Pregnancy · Symptom triage
Trimester Symptom Quiz
Tick the symptoms you're currently experiencing alongside your week of pregnancy. The quiz separates what's typical for your trimester from what's less typical, and flags every symptom that needs same-day or emergency clinical assessment — referenced to NICE, ACOG, RCOG and SMFM guidelines.
Last reviewed 25 May 2026
Trimester symptom triage
Is what I’m feeling normal?
How many weeks pregnant are you?
Tick every symptom you’re currently experiencing
Enter your week of pregnancy and tick symptoms above to see your triage summary.
How to use this triage tool
Enter your current week of pregnancy (1–42) and tick every symptom you’re experiencing right now. The tool sorts your selections into three buckets:
- Typical for your stage — symptoms with >15 % prevalence in routine antenatal cohorts for your trimester. Reassurance, not dismissal — raise anything that bothers you with your midwife.
- Less typical for your stage — symptoms that are recognised but unusual for your trimester. Worth mentioning at your next appointment.
- Red flags — symptoms that screen for an obstetric emergency (preeclampsia, placental abruption, preterm labour, PROM, VTE, obstetric cholestasis, sepsis, fetal compromise). The banner shows the urgency (A&E now / call provider today / within 24 hours) and the conditions being screened for.
Background — how trimester-typical symptoms are defined
The trimester boundaries follow the ACOG convention: first trimester 0–13+6 weeks, second trimester 14+0–27+6 weeks, third trimester 28+0 weeks onward. The commonness flags for each symptom are drawn from prevalence data in NICE CG62 (Antenatal care), Williams Obstetrics (26th ed.), and the symptom-specific reviews cited in the source list below.
Symptoms shift through pregnancy in predictable ways: progesterone and oestrogen surges in the first trimester drive nausea, fatigue, and breast changes. Plasma volume expansion and mechanical accommodation in the second trimester underlie back pain, nasal congestion, and gum bleeding. Mechanical pressure from a term-sized uterus and dropping cortisol patterns in the third trimester drive breathlessness, pelvic pressure, insomnia and Braxton-Hicks.
The red-flag list — what each one screens for
Every red-flag tick triggers an emergency or same-day prompt. The underlying conditions, with their guideline references:
- Heavy bleeding — threatened or completed miscarriage (first trimester), placental abruption or praevia (after 24 weeks), postpartum hemorrhage. ACOG PB 234, RCOG GTG 27a/b.
- Severe constant abdominal pain — placental abruption, ectopic pregnancy (first trimester), appendicitis, ovarian torsion. ACOG PB 193.
- Visual disturbance / severe headache / RUQ pain / sudden facial oedema — classic tetrad of preeclampsia / HELLP. Risk peaks after 20 weeks. Severe-features preeclampsia can progress to eclampsia within hours. NICE NG133, ACOG PB 222.
- Reduced fetal movements — the single strongest predictor available to a pregnant woman of fetal compromise / stillbirth. Use your own baseline; if movements feel reduced after 24 weeks, ring the labour ward TODAY. SMFM Consult 46, RCOG GTG 31.
- Fever ≥ 38.5 °C — pyelonephritis, chorioamnionitis, sepsis, severe influenza or COVID-19. RCOG GTG 36.
- Persistent vomiting unable to keep fluids down — hyperemesis gravidarum needing IV rehydration / antiemetics. RCOG GTG 69.
- Burning urination + flank pain / haematuria — UTI / pyelonephritis. Untreated UTI in pregnancy raises preterm birth risk. NICE NG109.
- Sudden gush or persistent slow leak of fluid — rupture of membranes (PROM at term, PPROM if < 37 weeks). ACOG PB 217.
- Regular contractions < 37 weeks (≥ 6/hr) — preterm labour. ACOG PB 234.
- Sudden severe SOB / chest pain / unilateral calf swelling — pulmonary embolism or deep vein thrombosis. Pregnancy raises VTE risk ~5×. RCOG GTG 37a/b.
- Intense itching of palms / soles, worse at night, no rash — obstetric cholestasis. Stillbirth risk rises sharply at bile acid > 100 µmol/L. RCOG GTG 43.
- Abdominal trauma — placental abruption can present up to 24 hours later. ACOG CO 723 — Guidelines for diagnostic imaging during pregnancy and trauma in pregnancy.
- Persistent low mood + thoughts of self-harm — antenatal depression. EPDS screen, same-day mental-health contact. NICE CG192.
How to interpret your result
A clear “typical for your stage” panel with no red flags is reassuring — your body is doing what bodies do at this point in pregnancy. Persistent or severe versions of any symptom still deserve a conversation at your next appointment.
An “unusual for your stage” finding (e.g. first quickening at 32 weeks, light bleeding at 30 weeks, severe nausea at 28 weeks) doesn’t guarantee a problem but warrants proactive contact with your provider — sometimes it’s benign, sometimes it’s an early sign of an issue worth catching.
Any red-flag tick triggers an action banner. The colour codes match urgency:
- Red (A&E now): obstetric emergency. Don’t drive yourself; ring 999/911 if severe.
- Amber (call today): same-day clinical review needed; ring the maternity unit / labour ward direct number on your handheld notes.
- Yellow (within 24 h): not immediately dangerous but should not wait a week.
Limitations
- This is a triage screen, not a diagnosis. It cannot examine you, take blood pressure, listen to fetal heart, or send blood tests.
- Common-stage prevalence flags are population averages — your individual experience can vary widely and still be normal.
