Most cases of morning sickness are annoying -- but not harmful. But if you're throwing up so much that you can't keep liquids down or if you're not urinating, you need to let the doctor know right away. "This can lead to severe dehydration, which isn't good for you or your baby," says Isabel Blumberg, MD, an ob-gyn in New York City. It can also be a sign that you're suffering from hyperemesis gravidarum -- a type of extreme morning sickness that can last throughout your entire pregnancy. Also call if you haven't been able to keep food down for two days straight, if you think you have food poisoning, or if the vomiting is accompanied by a high fever. In these cases, you may need to go to the hospital for IV fluids.
Intense abdominal pain
If you're less than 12 weeks pregnant, you're doubled over with sharp cramps on one side of your stomach, and you've yet to have an ultrasound, your doctor will want to rule out an ectopic pregnancy (one in which the egg has implanted itself in the fallopian tube rather than in the uterus). Later on in your pregnancy, call if the pain is intense or recurrent, since it could be anything from contractions to appendicitis.
Contractions or lots of watery discharge
If you're near the end of your pregnancy, a discharge probably means your water has broken, so head to the hospital right away. But if you suddenly experience a gush of fluids anytime before 37 weeks, call your doctor pronto. It might be a sign that your amniotic sac has ruptured and you're going into preterm labor. Still, don't assume the worst. "Women immediately think that their water has broken too early, when in reality the baby may have just kicked them hard in the bladder and they lost some urine," says Bruce Flamm, MD, an ob-gyn in Riverside, California.
Contractions are another potential sign of preterm labor. So if you suddenly feel them when you're 24 to 36 weeks pregnant, pick up the phone. While they could just be harmless Braxton Hicks contractions, talk to your doctor to make sure.
Any time you have vaginal bleeding, you should talk to your doctor. "In your second or third trimester, it could mean that you have a tear in your placenta or another problem that should be diagnosed by ultrasound," says Dr. Flamm. "But don't panic -- most bleeding during pregnancy doesn't necessarily lead to long-term problems." If you're in your first 12 weeks, keep in mind that many women spot during the first trimester and bleeding doesn't mean you're having a miscarriage," he says.
Severe headache or swelling all over
If you get a bad headache in your first trimester or regularly suffer from migraines, it's probably no big deal. Ditto if you have some swelling of your ankles as your pregnancy progresses -- that just means you're retaining fluid. But if you suddenly get a splitting headache in your second or third trimester, or if your hands and face swell like crazy and won't go down, you could be suffering from preeclampsia (pregnancy-induced high blood pressure) and need to see your doctor immediately. Another possible sign of preeclampsia that your doctor should know about: Your vision suddenly becomes blurry.
Lack of fetal movement
If you haven't felt much in the way of kicking for about an hour, no need to call right away. Instead, drink a glass of fruit juice (the natural sugars in juice will make your baby's blood-sugar levels jump, thus increasing the chances that he'll start kicking), then lie on your left side in a quiet room for half an hour. "If you don't count three to four movements within that time frame, give your doctor a call," says Dr. Blumberg. "Usually it's nothing -- the baby was just being especially still -- but he'll probably want you to have a stress test or an ultrasound to make sure there aren't any problems."
No woman should sit at home and worry needlessly. If something's really got you anxious, it's worth a call.
3 symptoms not to worry about
These symptoms should be checked out as well, but they don't require a phone call at 2 a.m. Do your doc a favor and wait until the next day.
Vaginal itching, burning, or redness, and excessive discharge that's creamy or white
What it probably is: A yeast infection
Why your doc needs to know: She'll likely prescribe a cream or suppository that works better than the over-the-counter antifungal treatments during pregnancy.
Itching all over your body, especially your hands and feet
What it probably is: Cholestasis of pregnancy, a common liver ailment that occurs during pregnancy
Why your doc needs to know: Your doctor will want to see you to monitor the condition. While it is often harmless and treated with topical anti-itch meds, it can lead to preterm birth in extreme cases.
Pain or burning when you pee, frequent urination, urine that's cloudy or has blood in it
What it probably is: A urinary tract infection
Why your doc needs to know: Left untreated over several days or weeks, a UTI can lead to a kidney infection, which has been linked to preterm labor. (If you have a high fever in addition to the symptoms above, call immediately.)
Originally published in the June 2007 issue of Parents magazine.
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