Problems in pregnancy

Baby/fetal Movements

You will usually start feeling your baby move between 16 and 22 weeks. Some second time mothers feel 'movements' earlier and describe them as a 'bubbly feeling'.

Later in pregnancy, your baby will develop their own pattern of movements. This will range from kicks, flutters and jerks to rolls and ripples. Sometimes your baby will hiccup. You will very quickly get to know the pattern of your baby's movements.

It's a myth that babies move less towards the end of pregnancy.
You can start keeping track of your baby's movement pattern from 24 weeks.

What if my baby's movements change?

A change, especially a reduction in movements, may be a warning sign that your baby needs checking by listening with a Doppler or monitoring of the baby's heart using a CTG (cardiotocograph).

If you feel that your baby is not moving as much as usual, you should lie down on your left side and focus on the movements for the next 2 hours. If you do not feel 10 or more separate movements during these 2 hours, you should seek help as soon as possible.

You must not wait until the next day to seek help if you are worried about your baby's movements

This is because when a baby is unwell, they may slow down to conserve energy by slowing down their movements. It is therefore really important that you contact a midwife#be007a for urgent advice.

What will happen if I am less than 26 weeks?

What happens if I'm over 26 weeks?

You would usually be seen in the Day Assessment Unit or your local birthing centre and should contact your community midwife.

You will have an antenatal check-up.

Your bump will be measured. Your baby's heart beat will be monitored using CTG. These checks usually show that all is well with your baby.

You may have an ultrasound scan if:

- Your baby is smaller than expected

- Your pregnancy has other risk factors associated with stillbirth

Who do I contact if my baby isn't moving?

Useful links

Tommy's - a registered charity. It provides accredited midwife-led pregnancy health information for parents-to-be, and funds research into the causes of pregnancy loss. They fund four maternal and fetal research centres in the UK.

MAMA Academy - a registered charity that supports parents and midwives to help babies arrive safely.

Vaginal Bleeding after 24 weeks

Bleeding can come from anywhere in the birth canal, including the afterbirth (placenta). Occasionally, there may be an abruption, where part of the placenta separates from the uterus, which puts the pregnancy at great risk. If the placenta is low lying, tightenings or contractions may also cause bleeding.

After the 24th week of pregnancy, painful, light to heavy vaginal bleeding is most often caused by placental abruption, in which the placenta becomes partially separated from the wall of the uterus.

Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24 weeks.

What happens if I experience vaginal blood loss?

You will be invited into the hospital. Any vaginal loss should be reported immediately, day or night. Don't wait until your next appointment, even if the bleeding is only a very small amount. There may be a large amount of concealed bleeding with only a small amount of revealed vaginal bleeding.

Some women may experience a light bleed later on in their pregnancy. This is may not be from inside the womb, but from the cervix, for example, bleeding after sexual intercourse can occur due to this. This may settle and doesn't necessarily mean there is a problem, but you should always let your midwife or doctor know immediately of any bleeding.

What happens when I go to the Maternity unit?

Who do I contact if I am experiencing vaginal bleeding?

RUH Bath:

If you are being cared for by a continuity of care team, contact your named midwife in the first instance. Otherwise:

Up to 14 weeks: Phone 01225 825803
Early Pregnancy Assessment Clinic (EPAC), Princess Anne Wing
Self-refer to this clinic Monday - Friday

14-22 weeks: Please contact your GP

22+ weeks
Day Assessment Unit: 01225 826454
RUH Bath Birthing Centre: 01225 824447

GWH Swindon:

Up to 22 Weeks:

Contact your GP / emergency out of hours service OR your named midwife if you are being cared for by a Continuity of Care team.
You will be referred by your midwife or GP and seen in the early pregnancy unit (EPU) on the 2^nd floor at GWH.
The EPU is open 24 hours a day but does US scans by appointment between 9 & 12pm Monday - Friday.

22+ weeks: please contact Delivery Suite on 01793 604575

Cervical screening during pregnancy

Low-lying placenta

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Blood clots and Reducing the Risks

A venous thrombosis embolism (VTE) refers to the formation of a clot within veins. This can occur anywhere in the venous system but mostly occur in the vessels of the leg (giving rise to deep vein thrombosis or DVT) and in the lungs (resulting in a pulmonary embolism or PE).

A VTE is uncommon in pregnancy and in the first 6 weeks postnatally. It can occur at any stage in pregnancy but the first 6 weeks following birth is the time of highest risk, with the risk increasing by 20-fold.

