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PubMed This is a summary of 13 peer-reviewed journal articles Updated
Obstetrics

Knowing the Signs: Normal Discomfort vs. Warning Signals

At a Glance

Preeclampsia warning signs include severe headaches that won't go away, vision changes like seeing spots or flashing lights, sudden swelling in the face or hands, and sharp pain in the upper right abdomen. Seek immediate emergency care if your blood pressure reaches 160/110 mmHg or higher.

Pregnancy comes with many new sensations, and it can be difficult to tell the difference between typical discomfort and a medical warning sign. Because preeclampsia can progress quickly, learning to identify “red flags” is a vital part of keeping you and your baby safe [1].

Normal Discomfort vs. Preeclampsia

While some symptoms of preeclampsia overlap with common pregnancy experiences, there are key differences in how they feel and how long they last.

Headaches

  • Typical: Occasional tension headaches that usually improve with rest, hydration, or acetaminophen (Tylenol) [2].
  • Preeclampsia Red Flag: A new-onset, persistent, or severe headache that feels different from your usual headaches. It may feel like a migraine or a “pounding” sensation and does not go away after taking medication [3][4].

Vision Changes

  • Typical: Slight dryness or mild changes in your prescription due to fluid retention.
  • Preeclampsia Red Flag: Seeing flashing lights, “stars,” or dark spots (scotomata). You may also experience blurred vision or a sudden loss of vision [5][6]. These are signs that the high blood pressure may be affecting your central nervous system [7].

Abdominal Pain

  • Typical: Heartburn, indigestion, or “rib pain” as the baby grows and pushes upward.
  • Preeclampsia Red Flag: Sharp, deep, or stabbing pain in the upper right quadrant (RUQ)—the area just under your right ribs. This can be a sign of liver stress and is often accompanied by nausea or a feeling of extreme “fullness” that isn’t related to eating [8][6].

Swelling (Edema)

  • Typical: Swelling in the feet and ankles that gets worse at the end of the day or in hot weather.
  • Preeclampsia Red Flag: Sudden swelling in your face (especially around the eyes) or your hands. A sudden weight gain of more than 2-3 pounds in a single week can also be a warning sign [9][2].

Severe Features of Preeclampsia

When doctors talk about “severe features,” they are referring to specific signs that the condition is affecting your organs or that your blood pressure has reached a dangerous level. These include:

  1. Severe Hypertension: Blood pressure readings of 160/110 mmHg or higher [5].
  2. Kidney Issues: Decreased kidney function, sometimes seen as a rise in “creatinine” in blood tests [8].
  3. Liver Issues: Elevated liver enzymes or severe pain in the upper abdomen [3].
  4. Low Platelets: A drop in the cells that help your blood clot (thrombocytopenia) [5].
  5. Lung Congestion: Fluid in the lungs (pulmonary edema), which can cause shortness of breath [10].

How to Take Your Blood Pressure at Home

If you are asked to monitor your blood pressure at home, doing it correctly is vital to avoid false alarms.

  • Rest first: Sit quietly for 5 minutes before taking a reading [11].
  • Position matters: Sit in a chair with your back supported and both feet flat on the floor (do not cross your legs).
  • Arm placement: Rest your arm on a table so the cuff is at the same level as your heart.
  • Use the right equipment: Use an arm cuff rather than a wrist monitor, as arm cuffs are generally more accurate.

When to Call Your Doctor (Same Day)

While severe symptoms require an ER visit, you should call your obstetrician or midwife the same day if:

  • Your blood pressure is consistently 140/90 mmHg or higher, but less than 160/110 mmHg, and you have no other severe symptoms [5].
  • You are unsure if a symptom is normal discomfort or a warning sign.

ER Checklist: When to Seek Help Immediately

If you experience any of the following, do not wait for your next appointment. Go to the nearest emergency room or Labor & Delivery triage unit immediately:

  • [ ] You notice a decrease in your baby’s normal movements or kick counts [12].
  • [ ] Your blood pressure is 160/110 mmHg or higher (even if you feel fine) [5].
  • [ ] You have a severe headache that won’t go away.
  • [ ] You see spots, flashes, or have sudden blurred vision.
  • [ ] You have severe pain in your upper right abdomen or stomach area.
  • [ ] You are having trouble breathing or feel a sudden “tightness” in your chest.
  • [ ] You experience a seizure (this is called eclampsia) [13].

It is always better to be evaluated and sent home than to ignore a potential warning sign. Your care team expects and encourages you to reach out if something doesn’t feel right.

