Minor Disorders of Pregnancy
Definition
Symptoms and signs due to non-serious illnesses whcih occur during pregnancy which are easily treatable
Etiology
Hormonal changes
Accommodation changes
Metabolic changes
Postural changes
All body systems may be affected
Digestive System
Nausea and vomiting - especially in the morning soon after getting out of bed, common in primies, commonly in the first 10 weeks - related to higher levels of HCG
Management : Dietary changes, Behaviour modification, if needed hospitalization and correction of fluid and electrolyte imbalance, Explaining the patient the cause and course, reassurance, and symptomatic treatment
Constipation
Management:
High fiber foods such as whole-grain cereals and breads, brown rice, beans and fresh fruits and vegetables.
10 to 12 glasses of fluid everyday in the form of water, milk, juice or soup. warm or hot fluid is particularly helpful.
Active lifestyle with regular exercise such as walking, swimming, riding a stationary bike and yoga.
Bowels are most likely to be active after meals: use toilet after eating.
If needed laxatives
Less iron.
Acidity and heartburn (pyrosis) - due to relaxation of the esophageal sphncter & hiatus hernia and GERD, in late pregnancy due to displacement of the stomach and duodenum by the uterine fundus - occurs when lying down or bending over
Management :
Avoid over eating, Eat five to six smaller low fat meals throughout the day rather than three large meals.
Avoid spicy, greasy and fatty food
Chew the food well and eat slowly
Do not go to bed immediately after a meal
Elevate the head of bed.
Semi-reclining position; hiatus hernia spontaneously after delivery
Wear loose-fitting clothing.
Antacids prescribed by doctors
Excessive salivation called ptyalism - decrease intake of carbohydrates
Abdominal discomfort : due to the weight of the uterus and traction of ligaments. Flatulence and distension are due to large meals, gas forming foods and chilled beverages
Management : rest frequently in the lateral reclining position, maintain regular bowel habits, exercise, acetaminophen
Pica: it is crave to eat certain food or unnatural substances
Musculo-skeletal system
Fatigue : especially during last trimester. Due to altered posture and extra weight carried
Management : anemia corrected. frequent rests
Backache : strain due to joint ligament laxity (relaxin, estrogen), weight gain, hyperlordosis and anterior tilt of the pelvis, faulty posture, muscular spasm, urinary infection or constipation
Management : avoid excessive weight gain, rest with elevated legs to flex the hips, pelvic girdle belt, rest in hard bed, avoid high heeled shoes. Massage back muscles, analgesics, rest, back exercises, local heat, acetaminophen, rule out intervertebral disc prolapse and radiculitis
Leg cramps : usually in the legs, worse at night. ? due to vitamin B1, calcium deficiency or elevation of phosphorus. ? due to ischemia and changes in pH or electrolyte status
Management :
Calcium.
B1
Elevation of foot end while sleeping
Avoid standing or sitting with legs crossed for long period of time.
Massage calves and feet regularly
Rotate ankles and wiggle toes often
Walk every day.
Avoid getting too tired. lie down on left side to improve circulation to legs.
Warm bath before going to bed.
Wear supportive stockings.
Apply local heat.
Eat a well-balanced diet that includes lots of calcium and magnesium.
Stay hydrated
Round ligament pain : stretching of the round ligament during movements causes sharp pain in the groins; unilateral or bilateral. usually in the second trimester onwards. more common in the right side as a result of dextrorotation of uterus. May wake up the pt during change of positions.
Management : avoid sudden change of positions, local heat, anagesics if needed
Circulatory System
Varicose veins : legs, vulva, anal canal. in later moths, due to pressure of the uterus, due to smooth muscle relaxation, weakness of the vascular walls and incompetent valves
Management : elastic compression garment for legs, elevation of limbs, control wt.
Hemorrhoids
Syncope : on standing. due to pooling of blood in the lower limbs and compression of the pelvic veins by uterus. may also be due to dehydration hypoglycemia or overexertion
Management ; lie down in left lateral position. Recurrent syncopy → cardiological evaluation. frequent small meals rather than 3. Coffee, tea may help
Ankle edema : in late pregnancy. Due to water retention and venous pressure. Generalized edema must be investigated
Management : Rest with elevation of the lower limbs. No diuretics. Reduce salt. elastic support for varicose veins.
Nervous system
Insomnia : in late pregnancy; due to discomfort by fetal movts, frequent micturition and difficulty in finding a comfortable position, anxiety, feat
Management : rest in the afternoon, warm milk at bed time, tuck a pillow under the abdomen while in a lateral position, alleviate fear and anxiety
Headache : due to tension. severe and persistent headache may indicate pre-eclampsia
Carpal tunnel syndrome : pain and numbness in the thumb, index and the middle fingers, weakness of thumb movements. due to pressure on median nerve. due to fluid retention
Management : symptomatic treatment : splint in wrist flexion, rarely steroid injection or surgical decompression needed. Resolves spontaneously following delivery.
Genitourinary System
Vaginal discharge : local cleanliness. if present Trichomonas, candida and bacterial vaginosis treated with vaginal metronidazole or miconazole.
Leucorrhea : increase of nonirritating vaginal discharge due to estrogen stimulation of cervical mucus is normal. such discharge is milky, thin and non-irritating unless there is infection. mild pruritus only. if severe suspect infection
Management : reassurance, protective perineal pads;
Urinary symptms : frequency, urgency and stress incontinence especially in advanced pregnancy; due to increased intra abdominal pressure; suspect urinary tract disease if dysuria or hematuria is present.
Management : limit caffeine, spices and popular beverages. Pelvic floor exercises
Respiratory System
Breathlessness : not dyspnoea. due to progesterone effect. Free of cough or allergic problems. as early as 12th week
Management : nil specific
Integumentary System
Generalized itching. starts with abdomen. Liver's response to the hormones with raised bilirubin
Management : local applications with caladry lotion. vulvar irritation if present rule out glycosuria, infection like thrush, gestational diabetes. wash with soap. cotton underwear.
Disorders that require immediate action
Vaginal bleeding
Reduced fetal movement
Frontal or recurring headache
Sudden swelling/edema
Rupture of the membrane
Premature onset of contraction
Sudden nausea and sickness
Epigastric pain
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