MINOR AILMENTS IN PREGNANCY AND ITS MANAGEMENT

Prof. K.Punithalakshmi

Principal

JIETCON

INTRODUCTION

• The anatomical, physiological and biochemical adaptations to pregnancy are profound. Minor disorder may occur due to hormonal changes, accommodation changes, metabolic changes and postural changes. Every system of the body is affected by pregnancy. She also needs knowledge when she presents with discomforting or worrying symptoms.

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MEANING

Pregnancy is a very exciting time, but often the minor ailments associated with Pregnancy can cause discomfort. The discomfort can be overcome by making small adjustments to your lifestyle, thereby ensuring that you have a healthy and comfortable pregnancy.

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DEFINITION

During the course of pregnancy period many changes occur in a woman’s body as a result of hormonal influences and adaptation to the gestational process. Thereby, they experience a variety of physiological and psychological symptoms such as nausea, vomiting, backache, giddiness, heartburn and anxiety etc., These are termed as minor ailments or discomforts of pregnancy.

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The main minor ailments in pregnancy according to the human system

• DIGESTIVE SYSTEM
• CIRCULATORY SYSTEM
• RESPIRATORY SYSTEM
• INTEGUMENTARY SYSTEM
• MUSCULOSKETAL SYSTEM
• NERVOUS SYSTEM
• URINARY SYSTEM
• REPRODUCTIVE SYSTEM

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DIGESTIVE SYSTEM

• Nausea and vomiting
• Heart burn/ Pyrosis
• Pica
• Excessive salivation ( Ptyalism)
• Constipation
• Sequelae / Eupulis & tender gum
• Flatulence
• Bloating Belching
• Hemorrhoid

NAUSEA AND VOMITING

• Usually last 4-16 weeks
• It is usually common in primi gravida and usually appears following first or second missed period subsides by the end of first trimester, vomiting occurs soon after getting out of bed.
• The cause of vomiting is not clear but increase Human chorionic gonado trophin has been implicated to play a major role.

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NURSING MEASURES

• Adequate rest & relaxation
• Small frequent feeds, especially crackers , dry toast and cereals .
• Avoid spicy and greasy food .
• Protein diet.
• Anti-emetics are better avoided.
• Pre-natal vitamins with iron are avoided for the first 12 weeks.
• Avoiding slouching after meals.

HEART BURN (PYROSIS)

• From 20 weeks to term
• This common complaint is the result of reflux of acid contents of the stomach. The relaxation of the esophageal sphincter due to effect of progesterone and the weight effect of the pregnant uterus preventing stomach empting are the causes for this reflux of acid contents . Over eating, late eating, consumption of alcohol and spicy foods contribute to the problem .
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• Hiatus hernia which is common during pregnancy is another cause of heart burn

NURSING MEASURES

• Avoid lying flat.
• Propped up position after meals.
• Smaller meals more often.
• Antacids.
• Avoiding aggravating factors, e.g. citrus juice, spicy & fried food.

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EXCESSIVE SALIVATION

This occurs from 8^thweek of gestation and it is thought that the hormones of pregnancy are the cause for it . It may accompany heartburn.

PICA

• This is the term used when the mother craves certain foods or unnatural substances such as coal.
• The cause is unknown but hormones and changes in metabolism are thought to contribute to this.
• If the substances craved are harmful to the unborn baby the mother must be helped to seek medical advice.

CONSTIPATION

• Can last entire pregnancy .
• Various factors contribute to constipation during pregnancy which include effect of progesterone on gut motility, physical weight of the grand uterus on the rectum and the use of iron tablets .

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NURSING MEASURES

• Plenty of fluids , green leafy vegetables and fibers in diet.
• Laxatives could prescribed by physician.
• Regular exercises & walking.

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SEQUELAE/EUPULIS & TENDER GUMS

• Increased vascularity and hypertrophy of the inter dental papillae. It is improved usually after pregnancy termination.

SEQUELAE

• Increased tendency for bleeding.
• Retention of food debris predisposes to sepsis & dental caries.

NURSING MEASURES :-

• Proper dental hygiene.
• Cryosurgery for severe cases.

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FLATULENCE

This is usually due to bacterial action in the intestines which produce gas.

• To help relieve this, eat small amounts and try to establish a daily bowel action.

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BLOATING BELCHING

• This is partly caused by hormonal changes but usually occurs later in the pregnancy when the growing womb presses on the stomach.

NURSING MEASURES

• Try eating smaller meals more often.
• Sit up straight when you are eating as this takes the pressure off your stomach.
• Avoid particular foods that make your symptoms worse, especially fatty and spicy food.

HAEMORRHOID

• Laxity of the rectal vein by progesterone effect.
• Pressure by the gravid uterus.
• Tendency to constipation.

NURSING MEASURES

• Avoid constipation.
• Soothy & astringent agents.
• Local anesthetic.
• Surgical & local injection treatment have to be avoided.

CIRCULATORY SYSTEM�

• FAINTING
• VARICOSE VEIN
• ANKLE EDEMA

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FAINTING

Fainting is not unusual during the early weeks of pregnancy because the blood pressure tends to fall at that time.

