Compression stockings might not be needed to prevent blood clots ...
Week 1 Pregnancy Symptoms: What To Watch For
Missed PeriodOne of the earliest signs of pregnancy is a missed period, says Dr. Zore; this is often what prompts someone to take a pregnancy test. However, it's important to know that this missed period may happen after the first week of being pregnant. Most people miss their period two weeks after conception since implantation tends to occur two weeks after ovulation—and therefore about two weeks before the next period starts.
The ovaries make estrogen and progesterone throughout the menstrual cycle to build up and stabilize the uterine lining. Pregnancy hormones will stimulate the ovaries to continue to make estrogen and progesterone so if someone is pregnant, they will not experience bleeding or a period. If there is no pregnancy to continue to encourage the ovaries to make these hormones, then the lining will shed and the person will get a period.
Breast TendernessBesides a missed period, Dr. Zanotti says that another one of the very earliest signs of pregnancy that can occur during week one is breast tenderness. "What happens during implantation is that cells are starting to form to become the placenta, and then you start getting more of the hormone human chorionic gonadotropin (hCG), which is produced by the placenta," she says.
Once there's hCG in one's system, someone can start experiencing early pregnancy symptoms, including breast tenderness, she explains. Some people may experience breast tenderness in a specific spot, while others feel sore all over their breasts or under their armpits. According to a study in the Journal of Clinical Nursing, 76% of people experience breast tenderness during the first trimester .
Nausea"A lot of women experience nausea or an aversion to food," Dr. Zanotti says, naming another early pregnancy symptom. To her point, nausea and vomiting was the top symptom people in the Journal of Clinical Nursing study experienced, with 88% of people experiencing this symptom .
Just like breast tenderness, Dr. Zanotti says the reason for nausea is connected to the rise in hCG. People who experience nausea and vomiting during the first trimester tend to have higher levels of hCG than those who don't experience these symptoms. While nausea and vomiting are no fun to deal with, these are normal symptoms of pregnancy and not cause for concern.
FatigueBoth doctors say that fatigue is another common and normal symptom of pregnancy, including in the very early days. This is due to a change in hormone levels, not just with hCG but also progesterone. Progesterone levels rise significantly in early pregnancy. This stark change causes the heart to beat faster to help supply the developing placenta and fetus with more blood. But it can also make you feel more fatigued as a result.
CrampingSince becoming pregnant puts a pause on getting your period, that means no uncomfortable premenstrual cramping, right? Not exactly. Both doctors say that experiencing cramping during early pregnancy is common. "Cramping in early pregnancy can be normal due to early expansion, including growth of the uterus in pregnancy," says Dr. Zore. "Other causes can be due to gastrointestinal symptoms such as constipation, gas or bloating."
If cramping is causing you severe pain or is accompanied by bleeding, Dr. Zore says it could be a sign of either miscarriage or ectopic pregnancy and it's important to see your doctor.
BleedingExperiencing bleeding in early pregnancy can be stressful. There are several different reasons why this can occur, according to Dr. Zanotti. "The number one thing we worry about with bleeding in early pregnancy is a miscarriage," she says. "Bleeding can be a sign of an abnormal pregnancy, which is called an ectopic pregnancy and happens when the pregnancy does not implant in the uterus."
But this is not the only cause of bleeding in early pregnancy. "Sometimes, bleeding occurs from the implantation," she adds. She explains that this is because when implantation occurs, it disrupts the lining of the uterus, causing light bleeding. If you have bleeding in pregnancy, review it with your own doctor to know what's happening in your pregnancy.
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15 Early Signs And Symptoms Of Pregnancy
While pregnancy tests and ultrasounds are the only way to know if you're pregnant, you can look for other signs and symptoms like morning sickness, fatigue, and more.
Though it may sound odd, your first week of pregnancy is based on the date of your last menstrual period. Your last menstrual period is considered week 1 of pregnancy, even if you weren't pregnant yet.
The expected delivery date is calculated using the first day of your last period. For that reason, you may not have symptoms during the first few weeks of your 40-week pregnancy.
If you're pregnant, you may notice common early indicators. These can include:
Other signs may include:
About 10 to 14 days (week 4) after conception, you may experience implantation bleeding, which may be mistaken for a light period. It does not occur for everyone. If it does occur, it will usually happen around the time you expect your period.
Signs of implantation bleeding include:
If you think you may be experiencing implantation bleeding:
After implantation, your body starts making the hormone human chorionic gonadotropin (hCG), which helps maintain the pregnancy. It also tells the ovaries to stop releasing mature eggs each month.
You will likely miss your next period 4 weeks after conception. If you typically have an irregular period, you'll want to take a pregnancy test to confirm.
Most home tests can detect hCG as soon as 7 days after a missed period. A pregnancy test detects hCG levels in your urine and shows if you are pregnant.
