Minor problems of
pregnancy
Objectives:
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To understand the causes and management of minor
complications of pregnancy.including:
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Backache
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Symphysis pubis dysfucnstion
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Carpal tunnel syndrome
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Constipation
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Nausea& Vomiting of pregnancy & hyperemesis
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Heart burn
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Haemorrhoids & varicosities
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Oedema
Backache
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Due to laxity of spinal ligaments and an
exaggerated lumbar lordosis
Management:
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maintenance of correct posture
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avoiding lifting heavy objects
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avoiding high-heels
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regular physiotherapy
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simple analgesia
Symphysis pubis dysfunction
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Occur in the third
trimester. The
symphysis pubis
joint becomes
'loose'
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analgesia
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a low stability belt.
Carpal tunnel syndrome:
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Compression neuropathies due to increased soft-tissue
swelling.
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The median nerve is most susceptible to compression.
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Diuretics are not advised; simple analgesia and
splinting of the affected hand usually help.
Constipation
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Causes: relaxing effect of progesteron on
GIT, iron therapy, mechanical compression
Management:
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high-fibre diet
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increase fluid intake
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mild (non-stimulant) laxative such as
lactulose.
Nausea & vomiting of pregnancy
& Hyperemesis Gravidarum
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NVP affects up to 70-80% of pregnants.
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HG affects about 0.3–2% of pregnant
women
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is related to high circulating human
chorionic gonadotrophin (hCG) level
Start at 5-6 weeks' gestation, peek at 9 wks
and improve at 16-20 wk.
Hyperemesis Gravidarum
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woman is unable to maintain hydration &
nutrition because of severity or duration of
symptoms.
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HG diagnosed when there is protracted
NVP with the triad of more than 5%
prepregnancy weight loss, dehydration
and electrolyte imbalance.
Risk factors for HG include:
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multiple pregnancy
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nulliparity
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Obesity
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metabolic disturbances
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a history of HG in a previous
pregnancy
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trophoblastic disorders
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psychological disorders
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history of migration
It is associated with
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Mallory-Weiss tears
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haematemesis
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marked weight loss
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muscle waisting
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Ketonuria
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Dehydration
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electrolyte disturbance including
hypokalaemia & metabolic hypochloraemic
alkalosis
Complications :
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fetal growth restriction
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maternal hyponatraemia
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thiamin deficiency leading to Wernicke's
encephalopathy.
Conditions causing nausea and vomiting in
pregnancy include:
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Genito-urinary conditions: UTI, pyelonephritis,
ovarian torsion.
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Endocrine conditions: thyrotoxicosis, diabetic
ketoacidosis, Addison's disease.
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Gastrointestinal conditions: gastritis, peptic
ulcer, pancreatitis, bowel obstruction, hepatitis,
cholelithiasis, appendicitis.
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Neurological conditions such as vestibular
disease, migraine.
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Other pregnancy-related conditions such as
acute fatty liver of pregnancy, pre-eclampsia.
Management:
Exclude other causes of nausea & vomiting
Work up:
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Urinalysis for ketones and specific gravity
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Hematocrit
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Serum electrolytes
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Liver enzymes and bilirubin
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An US scan is important to exclude
hydatidiform mole & to diagnose multiple
pregnancy, both of which increase the risk
of hyperemesis.
TREATMENT
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adequate rehydration :
normal saline with added potassium chloride. Or ringer
lactate.
Fluid Replacement
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If significant ketonuria, 1000 ml 0.9% sodium
chloride intravenously over 2 to 4 hours. Hartmann’s
can also be used.
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Thereafter fluids should be reduced to 500 ml 4–6
hourly, the regime being guided by U&E results,
which should be performed daily, particularly for
monitoring potassium levels.
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Avoid glucose initially as it contains insufficient
sodium and especially as Wernicke’s encephalopathy
may be precipitated unless thiamine is given first.
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Antiemetics such as phenothiazines are safe,
metoclopramide is safe and effective, but
because of the risk of extrapyramidal effects it
should be used as second-line therapy
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Pyridoxine is not recommended for NVP and
HG
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Ginger
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In resistant cases a trial of steroid may be
effective
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If persistent dehydration, electrolyte loss,
and/or weight loss occur despite above
therapy give Paranteral nutrition
Gastroesophageal reflux
:
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causes
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Management: simple lifesyle modification.
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Liquid antacid preparations & H2 receptor antagonist
& proton pump inhibitor.
Varicose veins and Haemorrhoids:
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relaxant effect of progesterone on vascular
smooth muscle & the dependent venous stasis
caused by the weight of the pregnant uterus on
inferior vena cava & superior rectal veins &
increased circulating volume.
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piles may be improved with local anesthetic/anti-
irritant creams and a high-fibre diet.
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Varicose veins of the legs may be
symptomatically improved with support
stockings, avoidance of standing for
prolonged periods and simple analgesia
Oedema
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there is generalized soft-tissue swelling
and increased capillary permeability.
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Generalized edema may be a feature of
pre-eclampsia so remember to check
blood pressure & urine for protein. .
Severe edema may indicate cardiac
impairment or nephrotic
syndrome.