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NURSING MEASURES

  Wear cooler, loose clothes.

• Do not stand for too long.
• Beware of hot, enclosed areas.

If the client feel like fainting:

• Try to find somewhere to sit down.
• Loosen tights clothes.
• Put the head down.
• Get into fresh air as soon as possible

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VARICOSE VEIN

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• 16 weeks to term.
• Varicose veins in the legs & vulva may appear for the first time or aggravate during pregnancy.
• It is due to the destruction of the venous return by the weight of pregnancy uterus on the inferior vena cava. It is also thought to be due to the relaxant effect of progesterone on the vascular smooth muscle. 

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NURSING MEASURES

• Apply elastic stocking or crape bandages for leg varicosities.
• Elevation of limb during rest.
• Usually disappear after delivery.
• No surgical intervention is required.

ANKLE EDEMA

• As pregnancy advances the patient may notice swelling of their feet & ankles.
• This is due to impediment of venous return from the lower limbs due to pressure effect on the gravid uterus on the lower limb veins.

NURSING MEASURES

Frequent periods of rest with limb elevation for at least 15 minutes each time.

• Avoiding long period of standing or sitting.
• Diuretics should not be used.

RESPIRATORY SYSTEM�

• NASAL STIFFNESS
• EPISTAXIS
• DYSNEA
• SHORTNESS OF BREATH

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NASAL STIFFNESS

• Some mothers-to-be who develop “stuffy” or “snuffy” noses find them difficult to get rid of.   The problem may last until after the baby is born and may not be connected with a cold at all :�- Don’t take cold cures for it.�- Consult your Doctor if it is very irritating or gets worse.

EPISTAXIS

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• Nosebleeds are quite common in pregnancy because of hormonal changes. The nose bleeds are usually short but can be quite heavy.
• To help the bleeding stop, press the sides of your nose together between your thumb and forefinger, just below the bony part of your nose, for 10 minutes. Repeat for a further 10minutes if this does not work. As long as you don’t lose a lot of blood, there is nothing to worry about.

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• If you have more than two bad nosebleeds (or lots of little ones), consult your GP.
• Severe and frequent nosebleeds may contribute to anemia, or may be a sign of underlying illness.
• You may also find that your nose gets more blocked up than usual. The pregnancy hormones may cause the lining of your nose and sinuses to swell, so you feel continually blocked up and stuffy. To help with this and to avoid nosebleeds.

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• Blow your nose gently and try to avoid explosive sneezes.
• Try a steam inhalation, perhaps with a few drops of tea tree oil in the water.
• If your nose is blocked, you will probably find that you breathe through your mouth, especially while you are asleep. This will give you a very dry mouth, so keep a glass of water handy for when you wake and use. Vaseline to keep your lips moist. You may start to snore. Sleeping on your side may relieve this.

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• If things get very bad, ask you doctor about safe decongestant medications.

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DYSPNOEA

• It may occur early in pregnancy due to hyperventilation caused by progesterone.
• Late in pregnancy, it occur due to pressure on the diaphragm by the pregnant uterus.

  SHORTNESS OF BREATH

• It occurs due to unfamiliarity with co2 tension in the alveolar capillaries.

� INTEGUMENTARY SYSTEM�

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• SKIN CHANGES
• CHLOASMA GRAVIDUM
• LINEA NIGRA
• LINEA ALBICANS & STRAIEGRAVIDUM

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SKIN CHANGES

• Some mothers complain of generalized the itching ,which often starts over the abdomen.
• This occur due to liver’s response to the hormones in pregnancy with raised bilirubin level.
• It clears after the baby is born and comfort can be gained from local applications
• An anti-histamine is prescribed .
• Washing with mild soap and wear cotton underwear .

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CHLOASMA GRAVIDUM

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• (Mask of pregnancy) a butterfly pigmentation on the cheeks & nose. It usually disappear few months after labor.

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LINEA NIGRA

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• Reassure the mother that pigmentation in middle below the umbilicus is normal & after delivery there are some topical ointments that helps to remove this scar.

STRAIE GRAVIDUM

• Pigmentation in the lower abdomen, flanks, inner thigh, buttocks & breasts increases as pregnancy advances.
• It starts pink (straie rubra) then becomes pale to become white (straie albicans) after delivery, white persists.

• In Primigravida, the straie rubra present only.
• In multigravida, both striae rubra & striae albicans present.

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• MUSCULOSKELETAL SYSYEM
• LOW BACKACHE
• LEG CRAMPS

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LOW BACKACHE

• Usually lasts from 20 weeks to term.
• During pregnancy there is laxity of spinal ligaments which along with the weight of pregnancy puts a strain on the joints of the lumbo sacral spine & pelvis resulting in lumbar lordosis & consequent backache.

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NURSING MEASURES

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• Maintenance of correct posture.
• Avoiding lifting heavy objects.
• Avoid high heels.
• Regular exercises.
• Firm mattress to sleep on.

