minor problems of pregnancy

Minor Problems of Pregnancy د.نادية مضر الحلي

Backache
Backache is due to the laxity of spinal ligaments and weight of the pregnancy causing an exaggerated lumbar lordosis. Pregnancy can exacerbate the symp¬toms of a prolapsed intervertebral disc, occasion¬ally leading to complete immobility. Advice should include maintenance of correct posture, avoiding lifting heavy objects (including children), avoiding high-heels, regular physiotherapy and simple analgesia (paracetamol or paracetamol-codeine combinations).


Symphysis pubis dysfunction
This is an excruciatingly painful condition usually occurring in the third trimester. The symphysis pubis joint becomes loose , causing the two halves of the pelvis to rub on one another when walking or mov¬ing. The condition will only improve after delivery, and the management revolves around simple anal¬gesia and, under the physiotherapist s direction, a low stability belt may be worn.

Constipation
Constipation is usually blamed on the effect of proges¬terone in slowing gut motility, but the physical weight of the gravid uterus on the rectum may contribute, as may concomitantly administered iron tablets. A high-fibre diet should be encouraged, increase daily fluid intake and a mild (non-stimulant) laxative such as lactulose may be suggested.








Nausea & vomiting & Hyperemesis Gravidarum:
Nausea & vomiting are common symptoms in early pregnancy affecting over half of pregnant women. The onset of symptoms is around 5-6 weeks gestation & cessation of symptoms occurs at about 16 weeks. It is erroneously referred to as morning sickness. It is worse in multiple pregnancy & is related to high circulating human chorionic gonadotrophin (hCG) level.
Hyperemesis is less common but associated with more morbidity, hospital admission & can be dangerous if not treated appropriately. Nausea & vomiting becomes hyperemesis when the woman is unable to maintain hydration & nutrition because of severity or duration of symptoms. A standard definition of HG is the occurrence of more than three episodes of vomiting per day with ketonuria and more than 3 kg or 5% weight loss.
Risk factors for HG include multiple pregnancy, nulliparity, obesity, metabolic disturbances, a history of HG in a previous pregnancy, trophoblastic disorders, psychological disorders (for example, eating disorders such as anorexia nervosa or bulimia) and a history of migration
It is associated with Mallory-Weiss tears, haematemesis, marked weight loss, muscle waisting, ketonuria, dehydration & electrolyte disturbance including hypokalaemia & metabolic hypochloraemic alkalosis. A common symptom is ptyalism (inability to swallow saliva).
The complications associated with hyperemesis include fetal growth restriction, maternal hyponatraemia & thiamin deficiency leading to Wernicke s encephalopathy.
Markers of severity include weight loss > 10%, abnormal thyroid function test & abnormal liver function.