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Blocked nose

Blocked nose

Girl with blocked sinuses Having a blocked nose in pregnancy is quite common. Many conditions affecting the nasal passages and sinuses are sometimes caused by infection, e.g. common cold, or irritants, e.g. hayfever. Nasal infections are usually self-limiting but the symptoms can be uncomfortable and distressing. Recommended treatment aims to remove excess mucus and to alleviate congestion. Increasing fluid intake can help thin the mucus, steam inhalation may reduce the feeling of congestion and raising the head while sleeping can help to drain excess mucus.
Non-allergic rhinitis
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Fibroids

Fibroids

Drawing of uterus showing fibroids which have grown inside and outside of it Fibroids are benign (non-cancerous) growths that are found in or on the womb (uterus). Owing to their location they can have an impact on fertility and getting pregnant. Uterine fibroids are relatively common. 30% of women between the ages of 25 and 44 have symptoms of fibroids. This means that uterine fibroids are common during a woman’s childbearing years. You may not even be aware that you have a fibroid until this shows up on an ultrasound scan. Most women will experience no effects from fibroids during their pregnancy. Some women with fibroids will develop complications during pregnancy. Pain is the most commonly report complication, particularly if the fibroids are bigger than 5 cms. Fibroids may increase the risk of other complications during pregnancy and birth. These include:
  • Fetal growth restriction (slow growth) – large fibroids may prevent a baby from growing well as there is less space in the womb.
  • Placental abruption – this occurs when the placenta comes away from the wall of the uterus because it is blocked by the fibroid.
  • Preterm birth – pain from fibroids may lead to uterine contractions, which can result in the baby being born early.
  • Miscarriage – the presence of fibroids increases the risk of spontaneous miscarriage in early pregnancy.
  • Caesarean birth – the presence of fibroids increases the need for caesarean birth due to the location of the fibroids in the womb. If the fibroids are located in the lower part of the uterus, they may block the opening of the birth canal resulting in the need for caesarean birth.
  • Postpartum haemorrhage – poor contracting can lead to bleeding after the birth. If the uterus is unable to contract because of the presence of fibroids, the blood vessels that supplied the placenta may continue to bleed. Postpartum haemorrhage (bleeding) is a medical emergency and usually occurs 24-48 hours after birth. You should get help urgently.
If you know that you have a fibroid and experience pain, bleeding or contractions during pregnancy, you should seek medical advice from your maternity unit as soon as possible.
Fibroid complications
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Deep vein thrombosis in pregnancy: Treatment

Deep vein thrombosis in pregnancy: Treatment

If you have been prescribed a treatment dose of blood thinning injections because you have been told that you have or may have a blood clot, here is some important information for you. Also read:
Deep vein thrombosis (VTE) in pregnancy: Frequently asked questions

Advice for you and staff caring for you

If you think labour has started or your waters have broken or you experience vaginal bleeding

Do not take further blood thinning injections and contact your maternity unit to arrange a review. Aim for vaginal birth on labour ward with spontaneous onset of labour.

If the birth is planned as an elective caesarean section

Stop taking blood thinning injections 24 hours prior to planned operation date.

If you require an induction of labour

Stop taking blood thinning injections 24 hours prior to admission for induction of labour. On admission, tell the midwife the time you took your last injection.

In labour

All efforts will be made to reduce the time interval that you are without blood thinning injections, to help keep your blood clot risk low. On admission, inform the midwife the time you took your last injection. You will have medical and anaesthetic involvement during labour and induction of labour. Active management of the third stage of labour is recommended. For more information read:
Labour: Third stage
If postpartum haemorrhage (PPH) occurs, this will be managed by senior members of the maternity team

If you are considering an epidural in labour

The safe time interval between blood thinning injections and having an epidural is at least 24 hours. This is to minimise the risk of bleeding. Inform staff the time of your last injection.

After the birth

The dose will be restarted as soon as possible after the birth and will depend on your risk of bleeding.

Duration of treatment after the birth

Treatment must continue for at least 6 weeks after the birth as the risk of blood clot is highest after the birth. The total duration will depend on when the treatment was started in pregnancy and must be at least 3 months. The maternity team will discuss the medication options before you go home. Switching to an oral anti-coagulation medication can be considered but this should be 5 days or more after birth. However direct oral anticoagulation medication is only an option if bottle feeding. Warfarin and LMWH are safe with breastfeeding.

Follow up after hospital discharge

A clinic appointment with a specialist doctor will be arranged to provide you with guidance for the future, including the next pregnancy.