- Symptom lists are not exhaustive. If something feels wrong and isn’t on the list, that’s also a reason to call.
- The tool assumes a singleton, low-to-moderate-risk pregnancy. High-risk pregnancies (twins, prior preterm, hypertensive disorder, GDM, placenta praevia, etc.) have additional triggers your team should have given you in writing.
Sources
- National Institute for Health and Care Excellence. Antenatal care (NG201, updated 2024; previously CG62).
- NICE. Hypertension in pregnancy: diagnosis and management (NG133, 2019).
- American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia (Practice Bulletin 222, 2020).
- ACOG. Prelabor rupture of membranes (Practice Bulletin 217, 2020).
- ACOG. Management of preterm labor (Practice Bulletin 234, 2021).
- Society for Maternal-Fetal Medicine. SMFM Consult Series #46: Evaluation and management of decreased fetal movement at term (2018).
- Royal College of Obstetricians and Gynaecologists. Reduced fetal movements (Green-top Guideline 31, 2011).
- RCOG. Obstetric cholestasis (Green-top Guideline 43, 2022).
- RCOG. Reducing the risk of venous thromboembolism during pregnancy and the puerperium (GTG 37a/b, 2015).
- Niebyl JR. Nausea and vomiting in pregnancy. N Engl J Med 2010;363:1544-50.
- Hasan R, et al. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. Obstet Gynecol 2009;114:860-7.
Frequently asked questions
What counts as a true red-flag in pregnancy?
Any one of: heavy vaginal bleeding (soaking a pad), severe constant abdominal pain, sudden visual changes (blurring, flashing lights), severe persistent headache, right-upper-quadrant pain, sudden facial swelling, reduced fetal movements after 24 weeks, fever ≥ 38.5 °C, sudden gush of fluid before 37 weeks, painful unilateral leg swelling, sudden severe shortness of breath, intense itching of palms/soles, or abdominal trauma. Each of these screens for an obstetric emergency — placental abruption, preeclampsia/HELLP, fetal compromise, sepsis, preterm rupture of membranes, venous thromboembolism, or obstetric cholestasis. Call your maternity unit or attend A&E without trying to self-resolve.
How much vaginal spotting is too much?
Light pink or brown spotting (less than a panty liner) in the first trimester is common, often related to implantation or cervical changes, and affects roughly 20–30 % of confirmed pregnancies (Hasan 2009, Obstet Gynecol). Bright-red bleeding, bleeding that fills a pad, or any bleeding with pain warrants same-day assessment to rule out miscarriage, ectopic, or in later pregnancy placental abruption / praevia. After 24 weeks, ANY vaginal bleeding needs immediate review.
I'm worried I'm not feeling baby move enough — what's the rule?
There is no single universal kick-count threshold (the RCOG specifically advises AGAINST the old '10 kicks in 12 hours' rule because it caused both false reassurance and false alarm). The reliable rule is RELATIVE: if movements feel reduced from your own usual pattern after 24 weeks, ring the labour ward TODAY for a CTG/scan. Eating, drinking, or lying on your left side does not need to come first — call first, snack later (SMFM Consult 46, 2018; RCOG Green-top 31, 2011).
What headache or visual change should prompt an emergency call?
Severe headache that does not settle with paracetamol, especially with visual disturbance (blurring, flashes, double vision), pain behind the eyes, or right-upper-quadrant pain — these are the classic signs of preeclampsia and need same-day blood pressure / urine / blood-test review (NICE NG133, ACOG PB 222). Preeclampsia is most common after 20 weeks, and 'severe-features' preeclampsia is a medical emergency that can progress to eclampsia (seizure) or HELLP syndrome within hours.
Is intense itching really an emergency?
Itching without a rash, especially on the palms and soles and worse at night, in the second half of pregnancy, is a textbook presentation of obstetric cholestasis. Bile acids cross the placenta and are associated with stillbirth, preterm birth, and meconium aspiration — risk rises sharply at bile acid levels > 100 µmol/L. It needs same-day blood tests (LFTs + bile acids) and ongoing monitoring through to delivery (RCOG Green-top 43, 2022).
Why is breathlessness sometimes normal but sometimes an emergency?
Mild breathlessness on exertion in the second and third trimester is common (~75 % of women) — pregnancy raises minute ventilation by ~40 %, the diaphragm rides higher, and progesterone enhances respiratory drive. SUDDEN severe shortness of breath, breathlessness at rest, sharp chest pain, or a painful swollen calf are different — these screen for pulmonary embolism and DVT. Pregnancy raises venous thromboembolism risk roughly five-fold, and PE remains a leading direct cause of maternal mortality in high-income countries (RCOG Green-top 37a/b).
Are Braxton-Hicks contractions ever a sign of labour?
Braxton-Hicks are irregular, painless or mildly uncomfortable tightenings that don't progress in frequency or intensity, typically start around 20 weeks, and settle with rest, hydration, or position change. True labour contractions are regular, rhythmic, increase in intensity, and don't settle when you change position. Before 37 weeks, six or more contractions per hour — even if they feel mild — should be assessed for preterm labour (ACOG PB 234).
I have a fever — when should I worry?
Fever ≥ 38.5 °C (101 °F) in pregnancy needs same-day review. The biggest concerns are pyelonephritis (kidney infection from an untreated UTI — preterm birth risk), chorioamnionitis (intrauterine infection — risk to mother and baby), and sepsis. Influenza and COVID-19 also cause more severe disease in pregnancy than in the general population (RCOG/RCM joint statement). Don't wait to see if it settles — call your maternity unit or 111.