Risk factors include:

previous VTE or thrombophilia (a tendency to form blood clots)

obesity

increased maternal age

immobility and long-distance travel

admission to hospital during pregnancy

other existing health problems such as heart disease, inflammatory bowel disease and pre-eclampsia

Anticoagulant (anti-clotting) Injections

You may be advised to start treatment with injections of anticoagulant which is used to thin the blood.

What does anticoagulant treatment involve?

It is given as an injection under the skin (subcutaneous) at the same time every day (sometimes twice daily).

The dose is worked out for you depending on your risk factors and your weight in early pregnancy or before you became pregnant.

You may be on a low-dose or a high-dose regimen.

You (or a family member) will be shown how and where in your body to give the injections.

You will be provided with the needles and syringes (already made up) and will be given advice on how to store and dispose of these.

Will I need anticoagulant injections after the birth of baby?

A risk assessment will be carried out after the birth of your baby. Even if you weren't having injections in pregnancy, you may need to start injections for the first time after birth.

This will depend on what risk factors you have for a deep vein thrombosis (DVT). You may be advised to have injections for 10 days after birth or sometimes for 6 weeks after birth.

If you were taking warfarin before pregnancy and have changed to injections during pregnancy, you can change back to warfarin usually 3 days after birth.

Reducing the risk of venous thrombosis in pregnancy and after birth

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Breech Presentation

During pregnancy, babies change positions often. By the time labour begins most babies settle into a position that allows them to be born head first. That doesn't always happen though.

Feet first (breech baby)

If your baby is lying feet first with their bottom downwards, they are in the breech position. This can make your birth more complicated.

An obstetrician will discuss with you the best and safest form of care. You will be advised to have your baby in hospital. Your options will include : Planned Caesarean birth, planned vaginal breech birth or external cephalic version (ECV) - turning your baby back to a head down position. As maternity health professionals our role is to provide you with information to support your decision making and to help you understand the potential risks and benefits of the choices that are available to you.

Turning My Baby if it is Breech (ECV)?

If you baby stays in the breech position at 37 weeks, you may be offered the option of an external cephalic version (ECV) . ECV is not recommended for all women. For example, if you've had vaginal bleeding recently or you are expecting twins or more, it would not be safe to try it.

An ECV is when an obstetrician tries to turn the baby into a head-down position by applying pressure on your tummy. It is a safe procedure although it can be a little uncomfortable. You will be offered a drug to relax the womb.

Around half of breech babies can be turned using ECV, and of those, most stay head-down, allowing you to have a normal birth, although it is also possible that the baby may turn around again

An obstetrician experienced in performing ECV will undertake the procedure in hospital, where there is ultrasound scanning equipment and the ability to monitor the baby's wellbeing throughout..

Will I need anti-D?

Anti-D is offered only if you have a rhesus negative blood type and you do not know whether your baby is rhesus positive or rhesus negative.

There is a small chance that there could be mixing of the baby's blood and your blood during the procedure and so women who are rhesus negative are given an injection of "Anti-D" which will 'mop up' any rhesus positive antigens in your blood, preventing the production of antibodies against the baby, which could be a risk for the current or future pregnancies

Anti-D injections reduce the risk of a rhesus negative woman becoming sensitised.

When is ECV not performed?

What if ECV doesn't work?

If an ECV doesn't work, the obstetrician will discuss your options with you. Although breech babies can be born vaginally, you may be offered a planned caesarean birth at or near to your due date.

If you plan a caesarean and then go into labour before the operation, the caesarean will usually be done as an emergency. Occasionally it may be better for you to proceed with a vaginal birth if labour progresses quickly.

Breech baby at the end of pregnancy

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Gestational Diabetes

Gestational diabetes is a type of diabetes that affects pregnant women, usually during the second or third trimester. Women with gestational diabetes don't have diabetes before their pregnancy, and after giving birth it usually goes away. In some women diabetes may be diagnosed in the first trimester, and in these cases the condition most likely existed before pregnancy.

Gestational diabetes is usually diagnosed through a Glucose Tolerance Test at 24-28 weeks into pregnancy.

If you have had the condition in a previous pregnancy you will be tested earlier.

Good management of gestational diabetes helps keep your pregnancy and baby healthy.

Healthy Diet

Vitamins and Supplements

Exercise in pregnancy

Glucose Tolerance Test (GTT)

This blood test is used to determine if you have gestational diabetes or not.

What do I have to do before I come for a GTT?

What happens during the GTT?

You will first have blood taken to measure your blood glucose level.

Then you will be asked to drink a very sweet tasting, glucose drink.

You must finish the drink within 5 minutes.

Further blood samples will then be taken after 2 hours. The test could take up to 3 hours.

