Minor Disorders Minor Disorders PregnancyPregnancy

Minor Disorders Minor Disorders PregnancyPregnancy

Max Brinsmead MB BS PhDMax Brinsmead MB BS PhDMay 2015May 2015

An important role for a primary caregiver

• To recognise minor disorders of pregnancy that arise from physiological processes

• To reassure...• To provide simple and safe advice• But above all...• To distinguish these from serious

pathological processes that require major obstetric interventions

nausea and vomiting• Affects approx. 50% women• “Morning sickness” can last all day• Aggravated by smells, stress, travelling• Due to hormone changes (HCG or

oestrogen?)• Eat cold rather than cooked foods• Small frequent meals, high CHO, low in fats, • Ginger, B6 and acupuncture• Admission and IV Fluids when dehydration

threatens (poor urine output)• Anti emetics e.g. Maxolon, Meclozine,

Stemetil or Zofran• Only rarely should termination of pregnancy

be required

But beware...• Nausea and vomiting can be a

manifestation of severe pre eclampsia• Particularly if there is epigastric pain• And it occurs in the 2nd half of pregnancy• Check the BP and test urine for protein

fatigue

• Is common and not always due to anaemia or poor nutrition

• Is due to the sedative effects of Progesterone.• Serves a physiological role to ensure optimal

uterine blood flow• A little nap every day is a good idea

But beware...• Fatigue can be a symptom of

serious anaemia and sometimes depression

• Is this a patient at risk?• Every pregnant woman deserves a

HB check

breathlessness

• Depth of breathing increases by 40%

• Helps mother and the baby to unload CO2

• A direct effect of Progesterone on the CNS respiratory centre

• Aggravated by abdominal pressure on the diaphragm in later pregnancy

• Smoking ?• An opportunity to intervene• Asthmatics should continue their regular

medication

But beware...• Breathlessness is serious if it is...

– accompanied by chest pain– limits activities– or if it occurs at night

• Then is might be a symptom of heart disease

• Or less commonly pulmonary embolism

varicose veins

• Blood volume increases by 40 - 60 %• Helps mother to provide nutrients to the uterus • But Progesterone also relaxes veins• Aggravated by pelvic pressure• Will decrease dramatically after pregnancy• Rest with legs elevated• Supportive stockings?• Haemorrhoids are another form of varicose veins• Avoid constipation and straining

constipation

• Due to the relaxant effect of pregnancy hormones on bowel smooth muscle

• Designed, of course, to relax the uterus• May be aggravated by iron medication• Increase fluid intake• Increase fibre in the diet• Use only faecal softening or bulk-forming

laxatives e.g. Coloxyl or Metamucil• Avoid smooth muscle stimulants

Physiological Causes of Abdominal Pain

• The corpus luteum• Round ligament pain• Ureteric obstruction• Nerve entrapment• Constipation and colic• Symphyseal separation• Acid reflux & oesophagitis• Umbilical skin stretching

Pathological Causes of Abdominal Pain

• Ectopic pregnancy• Placental abruption• Premature labour• Severe pre eclampsia• Fibroid degeneration• Uterine rupture• Appendicitis• Cholecystitis• Urinary tract infection• Pancreatitis

bleeding

• Congestion of many sites may cause bleeding• Nose bleeds – check BP• Bleeding gums – check mouth hygiene• Blood in the urine can occur• PV bleeding of small amounts can be due to

cervical congestion• Bleeding haemorrhoids (piles)

swelling (fluid retention)

• Oedema is normal to a certain extent• Worse in hot and humid weather• Mothers with oedema have bigger and better

babies than women who do not have pregnancy oedema

• May respond to rest and elevation• Do not use diuretics

And beware...• Sudden onset of generalised oedema

in the 2nd half of pregnancy may be due to pre eclampsia

• So always measure BP and test urine for protein

skin changes

• Pigmentary changes due to placental ACTH which has an MSH effect

• Stretch marks common• Topically applied Vitamin E creams may help• Itching is common and may begin in stretch

marks• It is reasonable to treat vaginal itch with an

antifungal (thrush) and only investigate further if it does not settle

But beware• Skin itching can be due to...

– Scabies– Any form of dermatitis– And a rare pregnancy-related

condition called cholestasis of pregnancy

– Look for jaundice

headaches

• Very common especially during the second trimester

• Which is a time of rapid salt and water accumulation

• Increase water and salt intake• Avoid caffeine• Use simple analgesics but always Paracetamol

rather than Aspirin or NSAID

dizziness

• Can be due to hypotension or• Hypoglycaemia• Pregnant women should not lie flat on their

backs• And should take care when standing suddenly• Use foods with complex carbohydrates rather

than simple sugars for a steady blood glucose

back ache

• Due to the effect of pregnancy-relaxant hormones on ligaments

• And changes in body weight/centre of gravity with the enlarging uterus

• Back-strengthening exercises useful• Attention to posture, rest, bed support etc.

pins and needles• Commonly due to nerve entrapment by

increasing tissue fluid in a fibrous tunnel traversed by a nerve

• Three classic sites– Carpal tunnel– Lateral side of the thighs– Below the right (sometimes left) costal margin

• Some disappear spontaneously• Night splints may be useful for carpal tunnel

syndrome • Do not use diuretics

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