Complications of pregnancy

Heart health in pregnancy

Chest pain in pregnancy and/or afer your baby’s birth should never be ignored. Some chest pain can be serious and can lead to a heart attack, heart failure, cardiac arrest or even death. Most women do not suffer from these conditions during or after pregnancy but it is important to recognise the symptoms and, if you have any of them, to seek treatment quickly.

Pre-existing heart conditions

If you have a known heart condition, were born with a congenital heart defect or have been diagnosed with heart disease, you should tell your midwife/GP/cardiologist and they will monitor your heart health before, during and after pregnancy and your health.

Symptoms of health attack can include:

• Central chest pain
• Arm pain or numbness
• Pain in the jaw, back or shoulders
• Nausea
• Sweating/clamminess
• Breathing difficulties

Some people experience indigestion-like chest or throat pain that does not respond to indigestion remedies.

When should I contact the midwife or doctor?

If you feel unwell, contact your midwife or GP for guidance. If you experience some/all of the above symptoms, dial 999 and ask for an ambulance as your heart health needs to be investigated quickly. An ECG monitor and a troponin blood test should be carried out to find out if you have had a heart attack.

When am I more likely to have a heart attack?

You are more likely to have a heart attack if you:

• have a family history of heart problems
• have high blood pressure
• have high cholesterol
• smoke
• drink excessively
• are obese

Rarely, women with no risk factors or history of heart disease in their family will experience heart attack symptoms. Heart attack symptoms in pregnancy should never be ignored. Contact your midwife or GP for further advice.

Sepsis during pregnancy

Infection in pregnancy and/or after your baby’s birth should never be ignored. Some infections can progress to a more serious situation known as sepsis, where the infection spreads to the blood stream and through the whole body. If left untreated sepsis can lead to shock, organ failure and death. Whilst most women do not suffer from infection or sepsis during or after pregnancy, it needs to be recognised and treated quickly if they do.

Signs of sepsis

The first signs of sepsis are usually a rise in your temperature, heart rate and breathing. You may also feel unwell, have chills and flu-like symptoms and a worrying pain in your tummy and/or diarrhoea. This can progress very quickly so it is important to seek advice if you are concerned about your health.

How can infection in pregnancy or after childbirth be prevented?

Good personal hygiene helps. This can include: daily showers/baths, proper hand washing and drying, perineal hygiene to include keeping the perineal area (between the vagina and back passage) clean, dry and frequent changes of maternity/sanitary pads. It is important to wash your hands before and after going to the toilet and changing maternity/sanitary pads.

When am I more likely to get an infection or sepsis?

Sepsis may happen in pregnancy or after your baby is born. The risk of getting an infection is increased in the following circumstances:

• After having a miscarriage or an ERPC (ERPC – evacuation of retained products of conception is a surgical procedure to remove tissue from the womb)
• Premature rupture of membranes (when your waters break long before your baby is due)
• If your waters break more than 24 hours before your baby is born
• If you develop a urine infection (UTI)
• If your baby was born prematurely/early (before its due date)
• After you have had your baby – this is the most common time for serious infection to develop; especially if you had your baby by an emergency caesarean section, by forceps or vacuum delivery, or if you had a perineal wound or an episiotomy).

When should I contact the midwife or doctor?

You should contact your GP or the maternity unit if you are worried, unwell and/or if you notice any of the following:

• Pain/burning on passing urine or struggling to pass urine, this could be a symptom of a urinary tract infection
• Vaginal discharge which may be foul smelling and/or an unusual colour, this could be a sign of a genital tract infection (vaginal/womb infection)
• Abdominal pain that does not seem to be getting better with simple analgesia, this could be a sign of womb/wound infection or abscess
• Chills, flu type symptoms or feeling faint and unwell
• Fast breathing or shortness of breath
• Fast heart rate
• Persistent cough with or with sputum, shortness of breath or chest pain could be a sign of chest infection or pulmonary embolism (blood clot in the lung)
• A wound that is not healing well, broken down or is red
• Severe pain in one area of breast
• Diarrhoea
• Sudden increase in vaginal bleeding (after your baby is born).

Contact the maternity unit where you gave birth, your midwife or GP for urgent advice. For more information:

Female Genital Mutilation (FGM)

What is FGM?

FGM is sometimes called female genital cutting or female circumcision. The definition of Female Genital Mutilation is “any cutting or damage to the external female genitalia that was carried out for non-medical reasons.” It is a form of child abuse and is a cultural practice that is illegal in the U.K. FGM is carried out in many parts of the world including Africa, Asia, the Middle East as well as among certain ethnic groups in Central and South America. Through migration of peoples it is also found in Europe, USA, Canada, Australia and New Zealand.

What are the different types of FGM?

The World Health Organisation (WHO) estimates that 200 million women and girls worldwide have been affected by FGM. WHO has classified 4 Types of FGM: Type 1: part or all of the clitoris and/or clitoral hood has been removed. Type 2: part or all of the clitoris and/or clitoral hood has been removed, as well as the inner labia (lips that surround and protect the urine hole and vaginal opening). Type 3 (pharaonic circumcision): the labia or Inner lips have been removed and the remaining edges are then sewn together or fuse together forming a layer of scar tissue with a small single opening at one end. Type 4: any other harmful practices to a woman’s genitals such as pricking, piercing, stretching or burning.

Possible health problems resulting from FGM

• urinary infections
• vaginal infections
• painful periods
• painful sex
• feeling sad, anxious or depressed
• problems during childbirth.

