Minor Disorders Pregnancy Max Brinsmead MB BS PhD May 2015.
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Transcript of Minor Disorders Pregnancy Max Brinsmead MB BS PhD May 2015.
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
Any Questions or Any Questions or Comments?Comments?
Any Questions or Any Questions or Comments?Comments?
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