Spontaneous Coronary Artery Dissection (SCAD) in pregnancy

SCAD is a rare but serious heart condition that causes a tear or bruise to develop in a coronary (heart) artery resulting in a blockage that prevents normal blood flow. It can cause heart attack, heart failure or cardiac arrest and can be fatal. SCAD can happen during pregnancy and during the weeks and months after you have given birth. Symptoms can include:

• central chest pain
• arm pain or numbness
• pain in the jaw, back or shoulders
• nausea
• sweating/clamminess
• breathing difficulties

Some people experience indigestion-like chest or throat pain that does not respond to indigestion remedies. If you experience some/all of these symptoms, call 111 or 999 and say you are worried about your heart.

Placenta accreta

The placenta can also sometimes implant abnormally into the wall of the womb. This is a rare condition known as placenta accreta. The risk of having placenta accreta is higher if there is a previous scar on the womb, such as from a previous caesarean section, as the placenta can invade into the previous scar. This is a very serious condition that can be challenging to manage and a hysterectomy (operation to remove the womb) is sometimes needed at the time of delivery.

Placenta praevia

This can be picked up on an ultrasound scan as a low lying placenta in mid pregnancy. This is when the placenta is covering all or part of the entrance to the womb. If you are found to have a low lying placenta you will be rescanned between 32-36 weeks. The majority of low lying placentas will move to the upper part of the womb by 36 weeks, however 10% of low lying placentas remain low. This can cause bleeding in pregnancy that is sudden and severe. A caesarean birth may be recommended in cases of severe placenta praevia, and the likelihood of needing a blood transfusion can be higher.

Intrahepatic cholestasis of pregnancy (obstetric cholestasis)

This is a liver disorder that can develop in pregnancy, usually after 30 weeks gestation, but which sometimes develop as early as 8 weeks, affecting up to one in every 140 pregnant women. Symptoms can include:

• itching, usually on the hands and feet but which can be anywhere on the body
• dark urine, pale stools
• yellowing of the skin and whites of the eyes.

Less common pregnancy complications

If you have any symptoms of gestational diabetes, pre-eclampsia or intrahepatic cholestasis of pregnancy call your maternity triage/assessment unit straight away.