If you experience any of the following symptoms during early pregnancy, contact your doctor or health care provider:
- any vaginal bleeding;
- swelling of the face or fingers;
- severe or continuous headache;
- dimness or blurring of vision;
- abdominal pain;
- persistent vomiting;
- chills or fever;
- burning or pain during urination;
- leaking of fluid from vagina; and
- swollen extremities.
Although most women do not experience significant complications during pregnancy, you should be aware of the complications that can occur so you can quickly recognize the symptoms and seek treatment. Complications that may occur during the first trimester of pregnancy include miscarriage, hyperemesis gravidarum (extreme vomiting), ectopic pregnancy, and molar pregnancy.
Miscarriage, or spontaneous abortion, is one of the most common complications of early pregnancy. At least 15 to 20% of all pregnancies end in miscarriage and most miscarriages (about 80%) occur during the first trimester.
More than one-half of all miscarriages are caused by problems with the fetus' chromosomes. As the cells of the embryo divide, genetic mishaps occur that make the fetus nonviable and it is miscarried. These genetic problems are not usually inherited chromosomal defects from the parents.
Symptoms of miscarriage include spotting, bleeding, cramping, and passage of tissue. If you have these symptoms, contact your doctor immediately.
Your doctor may perform a pelvic exam, ultrasound, and certain blood tests to diagnose miscarriage. Sometimes, it is necessary to have a procedure known as a dilation and curettage (D and C) to empty the uterus and stop the bleeding. Women who have Rh-negative blood will be given an injection of immunoglobulin (RhoGAM) after miscarriage to help prevent isoimmunization problems with future pregnancies.
When miscarriage happens, it is common for a woman and her partner to feel that they somehow caused it. Generally, this is not the case. Miscarriage is not caused by having sex, arguing, vomiting, or falling. Many couples that experience a miscarriage have a successful pregnancy in the future. Multiple miscarriages can occur, but are rare overall.
After experiencing a miscarriage, it is normal to grieve. This is a normal process for such an important loss, even if the loss occurred early in pregnancy. Give yourself the time you need to overcome your loss.
Common Misconceptions: Miscarriage is not caused by having sex, having an argument, vomiting, or falling.
Most women experience some nausea during early pregnancy, and many also have spells of vomiting. In the majority of women, this is temporary. In about one of every 300 women, vomiting is excessive and persistent. This is known as hyperemesis gravidarum and can lead to dehydration, poor nutrition for mother and fetus, and episodes of fainting. If it lasts long enough, hyperemesis gravidarum can affect the fetus.
Hyperemesis is not well understood. It is thought to be caused by high levels of the hormones beta-hCG and estrogen. It is more common in a first pregnancy, in younger women, and in those with multiple gestations (twins, triplets, etc).
Because a few other conditions can mimic hyperemesis, diagnosis involves examination and tests to rule out thyroid disease, gastrointestinal disorders, and molar pregnancy.
Treatment, involving rest, dietary changes, intravenous fluids, and medications to reduce vomiting, can help reduce the severity and frequency of symptoms. In severe cases, hospitalization and intravenous liquid nutrition is recommended. Most women's symptoms go away by about 16 weeks (four months) of pregnancy. Fortunately, the fetus does well and rarely suffers consequences.
Ectopic pregnancy (tubal pregnancy) is a pregnancy located outside the uterus, usually in the fallopian tubes. In rare instances, the fertilized egg may implant on the ovary, in the cervix, or within the abdomen.
Ectopic pregnancy is primarily caused by tubal scarring from pelvic infection, such as PID (pelvic inflammatory disease), chlamydia, previous surgery such as tubal ligation, and endometriosis. Because chlamydia, a common sexually transmitted disease, can cause a "silent" infection (without symptoms), many women will not know that they have had a past infection and are at risk for an ectopic pregnancy. About 1% of pregnancies are ectopic.