When you're pregnant, you may have a higher basal body temperature. Your core temperature may increase more easily with exercise or in hot weather. During this time, make sure to drink more water and exercise cautiously.
Fatigue can develop anytime during pregnancy. This symptom is common in early pregnancy. Rising progesterone levels can make you feel sleepy.
Around weeks 8 to 10, your heart may begin pumping faster and harder. Palpitations and arrhythmias are common in pregnancy. This is usually due to hormones.
Your blood flow can increase by around 50% during pregnancy. This adds to your heart's workload.
It's best to discuss any underlying heart conditions or medications you take with your medical team.
Breast changes can occur between weeks 4 and 6. You're likely to develop tender and swollen breasts due to hormone changes. This will likely go away after a few weeks when your body has adjusted to the hormones.
Nipple and breast changes can also occur around week 11. Hormones continue to cause your breasts to grow. The areola — the area around the nipple — may grow darker and larger.
During pregnancy, your body increases the amount of blood it pumps. This causes the kidneys to process more fluid than usual, leading to more fluid in your bladder.
Hormones also play a large role in bladder health. During pregnancy, you may run to the bathroom more frequently or accidentally leak.
Bloating may occur during early pregnancy due to hormone changes, which can also slow down your digestive system. You could feel constipated and blocked as a result.
Constipation can also increase feelings of abdominal bloating.
Nausea and morning sickness usually develop around weeks 4 to 6 and peak around week 9.
Although it's called morning sickness, it can occur anytime during the day or night. It's unclear exactly what causes nausea and morning sickness, but hormones may play a role.
Many people experience mild to severe morning sickness during the first trimester of pregnancy. It may become more intense toward the end of the first trimester but often becomes less severe as you enter the second trimester.
In most cases, blood pressure will drop in the early stages of pregnancy. This may also cause feelings of dizziness since your blood vessels are dilated.
High blood pressure (hypertension) due to pregnancy is more difficult to determine. Almost all cases of hypertension within the first 20 weeks indicate underlying problems. It may develop during early pregnancy but may also be present beforehand.
A medical professional will likely take your blood pressure during your first doctor visit to help establish a baseline blood pressure reading.
Smell sensitivity is a symptom of early pregnancy that's mostly self-reported. There's little scientific evidence about smell sensitivity during the first trimester. However, it might be important since smell sensitivity may trigger nausea and vomiting. It may also cause a strong distaste for certain foods.
You may experience either a heightened or lessened sense of smell during pregnancy, according to 2017 research. This is especially common during the first and third trimesters. Heightened smell is more common than lessened smell. Some smells that never bothered you before may become less pleasing or even trigger nausea.
The good news is that your sense of smell usually returns to how it was before, after delivery, or within 6 to 12 weeks postpartum.
Weight gain can become more common at the end of your first trimester. You may gain about 1 to 5 pounds in the first few months.
Calorie recommendations for early pregnancy won't change much from your usual diet but can increase as pregnancy progresses.
Hormones can cause the valve between your stomach and esophagus to relax. This allows stomach acid to leak, causing heartburn.
Many people may begin saying you have the "pregnancy glow." Increased blood volume and higher hormone levels push more blood through your vessels. This causes the body's oil glands to work overtime.
The increased activity of your body's oil glands gives your skin a flushed, glossy appearance. On the other hand, you may also develop acne.
Using an at-home pregnancy test, you can generally know if you're pregnant 1 week after you've missed a period.
While you can take a test earlier than this if you want, you risk getting a false negative result. If you take the test too early, there may not be enough hCG in your urine yet for the test to detect it.
Also, every person's body is a bit different. One person may get a positive result as early as a day after their period, while another person's positive results may not show up for another week.
Blood tests can often detect hCG earlier in a pregnancy than urine tests. Blood tests can give a positive result as early as 6 to 8 days after ovulation, while urine tests do so about 3 weeks after ovulation.
A medical professional usually does blood tests.
Pregnancy symptoms like nausea, fatigue, and breast tenderness sometimes occur even before you miss a period. These symptoms may give you the idea that you're pregnant, but only a test will tell for sure.
If you think you might be pregnant, the best time to take a home pregnancy test is 1 week after you first miss a period.
A blood test can often reveal a pregnancy much earlier, but it must be done at a doctor's office or clinical setting.
Your body will go through significant changes in early pregnancy. You may see signs such as nausea, breast tenderness, and the hallmark symptom of a missed period.
Many body changes and symptoms of pregnancy you experience in the first trimester will start to fade once you reach the second trimester.
If you think you might be pregnant, a good first step is to take a home pregnancy test. Tests are widely available without a prescription in pharmacies and other stores.
If you receive a positive result, call a doctor for an appointment. They will perform an examination and a further test to confirm your pregnancy. You can then get started on a prenatal program to safeguard your and the fetus's health.