Back to Home

Common questions in this guide

How can I tell a normal pregnancy headache from a preeclampsia headache?
A preeclampsia headache typically feels severe, pounding, or like a migraine. Unlike a normal tension headache, it does not go away after resting, drinking water, or taking typical pregnancy-safe pain medications like acetaminophen.
What kind of vision changes are warning signs of preeclampsia?
Warning signs include seeing flashing lights, dark spots, or "stars." You may also experience sudden blurred vision or vision loss. These indicate that high blood pressure may be affecting your central nervous system and require immediate evaluation.
Is abdominal pain normal during pregnancy or a sign of preeclampsia?
Mild indigestion or rib pain from your growing baby is a normal part of pregnancy. However, sharp, deep, or stabbing pain in your upper right abdomen under the ribs is a serious warning sign of liver stress from preeclampsia.
What is the proper way to take my blood pressure at home?
Rest quietly for five minutes before taking a reading. Sit in a supported chair with both feet flat on the floor, uncrossed. Rest your arm on a table so the cuff is at heart level, and use an arm cuff rather than a wrist monitor for the most accurate results.
When should I go to the emergency room for high blood pressure during pregnancy?
You should go to the emergency room immediately if your blood pressure reading is 160/110 mmHg or higher, even if you feel completely fine. You should also go if you experience severe symptoms like a persistent headache, vision changes, or trouble breathing.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my current symptoms, do I meet the criteria for preeclampsia with 'severe features'?
  2. 2.What is the best way for me to track my blood pressure at home, and what specific number should trigger a call to your office?
  3. 3.What blood pressure cuff do you recommend I buy?
  4. 4.Who do I call if I have a headache after hours?
  5. 5.Do you have a preferred hospital triage or Labor & Delivery unit I should go to if I experience red-flag symptoms?

Questions For You

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Related questions

Is My Pregnancy Headache Normal or Preeclampsia?Is My Pregnancy Swelling Normal or a Sign of Preeclampsia?What Causes Upper Right Abdominal Pain in Preeclampsia?

References

References (13)
  1. 1

    Factors Associated with Progression to Preeclampsia with Severe Features in Pregnancies Complicated by Mild Hypertensive Disorders.

    Barda S, Yoeli Y, Stav N, et al.

    Journal of clinical medicine 2023; (12(22)) doi:10.3390/jcm12227022.

    PMID: 38002636
  2. 2

    SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014.

    Lowe SA, Bowyer L, Lust K, et al.

    The Australian & New Zealand journal of obstetrics & gynaecology 2015; (55(5)):e1-29 doi:10.1111/ajo.12399.

    PMID: 26412014
  3. 3

    ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia.

    Obstetrics and gynecology 2019; (133(1)):1 doi:10.1097/AOG.0000000000003018.

    PMID: 30575675
  4. 4

    The Role of Headache in the Classification and Management of Hypertensive Disorders in Pregnancy.

    Sperling JD, Dahlke JD, Huber WJ, Sibai BM

    Obstetrics and gynecology 2015; (126(2)):297-302 doi:10.1097/AOG.0000000000000966.

    PMID: 26241418
  5. 5

    Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.

    Obstetrics and gynecology 2020; (135(6)):e237-e260 doi:10.1097/AOG.0000000000003891.

    PMID: 32443079
  6. 6

    Gestational Hypertension: A Contemporary Review of Epidemiology, Pathophysiology, and Therapeutic Approaches.

    Sunita , Kaushik R, Gaur PK, Verma KK

    Current hypertension reviews 2024; (20(3)):117-126 doi:10.2174/0115734021312990241115045601.

    PMID: 39601171
  7. 7

    Determinants of Preeclampsia Among Pregnant Women in Chiro Referral Hospital, Oromia Regional State, Ethiopia: Unmatched Case-Control Study.

    Katore FH, Gurara AM, Beyen TK

    Integrated blood pressure control 2021; (14()):163-172 doi:10.2147/IBPC.S336651.

    PMID: 34880674
  8. 8

    Association of severity features and laboratory biomarkers with adverse maternal outcomes in pre-eclamptic women: a retrospective cohort study in an Ethiopian tertiary hospital.

    Abraha HE, Teka H

    BMJ open 2025; (15(4)):e089935 doi:10.1136/bmjopen-2024-089935.

    PMID: 40204317
  9. 9

    Hypertensive disorder prediction among first-trimester antenatal patients using Gestosis score.

    P Kundargi A, K Naagar J, Jain R, et al.

    Bioinformation 2025; (21(4)):618-622 doi:10.6026/973206300210618.

    PMID: 40636191
  10. 10

    The hypertensive disorders of pregnancy (29.3).

    Magee LA, Pels A, Helewa M, et al.

    Best practice & research. Clinical obstetrics & gynaecology 2015; (29(5)):643-57.

    PMID: 26141795
  11. 11

    Hypertensive Disorders of Pregnancy: Diagnosis, Management and Timing of Birth.

    İnan C, Uygur L, Alpay V, et al.

    Balkan medical journal 2024; (41(5)):333-347 doi:10.4274/balkanmedj.galenos.2024.2024-7-108.

    PMID: 39239931
  12. 12

    Maternal and neonatal outcome among women with early-onset preeclampsia and late-onset preeclampsia.

    Rahman L, Anwar R, Mose JC

    Hypertension in pregnancy 2024; (43(1)):2405991 doi:10.1080/10641955.2024.2405991.

    PMID: 39305196
  13. 13

    Hypertension in pregnancy: Pathophysiology and treatment.

    Braunthal S, Brateanu A

    SAGE open medicine 2019; (7()):2050312119843700 doi:10.1177/2050312119843700.

    PMID: 31007914

This page is for informational purposes only and does not replace professional medical advice. If you experience any preeclampsia warning signs, contact your healthcare provider or go to the nearest emergency room immediately.

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