Decide family planning method

Progesterone Only Pill (POP)/Implant/Intrauterine device/other. See here for more information:
Resuming sex and contraception
Also see: Contraceptive choices after you’ve had a baby

Urgent concerns

Contact your maternity unit.
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Deep vein thrombosis in pregnancy: Prevention

Deep vein thrombosis in pregnancy: Prevention

If you have been told that you have a high chance of developing a blood clot during pregnancy and have been prescribed a PREVENTION dose of blood thinning injections, here is some important information for you. Also read:
Deep vein thrombosis (VTE) in pregnancy: Frequently asked questions

Advice for you and staff looking after you

If you think labour has started or your waters have broken or you experience vaginal bleeding

Do not take further blood thinning injections and make contact with your maternity team to arrange a review). Aim for vaginal birth on the labour ward with spontaneous onset of labour.

If the birth is planned as an elective caesarean section

Stop taking blood thinning injections 12 hours prior to planned operation date (so the last dose should be at around 18.00 on the night before admission).

If you require induction of labour

Stop taking blood thinning injections 12 hours prior to admission for induction of labour (so the last dose would be around 18.00 on the night before admission). On admission, tell the midwife the time you took your last injection.

In labour

All efforts will be made to reduce the time that you are without blood thinning injections, to help keep your blood clot risk low. For the delivery of the placenta. active management is recommended. See here for more information:
Labour: Third stage
If postpartum haemorrhage (PPH) occurs, this will be managed promptly by senior members of the maternity team.

If you are considering an epidural in labour

The safe time interval between blood thinning injections and having an epidural is at least 12 hours. This this is to minimise the risk of bleeding.

After the birth

The injections will be restarted as soon as possible after the birth and will depend on your risk of bleeding.

Duration of medication after the birth

Blood thinning injections must continue for at least 6 weeks after the birth as the chance of developing a blood clot is highest after the birth. Warfarin and LMWH are safe with breastfeeding. Switching to an oral medication may be considered after 5 days after the birth. However, direct oral anticoagulant therapy is only an option if you are bottle feeding your baby.

Decide family planning method

Progesterone Only Pill (POP)/Implant/Intrauterine device/other. See here for more information:
Resuming sex and contraception
Also see: Contraceptive choices after you’ve had a baby

Urgent concerns

Contact your maternity unit.
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Deep vein thrombosis (DVT) in pregnancy: Frequently asked questions

Deep vein thrombosis (DVT) in pregnancy: Frequently asked questions

How is the diagnosis made?

At your initial appointment with the midwife, periodically through the pregnancy and after your baby is born you will be risk assessed for your personal chance of developing a venous thromboembolism (DVT). All women will be recommended to keep hydrated and mobile during pregnancy, labour and birth. Those in groups with a medium to high chance of developing a DVT may have additional care recommended to them. Interventions during labour and birth, such as assisted vaginal birth or caesarean birth increase your chances of developing DVT.

What does this mean?

For Me

Women who have a higher chance of developing DVT during pregnancy may be recommended to take a medication during pregnancy and the postnatal period to reduce this chance. The medication is a daily injection of a blood thinning medication (low molecular weight heparin) which you will be taught how to administer to yourself. Your partner or family member can be taught how to give the injection to you if you prefer. In addition you may be given compression stockings, to wear when you are admitted to hospital.

For my baby

The low molecular weight heparin injections do not cross the placenta and your baby will not be affected by their use.

What symptoms and signs should I be looking out for?

If you develop any swelling or pain in your legs or chest pain or difficulty in breathing you should attend the maternity unit for review as soon as possible.

How may this impact my birth choices?

If you are taking a preventative dose of low molecular weight heparin during pregnancy, there needs to be a 12 hour window between your last injection and the siting of an epidural (pain relief). So if your labour is starting or your waters have broken and a dose of the medication is due, please speak to your midwife or obstetrician first.

How may this affect care after the birth?

Women who are at a higher chance of developing a DVT might be recommended to have low molecular weight injections for ten days or six weeks after their baby is born.

What will this mean for future pregnancies? How can I reduce my risk of this happening again?

Depending on the reasons you have an increased chance of DVT, these reasons are likely to occur in any future pregnancy.

Where can I find out more information about this condition?

Reducing the risk of venous thrombosis in pregnancy and after birth
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Placenta praevia: Frequently asked questions

Placenta praevia: Frequently asked questions

How is the diagnosis made?

The location of your placenta is identified at your mid-pregnancy anomaly ultrasound scan. If the placenta is covering the neck of the womb it is termed a placenta praevia; if it is not covering the neck of the womb but is within 20mm of the neck of the womb it is called a low lying placenta. The location of the placenta will be checked again closer to the end of the pregnancy, usually at around 36 weeks. 9 out of 10 women will not have a low lying placenta or placenta praevia at their follow up scan.

