SEMINAR

Shalini
joshi
M.Sc. Nsg

Minor
Disorder of
Pregnancy
and its
Management

WHAT IS MINOR AILMENTS OF

PREGNANCY
The anatomical physiological and biochemical
adaptations to pregnancy are profound. These
changes that the female body undergoes during
pregnancy begin soon after fertilization and
continue through gestation.

These changes occur in response to physiological

stimuli provided by the fetus and placenta. These
changes may be unpleasant as well as worrying
but they are rarely a cause for alarm as most of
these changes are usually normal. These so-called
minor disorders or ailments of pregnancy can be
troublesome on a day to day basis

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.

During the course of pregnancy period many changes

occur in a womans 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.

THE FOLLOWING ARE THE MINOR

AILMENTS OF PREGNANCY:
Backache
Constipation
Nausea and
vomiting
Heartburn
Ankle oedema
Varicose veins
Haemorrhoids

Leg cramps
Vaginal discharge
Syncope
Insomnia or
sleeplessness
Pain over round
ligament
Urinary frequency

BACKACHE:
backache usually lasts from 20
weeks to term.
During pregnancy there is laxity
(relaxin, estrogen) of the spinal
ligaments which along with the
weight of pregnancy puts a strain
on the joints of the lumbo-sacral
spine and pelvis resulting in lumbar
lordosis and anterior tilt of the
pelvis consequent backache.

MANAGEMENT AND ADVICE

Maintenance of correct posture

Avoiding lifting heavy objects
Avoid high heels
Regular physiotherapy
Firm mattress to sleep on
Enough rest particularly in later pregnancy.
Swimming often soothes backache.
Watch weight gain.
Avoiding standing for long hours of time.

Constipation
Can last entire pregnancy.

Various factors contribute to

constipation during pregnancy,
which include-effect of
progesterone on gut motility,
physical weight of the gravid
uterus on the rectum and the
use of iron tablets.

MANAGEMENT
Plenty of fruits, green
leafy vegetables and fibre
in diet (Isabgul)
Plenty of water to
drink
Laxatives
acting)

(surface

Regular exercises
Swimming

NAUSEA AND VOMITING

Usually last 4-16 weeks.

It is usually common in primigravidae and usually appears
following first or second missed period and subsides by
the end of first trimester. Vomiting occurs soon after
getting out of bed.
50% women have both nausea and vomiting, 25% have
nausea only and 25% unaffected.

The cause of vomiting is not clear but increased chorionic

gonadotropin has been implicated. Psychological
background has also been implicated to play a major role.

MANAGEMENT AND ADVICE

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

HEARTBURN (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 the
effect of progesterone and the weight effect of the
pregnant uterus preventing stomach emptying are the
causes for this reflux of acid contents.
Over-eating, late eating alcohol and spicy foods
contribute to the problem.
Hiatus hernia which is common during pregnancy is
another cause of heartburn.

MANAGEMENT
Propped up position
after meals
Smaller meals more
often
Antacids
Avoiding aggravating
factors

ANKLE OEDEMA
Usually after 28 weeks.
As pregnancy advances the patient may
notice swelling of their feet and
ankles. This is due to the impediment
of venous return from the lower limbs
due to the pressure effect of the
gravid uterus on the lower limb veins.
However eclampsia, underlying cardiac
or renal impairment is to be excluded.

MANAGEMENT
Frequent periods of rest with limb
elevation for at least 15 minutes each
time
Avoiding long periods of standing or
sitting.
Diuretics should not be used.

VARICOSE VEINS

16 weeks to term.

Varicose veins in the legs and vulva may

appear for the first time or aggravate during
pregnancy. It is due to the obstruction of
the venous return by the weight of pregnant
uterus on the inferior vena cava.

It is also thought to be due to the relaxant

effect of progesterone on the vascular
smooth muscles.

MANAGEMENT
Applying elastic stockings or crepe bandages
for leg varicosities
Elevation of limb during rest.
Usually disappear delivery
No surgical intervention is required.

HAEMMORRHOIDS

24 weeks to term.
Constipation during pregnancy tends
to aggravate the varicosity of the
veins in the rectum. Straining at
stool, prolonged sitting and spicy
food aggravate the condition.

MANAGEMENT
High fibre diet and Use of laxatives to keep the
bowel soft.
Local anaesthetic /anti irritant creams can be used
Replacement of prolapsed piles is essential

LEG CRAMPS:
This is due to the deficiency of
diffusible serum calcium or
elevation of serum phosphorous.

Management includes
Supplementary calcium therapy and
Vit. B1 (30 mcg) daily.
Application of local heat and
massage
High doses of Vit. E (400 mg) BD
often proves beneficial.

