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Obstetrics Simplified - Diaa M. EI-Mowafi

Minor Complaints During Pregnancy

Gingivitis

Increased vascularity and hypertrophy of the interdental papillae. It is improved usually after pregnancy termination.

  • Sequelae:
    • Increased tendency for bleeding.
    • Retention of food debris predisposes to sepsis and dental caries.
  • Treatment:
    • Proper dental hygiene.
    • Cryosurgery for severe cases.

Ptyalism (Sialorrhoea)

Increased salivation may occur early in pregnancy and subsides later on. It is due to failure of the patient to swallow the saliva rather than increase in its amount.

Treatment

  • Care of dental hygiene.
  • Discontinue smoking.
  • Anticholinergic drugs as belladonna, which induce dryness of the mouth, may be needed.

Heartburn

A common complaint caused by reflux of gastric contents into the lower oesophagus due to mechanical relaxation of the cardiac sphincter caused by upward displacement and compression of the stomach by the pregnant uterus. Sometimes the cardia actually herniates through the diaphragm.

Treatment

  • More frequent but smaller meals.
  • Avoidance of bending over or lying flat.
  • Antacids containing aluminium hydroxide are preferable as they buffer the gastric contents, do not cause an acid rebound and not absorbed so that alkalosis is unlikely.

Constipation

Causes

  • Reduced intestinal motility due to steroid hormones.
  • Increased fluid resorption from the large bowel.
  • Reduced exercise.
  • Mechanical compression by the gravid uterus.

Treatment

  • Evacuate the bowel at the same time every day.
  • Increase fluid intake.
  • Diet rich in green vegetables, bran and fruits.
  • Mild laxative as senna preparations. Liquid paraffin interferes with absorption of fat soluble vitamins, so better to be avoided.

Haemorrhoids

Causes

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

Treatment

  • Avoid constipation.
  • Soothing and astringent agents.
  • Local anaesthetics.
  • Surgical and local injection treatment have to be avoided.

Varicosities

Varicose veins may occur in the vulva and / or lower limbs.

In addition to the non-cosmetic appearance, they cause oedema, discomfort and even ulcers, dermatitis and superficial thrombophlebitis.

Causes

Congenital weakness which are exaggerated by:

  • increased venous pressure by compression with the pregnant uterus,
  • prolonged standing,
  • relaxation of veins walls by steroid hormones.

Treatment

  • Avoid prolonged standing.
  • Encourage active exercise.
  • Elevate the legs in higher level than the body during sitting and sleeping.
  • Avoid elastic bands for the hosiery.
  • Elastic stocking are worn while the patient is lying down and veins are empty.
  • Surgical or injection treatment should be avoided during pregnancy.

Dyspnoea

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

Urinary symptoms

Frequency and stress incontinence may occur during pregnancy.

Causes

  • Increased intra-abdominal pressure.
  • Pressure on the bladder by the enlarging uterus reducing its capacity.

Leucorrhoea

Increased vaginal discharge is a common complaint during pregnancy due to excess oestrogen production. No treatment is needed except if there is associated infection. Monilial infection is common.

Leg Cramps

Sustained involuntary painful contractions, usually affecting the calf and peroneal muscles may occur in the second half of pregnancy, particularly at night.

Causes

  • Depletion of serum calcium as well as sodium and chloride due to excessive vomiting, sweating or salt restriction.
  • Local vascular insufficiency.

Management

  • Massage of the contracted muscles and passive stretching.
  • Calcium gluconate may be helpful.

Paraethesia

Tingling sensation of the fingers and sometimes weakness of small muscles of the hand.

Causes

  • Oedema of the carpal tunnel which may be relieved by diuretics.
  • Brachial plexus traction due to dropping of the shoulders during pregnancy.

Backache

Causes

  • Lumbar lordosis.
  • Relaxation of ligaments and intervertebral joints by progesterone effect.

Management

  • Adequate rest and support the back when sitting in a chair by a pillow.
  • Avoid wearing high heeled shoes.

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