To receive week-by-week guidance about early pregnancy symptoms and more, sign up for our I'm Expecting newsletter.
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PE Looks Like Me: A New Initiative From The National PERT Consortium™
To physicians, the complexities and broad reach of pulmonary embolism (PE) are not new. The medical community is accustomed to the insidious and potentially fatal presentation of PE, and providers are trained to look for its symptoms. But, unlike conditions and events that can easily be recognized by nonclinicians (heart attacks, fractures, etc), PE can affect anyone of any ethnicity, gender, or age and with varying degrees of health and wellness. Although the understanding of the need for PERTs (PE response teams) is still growing across the medical community, patients and families are even further removed from how to spot the symptoms of a PE (when they present at all) and how to understand treatment options. Barnes et al stated that "optimal care of patients with venous thromboembolism (VTE) requires the input of patient preferences into clinical decision-making. However, the availability and impact of decision aids to facilitate shared decision-making in care of VTE is not well known."1 In addition to low patient awareness and understanding of PE, the investigators conclude that "despite numerous calls to increase use of shared decision-making, a paucity of data exists to help patients engage in the treatment decisions for VTE. Future studies of additional VTE clinical decisions with longer-term clinical outcomes appear necessary." Although PE may lack the flashiness and celebrity spokespersons of other conditions, the need to educate patients and families on recognizing symptoms is both clear and urgent. By leveraging the focused but meaningful efforts already undertaken by colleagues to broaden understanding of PE and help patients and families be active partners in treatment options, we can bring a new level of awareness to clinicians and patients—and save many lives.
THE NEED FOR INCREASED AWARENESS OF AND EDUCATION FOR PE Unknown True IncidenceThe presentation of PE can be insidious, and this fact makes true demographic data difficult to ascertain. PE is estimated to occur in 60 to 70 patients per 100,000 of the general population.2 However, much of these data were generated from autopsy studies and rates of VTE, which again cloud the true incidence of PE. What is known is that approximately 10% of patients with PE present with sudden death. This falls in line with the fact that PE is likely the leading cause of in-hospital death for patients in the United States. Septuagenarians have the highest rates of PE, but diagnosis is often difficult in these patients given other comorbid conditions that may mask or mimic PE symptoms. All of these data are sobering and reflect the significant challenges that PE presents to both patients and providers.
Variable and Nonspecific Risk FactorsRisk factors for PE are varied and often not specific to one certain population. Certain causes of PE are not preventable and include prior family history of PE or the need for surgery. Others, such as obesity and relative inactivity, fall into a category best labeled as modifiable. Regardless of whether a risk factor for PE is modifiable or not, PE can affect patients from all backgrounds and all ages. As an example, 2% of patients with PE in the RIETE registry were aged 10 to 24 years.3 Younger patients with PE tend to be female, but males develop more risk factors for PE beyond age 60 years, including malignancy and heart failure.4
The ubiquity of PE is undeniable, as any patient at any age can potentially be affected. However, there are special subpopulations of patients at higher risk for PE throughout their lifetimes. Patients with heritable thrombophilias represent a nonmodifiable risk factor for the potential development of PE, the most common of which is factor V Leiden deficiency, affecting 3% to 8% of people of European ancestry.5 Although common, this genetic mutation does not increase VTE risk as much as other genetic mutations like protein C or protein S deficiency, which may increase VTE risk 10-fold. Malignancy is another potential nonmodifiable risk factor for VTE and PE. Certain cancers, such as lung cancer, can be associated with VTE rates of 17% to 43%.6 Special attention should be paid to symptoms in patients with known risk factors for PE.
By Scott Kaatz, DO, MSc, FACP, SFHM CANCERMalignancy has a well-known association with VTE, and the type of cancer, chemotherapy, presence of metastatic disease, age of the patient, and need for surgery effect the risk. The American Society of Hematology (ASH) guideline recommends either low-molecular-weight heparin (LMWH) or a direct oral anticoagulant (DOAC) in the first week of acute VTE treatment, but suggest DOAC over LMWH for the initial 3 to 6 months of treatment. The guideline also recommends long-term (> 6 months) treatment with a preference for DOACs.1 For extended treatment, it is vital that bleeding risk is continuously evaluated because many cancer patients are at high risk.
PREGNANCYASH guidelines recommend treatment with LMWH for VTE during pregnancy and, although not explicitly stated in guideline statement, they allude that treatment is similar to nonpregnant patients, with a minimum of 3 months of treatment. There was general agreement among panel members that treatment should extend to 6 weeks postpartum.2 The panel suggests against systemic thrombolytic therapy for PE, with evidence of right ventricular dysfunction, unless there is hemodynamic instability. On the other side of the spectrum of the disease, they suggest outpatient therapy for low-risk VTE.
