Francine Cosner, MD Obstetrics/Gynecology Aurora Advanced Healthcare — Cedar Creek Clinic (Grafton) Aurora Advanced Healthcare — Port Washington Aurora Medical Center — Grafton

July 23, 2009

During pregnancy it is natural that you will become more attuned to the small changes in your body, and worry about the changes is natural. While many of these are common discomforts, and simply annoyances to you, it can be difficult to know if your symptoms warrant a call to the doctor or just some rest.

The key during pregnancy is having access to communication. Having the ability to reach a contact person is incredibly important. This can be achieved via a phone nurse, call center or office staff who has access to the physician throughout the day and night. Many times the physician will receive messages at the end of the day, so it is helpful if non-urgent concerns or questions can be dealt with during the day by someone who has access to a physician.

Things that you should always contact your physician about include bleeding; abdominal pain; sudden, persistent pain; vomiting interfering with hydration; and progressive and worsening dizziness.

Apart from these, most serious symptoms vary from trimester to trimester. During your First Trimester it is important to contact your doctor if you experience:

• Pain on either the right or left side
• Bleeding or cramping
• Leakage of fluid
• Fever associated with pain, cramping and unusual discharge
• Fever with back or side pain
• Abdominal pain with nausea or vomiting- with or without a fever
• Acute progressive shortness of breath (not associated with activity)

In the Second and Third Trimesters it is important to watch for:

• Abdominal pain with nausea or vomiting, with or without a fever
• Persistent headaches, especially with known high blood pressure or worsening swelling
• Seizures
• Bleeding, leakage of fluid or regular contractions of 6 or more per hour which do not subside with hydration or rest
• Progressive edema, headaches, vision changes, abdominal pain, seizure, swelling in face/upper extremities or shortness of breath
• Loss of fetal movement

Many common discomforts of pregnancy are often mistaken for serious problems, including general aches and pains, which are part and parcel of the physical changes associated with pregnancy. Headaches are also incredibly common in the first trimester, as well as swelling and constipation throughout your pregnancy.

While mood swings are common during your pregnancy, depression is a medical condition associated with hormonal imbalances, which may cause stress to the fetal environment. Depression, or any mood issues, should be addressed if it interferes with work, relationships, sleep, eating, etc. There are medications for depression that are considered safe for pregnancy, however, the risks and benefits do need to be examined by a medical practitioner. If you are struggling, it should always be discussed with your doctor.

Non-obstetric issues, like flu or colds, can often be managed by calling your primary care physician or urgent care physician. However, it is important to call your doctor to know what medications are safe in pregnancy.

Generally, if you experience a change that is persistent or progressive, or are worried about a change, it is always best to call your physician, just to be safe.