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heather asked...

I have a list of symptoms and I am not sure whether I in preterm labour...

Hello I have a list of symptoms and I am not sure whether I in preterm labour with twins please could you advise: lower back ache, jaw ache, feeling heavy in the lower abdomen, feeling tired and experiencing excessive discharge (some clear) and acid reflux. Thankyou.

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The answer

Thank you for writing in to Ask the Expert.

You do not say how many weeks pregnant you are but premature labour is a possibility with a twin pregnancy as your uterus size is larger than that of a singular pregnancy and you have increased risk of complications that could start labour earlier.

Often signs of premature labour can include abdominal discomfort and tightenings or contractions, your waters breaking and perhaps some blood loss or show.

During pregnancy your muscle tone alters due to the hormone levels changing and the change to muscle tone can lead to more discomfort in your lower back, hips and pelvic area.

Back pain usually in the loin area can indicate the presence of an urinary tract infection but this is often accompanied by frequency of passing urine, discomfort when passing urine or blood in the urine.

Some women do experience back pain when going into labour but this is usually accompanied by a dragging sensation in the lower abdomen or tightenings across the abdomen too. The abdominal contractions usually intensify as labour progresses.

The tiredness you are feeling is often experienced in pregnancy and is often due to lack of sleep or reduced iron levels. Your iron level should be tested regularly and if need be you may be asked to take ferrous sulphate tablets to boost your levels.

In relation to your digestion and the reflux that you are experiencing, again this can be because the stomach is compressed as the uterus expands and digestion slows down. It may well be the reflux is making you throat and jaw sore. Your GP may suggest that you take medication to help ease this discomfort.

Sometimes you can have a hiatus hernia and this can contribute to gastric reflux particularly after eating rich or spicy foods.

However if the reflux you are experiencing is accompanied by upper right sided abdominal pain (epigastric) this could be possible signs of Pre- eclampsia.

In relation to the discharge- discharge is normal in pregnancy but there are some things to be aware of:

Thrush- this usually presents as a creamy, cottage cheese like discharge which can cause the vaginal and perineal area to become irritated, sore and itchy. This is quite common in pregnancy again to hormonal changes or if you have diabetes. This can be treated with an anti-fungal cream.

Urinary Incontinence- As the uterus becomes larger the pelvic floor muscles can weaken and at times it is possible to leak urine particularly when lifting, sneezing, laughing or coughing. However if you have a urine infection or you are not emptying your bladder fully incontinence can sometimes occur.

Breaking of the Waters- Your waters can break at any time but usually you will feel a ‘pop’ and experience a large gush of fluid which cannot be contained. This fluid is usually a clear straw like colour but can be yellow- green if the baby has had a bowel motion inside you. Once the waters go you usually experience a constant draining/ dribble of fluid and you may find that you start experiencing some abdominal tightenings and period like cramping.

We would suggest that with the symptoms you are experiencing is that you seek an appointment as soon as possible with the Maternity Triage Department or Unit so that they can monitor your twins and also examine you for signs of your waters breaking, urine infection and rule out any other complications.

Wishing you all the very best and a safe delivery of your twins.

Answered by the Health at Hand nurses