Chest pain in pregnancy

Why it matters

Serious heart problems in pregnancy are rare. But according to the MBRRACE-UK reports, which review every maternal death in the UK, blood clots and heart disease are among the leading causes of women dying during pregnancy and in the year after. Many of those women had symptoms that were put down to normal pregnancy. You will never be wasting anyone's time by asking.

What's usually normal

Even these deserve a mention to your midwife if they are severe, getting worse, or you are worried.

The serious causes

Blood clots (pulmonary embolism)

Pregnancy and the weeks after birth make blood clots much more likely, especially after a caesarean. A clot in the leg (deep vein thrombosis) can travel to the lungs. Look for a swollen, painful, red or warm calf, often on one side, then sudden breathlessness or sharp chest pain when breathing in. This is a 999 emergency.

SCAD

Spontaneous coronary artery dissection is a tear in a heart artery that causes a heart attack. It's the most common cause of heart attacks in pregnancy and after birth, and often happens to women with no risk factors at all.

Peripartum cardiomyopathy

A weakness of the heart muscle that develops at the end of pregnancy or in the months after birth. Signs include breathlessness when lying flat, waking up breathless at night, swollen ankles that get much worse, a racing heart, and extreme tiredness. These are easy to mistake for normal life with a newborn. Tell your GP, midwife or health visitor.

Pre-eclampsia

High blood pressure in pregnancy can cause pain just below the ribs, usually on the right, along with a severe headache, vision problems or sudden swelling of the face, hands or feet. Call your midwife or maternity assessment unit straight away, or 999 if you feel very unwell.

Aspirin in pregnancy

Many pregnant women take a daily low-dose aspirin to lower the risk of pre-eclampsia. That's different from the single 300mg dose used in a suspected heart attack. If you're pregnant and think you're having a heart attack, tell the 999 call handler you're pregnant and follow their advice about aspirin.

CPR in pregnancy

If a pregnant woman collapses and isn't breathing normally, call 999 and start CPR in the normal way. If someone else is there and the bump is large, they can gently push it towards the woman's left side with both hands. This takes pressure off the big blood vessels and helps CPR work. Use a defibrillator as normal.

After a heart problem in pregnancy

If you had pre-eclampsia, gestational diabetes or high blood pressure in pregnancy, your risk of heart disease later in life is higher. Ask your GP for a blood pressure check at least once a year, and mention it at every health check.