What does this mean?

For me

Having a low lying placenta or placenta praevia increases the chance of experiencing bleeding during pregnancy. A planned caesarean birth will be recommended to all women with a low lying placenta or placenta praevia towards the end of pregnancy.

For my baby

If there is extremely heavy vaginal bleeding during pregnancy from a low lying placenta or placenta praevia, this may affect your baby’s wellbeing. A baby may need to be born prematurely if a woman experiences extremely heavy vaginal bleeding during pregnancy. If you experience any vaginal bleeding, contractions or pain you should attend hospital without delay.

What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?

If you experience any vaginal bleeding, contractions or pain you should attend hospital without delay.

How may this impact my birth choices?

A planned caesarean birth will be recommended to all women with a low lying placenta or placenta praevia towards the end of pregnancy. Heavy bleeding is possible during the caesarean birth, and this may require a blood transfusion and medications to limit the blood loss. Rarely, if there is no other way to control the bleeding, it may be necessary to remove your womb (hysterectomy) at the time of a caesarean birth for a low lying placenta or placenta praevia.

What will this mean for future pregnancies? How can I reduce my risk of this happening again?

A low lying placenta or placenta praevia is associated with previous caesarean birth, assisted reproductive technologies and smoking.
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Mental health and wellbeing concerns: Frequently asked questions

Mental health and wellbeing concerns: Frequently asked questions

How is the diagnosis made?

This was made before pregnancy. Ideally all women with mental health concerns/issues should be offered preconception counselling to optimise their health before pregnancy. Your GP will notify the maternity team however it is wise for you to tell your midwife at the first appointment (Booking appointment) so that the appropriate support can be put in place for you.

What does this mean?

For me:

You are at risk of your mental health worsening during pregnancy. If there is a family history of mental health you are at more risk of worsening mental health during pregnancy. It is really important that you tell your midwife if you are feeling mentally unwell and give your family permission to inform the maternity team too.

For my baby:

Your baby can be at risk if you do not look after yourself.

What will the medical team recommend?

You should ask to speak to someone as soon as possible if you feel your mental health is worsening.

What tests will/may be considered? How often may they be needed?

Depending on your level of need you will be cared for by the local perinatal mental health team, who may make specialist referral for you.

What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?

Low mood and feeling hopeless, helpless or isolated.

How are recommendations made regarding?

Treatment options

We can offer counselling or medication. Many medications are safe in pregnancy. If you are taking medication prior to pregnancy you should discuss your ongoing treatment with your GP and medical team before making any changes.

How may this affect care after the birth?

A birth plan prior to birth should be agreed with you to ensure there is a safe plan for you and your baby after birth.

What will this mean for future pregnancies? How can I reduce my risk of this happening again?

Optimise your mental health and symptoms between pregnancies.

What will this mean for future/my long-term health and how can I influence this?

Contraception and a follow up plan should be made to optimise your health for future pregnancies. This may include well-being and medication review.
Planning pregnancy with a mental health condition
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Chronic hypertension (high blood pressure): Frequently asked questions

Chronic hypertension (high blood pressure): Frequently asked questions

How is the diagnosis made?

You may have been told you have high blood pressure before you became pregnant and you may already be taking tablets to treat your blood pressure. Sometimes chronic hypertension is diagnosed in pregnancy as it is the first time you have had your blood pressure checked on such a regular basis and in this case, the diagnosis will be made as your blood pressure was high on two occasions before 20 weeks of pregnancy.

What does this mean?

For me:

  • Pregnancy can put a strain on your heart and blood vessels so your blood pressure may go up and need treatment
  • High blood pressure increases your chance of having pre-eclampsia (a pregnancy condition that can cause kidney, liver and other problems
  • You will be offered regular appointments to check your blood pressure and urine
  • You will be recommended to give birth in hospital on the labour ward
  • You will need long term follow up of high blood pressure with your GP to reduce risks of heart disease after your baby is born.

For my baby:

  • There is an increased chance of your baby not growing well in the womb
  • There is a higher risk of your baby being born early (before 37 weeks of pregnancy).

What will the medical team recommend?

  • Care under an obstetrician alongside your midwifery team
  • Regular blood pressure and urine tests 2-4 weekly and more often near the end of your pregnancy (this may be with your midwife, obstetrician or GP)
  • Blood pressure tablets if your blood pressure is high
  • Aspirin tablets (75 or 150mg) to reduce the risk of you developing pre-eclampsia
  • Home blood pressure monitoring
  • Induction of labour between 38 and 40 weeks of pregnancy. This decision will be agreed with you based on your blood pressure readings and the wellbeing of the baby, to reduce the risk of stillbirth. You will be supported to make the decision that is right for you.

