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MINOR DISORDERS OF PREGNANCY AND THEIR MANAGEMENT:
Introduction:
The anatomical physiological and biochemical adaptations to pregnancy are profound. These changes that the female body undergoes during pregnancy begin soon after fertilization and continue through gestation. These changes occur occur in response to physiological stimuli provid ed by the fetus and placenta. These changes may be unpleasant as well as worrying but they are rarely a cause for alarm as most of these changes are usually normal. These so-called minor disorders or ailments of pregnancy can be troublesome on a day to day basis. Nevertheless these minor ailments are considerably improved by offering a proper explanation and with simple treatments. The following are the minor ailments of pregnancy: a. Backache b. Constipation c. Nausea and vomiting d. Heartburn e. Ankle oedema f. Varicose veins g. Haemorrhoids h. Leg cramps i. Vaginal discharge j. Syncope k. Insomnia or sleeplessness l. Pain over round ligament m. Urinary frequency 1. BACKACHE: BACKACHE: usually lasts from 20 weeks to term. During pregnancy there is laxity of the spinal ligaments which along with the weight of pregnancy puts a strain on the joints of the lumbo-sacral spine and pelvis resulting in lumbar lordosis and consequent backache. Advice should include: a. Maintenance of correct posture b. Avoiding lifting heavy objects c. Avoid high heels d. Regular physiotherapy e. Firm mattress to sleep on f. Enough rest particularly in later pregnancy. g. Swimming often soothes backache. h. Watch weight gain. i. Avoiding standing for long hours of time.
2. CONSTIPATION: can last entire pregnancy. Various factors contribute to constipation during pregnancy, which includeeffect of progesterone on gut motility, physical weight of the gravid uterus on the rectum and the use of iron tablets. Advice should include: a. Plenty of fruits, green leafy vegetables and fibre in diet (Isabgul) b. Plenty of water to drink c. Laxatives (surface acting) d. Regular exercises e. Swimming
3. NAUSEA AND VOMITING: usually last 4-16 weeks. It is usually common in primigravidae and usually appears following first or second missed period and subsides by the end of first trimester. Vomiting occurs soon after getting out of bed. The cause of vomiting is not clear but increased chorionic gonadotropin has been implicated. Psychological background has also been implicated to play a major role. Advice should include: a. Small frequent feeds, especially crackers, dry toast and cereals. b. Avoid spicy and greasy foods c. Protein diet d. Anti-emetics are better avoided. e. Pre-natal vitamins with iron are avoided for the first 12 weeks. f. Avoiding slouching after meals. 4. HEARTBURN (PYROSIS): from 20 weeks to term. This common complaint is the result of reflux of acid contents of the stomach. The relaxation of the esophageal sphincter due to the effect of progesterone and the weight effect of the pregnant uterus preventing stomach emptying are the causes for this reflux of acid contents. Over-eating, late eating alcohol and spicy foods contribute to the problem. Hiatus hernia which is common during pregnancy is another cause of heartburn.
Management includes: a. b. c. d.
Propped up position after meals Smaller meals more often Antacids Avoiding aggravating factors
5. ANKLE OEDEMA: Usually after 28 weeks. As pregnancy advances the patient may notice swelling of their feet and ankles. This is due to the impediment of venous return from the lower limbs due to the pressure effect of the gravid uterus on the lower li mb veins. However eclampsia, underlying cardiac or renal impairment is to be excluded. Management includes: a. Frequent periods of rest with limb elevation for at least 15 minutes each time b. Avoiding long periods of standing or sitting. c. Diuretics should not be used. 6. VARICOSE VEINS: 16 weeks to term. Varicose veins in the legs and vulva may appear for the first time or aggravate during pregnancy. It is due to the obstruction of the venous return by the weight of pregnant uterus on the inferior vena cava. It is also thought to be due to the relaxant effect of progesterone on the vascular smooth muscles. Management includes: a. Applying elastic stockings or crepe bandages for leg varicosities b. Elevation of limb during rest. c. Usually disappear delivery d. No surgical intervention is required. 7. HAEMORRHOIDS: 24 weeks to term. Constipation during pregnancy tends to aggravate the varicosity of the veins in the rectum. Straining at stool, prolonged sitting and spicy food aggravate the condition. Management includes: a. High fibre diet and Use of laxatives to keep the bowel soft. b. Local anaesthetic /anti irritant creams can be used c. Replacement of prolapsed piles is essential
8. LEG CRAMPS: This is due to the deficiency of diffusible serum calcium or elevation of serum phosphorous. Management includes: a. Supplementary calcium therapy and Vit. B1 (30 mcg) daily. b. Application of local heat and massage c. High doses of Vit. E (400 mg) BD often proves beneficial.
9. VAGINAL DISCHARGE: This is due to the increased transudation of fluids as a result of increased vascularity during pregnancy. The discharge is clear and white and do not have unpleasant smell. Management includes: a. Assurance to the mother. b. Local cleanliness. c. Rule out any infection. 10. SYNCOPE: The enlarging gravid uterus compresses the veins in the pelvic bri m, impending venous return and causes pooling of blood in the lower limbs which in turn leads to decreased oxygen supply to the brain leading to syncope. In later pregnancy the gravid uterus compresses the inferior vena cava in the dorsal supine position causing supine hypotension. Management includes: a. Avoiding prolonged standing b. Getting up slowly after lying or sitting down. c. Left lateral tilt with a wedge below the right hip alleviates the problem. 11. SLEEPLESSNESS OR INSOMNIA: 28 weeks to term. It has been attributed to the hormonal changes that occur during pregnancy and can be a major cause of anxiety in a pregnant mother. Daily exercises, plenty of fresh air, avoiding caffeine and multivitamins before sleep, warm milky drink or a warm bath help to allay anxiety and hence insomnia.
nd
12. URINARY FREQUENCY: 2
trimester to term.
The pressure of the growing gravid uterus during the early part of pregnancy, and the pressure of the fetal head when it engages the pelvic brim near full term cause irritation of the bladder base and predispose to urinary frequency.
13. OTHER MINOR AILMENTS INCLUDE: a. b. c. d. e. f. g. h.
Itching of body Nose bleeds Headache Breast soreness Tiredness Altered taste sensation Striae Gravidarum and Chloasma Thrush.
CONCLUSION: During normal pregnancy, virtually every organ system undergoes anatomical and functional changes that can alter appreciably criteria for diagnosis and treatment of diseases. Equally astounding is that the woman who was pregnant is returned almost completely to her pre-pregnant state after delivery and lactation. Thus the understanding of these adaptations to pregnancy remains a major goal of obstetrics and proper care of a pre gnant woman. Without such knowledge, it is almost impossible to understand the disease process that can threaten women during pregnancy and also to bring about a healthy nursing care of both the mother and the newborn.
References rd 1. Williams obstetrics 23 edition Mc Graw Hill. 2. Manual of obstetrics-S N Daftary / S Chakvarti- B I Churchill Livingstone. th 3. Obstetrics by Ten Teachers-17 edition 4. Text book of obstetrics-D C Dutta
