Minor Disorders of Pregnancy

Session objectives

To describe the minor disorders of pregnancy

To discuss the management of the common
minor disorders of pregnancy.
 WHAT IS MINOR AILMENTS OF
PREGNANCY ?????

 The anatomical, physiological and biochemical

adaptations to pregnancy are profound.
 During the course of pregnancy period many changes
occur in a woman’s body as a result of hormonal
influences and adaptation to the gestational process.
 Thereby, they experience a variety of physiological and
psychological symptoms These are termed as minor
ailments or discomforts of pregnancy.
 most of the symptoms/signs are self limiting and rarely
worsen as gestational age advances.
 Minor disorder……………

THE FOLLOWING ARE THE MINOR AILMENTS OF PREGNANCY:

 Breast tenderness
 Backache
 Constipation
 Nausea and vomiting
 Heartburn
 Ankle oedema
 Varicose veins
 Haemorrhoids
 Leg cramps
 Vaginal discharge
 Syncope
 Urinary frequency
 NAUSEA AND VOMITING (MORNING SICKNESS)

Some degree of nausea and vomiting during first trimester

and usually appear following first or second missed period
and subsides by the end of first trimester.
Vomiting occurs soon after getting out of bed. It can appear
at any time of the day but is generally worse in the morning,
thus the name morning sickness.
Usually last 4-16 weeks. It is usually common in
primigravidae •
 50% women have both nausea and vomiting, 25% have
nausea only and 25% unaffected.
 Morning sick….

Thiscondition is believed to be caused by high or rapidly rising level of

human chorionic gonadotrophic hormone and estrogen.
It is worse in multiple pregnancy and gestational trophoblastic diseases.
Psychological problems like anxiety can aggravate the situation.
 Eating small feedings at frequent , especially crackers, dry toast and cereals
and avoiding food items whose smell precipitate or aggravate the symptoms
helps in relieving this problem. Avoid spicy and greasy foods and
 consuming protein diet may decrease the condition
 If persistent, anti-emetics can be given.
 Heartburn (PYROSIS )

Heartburn, epigastric burning sensation, is one of the most common complaints


of pregnant women especially during late pregnancy, from 20 weeks to term.
The symptom is usually mild. It is caused by reflux of gastric content into the
lower esophagus due to upward displacement and compression of the stomach
by the enlarging uterus and progesterone induced relaxation of the lower
esophageal sphincter.
 Over-eating, late eating alcohol and spicy foods contribute to the problem.
It is relieved by having smaller meals, avoiding bending over or lying flat.
Antacid preparation (aluminum hydroxide or magnesium trisilicate alone or in
combination) may help
In severe cases H2 - blockers like cimetidine can be used safely.
Hiatus hernia which is common during pregnancy is another cause of
heartburn.
PICA

craving of pregnant woman for items of low nutritional

value foods or unnatural substances such as coal, ice
(pagophagia) or clay (geophagia)
The cause is unknown but hormones and changes in
metabolism are thought to contribute to this.
common in patients with iron deficiency anemia. In these
cases, it is relieved by correction of anemia.
Some pregnant women may have the symptom with out
anemia.
Educating the woman is all that is needed.
EXCESSIVE
SALIVATION (ptyalism)

 This occurs from 8th week of gestation and it is thought t hat

the hormones of pregnancy are the cause for it.
 It may accompany heartburn.
Management
 eating smaller but more frequent meals.
 brushing your teeth and using mouthwash several times a day.
 chewing sugarless gum or sucking hard sweets.
 taking frequent, small sips of water.
 HEMORRHOIDS

More
 often pregnancy causes exacerbation or recurrence of previous hemorrhoids
due to increased pressure in the rectal veins caused by obstruction of venous
return by the large uterus.
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.
Hemorrhoids can be asymptomatic or present with rectal bleeding, rectal pain or
as a prolapsed mass through the anal orifice.
The later one can be strangulated and cause severe pain. Thrombosis occurring in
the dilated veins can also cause severe pain.
Treatment includes topically applied anesthetic and anti-inflammatory agents for
pain and swelling, warm soaks (sitz bath), laxatives and modification of bowel
habits.
Surgery is reserved for thrombosed and strangulated hemorrhoids.
Urinary complaints

 2nd 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.
 Increased glomerular filtration rate
Urinary tract infection is also common as the result of
incomplete emptying of the bladder and stasis of urine.
 Mastodynia

 Mastodynia, or breast tenderness, may range from tingling to

frank pain caused by hormonal responses of the mammary
ducts and alveolar system.
 Circulatory increases result in breast engorgement and venous
prominence. Similar tenderness may occur just before
menses.
Physiologic breast engorgement may cause discomfort,
especially during early and late pregnancy.
A well-fitting brassiere worn 24 hours a day affords relief. Ice
bags are temporarily effective. Hormone therapy is of no value.
Vaginal discharge/leucorrhea

