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| |    Is it Normal? The First Trimester Weeks 0-13 by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Bleeding Cramps Abdominal Pain Headache Vomiting Dizziness The first trimester is full of new sensations. Which are signs of a problem and which ones are just normal pregnancy changes? Here is a list of common symptoms, and guidelines to help you decide if you need to see your doctor right away or if it can wait. Of course, if you think something out of the ordinary is going on or you are very worried, you should use your own judgment about seeking medical care. Vaginal Bleeding Vaginal bleeding is quite common in early pregnancy. Technically, any bleeding before 20 weeks is called a threatened miscarriage, but a small amount of bleeding is most likely inconsequential. It is sad but true that if you are going to miscarry in the first trimester, there isn't any way to prevent it, so you only need to contact your doctor right away if the bleeding is very heavy or if you are having a lot of pain. Can usually wait for office hours: Mild or moderate bleeding that has not yet been evaluated by your practitioner. Call immediately: For bleeding heavier than a heavy period or bleeding accompanied by severe pain. If you can't reach your doctor, you may need to go to the nearest emergency room. Cramps Cramping is quite common in early pregnancy. Cramps are particularly likely after sexual activity or when your bladder is full. In the first trimester cramping is considered normal. Can usually wait for office hours: Mild cramps associated with bleeding like a period or less. Call immediately: For cramps associated with bleeding heavier than a heavy period (see above) or if pain is severe. Abdominal Pain There are lots of possible causes of abdominal pain in pregnancy. Many women change their diets when they find out they are pregnant, and may have gas from increasing their milk intake, for example. Constipation is also quite common in pregnancy. The real worry with abdominal pain is: could it be a sign of a tubal or ectopic pregnancy, or another serious medical condition? If you have already had an ultrasound that showed the pregnancy to be in the uterus, it is much less likely that even fairly severe pain represents a serious problem. Can usually wait for office hours: Crampy pain that is in the middle of the lower abdomen, or any pain in the upper abdomen unless it is incapacitating. Call immediately: For severe one-sided lower abdominal pain, particularly if associated with vaginal bleeding or dizziness. If you have not already had an ultrasound that showed the pregnancy to be in the uterus, go to an emergency room if you can't reach your doctor. Headache Headaches are very common in early pregnancy, and can be pretty severe. For some women, the headache is from abruptly discontinuing caffeine, whereas for other women there isn't a clear cause. Can usually wait for office hours: Headache that is persistent or severe, as long as it can be relieved with acetaminophen (Tylenol) or a caffeinated beverage like coffee or cola. If you have a history of migraines and this seems similar to prior headaches, even a severe headache is not worrisome. Do remember though that some migraine medications are not safe to take in pregnancy. Call immediately: For a headache that is different and worse than any headache you've had in the past and isn't relieved by acetaminophen. If you are having any neurological symptoms like numbness or tingling in an extremity or difficulty seeing, and you haven't had this happen before, go to an emergency room if you can't reach your doctor. Vomiting Nausea and vomiting are the norm in early pregnancy, but can be persistent and miserable. While there are medications that can help with these symptoms, it may be better to avoid medicines in early pregnancy while the fetus is most vulnerable to outside influences. Can usually wait for office hours: Vomiting numerous times during the day that is interfering with daily functioning. Call immediately: For vomiting up blood; being unable to keep any liquids down for 6 hours or more; or for dizziness or decreased urination that might be a sign of dehydration. Dizziness While most women are not dizzy or lightheaded in early pregnancy, feeling like you are going to faint isn't that unusual. The most common causes are low blood sugar when you haven't eaten, and low blood pressure from standing for long periods of time or getting up too quickly. To prevent drops in your blood pressure, keep well hydrated by drinking lots of fluids, get up slowly from bed, and don't make your showers too hot. Eating regularly, especially first thing in the morning can help keep your blood sugar steady. Can usually wait for office hours:Feeling faint or lightheaded on and off throughout the day. Call immediately: If you actually black out or lose consciousness, or if you are persistently too lightheaded to participate in your normal activities. Lightheadedness plus heavy vaginal bleeding or lower abdominal pain always requires urgent evaluation by the medical team.
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