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When To Call The Doctor During Pregnancy

When to call the doctor during pregnancy is a common question among pregnant women.  Especially about health concerns that occur prior to term.

When To Call The Doctor During Pregnancy

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The following list, though not all-inclusive, are some of the more common symptoms that raise the question of when to call the doctor during pregnancy:

  1. Contractions Before 36 weeks
  2. Vaginal Bleeding
  3. Decreased Fetal Movement
  4. Blurry or Spotted Vision
  5. Headaches
  6. Swelling
  7. Symptoms of Urinary Tract Infection
  8. Symptoms of Kidney Infection
  9. Breaking Your Water
  10. Vomiting
  11. Severe itching All Over

 

1. Contractions Before 36 Weeks

Contractions during the second and third trimester are a common reason for women to decide when to call the doctor during pregnancy. Frequency, duration, intensity, and how long you have been contracting, are all factors used to evaluate uterine activity. 

However, what is most important, assuming the contractions are not occurring as a result of an underlying problem, is at what gestational age they are occurring during your pregnancy. This will determine if you are experiencing preterm labor or full-term labor. (As of the time of this article, preterm labor* is defined as contractions occurring prior to 36 weeks.)

*The definition of labor is defined as regular uterine contractions with cervical change. There are many women who have gone through their pregnancy with contractions without ever changing their cervix. As an obstetrician, the problem is that you can never assume contractions are not labor without a cervical evaluation.

 

2. Vaginal Bleeding
When to call the doctor during pregnancy about vaginal bleeding depends on two main factors: 
  • How heavy is the vaginal bleeding?  Is the blood red or brown?
  • Do you have a diagnosis for why you are bleeding?

Aside from the cause of vaginal bleeding, most important is the amount of bleeding. The time of day should never factor into your decision to call, as there is always a doctor covering labor and delivery 24 hours a day and prepared to answer calls from patients. Most often your doctor will be up and in the hospital.

If you are actively bleeding, regardless of the cause, go directly to the hospital and call your doctor as you are making arrangements. Active bleeding can occur for many reasons during pregnancy (below) and there is no way to be sure if it is serious without a proper clinical evaluation.

Whether or not brown/dark blood or spotting is concerning will depend on many clinical factors you can discuss on the phone.

Is it the first episode of bleeding or have you had bleeding diagnosed?

This is a very important question. Many women who have bleeding during pregnancy have a diagnosis. The most significant diagnoses associated with bleeding during pregnancy are the following:

The first three causes of vaginal bleeding are most concerning and are due to abnormal placentation. They must be dealt with promptly. Most often abruption of the placenta (separation of the placenta prematurely) is extremely urgent as this can occur at any gestation and the only management (unless an abruption has stabilized and stops progressing) is immediate delivery. Once the placenta separates (abruption) there is no further delivery of oxygen to the baby. Placenta previa is a common cause for significant bleeding during pregnancy, particularly in the third trimester. The bleeding can be heavy and episodic and if persistent can result in delivery. Gestational age factors into the timing of delivery if bleeding episodes eventually stop and prematurity is a concern.

As can be seen, the only way to know how to manage bright red and active vaginal bleeding is an evaluation.

*Always remember that it is up to you to determine what warrants calling your doctor. If you are concerned for any reason (aside from what has been discussed above) call your doctor, even if it only for reassurance about an ongoing condition.

 

3. Decreased Fetal Movement

You will notice that you are asked about fetal movement at every prenatal visit. This is because fetal movement reflects fetal well-being. Because fetal movement is hard to measure, it can cause anxiety for expecting mothers.

Decreased fetal movement can clearly be a concerning symptom and there is no way around this. Many studies have been done to try and determine what is the best way to measure fetal movement.

What can affect fetal movement?

  1. The fetal sleep cycle.
  2. What you had to eat and when.
  3. If the placenta is located in the front of the womb.
  4. Maternal activity when fetal movement is being evaluated.

How to monitor fetal movement:

“The simplest one is to record the amount of time it takes for you to feel 10 movements, such as kicks, rolls, or jabs. You should feel 10 movements in no more than 2 hours. Write down the time and day in a journal. If you don’t feel your baby move about 10 times in 2 hours, call your doctor.” Courtesy of WebMD

 

4. Blurry vision / Spotted Vision

If you have toxemia or have had toxemia, you know the importance of monitoring visual changes and when to call the doctor during pregnancy. If you have blurred vision or see spots call your doctor.

5. Headaches

Headaches are another symptom that individuals with toxemia need to watch for, as headaches can correlate with increased blood pressure. They can also be caused by migraines, cerebral hemorrhage and other conditions. Always discuss headaches with your doctor day or night. Again, it is important to note that your prenatal care provider is available 24 hours a day and you should not hesitate to call if you have a concern.

