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These are conditions in pregnancy that are not threat to life but can distress the woman, making life miserable and undermine her health. Even if they can not endanger life, they should not be ignored or treated lightly. They can interfere with nutrition, sleep, outdoor recreation and normal household cores. These conditions should not be accepted as a normal associate of pregnancy but should be treated and alleviated. Minor disorder may escalate and become a serious complication of pregnancy.
The role of the midwife is to health educate the woman in order to tolerate the changes in pregnancy and her anxiety will be alleviated.
Causes can be due to hormonal, accommodation, metabolic and postural changes. Every system of the body changes and is affected by pregnancy.
In early pregnancy fainting may be due to vasodilation under the influence of progesterone, before compensatory increase in blood volume (haemodilution). In late pregnancy, it may be related to posture – lying flat on the back (supine hypoten sion). Turning to the side improves the condition rapidly. Other causes include fatigue stuffy room, anaemia and cardiac impairment or sudden drop in B/P.
Avoid prolong standing. Sit or lie down when she feels slightly fainting. Avoid crowding room. Avoid lying on the back, stuffy room and take good diet. Treat medical conditions if present.
Progesterone which relaxes the smooth muscles of the veins results in sluggish circulation. This causes the valves to be effective and varicosities result. The superficial veins of the legs, vulva and anus may become engorged. The situation is compounded by pelvic congestion varicose vein of the vulva is very painful and midwife needs to be aware of mothers at risk (-family history of varicose vein).
Avoid prolong period of standing. Exercising the calf muscles by rising onto the toes or making circling movement with the ankle will help the venous return. In early pregnancy resting the legs vertically against the wall for a short time will drain the vein.
Wearing of elastic stockings or crepe bandage or tights before rising or after raising the legs. A panty-girdle or sanitary paid will give support to the vulva. Avoidance of constipation by adequate fluids and roughages in diet will prevent exacerbation of haemorroids, which may bleed sometimes Encourage adequate rest. Refer to the Doctor if severe who may order xylocaine cream or anusol suppositories in case of heamorroids.
Warm sitz bath in puerperium with magnesium sulphate crystal to relief pain and reduce engorgement. Cold compress could be applied.
This result from pressure of the weight of the growing uterus on the brim interfering with venous return. A degree of oedema is normal and correlate with good state of health of the woman if it is not excessive. Physiological oedema may occur after rising and worsens during the day it is often associated with daily activities or hot weather.
Midwife should ask if the woman notices her rings to feel tighter and ankle swollen. Test for pitting oedema – if this reaches the ankle, it should be reported to the obstetrician.
Mother may be worried about the skin changes like the linea nigra, darkened area of the breast, chloasma. There may be generalized itching which may start from the abdomen. It is thought to be connected with liver’s response to pregnancy hormones which raises bilirubin levels.
Sometimes there may be itching of the vulva (Puritis vulvi), which may be related to poor hygiene, infection such as thrush or glucosuria as a result of diabetes.
Exclude medical cause. Advise on cotton under wear and washing with unscented soap. Treat the cause if identified. Warm bath at night, apply calamine lotion to rashes. or talcum powder. Vaginal swab for microscopy and culture. If moniliasis – pa int with Gentian violet and give metronidazole if due to Trichomonas .
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