are veins that have become swollen.
The veins in the legs are most commonly affected.
You can also get varicose veins in the vulva (vaginal
opening). They usually get better after the birth.
 If you have varicose veins you should:
 Try to avoid standing for long periods of time
 Try not to sit with your legs crossed
 Try not to put on too much weight as this increases
the pressure
 Sit with your legs up as often as you can, to ease
the discomfort
 Try support tights, which may also help to support
your leg muscles – you can buy them at most
pharmacies


65.  Try
sleeping with your legs higher than the
rest of your body – use pillows under your
ankles or put books under the foot of your
bed do foot exercises and other antenatal
exercises
such
as
walking
and
swimming, which will all help your
circulation
 Try these foot exercises:
 Bend and stretch your foot up and down 30
times
 Rotate your foot eight times one way and
eight times the other
 Repeat with the other foot