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• Enough rest particularly in later pregnancy.
• Swimming often soothes backache.
• Watch weight gain.
• Avoiding standing for long hours of time.

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LEG CRAMPS

• This is due to the deficiency of diffusible serum calcium or elevation of serum phosphorus.

NURSING MEASURES

 Supplementary calcium therapy & vitamin B1(30mcg) daily.

• Application of local heat & massage.
• High doses of vitamin E (400mg) BD often proves beneficial.

NERVOUS SYSTEM

• CARPAL TUNNEL SYNDROME
• INSOMNIA OR SLEEPLESSNESS

CARPAL TUNNEL SYNDROME

 Mothers complain of numbness & pins & needles in their fingers & hands.

• This usually happen in the morning, but it can occur at any time of the day.
• It is caused by fluid retention, which create edema & pressure on the median nerve.

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NURSING MEASURES

 Wearing a splint at night, with hands resting on two or three pillows some times helps.

• Restriction of salt intake.
• Flexing the fingers while the arm is held above the head can be recommended.
• Carpal tunnel syndrome usually resolves spontaneously following delivery.

FREQUENCY OF MICTURITION

• 2nd trimester to term.
• The pressure of the growing gravid uterus during the early part of pregnancy & the pressure of the fetal head when it engages the pelvic brim near full term cause irritation of the bladder base & predispose to urinary frequency

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REPRODUCTIVE SYSTEM

• LEUCORRHEA
• BREAST
• BRAXTON HICKS CONTRACTION

LEUCORRHEA

• This is due to the increased transudation of fluids as a results of increased vascularity during pregnancy.
• This discharge is clear & white & do not have unpleasant smell.

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NURSING MEASURES

 Assurance to the mother.

• Local cleanliness.
• Rule out any infection.
• Wear cotton underwear & avoid tights.

BREAST

• We may notice an increase in size and possibly some tenderness very early during the pregnancy and this can last for the entire pregnancy. The mother may need larger and more supportive bras.
• Also some women will have a clear to milky discharge from their nipples and may need to use shields or nursing pads to protect their clothing.

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BRAXTON HICKS CONTRACTION

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• Also known as 'false labour' is an uncomfortable, irregular uterine contractions that occur periodically towards the end of labour. This is a sign that your uterus is preparing itself for labour, Generally these contractions begin at the top of your uterus and gradually spread downwards before relaxing .In some women they are painless, however, others can find them uncomfortable and even a little painful.

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• Braxton Hicks contractions usually begin around the 20th week of pregnancy but for a first pregnancy may begin earlier. Generally, this 'false labour' will fade with a warm bath.
• If you find it uncomfortable try practicing the breathing exercises or any other coping techniques which you have learned for use in labour.

• If the contractions persist and you are not near full term - call your health provider.�If the contractions become regular, every five minutes and last sixty seconds each - call your healthcare provider.

SUMMARY

So far we have discussed regarding meaning, definition & minor ailments in pregnancy & its their management in detail.

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CONCLUSION

We have discussed about the minor ailments in pregnancy &its their management, meaning, definition, minor ailments in pregnancy & its their management according to systemwise:- Digestive system, Circulatory system, Respiratory system, Integumentary system, Musculoskeletal system, Nervous system, Urinary system, Reproductive system etc.

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REFERENCES

• “Annamma Jacob “, “ A comprehensive textbook of midwifery” , “Published by- Jaypee brothers”, “Second edition” ,” Page No.-116 to 120.”
• “Dutta D.C.” ,”Texbook of obstetrics ,”Published by-New central book agency pvt. Ltd.”,”6^th edition”, Page No-102-103.
• ”Myles”, Textbook for midwifery ,” Published by -Churcill Livingstone”, “14 edition” ,”Page No-217 to219 .”
• http://www.docstoc.com/docs/19844589/MINOR-AILMENTS-DURING-PREGNANCY-During-your-pregnancy-you-may
• http://www.welldonemum.ie/A_freqUrination.html

• http://www.gov.bm/portal/server.pt/gateway/PTARGS_0_2_5487_508_1203_43/http%3B/ptpublisher.gov.bm%3B7087/publishedcontent/publish/ministry_of_health_and_family_services/new_health/dept___health___women___important_information_for_women/content/minor_ailments_during_pregnancy.html
• http://www.royalberkshire.nhs.uk/pdf/minor_disorders.pdf
• http://www.powershow.com/view/25edf-MTIzN/Minor_Ailments_of_Pregnancy_powerpoint_ppt_presentation

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• http://environment.gov.bm/portal/server.pt/gateway/PTARGS_0_2_5487_508_1203_43/http%3B/ptpublisher.gov.bm%3B7087/publishedcontent/publish/ministry_of_health_and_family_services/new_health/dept___health___women___important_information_for_women/content/minor_ailments_during_pregnancy.html
• http://www.welldonemum.ie/A_minorDisorders.html
• http://onlinemidwife.hubpages.com/hub/Minor-disorders-in-pregnancy
• http://www.bahola.co.in/articles/MINOR-AILMENTS-DURING-PREGNANCY.pdf

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THANK YOU