Complications of Pregnancy: How to manage disorders of pregnancy

To get pregnant is the desire of every woman especially those who are finding it hard to achieve conception easily. And as pregnancy is the period of joy for many families, it does come with some minor or major discomforts or disorders which the woman might experience. 

 Some discomforts of pregnancy need treatment while some can easily resolve on their own without any medical attention. So, there is a need for pregnant mothers to cooperate with the instructions of her trained healthcare provider and report any discomfort to her midwife or other skilled birth attendants as quickly as possible for proper attention.

 Complications of pregnancy can be either minor or major depending on their severity in affecting pregnant women.

For your easier understanding, I have discussed these disorders of pregnancy based on the trimesters and equally suggest some measures to relieve them. Here are they:

Disorders and Complications of Pregnancy in First Trimester:

Nausea and Vomiting

  • Nausea and vomiting of pregnancy (NVP) appears earlier in about 70% to 85% of women.
  • Symptoms appear after the first missed menstrual period and usually cease by the 4th missed menstrual period
  • Some develop aversion to specific foods.
  • Some experience nausea when they get up in the morning, others throughout the day or in the evening.
  • Cause/Influencing Factors:
  • Unknown
  • Increased levels of human chorionic gonadotropin
  • Changes in carbohydrate metabolism
  • Emotional factors
  • Fatigue

Self -care measures for nausea and vomiting in pregnancy:

  • Avoid odors or causative factors.
  • Eat dry crackers or toast before arising in the morning
  • Have small but frequent meals.
  • Avoid greasy or highly seasoned foods.
  • Drink carbonated beverages.

Management of nausea and vomiting in pregnancy:

  • Midwife advises the woman to contact her health care provider if vomits more than one day or shows signs of dehydration such as dry mouth and concentrated urine.
  • Drugs such as pyridoxine (B6) in several cases are steroid, antiemetic (like Promethazine) but a last resort.

Urinary Frequency

  • This occurs in early pregnancy and during the third trimester because of the enlarging uterus
  • Considered normal but signs of bladder infection such as pain, burning with voiding or blood in urine should be reported

Self care for urinary frequency in pregnancy:

  • Void when urge is felt about every two hours.
  • Increase fluid intake only in the evening to decrease nocturia

 Fatigue

  • Specific causative factors are unknown.
  • May be aggravated by nocturia due to urinary frequency.
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Self care measures for fatigue in pregnancy:

  • Plan time for a nap or rest period daily
  • Go to bed earlier.
  • Seek family support or assistance with responsibilities so that more time is available to rest.

Breast Tenderness:

  • This occurs early and throughout pregnancy.
  • Increased estrogen and progesterone levels contribute to breast soreness and tingling and sensitivity of the nipples.

Self care measures for breast tenderness during pregnancy:

  • Wear a well fitting and supportive bra.

 Increased vagina discharge:

  • Increased whitish vagina discharge called leukorrhea
  • As a result of hyperplasia of the vagina mucosa and increased mucus production by the endocervical glands
  • The increased acidity of the secretions encourages the growth of Candida albicans.

Self care measures for increased vagina discharge in pregnancy:

  • Promote cleanliness by daily bathing.
  • Avoid douching, nylon pants and pantyhose.
  • Cotton under pants are more absorbent.
  • Powder can be used to maintain dryness if not allowed to lake

Nasal stuffiness and Nose bleeding (epistaxis) 

  • Elevated estrogen levels may produce edema of the nasal mucosa which results in nasal stuffiness, nasal discharge and obstruction
  • Nose bleeds may also result

Self care measures for nasal stuffiness and nose bleeding (epistaxis) during pregnancy:

  • May be unresponsive.
  • Cool air vaporizers and normal saline nasal spray may be helpful.

Ptyalism

  • Excessive, often bitter salivation
  • Cause is unknown

Self care measures for ptyalism in period of pregnancy:

  • Mouth washes.
  • Chew gum or suck hard candy.

Disorders and Complications of Pregnancy in Second and Third Trimesters:

 Heartburn (Pyrosis)

  • It is the regurgitation of acidic gastric contents into the esophagus.
  • It creates a burning sensation and sometimes leaves a bad taste in the mouth.

Causes of pyrosis in pregnancy:

  • Increased production of progesterone
  • Decreased gastrointestinal motility
  • Increasing relaxation of cardiac sphincter
  • Displacement of stomach by enlarging uterus
  • Thus regurgitation of acidic gastric contents into the esophagus.