Between blood tests you will need to wait so it's best to bring some reading material, or something else to keep you occupied.

You mustn't eat anything until after the second blood test has been taken, it's a good idea to bring a snack with you, as you will probably be hungry afterwards.

How do I know the result of my GTT?

What is an abnormal result?

Useful links

Itching in Pregnancy (Obstetric Cholestasis/intrahepatic cholestasis of pregnancy)

Obstetric cholestasis of pregnancy (OC) is a rare complication of pregnancy. OC is a liver disorder that occurs in around one in 140 pregnancies in the UK. Pregnancy hormones can affect gallbladder function, resulting in slowing or stopping the flow of bile.

The gallbladder holds bile that is produced in the liver, which is necessary in the breakdown of fats in digestion. When the bile flow is stopped or slowed down, it causes a build-up of bile acids in the liver which can spill into the bloodstream.

build-up of bile acids in the bloodstream causes a persistent itch, usually starting in the last third of pregnancy.

There can be an increased risk to your baby including stillbirth so your pregnancy will be closely monitored and you may be induced early. The symptoms go when you have your baby.

Who gets Obstetric Cholestasis?

How would I know if I had OC?

How is Cholestasis of pregnancy diagnosed?

How will the baby be affected if I am diagnosed with Cholestasis?

Women with OC are monitored more closely, and you will be under the care of an obstetrician. There may be a small increased risk of complications of pregnancy associated with this condition, but the evidence is not conclusive.

Induction of labour will be discussed with you at 36 weeks and a plan made with you, as to the best time to deliver your baby, usually around 37 or 38 weeks. This is done because it is thought that it may help prevent the possibility of stillbirth.

There have been no reports of any harmful effects to babies from OC pregnancies once they have been delivered.

What is the treatment for OC?

There is no cure for OC. Doctors will monitor your condition, treat symptoms and may advise delivering your baby early. Topical creams such as calamine lotion and aqueous cream with menthol, are safe and may provide some temporary relief from itching for some women.

A number of medications may be used in your treatment. As yet, a specific medication to manage OC is not available, although clinical studies are in progress.

Medication is currently aimed at reducing the build-up of bile salts in your blood, to relieve the itching and to protect your baby.

What if I am experiencing itching?

Useful links

Pre-eclampsia

Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.

At each routine antenatal appointment you will have your blood pressure and urine checked.

This is because early signs of pre-eclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria). It's unlikely that you'll notice these signs. In some cases, further symptoms can develop, including:

swelling of the feet, ankles, face and hands caused by fluid retention (oedema)

severe headache

vision problems

pain just below the ribs

Although many cases are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated (see below). The earlier pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby.

If you had this condition in a previous pregnancy, you are more likely to have it again, although it is likely to be less severe and starts later in pregnancy. It is more likely to happen again if you have a new partner.

What causes pre-eclampsia?

Who can be affected?

Mild pre-eclampsia affects up to 6% of pregnancies, and severe cases develop in about 1-2% of pregnancies.

There are a number of things that can increase your chances of developing pre-eclampsia, such as:

having diabetes, high blood pressure or kidney disease before starting pregnancy
having another condition, such as lupus or antiphospholipid syndrome
having developed the condition during a previous pregnancy

Other things that can increase your chances of developing pre-eclampsia include:

having a family history of the condition
being over 40 years old
it having been at least 10 years since your last pregnancy
expecting twins or triplets
having a body mass index (BMI) of 35 or over

If you have two or more of these together, then your chances are higher.

In early pregnancy, your midwife will screen you to see if you are at increased risk of developing pre-eclampsia and you may be advised to take low-dose aspirin daily from the 12th week of pregnancy until your baby is delivered.

Treating pre-eclampsia

If you' are diagnosed with pre-eclampsia, you will be under the care of an obstetrician. You may be cared for as an outpatient on the Day Assessment Unit or may require admission to hospital. This is so we can monitor you more closely and determine how severe the condition is.

The only way to cure pre-eclampsia is to deliver the baby, so you will usually be monitored regularly until it's is possible for your baby to be delivered. Your labour may need to be induced early; this would normally be after 37 weeks of pregnancy, but it may be earlier in more severe cases. If you become very unwell a caesarean may be necessary.

Medication may be recommended to lower your blood pressure while you wait for your baby to be delivered and you may also receive steroids to mature your baby's lungs if they are going to be born prematurely.

Complications of Pre-eclampsia

Who should I call if I notice symptoms of pre-eclampsia?

Useful links

Previous Caesarean Birth

If you have had one previous caesarean birth in the past you have a good chance of (around 75%) of having a vaginal birth this time.