Pregnant women normally develop increased vaginal discharge in

many instances. It is clear, whitish and odorless termed as
leucorrhea gravidarum
This is the result of estrogen mediated increased mucus secretion
by the cervical glands.
Vaginal infections like trichomoniasis and candidiasis should be
ruled out in every patient with this symptom.
Recurrent vulvo - vaginal candidiasis is common.
Curd like vaginal discharge and vulvar pruritis are major
manifestations.
Treatment with antifungal vaginal suppositories suffices. Systemic
antifungals are contraindicated.
SYNCOPE

 The enlarging gravid uterus compresses the veins in the pelvic

brim, 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
 Avoiding prolonged standing
 Getting up slowly after lying or sitting down.
 Left lateral tilt with a wedge below the right hip alleviates
the problem.
 Low Back and pelvic pain

backache
 usually lasts from 20 weeks to term.
During pregnancy there is laxity(relaxin, estrogen) 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 anterior
tilt of the pelvis consequent backache.
Its severity increases with the duration of pregnancy.


Low back pain can be reduced by having the woman squat rather than bending over when reaching down,


providing back support with a pillow when sitting down, and avoiding high heeled shoes.
Maintenance of correct posture


Avoiding lifting heavy objects



Regular physiotherapy


Firm mattress to sleep on



Enough rest particularly in later pregnancy.



Avoiding standing for long hours of time.



Relaxation of
 the joints of the pelvic girdle, cause pelvic pain and gait abnormalities.

In severe
 cases there may be tenderness over the symphysis pubis which prevents mobility. This condition is
pelvic pain……………..

Relaxation of the joints of the pelvic girdle, cause pelvic

pain and gait abnormalities.

In severe cases there may be tenderness over the

symphysis pubis which prevents mobility. This condition is
called pelvic osteoarthropathy and necessitates
admission.
Varicose veins

Varicose veins, dilatation of the superficial veins of the lower extremities,

could develop in predisposed women. It becomes more prominent as
pregnancy advances, weight increases, and the length of time spent upright is
prolonged.
16 weeks to term.
It is due to the obstruction of the venous return by the weight of pregnant
uterus on the inferior vena cava.
 It is due to progesterone mediated smooth muscle relaxation of the blood
vessels and increased venous pressure in the femoral veins due to compression
by the enlarging uterus.
In most, it is asymptomatic. In few it causes discomfort of variable degree.

 Treatment is periodic rest with elevation of legs and use of elastic stocking
or both.
Dependent edema

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 limb veins.
Usually after 28 weeks

As pregnancy advances the patient may notice swelling of their feet and ankles.

It is important to rule out preeclampsia eclampsia, underlying cardiac or renal

impairment especially in those with persistent dependent edema.

MANAGEMENT
 Frequent periods of rest with limb elevation for at least 15 minutes each time
 Avoiding long periods of standing or sitting.
 Diuretics should not be used.
Leg Cramps

 The cause of leg cramps in pregnancy is unknown but may be the

result of a reduced level of diffusible serum calcium or elevation of
serum phosphorus.

 Treatment for this includes curtailment of phosphate intake (less milk

and nutritional supplements containing calcium phosphate) and an
increase of calcium intake (without phosphorus) in the form of calcium
carbonate or calcium lactate tablets.

 Alternatively, a randomized trial showed that magnesium citrate, 300

mg/d, reduces leg cramps. Symptomatic treatment consists of leg
massage, gentle flexing of the feet, and local heat.
 Discomfort in the Hands

Acro dysesthesia of the hands consists of periodic numbness and tingling of

the fingers.
It affects at least 5% of pregnant women. In some cases it is thought to be a
brachial plexus traction syndrome caused by drooping of the shoulders
during pregnancy;
Carpal tunnel syndrome is a common cause of a similar symptom complex.
This usually happen in themorning, but it can occur at any time of the day.It
is caused by fluid retention, which createsedema & pressure on the median
nerve.
The discomfort is most common at night and early in the morning.
It may progress to partial anesthesia and impairment of manual
proprioception. The condition is apparently not serious, but it may persist
after delivery as a consequence of lifting and carrying the baby.
OTHER COMPLAINTS

Fatigue is the other common complaint during early pregnancy. The

woman will have a desire for excessive sleep. This symptom remits
spontaneously by the fourth month of the pregnancy and has no special
significance.

Palpitation is another common complaint. If significant, cardiac

pathologies must be ruled out.

Epistaxis and gum bleeding occur as the result of vascular congestion

and do not need special treatment. In rare cases surgical excision is
needed for tumorous condition of the gums called Epulis gravidarum.
 THANK YOU!!!