VAGINAL DISCHARGE
This is due to the increased
transudation of fluids as a
result of increased vascularity
and
hyperestrogenic
state
during pregnancy. The discharge
includes:
is clear and white and do Management
not
have unpleasant smell.
Assurance to the mother.

Local cleanliness.
Rule out any infection.
200mg
Metronidazole
thrice daily for 7 days,
high up in the vagina at
bed time.

SYNCOPE

The enlarging gravid uterus compresses the veins

in the pelvic brim, impending venous return and
causes pooling of blood in the lower limbs which
in turn leads to decreased oxygen supply to the
brain leading to syncope.
In later pregnancy the gravid uterus compresses
the inferior vena cava in the dorsal supine
position causing supine hypotension.

Management
Avoiding prolonged standing
Getting up slowly after lying or
sitting down.
Left lateral tilt with a wedge
below the right hip alleviates the
problem.

SLEEPLESSNESS OR
INSOMNIA:
28 weeks to term.
It has been attributed
to the hormonal changes
that occur during
pregnancy and can be a
major cause of anxiety
in a pregnant mother.

Management
Take rest in the afternoon.
Drink a glass of warm milk at bed time.
Tuck a pillow under the abdomen when
lying in a lateral position.
Daily exercise. Plenty of fresh air.
Avoid caffeine & multivitamin before
sleep.
Warm milk drink or a warm bath help
to allay anxiety & hence insomnia

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

OTHER MINOR
AILMENTS AND
MANAGEMENT

ITCHING OF BODY
Some mothers complain of generalized the itching ,which
often starts over the abdomen.
This occur due to livers response to the hormones in
pregnancy with raised bilirubin level.
It clears after the baby is born and comfort can be
gained from focal applications

Management
An anti-histamine is prescribed .
Washing with mild soap and wear cotton underwear

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

LINEA ALBICANS & STRAIEGRAVIDUM

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.

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 creates
edema & pressure on the median nerve.

Nursing advice
Wearing a spent at night, with
hands resting on two or three pillows
sometimes helps.
Restriction of salt intake.
Flexing the fingers while the arm is
held above the head can be
recommended.
tunnel syndrome usually
Carpal
resolves
spontaneously
following
delivery.

BREAST SORENESS
Increase in size and possibly some
tenderness very early during
pregnancy and this can last for the
entire pregnancy.
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.
Advise to wear larger and more
supportive bras.

BRAXTON HICKS CONTRACTION

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

 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 mother finds it uncomfortable try practicing
the breathing exercises or any other coping
techniques which have learned for use in
labour.

 If the contractions persist and mother is not

near to full term then tell mother about the
contraction and difference between false and
true pain and contraction. If the contractions
become regular, every five minutes and last
sixty seconds each advise mother to call
healthcare provider.

EPISTAXIS
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 nose
together between thumb and forefinger, just below the
bony part of nose, for 10 minutes. Repeat for a further
10minutes if this does not work. As long as mother
doesnt lose a lot of blood, there is nothing to worry
about.
If you have more than two bad
nosebleeds (or lots of little ones),
consult the Doctor.

 Severe and frequent nosebleeds may

contribute to anaemia, or may be a sign of
underlying illness.
Mother may also find that her nose gets more
blocked up than usual. The pregnancy
hormones may cause the lining of nose and
sinuses to swell, so mother feels continually
blocked up and stuffy.

NURSING MANAGEMENT
AND ADVICE
To help with this and to avoid nosebleeds:
Blow 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 nose is blocked, mother will probably finds that she
breathe s through her mouth, especially while she
sleeps. This will give a very dry mouth, so keep a
glass of water handy for when wake and use Vaseline
to keep lips moist. she may start to snore. Sleeping
on side lying may relieve this.

 If things get very bad, ask

doctor about safe decongestant
medications.
Passing water frequently
Needing to pass water often is
an early sign of pregnancy.
Sometimes, it continues right
throughout the pregnancy. In
later pregnancy, it is the result
of the babys head pressing.

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

Advice
Dont take cold cures for it.

Consult your Doctor if it is very irritating or gets

worse.

EXCESSIVE SALIVATION
This occurs from 8th week 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.

SEQUELAE/EUPULIS & TENDER GUMS

Increased vascularity and hypertrophy of the
interdental papillae. It is improved usually after
pregnancy termination.
Sequelae is an Increased tendency for bleeding.
Retention of food debries predisposes to sepsis &
dental caries.

Nursing advice

Proper dental hygiene.

Cryosurgery for severe cases.