This is known as VBAC - vaginal birth after caesarean. You will be offered an appointment with an obstetrician who will discuss with you the reasons for your last caesarean birth and your options for birth this time.

Labour after a previous caesarean birth is monitored more closely and we strongly recommend that you give birth in hospital. This is because of the small risk of your scar tearing. We advise that your baby's heart beat is monitored continuously once your contractions have started.

Planned/Elective Caesarean Birth

Birth options after previous caesarean section

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Rupture of Membranes ("Waters breaking")

Your unborn baby lies in an amniotic sac of fluid or 'waters'. 'Waters breaking' means that the sac has ruptured or broken.

Your waters normally break around the time labour is due, but in around 2 in 100 pregnancies they break early for various reasons.

How will I know my waters have broken?

You may notice a 'gush' of fluid or you may feel damp.

The fluid (known as amniotic fluid or liquor) should be a clear or pinkish colour. Sometimes, it may appear 'greenish' or brown and this may be cause for concern.

Whenever you think your waters have broken, you should phone your midwife or the local Maternity Unit and we will ask you to come in to be reviewed.

A midwife will assess you and your baby and confirm whether your waters have broken.

An internal examination using a small plastic instrument (a speculum) may be required to confirm that the membranes have or have not ruptured.

Please contact your midwife if you feel your waters have broken.

Before 37 weeks (pre-term)

Spontaneous rupture of membranes at term

Spontaneous rupture of membranes (SRoM) refers to when a pregnancy is at or has gone beyond 37 weeks and the "waters" around the baby have broken before the onset of labour.

Prolonged rupture of membrane (PROM) is when the waters break and labour does not start within 24 hours. You will be offered induction of labour to reduce the risks of infection.

Please contact your midwife if you feel your membranes have broken.

Advice for women presenting with PROM at term

There is a risk of:

serious neonatal infection - with PROM alone, this is 1% ( 1 in 100) rather than 0.5% (1 in 200) for women with no risk factors and intact membranes

Most women with PROM will go into labour within 24 hours

Induction of labour is appropriate approximately 24 hours after PROM. For more information about Induction of labour (IOL) : {please link to "Induction of Labour" document in Labour}

Do I have to stay in hospital and what happens next?

No, providing your pregnancy has been uncomplicated and there are no concerns regarding your own or your baby's wellbeing, you will be able to go home and carry on with your normal activities.

If you have not gone into spontaneous labour we advise that you have your labour induced approximately 24 hours after your waters broke, to reduce the risk of infection.

You will be given information about what to do to reduce any possible risks of infection whilst you wait for labour to start and what will happen regarding being invited in to the hospital for Induction of labour if labour does not start spontaneously.

Contact your midwife / local maternity unit if you are concerned at any time.

For more information about Induction of labour (IOL) : Induction of Labour

Observations of baby after birth

Baby loss

Please visit the Baby loss page

Problems in Pregnancy

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Baby/fetal Movements

Feeling your baby move is a sign that they are well

Feeling your baby move is a sign that they are well

Movements Matter

Your baby's movements in pregnancy

Your baby's movements in pregnancy

Useful links

Vaginal Bleeding after 24 weeks

Low-lying placenta

Low-lying placenta

Blood clots and Reducing the Risks

Anticoagulant (anti-clotting) Injections

Reducing the risk of venous thrombosis in pregnancy and after birth

Reducing the risk of venous thrombosis in pregnancy and after birth

Breech Presentation

Breech baby at the end of pregnancy

Breech baby at the end of pregnancy

Gestational Diabetes

Glucose Tolerance Test (GTT)

Useful links

Diabetes.org: Gestational Diabetes

Diabetes.org: Gestational Diabetes

Tommy's: Gestational Diabetes

Tommy's: Gestational Diabetes

Tommy's: Testing for Gestational Diabetes

Tommy's: Testing for Gestational Diabetes

Itching in Pregnancy (Obstetric Cholestasis/intrahepatic cholestasis of pregnancy)

Useful links

British Liver Trust

British Liver Trust

ICP Support

ICP Support

RCOG: Obstetric Cholestasis

RCOG: Obstetric Cholestasis

Tommy's: Obstetric Cholestasis

Tommy's: Obstetric Cholestasis

Pre-eclampsia

Useful links

Action on Pre-eclampsia

Action on Pre-eclampsia

NHS Choices

NHS Choices

Tommy's Charity

Tommy's Charity

Previous Caesarean Birth

Birth options after previous caesarean section

Birth options after previous caesarean section

Rupture of Membranes ("Waters breaking")

Baby loss