7/30/2019 Ask the Woman for the Following Symptoms in the Present Pregnancy

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Ask the woman for the following symptoms in the present pregnancy:

Symptoms that indicate discomfort

nausea and vomiting

heartburn constipation increased frequency of micturition Fever Vaginal discharge Palpitations, easy fatiguability and breathlessness at rest Generalized swelling of the body; puffiness of the face Vaginal bleeding Decreased or absent foetal movements Leaking of watery fluid per vaginum (P/V) Decreased urinary output

Common symptoms and signs that may be encountered in a pregnant woman,

probable diagnosis and action required at primary level

Symptoms Signs/investigations Most probablediagnosis

Action(s) to be taken

Vomiting during

the first trimester

May bephysiological

(morning sickness)

Advise the woman to eatsmall frequentmeals; avoid greasy

food, eat lots of green

vegetables and drinkplenty of fluids.

If vomiting is excessive

in the morning ask her toeat dry foods such as

biscuits or toast afterwaking up in themorning.

Excessive vomiting,

especially after the

firsttrimester; inability

toretain anything

takenorally

The woman may be

dehydrated

Hyperemesis

gravidarum Provide management

Palpitations, easy Conjunctival Severe anaemia

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fatiguability,

breathlessness at

rest

and/orpalmar pallor

present

Hb level 140/90 mmHg Proteinuria absent BP >140/90

mmHg

Proteinuriapresent

BP >140/90 mmHg

Proteinuriapresent

Hypertensivedisorder ofPregnancy

Pre-eclampsia

If the BP is160/110

mmHg .

Heartburn and

nausea

Reflux Hypertensive

disorder of

pregnancy

Advise the woman

to

avoid spicy andrich

foods.

Increased frequency

of urination up to10-12 weeks ofpregnancy

Increased frequency

of urination after 12weeks, or persistent

symptoms, orburning

on urination

Tenderness may be

present at the sidesof the abdomen andback.

The body

temperaturemay be raised

May be

physiologicaldue to pressureof the gravid

uterus on theurinary

bladder

Urinary tract

infection

Reassure her that it

will be relieved onits own

Constipation Physiological

Bleeding P/V,before 20

weeks of gestation

Check the pulse and

BPto assess for shock

Ask for history of

Threatened

abortion/spontaneous

abortion/

hydatidiform mole/ectopic pregnancy

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violence

Spontaneousabortion

due to violence

Bleeding P/V, after

20 weeks ofgestation

Check the pulse

and BPto assess for shock

Fever The bodytemperature is

raised Blood peripheral

smear is positive

for malarialparasite

Site ofinfection

somewhere,including

possible sepsis

Malaria

Decreased or absentfoetal movements

(NOTE: Foetalmovements are felt

onlyafter about 4 months

ofgestation)

FHS heard, andwithin the normal

range of 120-160beats/minute

FHS heard, butthe rate is 160 beats/minute.

FHS not heard

Baby is

normal

Foetal distress

Intrauterine

foetal death

Reassure the

woman.

Re-check the FHS

after 15 minutes.

Leaking of wateryfluids P/V

Wet pads/cloths Premature or prelabourrupture of membranes