The guideline panel suggests a scheduled delivery with discontinuation of LMWH and muse about transitioning LMWH to unfractionated heparin if there was a recent proximal deep vein thrombosis or PE to shorten the interruption of anticoagulation. Additional considerations in pregnancy include a suggestion not to perform routine anti–factor Xa monitoring and recommends against the use of DOACs while breastfeeding.
THROMBOPHILIAASH has also published a guideline to address thrombophilia testing. For patients with unprovoked VTE, the guideline panel recommends against testing because other guidelines suggest indefinite treatment for these patients.3 For surgically provoked VTE, the panel suggests not testing because treatment is usually limited to 3 months. When a patient is in the gray zone between VTE that is clearly provoked (surgery) and unprovoked (eg, hospitalized for medical reason < 3 days, confined to bed for > 3 days, out of hospital with an acute illness, or leg injury with decreased mobility > 3 days), caused by pregnancy or postpartum, or estrogen-associated VTE, the panel suggests testing for hereditary and acquired thrombophilia to guide the duration of treatment beyond 3 months.
PEDIATRICSMany of the recommendations and suggestions for pediatric patients with VTE are extrapolated from literature in adults given the relative paucity of strong evidence in the pediatric population. The panel recommends treatment of symptomatic VTE but recommends anticoagulation or no anticoagulation in asymptomatic disease (such as incidental findings on imaging) and suggests against thrombolysis in submassive PE unless there is hemodynamic compromise.4 Warfarin or LMWH are the suggested anticoagulants in pediatric patients, with a duration of ≤ 3 months for provoked VTE. For unprovoked VTE in children, the suggested duration is 6 to 12 months versus a longer duration (as is suggested for adults), as the burden of treatment and bleeding risk is considered to be higher in this young population.
Pregnancy is another common risk factor for PE and can affect many unsuspecting mothers and mothers-to-be. Pregnancy increases the risk of VTE by four- to 4.5-fold when adjusted for age.7 Moreover, PE during or after pregnancy accounts for just over 9% of all maternal mortalities. Indeed, 60% of maternal mortalities related to PE occur within 42 days after delivery. Pregnancy is an extremely common medical condition, and slightly over 50% of the United States population may be pregnant during their lifetimes. Although a good deal of effort and patient education has gone into the recognition of certain risk factors for PE such as thrombophilias and cancer, less has been mentioned about pregnant patients and PE. The National Pulmonary Embolism Response Team (PERT) Consortium™ aims to change that.
THE "PE LOOKS LIKE ME" CAMPAIGNThis article serves to highlight that PE can and does occur to a wide variety of patients, some of whom have known risk factors but many of whom have common medical conditions that predispose to PE. The National PERT Consortium™ is proud to announce a new campaign called "PE Looks Like Me," and hopefully, through this article and indeed through this entire supplement to Endovascular Today, the point has been reinforced that PE is a ubiquitous yet underrecognized disease. PE can afflict the young and the old, the seemingly healthy and the seemingly ill, and patients of all races.
"PE Looks Like Me" seeks to bridge the gap between care providers and patients to raise awareness of the diagnosis of PE in all patients and discuss prevention of PE on a broader level. The National PERT Consortium™ is uniquely positioned to accomplish these goals given the pioneering, team-based approach to the treatment of PE and the many treating specialties involved in The Consortium. The reach of The Consortium is far, but in partnering with our patients, we can further improve PE care. With our patients as partners in this endeavor, "PE Looks Like Me" will broaden the scope of knowledge of PE and save lives through increased prevention and awareness.
Brent Keeling, MDAssociate Professor of SurgeryDivision of Cardiothoracic Surgery, Department of SurgeryEmory University School of MedicineAtlanta, Georgiabrent.Keeling@emory.EduDisclosures: Consultant to AngioDynamics, Penumbra, Inc., and Viz.Ai.
Amy Ranier, MPMBoard Member, The National PERT Consortium™Vice President, Marketing and Communications StrategyBeth Israel Lahey HealthBoston, MassachusettsDisclosures: None.
Scott Kaatz, DO, MSc, FACP, SFHMClinical Professor of Medicine, Michigan State University–College of Human MedicineClinical Professor of Medicine, Wayne State University–School of MedicineSenior Staff HospitalistMedical Director for Professional Development and ResearchDivision of Hospital MedicineCo-Director, Anticoagulation ClinicsHenry Ford HospitalDetroit, MichiganDisclosures: Consultant to Janssen, Pfizer, Bristol Myers Squibb, AstraZeneca, Gilead, Phase Bio, Boston Scientific; research funding from Janssen, Bristol Myers Squibb, Osmosis Research, NIH; board member for Anticoagulation Forum, National Blood Clot Alliance; scientific advisory board for The PERT Consortium™.
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