From 13 weeks of pregnancy

You should call Maternity Advice Line on 0300 3690388 if you have any of the following symptoms:

  • Vaginal bleeding

  • Severe pain in your bump or back

  • Inability to keep water down or pass urine

  • Leaking fluid

  • Reduced movements / change in pattern from 24 weeks onwards

If necessary, the Maternity Advice Line midwife will arrange for you to be seen at the early pregnancy assessment unit in Bournemouth or antenatal day assessment unit in Poole for assessment. At Dorset County Hospital you may see the day assessment unit or the early pregnancy clinic depending on your symptoms.

Contact your general practitioner (GP) or call 111 if you have any pregnancy concerns prior to your 13th week of pregnancy.

We have provided information about most complications that can occur but please be assured that most pregnancies are straightforward. Your midwife and consultant will monitor you for any signs of complication throughout your pregnancy.

Complications in pregnancy

Although most pregnancies are straightforward, your midwife and/or consultant will be monitoring you for signs of complications throughout your pregnancy.

This section covers some of the complications that can occur during pregnancy. Some complications may affect your birth choices, such as method of delivery or where you can have your baby. If any of these things affect you, your team will give you personalised care and advice on how this will affect you and your baby.

During labour, your cervix gradually dilates (opens) to allow your baby to pass through it. Cervical incompetence means that the cervix has started to shorten and dilate much earlier in pregnancy (usually 16-24 weeks) without any other symptoms of labour. This can lead to preterm pre-labour rupture of membranes (PPROM) (your waters breaking early) and premature birth or miscarriage.

Not all premature births are due to cervical incompetence. True cervical incompetence, where there is a structural problem with the cervix, is uncommon. Since preterm birth is rarely caused by true cervical incompetence, most women who have a preterm baby will not have the same problem in future pregnancies.

Causes of structural problems with the cervix include:

  • Treatment on the cervix for pre-cancerous cells, such as a cone biopsy or a large loop excision of the transformation zone (LLETZ), which remove part of the cervix
  • Damage to the cervix from a previous birth
  • Damage to the cervix from a dilation and curettage (D&C) during an abortion or miscarriage
  • Damage to your cervix from an emergency caesarean when fully or partially dilated
  • Being born with a cervical weakness

Women are not routinely screened for cervical incompetence, and there are no obvious symptoms. If you have had a previous premature birth or miscarriage in the second or early third trimester, you are at increased risk of having cervical incompetence.

If you are at risk from a previous pregnancy or have risk factors, the obstetric team may decide that you need close monitoring in this pregnancy. This would involve having your cervix measured between 16-22 weeks via transvaginal ultrasound, which involves inserting a probe into your vagina and measuring your cervical length.

Your plan of care will be arranged with the obstetric team. If the cervix is shortening, they will discuss the possibility of inserting a cervical suture.

Waters usually break just before or during labour, but in 2% of cases waters will break prematurely (before 37 weeks of pregnancy). This is known as preterm pre-labour rupture of membranes, or PPROM. Waters can break for various reasons. Sometimes this will trigger labour to start, but this is not always the case.

If you think your waters have broken, you must call Labour Line immediately on 0300 3690388

When waters break, it can be a trickle or a gush. Use a sanitary towel if you think your waters have broken, as this will help you to check what colour they are and whether there is an odour. The Labour Line midwife will use this information to assess you.

If the fluid looks slightly green or brown, your baby may have passed meconium (baby’s first bowel movement) and Labour Line will arrange for you to be seen at your nearest consultant-led unit.

What will happen now?

  • You may be given a course of antibiotics, and / or steroid injections to help with baby’s development
  • You may have an ultrasound to check the fluid levels
  • You may have an internal examination to assess whether your cervix is preparing for labour
  • They will usually also take a swab to check for infection

The obstetric team will make a plan based on your situation. You may be allowed home until things progress, but you will need to return if you experience any of the following:

  • A raised temperature (more than 37 °C)
  • Flu-like symptoms (feeling hot and shivery)
  • Vaginal bleeding
  • Fluid that becomes greenish or smelly
  • Contractions
  • Abdominal pain
  • Changes to your baby’s normal pattern of movement

Support links:

Little Heartbeats

Read about waters breaking

By the late stages of pregnancy, most babies lie with their heads down, closest to the cervix. Sometimes babies lie with their bottom or feet closest to the cervix – this is known as “breech”. If your baby is in the breech position, it makes birth more difficult, and increases the risk of interventions and complications.

3-4% of babies will be in the breech position towards the end of pregnancy. Your baby’s position will be checked at your 36-week appointment. If your midwife suspects that your baby is not head down, you will be referred for a scan to confirm this.

If your baby is confirmed to be in the breech position, you will speak to a consultant to discuss your options. You may be offered an external cephalic version (ECV) which involves the doctor manually turning your baby into the head down position by placing hands on your abdomen.

This can be uncomfortable for you but is generally safe for your baby. This will happen at either Dorset County Hospital or University Hospitals Dorset in Poole. If this is not appropriate for you (e.g. multiple pregnancy, high risk pregnancy) or if the ECV is unsuccessful, the doctor will discuss delivery options with you. This will either be a vaginal breech birth or an elective caesarean.

If you decide to have a vaginal breech birth, you will be advised to have your baby in a consultant-led unit. You’ll need to have continuous monitoring to make sure your baby is coping well. If your baby’s heart rate drops or your labour is not progressing, you might need an emergency caesarean.

Learn more about breech position and ECV’s.

Your baby should be lying with their head down by the end of your pregnancy. Some babies will be breech (lying with their bottom or feet closest to your cervix), but a smaller number of babies will be lying across the womb – this is called transverse lie. It is not possible to have a vaginal birth with the baby in this position as they will be unable to pass through the birth canal.

If your baby is lying across the womb, your plan of care will be discussed with a consultant. You may be offered an ECV which involves the doctor manually turning your baby into the head down position by placing hands on your abdomen. This can be uncomfortable for you but is generally safe for your baby. This will happen at either Dorset County Hospital or University Hospitals Dorset in Poole.

If an ECV is not appropriate (e.g. multiple pregnancy, high risk pregnancy) or is unsuccessful, the consultant will advise you to have an elective caesarean.

Find out more about transverse lie.

When pregnancy goes wrong

Sadly, sometimes pregnancy can go wrong. Women may have to face a miscarriage, an ectopic pregnancy or the death of the baby. NHS Choices provides some useful information to support you with this:

Useful links: