The minor disorders of pregnancy

The minor disorders of pregnancy

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.

1. Digestive system

Nausea and vomiting – (Morning Sickness)

This condition is very common in pregnancy. It occurs between 4 – 16^th weeks gestation in about 50% of all pregnant women. It is associated with high level of oestrogen and progesterone, hypoglycaemia may also be a contributor. It is most marked when the woman wakes up in the morning though it can occur at any time of the day. It is more of retching rather than actual vomiting and may be aggravated by the smell of food.

Treatment

·              Understanding of the cause, and encouragement to look positively towards resolution of the problem between 12 – 16 weeks of gestation.

·              Snacks like dry biscuits, toast etc are more tolerable than full meals, expecially carbohydrate snacks at bed time and before rising up from bed with a cup of tea.

·              Avoidance of food which irritates, – fatty food.

·              Easily digestible foods.

·              Getting up slowly from bed.

·              Take spices that can clear mouth – cola chewing st ick etc can refresh the mouth, a void starvation and dehydration. Avoid self medication as this can be very hazardous to the fetus. Rule out other conditions that have similar symptoms

appendicitis close monitoring to ensure it does n ot become severe. Solve emotional problems

·              Involve the husband in care of the woman.

Heart burn

This is a burning sensation in the intestinal region. It is due to reflux of gastric content into the oesophagus, resulting from relaxing effect of progesterone on the cardiac sphincter of the stomach. Heart burn can be very troublesome between 30-40 weeks gestation because the stomach is under pressure from the growing uterus.

Treatment

Depends on the severity of the condition. Avoid rushing over meal, small at a time rest after meal. Take less fatty and greasy food. Avoid bending over for too long. Sleep with extra pillows. Lie on the right side. Severe cases – Refer Dr. who will prescribe Antacides – Mist Magnissium Trislicate(MMT), Gelusi l.

Constipation

Progesterone causes relaxation and decreased peristalsis of the gut, which is also displaced by the growing uterus. It may be very troublesome in pregnancy.

Treatment:

Increased fluid intake.

Fresh fruits, vegetable and whole meal food in diet aid digestion. Exercises also aid digestion. A glass of warm water in the morning helps to reactivate and regulate bowel movement. Mild aperients as last result in severe cases.

Ptyalism (Excessive Salivation))

Excessive salivation may occur from the 8^th week’ gestation. It is thought to be caused by pregnancy hormones. It may prove distressful to the woman. It coincides with time of morning sickness. The woman spit the saliva instead of swallowing it. The condition may reoccur with subsequent pregnancies psychological factors may be contributory.

Treatment

Explanation and attentive listening are helpful treatment.

Pica

This term is used when mother craves for certain strange foods or unusual substances such as coal, chalk, Petrol etc. the cause is unknown but hormones and changes in metabolic imbalance may not be unconnected. Midwife needs to health educate the woman as the substance craved for may be potentially harmful to the unborn baby.

2. Musculoskeletal system

Backache

This is a common problem during pregnancy, an average of 75% of women experience backache at one stage of their pregnancy. The pregnancy hormones soften the ligament and it may be partly due to posture by some women to balance the weight of the gravid uterus.

Treatment

Health educate on posture

Good shoes (low heel)

Adequate rest

Sleep on flat surface or with board under the bed.

Physiotherapy – Tailor sitting position can be help ful.

Lying       on   one   side   away   from   the   discomfort   –  affect ed    leg

uppermost in sciatic – like pain.

Pillows to support the whole limb.

Cramp

The actual cause of cramp in pregnancy is not known. It can be attributed to ischaemia or result from changes in pH or electrolyte status (– lack of calcium, chloride and vitamin B) though no significant evidence to support the claim.

It may be due to temporary circulatory changes in the legs. 

Treatment

Calcium gluconate, milk, cheese Vitamin B, Gentle leg exercises at bed time or while in warm bath.

3. Genito-urinary system

Frequency of micturation

Occurs in the first few weeks of gestation when the growing uterus is still within the pelvic cavity. This reduces the space available for the bladder. Also in the latter weeks when the fetal head engages. The problem is resolved when the uterus grows out of the pelvis at about 12 weeks. Other causes of bladder irritation should be ruled out. The woman should be encouraged to sleep during the day to make up for the night.

Leucorrhoea

This is the whitish, non-irritant vaginal discharge in pregnancy. The patient may find the discharge disturbing. She should be encouraged to increase personal hygiene, wear cotton under wears and avoid nylon pants and tights. Wash with plain water twice a

day and mild cream is better than talcum powder. Thrush and trichomonas should be excluded.

4. Circulatory system

Fainting

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.

Treatment

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.

Varicosities

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).

Treatment

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.

Oedema of the legs

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.

Intergumentary

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.

Treatment

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 .

5. Nervous system

Insomnia:

This occurs mainly in late pregnancy. It may be due to discomfort from fetal movement, frequency of micturation or difficulty in finding a comfortable position to lie. It may also result from anxiety or fear. It should not be ignored simple warm bath and hot or warm beverage at night may help. Mild sedation could be given (e.g. barbiturate, valium). Good counseling can be very effective – Early to bed, explain the situation to enable her cope with the reality.

Carpal Tunnel Sydrome/Paraesthesia

Numbness and pins and needles ‘tingling in the fingers and hands. It occurs usually in the morning but can occur anytime. It results from fluid retention which causes oedema and pressure on the median nerve. It resolves immediately after delivery. Doctor may prescribe diuretics but conservative treatment is better splint the hand at night and raise high on 2-3 pillows.

Glossitis and Gingivitis

Occurs as a result of poor oral hygiene and diet poor in vitamins and calcium intake. Patient develops poor appetite and anaemia may result. Can be treated with vitamin B – Complex ---- and food rich in vitamins and calcium, fruit and improving on oral hygiene.