FGM and pregnancy

In pregnancy all women will be asked about FGM. Women with FGM should have a appointment with a specialist Midwife or Doctor in order to make a personalised plan of care as FGM may have physical and/or psychological consequences that can affect your pregnancy or labour. A safeguarding risk assessment will be carried out to ensure that, if you have a baby girl, she will be protected from FGM.

FGM and UK law

In the UK, it is against the law:

• for anyone to carry out FGM
• to take girls or women who live in the UK to another country to carry out FGM
• to help someone else carry out FGM (this includes making travel arrangements)
• to sew women up after childbirth (known as reinfibulation).

Women with FGM

If you thing you have FGM tell your midwife. She will refer you to a clinic where you will be given support by a FGM specialist midwife.

How can I protect my daughter/s?

The following resources are helpful: NSPCC/FGM Helpline: 0800 0283550 Police (emergency): 999 Non emergency: 101 Foreign and Commonwealth office (if abroad): 00 44 207 0081500

Stillbirth

When a baby passes away after 24 weeks of pregnancy, either before or during birth, this is known as a stillbirth. Stillbirth is one of the most devastating things a family can experience, and a range of support is given through a specialist team (including midwives, obstetricians, counsellors and charities) to parents who are affected by it. Many stillbirths are linked to a problem with the placenta, which is essential to a baby’s growth and development. If the placenta doesn’t work properly it can cause babies not to receive the oxygen and nutrients they need. Other causes include infection, heavy bleeding (known as haemorrhage), pre-eclampsia and pre-existing diabetes. Not all stillbirths can be prevented, but there are some simple things that can be done to minimise the risk:

• stopping smoking and avoiding alcohol and drugs during pregnancy
• sleeping on your side from around 28 weeks gestation, or turning on to your left side if you wake up on your back overnight
• attending all of your appointments and scans so that your maternity team can monitor your baby’s health
• calling your midwife/going to your maternity unit straight away if your baby’s movements are reduced from what you’re used to feeling.

Pre-existing conditions and pregnancy

It is important to tell your GP, obstetrician and/or midwife about any pre-existing physical or mental health conditions. This also includes any previous surgery (including cosmetic procedures) or any childhood conditions or health problems from which you have now recovered. This information helps the team assess if anything further is needed to keep you and your baby healthy during the pregnancy. If you are under specialist care for your medical condition, it is important that you speak to them and discuss any impact your condition may have on your pregnancy. Ask them for a summary and for this to be written in your antenatal notes. Notes don’t automatically move between maternity units and/or departments, so don’t assume that your midwife or doctor knows what your previous carers have said or recommended. If you would like more information, please use the links below to check the safety of your medication in pregnancy. Conditions we need to know about early (before 12 weeks) include:

Chronic hypertension and other medical conditions that may increase the risk of you developing blood pressure concerns in pregnancy

Women with chronic hypertension and certain medical conditions are at a high risk of developing pre-eclampsia and will be prescribed low dose aspirin from 12 weeks. This includes any one of the following high risk factors:

• Chronic hypertension.
• Pre-eclampsia during a previous pregnancy.
• Chronic kidney disease, diabetes, or an inflammatory disease, eg, Systemic Lupus Erythematosus (SLE).

Or more than one of the following moderate risk factors:

• First pregnancy.
• Maternal age over 40.
• Last pregnancy was more that 10 years ago.
• Body Mass Index (BMI) of 35 or more.
• Family history of pre-eclampsia.
• Expecting more than one baby in this pregnancy.

Thyroid disease

Hypothyroidism (under active thyroid)

As soon as you are pregnant, it is usually recommended that your Levothyroxine dose is increased by 25-50 mcg daily. You should then also contact your GP to arrange blood tests.

Hyperthyroidism (overactive thyroid)

You must discuss your plans for pregnancy with your endocrinologist to assess your disease status and the safety of the medications you are taking.

Epilepsy

Pregnancy may affect your seizures or the effect of your medication. If you become pregnant without having had a chance to discuss your medication(s), it is recommended that you see your GP or specialist as soon as possible. Prior to this review, keep taking your anti-epileptic medicines as normal. Certain medications may need to be stopped and changed to an alternative before you become pregnant, or as soon as possible if you’re already pregnant, due to the risks they pose to your baby. Some other medications need to be increased. Your doctor will prescribe a higher dose of folic acid supplementation (5mg per day).

Mental health and wellbeing concerns

It is understandable to worry about the effects of some medicines used to treat mental health conditions and concerns, but it is important not to stop taking your medications without speaking to your GP or specialist. This may lead to withdrawal symptoms, especially if stopped abruptly, could cause a recurrence of your symptoms or make your condition worse.

Diabetes

Women with Type 1 and 2 Diabetes should aim to have tight control of their diabetes prior to and throughout the pregnancy to reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. Pregnancy typically places higher demand for insulin than normal and so close monitoring and control of diabetes is important.

Crohn’s Disease, Ulcerative Colitis and other forms of Inflammatory Bowel Disease (IBD)

It is important to keep Crohn’s or colitis under control during pregnancy and you should not stop taking any of your medications unless your IBD team has advised you to do so. The risk from most medication is lower than the risk of a flare up.

Pregnancy with a heart condition

Women with known heart conditions need a referral to the specialist maternity services as soon as possible in early pregnancy and ideally would have had some pre-pregnancy counselling before trying for a pregnancy. This is because some heart conditions can increase the risk of complications in pregnancy and some medications may need to be stopped or adjusted. Please do not stop, or change, any medications without medical advice. If you would like more information, please use the link below to check the safety of your medication in pregnancy.