When to call a health care professional during weeks 25 to

At this point in your pregnancy, you need to be alert to the possibility of preterm labor. Preterm labor means contractions that begin opening (dilating) your cervix before the end of the 37th week. Babies born early usually have a low birth weight, which is defined as less than 5 1/2 pounds. Their low weight and other problems associated with preterm birth put them at risk of several health problems.

Be vigilant for these signs and symptoms of preterm labor:

• Uterine contractions, possibly painless, that feel like abdominal tightening

• Contractions accompanied by low back pain or a feeling of heaviness in your lower pelvis and upper thighs

• Changes in vaginal discharge, such as light spotting or bleeding, watery fluid leaking from your vagina or thick discharge tinged with blood

If you notice more than five uterine contractions in an hour, even if they're not painful, take these steps: Drink a large glass of water and lie down. If you experience six or more contractions in the next hour, contact your health care provider or your hospital or go in. This is especially important if you have bleeding along with cramps or pain. Any vaginal bleeding at this stage of pregnancy may be a warning of preterm labor and needs to be evaluated.

This month you may be interested in:

• "Complications: Preterm labor," page 533

• "Complications: Gestational diabetes," page 547

• "Complications: Rhesus factor incompatibility," page 559

When to call

1 | Here's a guide to possibly troublesome signs and symptoms and when you 1 • 1 should notify your health care provider in the seventh month.

Signs or symptoms

When to tell your health care provider

Vaginal bleeding, spotting or discharge

Slight spotting

Same day

Any spotting or bleeding lasting longer than a day

Immediately

Moderate to heavy bleeding

Immediately

Any amount of bleeding accompanied by pain, cramping, fever or chills

Immediately

Persistent vaginal discharge that's greenish or yellowish, strong smelling, or accompanied by redness, itching and irritation around the vulva throughout the day

Within 24 hours

Pain

Uterine contractions, more than six each hour for two or more hours

Immediately

Occasional pulling, twinging or pinching sensation on one or both sides of your abdomen

Next visit

Occasional mild headaches

Next visit

A moderate, bothersome headache that doesn't go away after treatment with acetaminophen (Tylenol, others)

Within 24 hours

A severe or persistent headache, especially with dizziness, faintness, nausea or vomiting, or visual disturbances

Immediately

Moderate or severe abdominal or pelvic pain

Immediately

Leg cramp that awakens you from sleep

Next visit

Leg cramp with swelling and redness

Immediately

Pain with fever or bleeding

Immediately

Signs or symptoms

When to tell your health care provider

Vomiting

Occasional

Next visit

Once every day

Next visit

More than three times a day or with inability to eat or drink between vomiting episodes

Within 24 hours

With pain or fever

Immediately

Other

Chills or fever (102 F or higher)

Immediately

Steady or heavy discharge of watery fluid from your vagina

Immediately

Sudden swelling of your face, hands or feet

Same day

Visual disturbances (dimness, blurring)

Immediately

Cravings for nonfood substances, such as clay, dirt and laundry starch

Next visit

Consistently low mood, loss of pleasure in things you normally enjoy

Next visit

Above signs and symptoms along with thoughts of harming yourself or others

Immediately

Fatigue and weakness, shortness of breath, heart palpitations, dizziness or lightheadedness

Next visit if occurring occasionally Same day if occurring often

Fainting

Immediately

More frequent urination with pain or burning on urination, fever, abdominal pain or back pain

Same day

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