What tests will/may be considered? How often may they be needed?

  • When you are first diagnosed in the pregnancy, your kidney function (blood test) will be checked and you may be asked to have an ECG (heart tracing) to check if your body has been affected by the high blood pressure
  • You will be offered extra scans of your baby to check your baby is growing well in your womb and how well your placenta is working
  • If we suspect you are developing pre-eclampsia, we will recommend tests of your liver, kidneys and blood and we may check your placental growth factor level (which is an indicator of how well your placenta is working).

What symptoms and signs should I be looking out for?

  • Headaches can occur if your blood pressure is too high or if you are developing pre-eclampsia
  • Other symptoms of pre-eclampsia include: swelling in your hands and face, blurred vision, pain in your tummy, vomiting, baby not moving so well

What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?

  • If your baby isn’t moving as normal, then you should be seen at the hospital immediately
  • If you have any of the symptoms of pre-eclampsia listed above then you should contact your maternity unit immediately.

Likely recommendations

Treatment options

Tablet treatment for your blood pressure will be recommended if your blood pressure is more than or equal to 140/90 mmHg The tablets most commonly used are:
  • Labetalol
  • Nifedipine
  • Methyldopa

Timing of birth

  • This will depend on how well you and your baby are in the pregnancy and on whether you develop pre-eclampsia
  • If the baby is well grown and the blood pressure is well controlled, then an induction of labour is likely to be recommended between 38 and 40 weeks of pregnancy.

How may this impact my birth choices?

Continuous monitoring of your baby’s heart beat in labour will be recommended whether your labour starts naturally or is induced. This is because the placenta may be working less well and we would not want to miss changes in the heart rate that would indicate the baby is not coping well with labour. This takes place in hospital on the labour ward.

How may this affect care after the birth?

  • You will need to have your blood pressure checked regularly and stay in the hospital for at least 24 hours after you give birth
  • Your blood pressure treatment will be switched to those suitable for breastfeeding
  • You will need to see your GP for ongoing monitoring of your blood pressure and treatment.

What will this mean for future pregnancies? How can I reduce my risk of this happening again?

  • High blood pressure can be reduced through diet and exercise if you are overweight or inactive
  • Ensuring your blood pressure is monitored and well controlled (less than 140/90 mmHg) will reduce the risk of harm for you and/or your baby in future pregnancies

What will this mean for future/my long-term health and how can I influence this?

  • Chronic hypertension increases your long term risk of heart disease including heart attacks and stroke.
  • Your risk of heart disease can be reduced by eating healthily, especially by reducing your salt intake and exercising regularly
  • Your risk of heart disease can also be reduced by taking your blood pressure treatment to control your blood pressure and your GP will tell you how low they would like your blood pressure to be while on treatment.

Where can I find out more information about this condition?

Information on chronic hypertension NHS High blood pressure Action on pre-eclampsia: High blood pressure High blood pressure and planning a pregnancy
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Deep vein thrombosis in pregnancy

Deep vein thrombosis in pregnancy

Woman's hand holding her leg below the knee Being pregnant increases your risk of developing deep vein thrombosis (DVT), with the highest risk being after you have had your baby. However, a DVT can occur at any time during your pregnancy, including the first three months of pregnancy.

Signs/symptoms

  • Pain/tenderness in the leg behind the knee or in the calf.
  • Feeling of heat in the affected area or a red discolouration of the skin.
  • Swelling of the affected area.
  • A pulmonary embolism may cause shortness of breath and chest pain, which comes on suddenly and worsens with deep breaths, coughing or chest movement.
If you have any of these symptoms you should speak to a health professional immediately, or attend your local A&E department.

Treatment

These conditions are serious and will require urgent treatment in hospital with medications that prevent the clot from getting bigger and breaking off and travelling to another part of the body.
Deep vein thrombosis in pregnancy: Treatment

Prevention

  • Keep mobile and rotate your ankles regularly.
  • Wear compression stockings if your midwife or doctor have advised you to do so.
  • Consider taking short walks when you feel up to it.
  • Stay well hydrated.
  • Avoid sitting/lying down for prolonged periods, ie, in a car/on a train.
Staff use a venous thromboembolism risk scoring system at your Booking appointment to determine your risk during pregnancy. Read the related links to find out what conditions can increase the risk of a DVT during pregnancy.
Deep vein thrombosis in pregnancy: Prevention before labour, during labour and beyond
Deep vein thrombosis (DVT) in pregnancy: Frequently asked questions
DVT blood clot in pregnancy Reducing the risk of venous thrombosis in pregnancy and after birth