6. Increased Swelling

Swelling during pregnancy is very common and particularly severe during the hot summer months. However, swelling can also occur again as a result of toxemia. If you have toxemia, no doubt you will have been instructed when to call. Typically it is when the swelling increases significantly in spite of making efforts to keep it under control. Also if the swelling is not just in the ankles but has gone to the hands and face it is important to let your doctor know as this is more common with toxemia.

7. Symptoms of Urinary Tract Infection 

During pregnancy, it is particularly important to watch for and take preventive measures to avoid urinary tract infections (UTI’s). The classic symptoms of a UTI are:

  • Dysuria (burning with urination)
  • Frequent Urination
  • Urgency (persistent feeling that you have to urinate)

* If bladder infection gets severe you may get hematuria (blood in urine)

During pregnancy, you will be more susceptible to urinary tract infections. This is because there is partial obstruction of the ureters due to the enlarging uterus (this causes urinary stasis) and because the hormone progestin slows down the motility of the urinary tract. 

Even asymptomatic bacteriuria (bacteria found in the urine without symptoms of a urinary tract infection) is treated during pregnancy to avoid the complications associated with UTI’s progressing to an upper tract infection of the kidneys, known as pyelonephritis. 

8. Symptoms of Kidney Infection

If you develop a kidney infection during pregnancy, most often it will occur on the right side because of the way the uterus compresses the ureter at the pelvic brim.

The symptoms associated with a kidney infection include:

  • Fever (UTI’s or lower tract infections do not cause fever)
  • Flank Pain (Pain over the area of the kidney. Tapping on the area over the affected kidney will cause pain called CVA tenderness.)
  • Kidney infections can progress quickly and are often due to infection with E.Coli.
  • Pyelonephritis (kidney infections) are particularly concerning during pregnancy because they can cause premature labor.

*I have seen this many times during my clinical practice. Treatment of the infection with IV antibiotics and suppression of contractions often will resolve the situation. It is extremely important, not to delay the treatment of an infection involving the urinary tract. It is also important to take precautionary measures to avoid UTI’s. Remember that kidney infections are more common during pregnancy and not necessarily related to anything you have done.

Here is a list of ways to help prevent a UTI (courtesy of the Mayo Clinic):

  1. Drink plenty of liquids, especially water.
  2. Drink cranberry juice.
  3. Wipe from front to back.
  4. Empty your bladder soon after intercourse.
  5. Avoid potentially irritating feminine products.

 

9. Breaking Your Water

“Breaking your water” does not have to result in a gush of fluid. In fact, since the fetal head is often well applied to the pelvis, fluid may be minimal as the head is like a ball valve and holds fluid in the womb. If the fetal head is not well applied to the pelvis a large amount of fluid may be seen.

It is very important to know that your membranes can rupture before term. When this occurs it is called premature rupture of membranes (PROM). What is concerning about PROM is the risk that it may go undetected. PROM needs to be detected and treated early or a serious infection can develop in the uterus called chorioamnionitis.

If you have concerns that your water may have broken at any time during your pregnancy, call your doctor, as this needs to be evaluated using special tests. Even If it turns out to be urine it is always better to be safe than sorry.

 

10. Vomiting

Persistent vomiting at any time during your pregnancy can be a significant problem that may require immediate attention. Early on this can be related to “morning sickness” and if not managed properly can lead to dehydration. In severe cases known as Hyperemesis Gravidarum, persistent vomiting can result in hospitalization and even administration of IV nutrition (hyperalimentation).

During the second and third trimester, vomiting can be related to gastroenteritis, flu/viral syndrome, etc.. If not treated properly, the metabolic demands of pregnancy can lead to dehydration and problems such as preterm contractions/preterm labor, hypotension/fainting (low blood pressure) and ketosis due to lack of adequate caloric intake.

Do not manage nausea and vomiting the way you would when you are not pregnant. You can get behind on fluids and nutrition very quickly during pregnancy.

Even the symptoms of appendicitis can be different during pregnancy.

 

11. Severe Itching All Over

Cholestasis of pregnancy can cause diffuse itching. It occurs when the flow of bile through the liver is affected by pregnancy hormones. Though this condition is not common, it is common enough to mention because the symptom can be very bothersome, frustrating and usually unmistakable. There are blood tests that will be done to confirm it. When cholestasis occurs, the bile salts in the bloodstream cause severe itching all over the body. 

Know The Locations Of Where You Will Go To Be Treated (Even in the middle of the night)

Now that you have an idea of some (not all) of the reasons when to call the doctor during pregnancy, it is important to know where you will be treated should you need to be seen for medical care. This varies tremendously between medical practices, hospitals, and states.

When you talk to a covering physician, make sure you have any information about your prenatal course available. See our post about your prenatal record:  Your Prenatal Record Don’t Leave Home Without It 

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