1. Minor Disorders Pregnancy
Max Brinsmead MB BS PhD
May 2015

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Pathological Causes of Abdominal Pain
Ectopic pregnancy
Placental abruption
Premature labour
Severe pre eclampsia
Fibroid degeneration
Uterine rupture
Appendicitis
Cholecystitis
Urinary tract infection
Pancreatitis

13. 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)

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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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