Cramping in pregnancy
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Most women will suffer from cramping at some point in their pregnancy, ranging from mild to severe. How do you know what is normal and what gives cause for concern? Any cramping you are concerned about is worth a trip to the doctor's office, but it is also helpful to familiarise yourself with the common causes of cramping during pregnancy.
 Cramping in Early Pregnancy
Cramping in the first trimester tends to cause the most worry because of the high risk of miscarriage, but it is often caused by something completely harmless. Many women experience period-like implantation cramping when the fertilised egg implants itself into the uterus. This normally occurs 8-10 days after fertilisation. Cramping can also be caused by the expanding uterus, even at this early stage. Sometimes it is caused by constipation or gas pains.
If your cramping is accompanied by spotting or bleeding, you should see your doctor as this can be a warning sign that you have had or are having a miscarriage. Unfortunately as many as 25% of pregnancies end in miscarriage, although many women would never have known they were pregnant. As difficult as it sounds you should try not to panic as this could just make things worse. Wait to get a medical opinion before jumping to conclusions. Another rare cause of cramping in the first trimester is ectopic pregnancy, where the fertilized egg implants itself outside the uterus. The symptoms of this include severe cramping, abdominal pain on one side and bleeding. See your doctor immediately if you believe you are suffering with this as it requires immediate medical assistance.
 Cramping in the Second and Third Trimesters
As the chance of miscarriage is greatly reduced after the first trimester, this is unlikely to be the cause of cramping after Week 12, which is a great relief for many women. The most likely cause of pain from this time onwards is Round Ligament Pain, an uncomfortable but harmless side-effect of the ligaments around the uterus stretching to accommodate its increasing size. Round Ligament pain comes as a dull ache across the belly or a sharp pain in one side, felt most often when getting up from a bed, chair or bathtub, or when coughing.
Later in the second trimester, you may experience cramping with Braxton Hicks contractions: usually painless ‘practise’ contractions that occur intermittently throughout pregnancy but are only felt as the uterus gets bigger. Unless these become more frequent, stronger and more intense, there is no cause for concern. They will become more frequent in the weeks leading up to labour, and have been the cause of many a false alarm, but the main difference is that Braxton Hicks contractions are irregular and labour contractions are regular, coming every five to ten minutes. Cramping also occurs the closer to labour you get, and may be a sign that labour is about to begin.
However, cramping prior to Week 37 and accompanied by lower back pain and diarrhea can be a warning sign for preterm labour. Call your doctor for advice if you are also experiencing: regular contractions, where your abdomen feels like it is tightening into a fist, every ten minutes or less; pelvic pressure where it seems like the baby is pushing down; period-like cramps; diarrhea, a change in vaginal discharge, especially leaking fluid or bleeding; and dull, low backache.
After Week 37 cramping could be caused by labour itself, though there will be days when you are expecting something to happen but nothing does. You should speak with your doctor about when he or she would like you to go to the hospital, but generally labour has begun when: your contractions are between five and ten minutes apart; your water breaks, especially if it is greenish brown; you have bleeding, known as the bloody show; or you are incapable of walking or talking during contractions.