Self care measure for pyrosis in pregnancy:

  • Eat small and more frequent meals.
  • Use low sodium antacids like Gelusil tablets.
  • Avoid over eating, fatty and fried foods, lying down after eating and sodium bicarbonate

Ankle edema:

  • Ankle oedema is experienced in the last trimester due to increasing difficulty of venous return from the lower extremities, prolonged standing or sitting, varicose veins.
  • Ankle edema becomes a concern only when accompanied by hypertension or protein urine or when it is not postural in the organ.
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Self care measures for ankle edema in pregnancy:

  • Practice frequent dorsiflexion of feet when prolonged sitting or standing is necessary.
  • Elevate legs when sitting or resting
  • Avoid tight garters or restrictive bands around legs

Varicose veins:

  • It occurs as a result of venous congestion in the lower veins that increases with pregnancy due to pressure on the pelvic veins.
  • Or hereditary factors (weakening of walls of veins, faulty valves) and as a result of increased age and weight gain.
  • Less common varicosities in the vulva and perineum may develop.
  • But when varicose veins occur in the vulva, the vagina and the surrounding area, this may cause swelling and pain during sexual intercourse. Therefore, this may require special treatment.

Self care measures for varicose veins in pregnancy:

  • Elevation legs frequently.
  • Wear supportive hose
  • Avoid crossing legs at the knee, stand for long period, garters and constrictive bands
  • Weary two sanitary pads inside under pants can provide support for Valval varicosities

Flatulence:

  • Results from decreased gastrointestinal motility leading to delayed emptying
  • And from pressure of growing uterus on large intestine

Self care measures for flatulence in pregnancy:

  • Avoid gas forming foods.
  • Chew food thoroughly.
  • Get regular daily exercise.
  • Maintain normal bowel habits.

Constipation

This results from increased progesterone level, which causes general bowel sluggishness from pressure of enlarging uterus on the intestine and displacement of the intestines. It is also caused by iron supplements. Diet, lack of exercise and decreased fluid contributes to constipation

Self care measures for constipation in pregnancy:

  • Increase fluid intake, fibers in the diet and exercise
  • Develop regular bowel habits
  • Use stool softeners as recommended my physician or mid laxatives or suppositories

Haemorrhoids:

They are varicosities of the veins in the lower rectum and the anus due to increased pressure of the gravid uterus on the veins. Constipation is also a contributing factor due to straining.

  • Symptoms of haemorrhoids include pain, swelling, itching and bleeding

Self care measures for haemorrhoid in pregnancy:

  • Avoid constipation.
  • Apply ice packs, topical ointment, anaesthetic agents, and warm soaks.
  • Gently reinsert into rectum.

Backache

It is caused by increased curvature, of the lumbosacral vertebrae as the uterus enlarges, and increased levels of hormones of pregnancy, which causes softening of cartilage in body joints. Fatigue and poor body mechanics can contribute to this.

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Self care measure for backache in pregnancy:

  • Good posture and proper body mechanics.
  • Practice pelvic fit exercise.
  • Avoid uncomfortable working heights, high heeled shoes.
  • Lifting heavy loads and fatigue.

Leg cramps:

They are painful muscle spasms that often occur at  night or other times. The exact cause is not known. Contributing factors are:

  • Pressure of the enlarged uterus on pelvic nerves or blood vessels leading to the legs.
  • Pointing toes or extension of the foot can cause leg cramps.
  • Imbalance of calcium/phosphorus ratio

Self care measures for leg cramps in pregnancy:

  • Practice dorsiflexion of feet to stretch the affected muscle.
  • Elevate diet.
  • Apply heat (hot compression) to affected muscles.
  • Arise slowly from resting position.

Faintness:

This occurs in especially in warm, crowded areas

It is caused by:

  • Postural hypertension.
  • Standing for a long period in a warm or stuffy area.
  • Anemia.
  • Sudden change of position causing venous pooling in dependent veins.

Self care measure for faintness in pregnancy:

  • Elevate haematocrit and haemoglobin.
  • Avoid prolonged standing in warm or stuffy environments.
  • Slowly getting up from resting position.
  • If she feels faint in warm crowded areas, she should sit down and lower her head between her knees.

 Dyspnoea or shortness of breath

  • Occurs as the uterus rises into the abdomen and causes pressure on the diaphragm
  • Worsens in the last trimester because the enlarging uterus presses directly on the diaphragm
  • Relief occurs in the primigravida in the last few weeks of pregnancy when lightening occurs
  • The multigravida feels it throughout because she does not experience lightening until labor

Self care measures for dyspnoea or shortness of breath in pregnancy:

  • Use proper posture when sitting or standing.
  • Sleep propped up with pillows for relief.

 Carpal Tunnel Syndrome:

  • Characterized by numbness and fingering of the hand near the thumb
  • Caused by the compression of the median nerve of wrist
  • Aggregated by repetitive hand movement such as typing

Self care measures for carpal Tunnel Syndrome in pregnancy:

  • Avoid aggregating hand movements
  • Use splint as prescribed
  • Elevate affected arm.

Having come to this level, I strongly believe that you have understood both minor and major disorders of pregnancy and their management. I hope you enjoy it. Share with your family and friends please.