The fallopian tubes are narrow, about the size of pencil lead, and cannot hold a growing pregnancy for an extended period of time. As the pregnancy grows, the tube stretches and eventually bursts. Life-threatening internal bleeding can occur. A woman may feel pain or faint, but have little or no external bleeding. About 50 women die each year in the from ruptured, ectopic pregnancies.
Diagnosis is accomplished by a pelvic exam, lab tests, ultrasound examination, and possibly a diagnostic laparoscopy or dilation and curettage or D and C (dilating the cervix and scraping the uterine lining) and/or culdocentesis (aspirating fluid through a needle inserted into the pelvis through the vagina).
Symptoms of ectopic pregnancy include pain, faintness, and slight bleeding from the vagina.
Surgery is sometimes required to remove the abnormal pregnancy, especially if the tube has ruptured and there are signs of internal bleeding. If the ectopic pregnancy is small and there are no signs of internal bleeding, it may be dissolved using a methotrexate injection, a highly effective chemotherapy drug.
Once a woman has had an ectopic pregnancy, she is at increased risk to have another one. However, if the fallopian tubes are not removed during surgery and if there is minimal residual scarring, the chance of having a successful pregnancy in the future is relatively high, about 60%. Even with only one tube in place, the chance may be at least 40%. Some women have extensive tubal blockage or their fallopian tubes surgically removed. These women require in vitro fertilization (IVF or test tube baby) treatment to become pregnant. In the meantime, until another pregnancy is desired, these women should use an effective contraceptive.
Gestational Trophoblastic Disease ( GTD) is a group of disorders that result in the abnormal proliferation of placental (trophoblastic) tissue. Molar pregnancy, which accounts for 80% of GTD, is a rare condition that occurs in about one in every 2,000 pregnancies in the U.S. It is more common in women from certain parts of the world, such as the Philippines. Also known as hydatidiform mole, a molar pregnancy is an abnormal mass of placental-like tissue in the uterus. Ninety percent of molar pregnancies are benign, but the remaining 10% can progress to malignant GTD, either an invasive mole or choriocarcinoma.
Abnormal combinations of chromosomes cause molar pregnancy. Molar pregnancies can be of two types: complete (cluster of grape-like placental tissue with no associated fetus) or partial (abnormal placental tissue and an abnormal fetus that does not survive).
The most common symptom of molar pregnancy is irregular or heavy vaginal bleeding early in the pregnancy. Usually, there is no pain associated with the bleeding, but some women may experience uterine contractions. Other symptoms include nausea, vomiting, and irritability. Some women may develop signs of an overactive thyroid (nervousness, tremors, and decreased appetite), and require medication to control blood pressure and heart function for a short period of time after treatment.
If the molar pregnancy is complete, a pelvic exam may show grape-like clusters in the vagina or blood in the cervical os (mouth of the cervix). When your doctor examines your abdomen, he may notice that there are no fetal heart sounds and that there are discrepancies between the size of the uterus and the dates of the pregnancy. Your doctor may also note a rapid pulse, rapid breathing, high blood pressure, and signs of preeclampsia or hyperthyroidism.
First, your doctor will obtain a blood level of beta-hCG; molar pregnancies are often associated with much higher levels of beta-hCG. Second, to confirm the diagnosis, your doctor may order a pelvic ultrasound, which will reveal the characteristic "snowstorm" pattern diagnostic of GTD.
Regardless of how far along the pregnancy is, the treatment of molar pregnancy includes the immediate removal of the contents of the uterus. This is achieved through suction evacuation. There is a risk of excess bleeding during this procedure, so it is common to give the drug oxytocin (Pitocin) to help the uterus firmly contract.
Though the prognosis for molar pregnancy is excellent, women who have had a molar pregnancy require close follow-up from their doctors, as some women with complete molar pregnancies develop invasive disease or choriocarcinoma. Fortunately, these tumors are rare and the cure rate is high, nearly 100%. These tumors are among the most sensitive to chemotherapy.
After treatment, monitoring of the beta-hCG level is necessary for a period of time. A reliable contraceptive method is advised for a period of a year, after which, if all is well, pregnancy can be attempted again.