Pregnancy Danger Signs and Antenatal Check-Ups

Most pregnancies end well. But serious problems can start quietly, and the two things that protect a mother and her baby most are simple: go for regular check-ups, and know the short list of warning signs that mean you should not wait at home.

How many antenatal check-ups do you need?

The World Health Organization (WHO) updated its advice in 2016 and now recommends eight or more antenatal contacts instead of the older four visits. WHO says eight or more contacts can reduce perinatal deaths by up to 8 per 1000 births compared with four visits, because there are more chances to find and treat a problem early.

WHO advises the first contact in the first 12 weeks of pregnancy, then contacts at 20, 26, 30, 34, 36, 38 and 40 weeks. In the United Kingdom the NHS offers at least 10 appointments for a first baby and at least 7 for later pregnancies, plus two ultrasound scans. The exact schedule your clinic uses may differ, so ask at your first visit and write the dates down.

What happens at an antenatal visit?

Most visits are short and simple. Based on the NHS schedule, you can expect:

• Blood pressure and a urine test at nearly every visit. These two checks are how pre-eclampsia is usually picked up.
• Blood tests early on for your blood group, and again at around 28 weeks to check your iron level.
• An ultrasound scan to date the pregnancy, and a later scan to check the baby's development. WHO recommends at least one scan before 24 weeks.
• Measuring your bump from around 25 weeks to see how the baby is growing.
• From around 36 weeks, feeling your abdomen to check the baby's position.
• Tetanus vaccination, which WHO recommends for all pregnant women, plus advice on food, activity and where you plan to deliver.

Take your record card or file to every visit, and tell the midwife or doctor about any medicine you are taking.

Which danger signs mean you should get help?

The NHS lists these pregnancy symptoms as needing medical advice. Do not wait for your next appointment:

• Bleeding from the vagina
• A severe headache that does not go away with simple painkillers
• Vision problems such as blurring or seeing flashing lights
• Sudden swelling of the face, hands or feet
• Pain below the ribs
• A fever of 38C or above
• Fluid leaking from the vagina
• Very severe vomiting
• Itching, which can point to a liver problem
• Sudden breathlessness, or breathlessness with chest pain or dizziness
• Any change in your baby's movements

What is pre-eclampsia?

Pre-eclampsia means high blood pressure with protein in the urine. The NHS says it is most likely from 20 weeks onwards, and it can also start in the days or weeks after delivery. Left untreated it can lead to fits, stroke and stillbirth, which is why the blood pressure and urine checks matter so much.

Risk is higher if this is your first pregnancy, you are over 40, you are expecting twins, you have diabetes, high blood pressure or kidney disease, you had pre-eclampsia before, or you are of South Asian or Black ethnicity.

Why do the baby's movements matter?

The NHS says a change in your baby's movements can sometimes be a sign of a problem, so it is important to get help if you notice any change. Do not wait until morning and do not try to "wake" the baby with cold drinks or sugar. Phone the maternity unit or go in.

When to get emergency help

For any of the following, call Rescue 1122 where available, or go to the nearest hospital emergency department:

• Heavy bleeding from the vagina
• A fit (seizure), or losing consciousness
• A severe headache with blurred vision or flashing lights
• Sudden swelling with breathlessness, chest pain or dizziness
• Your baby has stopped moving or is moving much less than usual
• High fever with shivering or feeling very unwell

It is always better to be checked and sent home than to wait.