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When to Call your Doctor

When You’re Pregnant—When to Call your Doctor

By Elizabeth Heubeck

There’s morning sickness, and then there’s non-stop, can’t-keep-anything-down, losing-instead- of-gaining-weight morning sickness.
Whether this is your first pregnancy or your fourth, each one’s different and comes with its own unique set of symptoms—some of them completely normal and benign, others that may indicate something potentially serious.
The question, of course, is how to tell the difference.

Dr. Robert Atlas, OB/GYN, chair of the Department of Obstetrics and Gynecology at Mercy Medical Center in Baltimore, answers this delicate and sometimes ambiguous question. He takes us through each trimester, addressing symptoms during each stage of gestation that warrant immediate attention.

The First Trimester

During the first third of pregnancy, morning sickness and bleeding comprise the two most potentially troubling symptoms. Atlas offers some guidelines on when these common symptoms become cause for concern.
Morning sickness is no fun for anyone. But, for a very small percentage of women who suffer from an extreme form of it, called hyperemesis gravidarium, morning sickness can be downright dangerous for the baby and mother—when left untreated.

Atlas shares his own guidelines on when he expects women to seek medical attention for morning sickness: “If you can’t keep any food or liquid down for 24 hours straight, or if you lose between 5 and 10 percent of your body weight, you need to seek medical attention.”
The short-term solution usually involves a brief hospital stay with an IV to re-hydrate. Long-term, some doctors prescribe an antiemetica—a drug that fights vomiting and nausea.
Beyond morning sickness, the biggest fear during the first trimester is bleeding. But, says Atlas, not all forms of bleeding carry the same level of concern.

Spotting accompanied by midline cramping generally doesn’t signal an emergency but is worth a call to the doctor, he notes. Spotting plus abdominal pain—particularly if the pain occurs on either the right or the left side—could indicate an ectopic pregnancy (whereby a fertilized egg has implanted outside the uterus), which warrants an immediate call to the doctor. Bleeding that is heavy, soaking a pad an hour, should be treated as an emergency.

The Second Trimester

During the second trimester, symptoms that may indicate preterm labor provoke the most concern among women—and their doctors. The trouble is, preterm labor isn’t easy to detect. “It’s a very difficult thing. We can’t make the diagnosis of preterm labor over the phone,” Atlas says.
He does offer his patients, particularly those at high risk for preterm labor, some subtle yet revealing symptoms to look for.

“I tell all my patients at risk for preterm labor to know their normal amount of discharge,” Atlas says. Any change in discharge—a substantial increase, for example, a change in texture, or the presence of a ‘grayish dark, thick substance’ may be a sign of preterm labor, Atlas explains. He urges women with these symptoms to contact their doctor immediately. For women at high risk for developing preterm labor, overall back pain or achiness and cramping may also indicate preterm labor.

In the second trimester, bleeding of any type may indicate a problem and requires a call to the doctor.
“Even with spotting, bleeding could mean that the cervix is dilating, or there’s a problem with the placenta,” says Atlas.
These guidelines on bleeding hold true throughout the remainder of the pregnancy.

The Third Trimester

As you enter the home stretch of your pregnancy, it’s important to remain vigilant to signs and symptoms that are out of the ordinary. Fetal movements, which by this time are well-established, can tell you something about the fetus’s health.
“Choose two times a day to assess fetal movement, when the baby is most active. Count 10 movements. If you haven’t reached 10 movements in two hours, then call your doctor,” Atlas advises. While the amount of movement shouldn’t change much during the course of the last trimester, expect the type of movements to change. “Between 34 and 36 weeks, you’ll feel more rolling than kicks and punches. That’s a normal process,” says Atlas.

During this last trimester, also be alert for symptoms of preeclampsia, a pregnancy-related disorder that can be harmful or fatal to mother and infant. Symptoms include protein in the urine (something your doctor will check for in the advanced stages of pregnancy), swelling in the face and hands, sudden weight gain, headaches, changes in vision, epigastric pain (in the upper and middle region of the abdomen), and a decreased output of urine. Preeclampsia can advance quickly, and not all symptoms are present in everyone.
Sometimes, the symptoms are subtler.

“Some women will say, ‘I just don’t feel well,’” Atlas says.
If you experience any of these symptoms, or just don’t feel right, call your doctor immediately.
Finally, there is labor. Just as all pregnancies differ, so too do labors and their symptoms. As a rule, Atlas tells first-time pregnant moms to call the doctor once contractions are occurring every five minutes, for at least an hour. Women who have a history of rapid deliveries should call at the onset of contractions. Another sign that it’s time to call the doctor is when your water breaks. If you notice greenish fluid at this time, make the call, but head directly to the hospital, as this could be a sign of fetal distress.
You won’t always know whether calling the doctor is absolutely necessary. But if your gut instinct is to call, chances are you’re making the right choice.
“Every physician is different; but I tell my own patients to give me a call,” Atlas says. BC

© Baltimore’s Child Inc. 2008

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