Headaches are common in early
pregnancy and may be severe. The etiology of such headaches is not known.
Treatment with acetaminophen in usual doses is recom-mended and is generally
adequate. A persistent headache unrelieved by acetaminophen should be further
The presence of significant edema in the lower extremi-ties
(dependent edema) and/or hands is very common in pregnancy and, by itself, is
not abnormal. Fluid retention can be associated with hypertension, however, so
that blood pressure as well as weight gain and edema must be evaluated in a
clinical context before the findings are pre-sumed to be innocuous.
The majority of pregnant women
experience some degree of upper gastrointestinal symptoms in the first
trimester of pregnancy. Classically, these symptoms are worse in the morning
(the so-called morning sickness).
However patients may experience symptoms at other times or even throughout the
day. Most mild cases of nausea and vom-iting can be resolved with lifestyle and
dietary changes, including consuming more protein, vitamin B6, or
vita-min B6 with doxylamine. Usually, nausea and vomiting improve
significantly by the end of the first trimester. Effective and safe treatments
for more serious cases include antihistamine
H1-receptor blockers and phenothiazines. Themost severe form of
pregnancy-associated nausea and vom-iting is hyperemesis gravidum, which occurs in less than 2% of pregnancies.
This condition may require hospitaliza-tion, with fluid and electrolyte therapy
(gastric reflux) is common, especially
post-prandially, and is often associated with eating large meals or spicy or
fatty foods. Patient education about smaller and more frequent meals and
blander foods, combined with not eating immediately before retiring, is
helpful. Antacids may be helpful, used judiciously in pregnancy.
is physiologic in pregnancy, associated
withincreased transit time, increased water absorption, and often decreased
bulk. Dietary modifications, including increased fluid intake and increased
bulk with such foods as fruits and vegetables, are usually helpful. Other
useful interventions may include use of surface-active bowel softeners such as docusate, supplemental dietary fibers
such as psyllium hydrophilic mucilloid, and
In early pregnancy, patients
often complain of extreme fatigue that
is unrelieved by rest. There is no specifictreatment, other than adjustment of
the woman’s sched-ule to the extent possible to accommodate this temporary lack
of energy. Patients can be reassured that the symp-toms disappear in the second
cramps, usually affecting the calves, are commonduring
pregnancy. A variety of treatments, including oral calcium supplement,
potassium supplement, or tonic water have been proposed over the years, none of
which are uni-versally successful. Massage and rest are often advised.
Lower back pain is common,
especially in late pregnancy. The altered center of gravity caused by the
growing fetus places unusual stress on the lower spine and asso-ciated muscles
and ligaments. Treatment focuses on heat, massage, and limited use of
analgesia. A specially fitted maternal girdle may also help, as will not
wearing shoes with high heels.
Sharp groin pain, especially as
pregnancy advances, is common, often quite uncomfortable, and disturbing to
patients. This pain is often more pronounced on the right side because of the
usual dextrorotation of the gravid uterus. The woman should be reassured that the
pain represents stretching and spasm of the round ligaments. Modification of
activity, especially more gradual move-ment, is often helpful; analgesics are
Varicose veins are not caused by
pregnancy, but often first appear during the course of gestation. Besides the
disturb-ing appearance to many patients, varicose veins can cause an aching
sensation, especially when patients stand for long periods of time. A support
hose can help diminish the discomfort, although it has no effect on the
appearance of the varicose veins. Popular brands of support hose do not provide
the relief that prescription elastic hose can. Hemorrhoids are varicosities of the hemorrhoidal veins.
Treatment consists of sitz baths
and local preparations. Varicose veins and hemorrhoids regress postpartum,
although neither condition may abate completely. Surgical correction of
varicose veins or hemorrhoids should not be undertaken for approximately the
first 6 months post-partum to allow for the natural involution to occur.
The hormonal milieu of pregnancy
often causes an increase in normal vaginal secretions. These normal secretions
must be distinguished from infections such as vaginitis, which has symptoms of
itching and malodor, and bacterial vaginosis, which has been linked to preterm
labor. Spontaneous rupture of membranes, which is characterized by leakage of
thin, clear fluid, is another possible cause that must be considered.