What are some common early pregnancy complications?

When you’re expecting a baby, it’s an emotional and exciting time, and you can expect to experience many changes to your body. While there are some changes which are completely harmless and perfectly normal, there are some others that you should pay more attention to. Dr Sharmistha Guha, a London based obstetrician and gynaecologist, gives us an overview of some of the most common complications that can occur during the first trimester and how you can take care of yourself and the little one growing inside of you.

What are some problems that can occur during early pregnancy?

Some common early pregnancy problems that women may experience in the first trimester include:

• Nausea
• Vomiting
• Pain in the lower abdomen
• Pain in one particular side of the abdomen
• Bleeding 
• Vaginal discharge
• Thromboembolism (clots in the legs or lungs)

The following are early pregnancy complications associated with the above symptoms:

Hyperemesis gravidarum

Nausea and vomiting can be normal in pregnancy and are termed as ‘morning sickness’. However, excessive vomiting in pregnancy is a significant problem and is termed as hyperemesis gravidarum. This could be associated with multiple pregnancies (twins or triplets), molar pregnancy and in some women with a healthy singleton pregnancy.

Whilst nausea and vomiting are signs of a healthy pregnancy, excessive vomiting can lead to dehydration and exhaustion of essential vitamins and minerals in the body. This can lead to a reduction in body weight and have a detrimental effect on the mother’s health and pregnancy. It also increases the risk of clots in the legs and lungs (thromboembolism).

Miscarriage

Approximately 1 in 5 women will have at least 1 miscarriage in their lifetime.

• Early miscarriage: this usually occurs in the first trimester (before 12 weeks) and is most commonly due to chromosomal abnormalities (80%). Therefore, this can't be prevented as it depends on the quality of the egg and sperm meeting and forming an embryo. The embryo may have chromosomal abnormalities that are not compatible with life.
• Threatened miscarriage: when this happens, some women may experience bleeding but the pregnancy is viable and continuing. The bleeding is due to the implantation of the gestational sac to the lining of the uterus.
• Delayed or missed miscarriage: this type is when the baby stops growing but there are no miscarriage symptoms. Some women may not find out about their miscarriage until their dating scan (ultrasound) at 12 weeks.
• Complete or incomplete miscarriage: this is when a woman experiences excessive, heavy bleeding with clots and severe period-like pain in the lower abdomen which leads to passing the foetus. This type of miscarriage depends on if the woman has passed the pregnancy tissue completely or partially.

Ectopic Pregnancy

Approximately 1 in 100 women may have a condition called ectopic pregnancy where the pregnancy is implanted outside the uterus, most commonly in the fallopian tubes. Certain factors may increase the risk of ectopic pregnancy such as previous infections, previous tubal surgeries, previous ectopic pregnancy, IVF and other artificial reproductive techniques and genetically different shapes of the uterus. An ectopic pregnancy is non-viable and is not compatible with life. Women with this type of pregnancy need immediate diagnosis and treatment. Ectopic pregnancies can rupture and cause a lot of bleeding in the abdomen, which can be life-threatening and requires surgery. 

Molar Pregnancy

Molar pregnancy is a gestational trophoblastic disease and a type of miscarriage which is caused by either two sperms fertilising an egg or one sperm splitting before fertilising the egg. This is a genetic abnormality and there is usually an overgrowth of the placental tissue. There might be a live foetus present in partial molar pregnancy, however, most of the time, it ends in a miscarriage. It is important to surgically remove a molar pregnancy and monitor that the women’s pregnancy hormones return to normal.

All molar pregnancy cases are registered in three gestational trophoblastic disease centres so that all patients can be monitored uniformly. Patients need to be monitored after every pregnancy, whatever the outcome is, as there is less than 1% risk of choriocarcinoma (cancer that occurs in the uterus) with molar pregnancy.

Which problems aren’t considered serious?

A small amount of bleeding during pregnancy can be normal, as long as an ultrasound scan has confirmed a viable pregnancy. Pain in the lower abdomen, especially on one side, is sometimes usual and could be due to a corpus luteum which is formed after ovulation and releases the hormone needed to maintain the pregnancy. Excessive vaginal discharge in pregnancy is also common although if it is associated with itching, it may be indicative of thrush and needs treatment. Nausea and vomiting are normal, although, for excessive vomiting medical help should be sought. 

When should you see a doctor?

It is always important to seek medical advice if any of the following occurs:

• If you are experiencing any bleeding in pregnancy, you should see a doctor. You would most likely need an ultrasound scan to confirm that the pregnancy is in the right place and is healthy.
• If you are having sharp shooting pain on one side of the lower abdomen or lower abdominal cramps (which do not settle after some time or after taking paracetamol) you should see the doctor. If you are having pain associated with bleeding, you should also seek help as you might need an ultrasound scan.
• If there is excessive pain in lower abdomen, rectal pain, dizziness, shoulder tip pain or you feel faint, you must seek immediate medical help or go to A&E, as these could be signs of a ruptured ectopic pregnancy.
• If you are vomiting excessively and not able to keep any food or fluid down, you must see a doctor as you may need intravenous fluids to maintain hydration and medications to stop being sick.
• If you are having any pain or swelling in your calves (especially one-sided), pain in your chest or shortness of breath especially after a long journey, you must seek medical help as there is a high risk of developing clots in the legs and lungs during early pregnancy.

Most of the time, an ultrasound scan will confirm a healthy pregnancy in the right place, but it is important to seek help for an expert opinion.

Dr Sharmistha Guha is a consultant obstetrician and gynaecologist based in London. If you are pregnant and concerned about anything mentioned in this article, make an appointment with Dr Guha by visiting her profile and checking her availability.