Early pregnancy

 

What are the early pregnancy signs and symptoms?

A pregnancy is best described as an exceptionally special time in a woman’s life and is often a much awaited and anticipated event. However, in many circumstances, the great news is either not forthcoming or presents itself amidst much confusion and, perhaps, even anxiety.
Not all early pregnancies are easily recognised nor are all pregnancies free from complications. This chapter deals with the common early symptoms and signs of pregnancy, and helps the reader understand the basis of some of the common problems which may occur in early pregnancy.

The missed period
This is most often the first telling sign of pregnancy.

Are all women who miss their periods pregnant?
No. It’s important to differentiate a woman whose menstruation is just delayed because of a problem with the egg being released from the ovaries (ovulation) with a woman whose delayed menstruation is due to pregnancy.
In a woman whose menstruation comes at regular predictable intervals, there is a 95% likelihood that she is ovulating. In these women, the missed period is a reliable indication of pregnancy.
In women whose menstruation is irregular or unpredictable, the missed period may not necessarily suggest a pregnancy, and a pregnancy test would provide the answer.

What is an implantation bleeding?
Some women experience an unusually light bleeding that occurs at the time of expected menstruation. This is called an ‘implantation bleeding’ and is due to the implantation of a young embryo in the lining of the womb.
The woman would likely notice that the bleeding is lesser than usual, but doesn’t suspect a pregnancy. This is because the general assumption is that pregnancy is unlikely to occur during menstruation. The following month, however, the menstruation doesn’t come at all and finally a pregnancy test reveals the true situation. Take note that in these situations, an ultrasound is extremely important to determine the age of the conception.
Implantation bleeding is a rather common situation and does not result in any threatening consequence.

Nausea and vomiting
This is the most recognisable and common symptom of early pregnancy. Nausea and vomiting occurs in up to 80% of normal pregnancies. However, its more severe form known as hyperemesis gravidarum may be disabling and potentially life threatening, and can occur in up to 1.5% of pregnancies. It may result in dehydration, and often necessitates admission to hospital for fluid infusion. Its exact cause is unknown, but the good news is that it can be spontaneously resolved by the end of the third month of pregnancy. There are also many treatment options available to help you cope with your daily routine.

Breast tenderness
This is also a common early pregnancy symptom and is attributed to rising hormone levels during pregnancy.

Other interesting symptoms
In addition to the symptoms mentioned above, women can have a myriad of other symptoms which they have never felt before as a result of pregnancy. The symptoms are caused by hormonal changes that affect various organs in the body. The prominence of these symptoms differs among women and can include heartburn, backache, constipation and frequent urination. Again, the good news is that these symptoms do not present any sinister consequences.

The pregnancy test
The pregnancy test is based on the detection of a chemical called Beta Human Chorionic Gonadotrophin (B-Hcg) in the urine of a pregnant woman. This chemical is released by the embryo into the blood stream and subsequently finds its way into the urine. The latest and most sophisticated pregnancy tests can detect the B-Hcg a few days before the missed period!
Test kits are available in any pharmacy and don’t cost very much. The procedure is easy and requires nothing more than a drop of wee.

Early pregnancy bleeding
Some patients who test positive for pregnancy soon after the missed period can develop some vaginal bleeding. This bleeding may vary from slight spotting to heavier, menstruation-like bleeding. This can raise some concern among pregnant women.

What are the causes of early pregnancy bleeding?
The two most significant causes of early pregnancy bleeding are miscarriages and ectopic pregnancies. Less common causes include problems at the neck of the womb (cervix).

Miscarriages
A miscarriage occurs when a woman with a confirmed pregnancy experiences bleeding and subsequently expels the product of conception. Sometimes the miscarriage is complete and requires no further treatment. In other instances, some residual product may still be retained within the womb. A short procedure called an evacuation may sometimes be required in these cases.

What causes miscarriages?
In most instances, the cause of miscarriage is unknown. However, it is believed that in more than 70% of cases, miscarriage is due to genetic abnormalities in the fetus. These women should be reassured that the likelihood of carrying a subsequent pregnancy to term is exceptionally high.

Ectopic pregnancies
In approximately 5% of pregnancies, the embryo decides to park itself outside the womb, most commonly within the Fallopian tube. These pregnancies soon result in pain and vaginal bleeding. An ultrasound examination can usually diagnose the problem but, sometimes, further tests may be required before a confirmed diagnosis can be made. These tests may include repeated blood measurements of B–Hcg. In exceptional circumstances, the diagnosis may require a special procedure called a diagnostic laparoscopy which is a key-hole inspection of the pelvis.

Is an early ultrasound scan useful?
The answer to this is very clearly yes. An early ultrasound gives information about where the pregnancy is (inside the womb versus ectopic pregnancies), tells us whether it’s a single pregnancy or multiple pregnancy (twins or triplets!) and, most importantly, helps confirm your due date.

When and why should you see a doctor?
You should see a doctor as soon as you think you are pregnant.
This will enable the doctor to obtain more information, assess your physical state and determine if there are any factors that may increase any risk to your pregnancy.
Furthermore, you may be advised on the importance of undergoing some special tests which can provide more information on the condition of the early pregnancy.
Also, an ultrasound examination can be done.
You may obtain general nutritional advice and in certain circumstances, if you have certain underlying medical problems (example: diabetes), you may be offered special advice on diet, medication, and what to expect as the pregnancy progresses.

A final bit of advice – if there is any doubt in your mind, consult your gynaecologist immediately!

This article was initially written for two good friends as a chapter in their book ‘mummy’s secrets’.