Primary care assessment and management of common physical symptoms in pregnancyBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2248 (Published 27 July 2020) Cite this as: BMJ 2020;370:m2248
- Meena Bhatia, consultant obstetrician1,
- Kamal R Mahtani, general practitioner and associate professor2,
- Ruby Rochman, patient contributor3,
- Sally L Collins, consultant obstetrician, subspecialist in maternal and fetal medicine, and associate professor14
- 1Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
- 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- 3London, UK
- 4Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Correspondence to M Bhatia
What you need to know
Many symptoms in pregnancy are related to hormonal and physiological adaptations
Clear, effective communication regarding the nature of symptoms and the management plan allays fears and offers reassurance
Offer a reason for referring, explain the potential concerns, and explain the likely course of management
Surgical causes of abdominal pain can present atypically in pregnancy
Considerations for covid-19
This article was commissioned and peer reviewed before the covid-19 pandemic. For further guidance on the management of symptoms related to covid-19 in pregnancy, please see guidance from the Royal College of Obstetricians and Gynaecologists: Coronavirus (COVID-19) infection in pregnancyhttps://www.rcog.org.uk/coronavirus-pregnancy
A wide range of physical symptoms commonly occur during pregnancy, and it can be challenging to
- Assess whether the symptom is pregnancy related—is it gastroenteritis or hyperemesis gravidarum? Is it asthma or restricted lung volume? Is it abruption or appendicitis? Is it increased urinary frequency or an infection?
- Decide whether the pregnancy changes your management—what medications are safe? When is specialist assessment needed?
Determining whether a symptom is concerning involves clinical judgment and interpretation of vital signs compared with baseline. Published research to establish reference ranges for vital signs in pregnancy may help clinicians distinguish when a symptom is physiological or pathological.1
In this article we discuss the primary care assessment and management of headache, breathlessness, nausea and vomiting, urinary symptoms, and abdominal pain—common presentations in primary care that can have more serious underlying causes; and we highlight red flags that suggest when specialist referral might be warranted. We refer to the most up-to-date evidence on vital signs.
We suggest when to consider same day referral and urgent (within a few hours) referral. When a referral timescale is not specified, use clinical judgment to assess whether same day, urgent, or non-urgent referral is suitable. Questions that might help with non-urgent referral decisions …