What are the warning signs for a term pregnant patient that require immediate medical attention, including signs of labor?

Warning Signs for Term Pregnant Patients: When to Call a Doctor

Term pregnant patients should immediately contact their doctor or go to the hospital if they experience any of the following: severe headache, visual disturbances, chest pain, difficulty breathing, severe abdominal pain, decreased fetal movement, vaginal bleeding, fluid leakage, fever, persistent vomiting, or signs of active labor including regular painful contractions and/or rupture of membranes. 1

Emergency Warning Signs Requiring Immediate Medical Attention

Severe Pre-eclampsia/Eclampsia Symptoms

• Severe headache that doesn't respond to usual pain relief 1
• Visual disturbances (blurred vision, seeing spots, light sensitivity) 1
• Severe upper abdominal pain (especially right upper quadrant pain suggesting hepatic swelling and risk of rupture) 1
• Chest pain or shortness of breath (may indicate pulmonary edema or heart failure) 1
• Confusion, agitation, or altered mental status 1

Cardiovascular Warning Signs

• Systolic blood pressure >160 mmHg or <90 mmHg 1
• Diastolic blood pressure >100 mmHg 1
• Heart rate <50 or >130 beats per minute 1
• Oxygen saturation <95% on room air 1

Bleeding and Fluid Loss

• Any vaginal bleeding (painless or painful) requires evaluation to exclude placenta previa, placental abruption, or vasa previa 1, 2
• Sudden gush or continuous leakage of fluid (suggesting rupture of membranes) 1
• Severe abdominal pain with bleeding (concerning for placental abruption) 1, 2

Infection Warning Signs

• Fever (temperature >38.3°C or 101°F) 1
• Persistent nausea and vomiting (especially if unable to keep fluids down) 1
• Decreased urine output (<35 mL/hour for 2 hours or more) 1

Fetal Concerns

• Decreased fetal movement (fewer kicks than usual or absence of movement) 1
• Any concern about fetal well-being warrants immediate evaluation 1

Signs of Labor at Term

Active Labor Indicators

• Regular, painful contractions that increase in frequency, duration, and intensity 3
• Rupture of membranes (water breaking - either sudden gush or continuous trickle) 1, 3
• Bloody show (mucus plug with blood-tinged discharge) 3
• Pelvic pressure with sensation of baby moving down 3

When to Go to Hospital for Labor

• Contractions every 5 minutes for 1 hour (or as instructed by your provider) 3
• Rupture of membranes regardless of contraction pattern 3
• Any vaginal bleeding beyond bloody show 1
• Severe pain between contractions (may indicate abruption) 1, 2

Critical Pitfalls to Avoid

Do not perform digital cervical examination at home or allow examination before ultrasound excludes placenta previa if bleeding is present 1, 2, 4

Do not dismiss persistent symptoms - maternal sepsis and pre-eclampsia can progress rapidly, and early recognition is critical for preventing severe maternal morbidity and mortality 1

Do not wait if multiple warning signs are present - the combination of symptoms (e.g., headache with visual changes, or bleeding with abdominal pain) significantly increases risk and requires immediate evaluation 1

Patients should be equipped with clear advocacy language to effectively communicate concerns to their care team, as timely recognition of complications directly impacts maternal and fetal outcomes 1