PHYSICAL EXAMINATION

• I. VITAL SIGNS

• A. Blood Pressure
• - The Bp is the most important vital sign that
should be monitored every clinic visit. There is
usually no significant change in Bp during gestation.
However, expect a slight drop in the 2nd trimester
that returns to normal on the 3rd trimester.

• B. Pulse Rate
• Pulse rate increases by about 10 bts/min. due to
increased cardiac workload.
• - Arrhythmias or palpitation are normal during
pregnancy as long as it is not accompanied by
dizziness and syncope.

• C. Respiratory Rate
• - Increases in depth, no significant change in
rate.
• - Shortness of breath and dyspnea late in
pregnancy is common.

• D. Temperature
• - There is a slight elevation in temperature early
in pregnancy due to the thermogenic effect of
progesterone. It drops to normal after 16 weeks.
• II. Physical Assessment

• A. Head and Scalp

• - Hair tends to grow faster during pregnancy.
Oily hair is also not uncommon. Excess hair dryness
indicates poor nutrition.

• B. Eyes
• - Pale conjunctiva indicates anemia. Edema of the
eyelids accompanied by visual disturbances is sign of
PIH.

• C. Nose
• - Normal nasal congestion occurs as a result of
estrogen stimulation.
• D. Ears
• - Nasal stiffness results in blockage of the
eustachian tube which may affect pregnant woman’s
hearing.

• E. Mouth and Teeth

• - It is normal to find swollen gums (epulis) due to
estrogen stimulation. Cracked corners of the mouth
may be caused by vitamin deficiency which pregnant
women are prone to develop. Dental carries should be
treated during pregnancy as they may become site of
infection. Major dental operations such as tooth
extraction should be postponed until the postpartum
period.
• F. Neck
• - Slight thyroid enlargement is brought about by
increased basal metabolic rate.

• G. Breast
• - Normal findings include enlargement of the
breast with wider and darker areola, prominent veins.
Breast masses, nodules, dimpling of the skin and
bloody nipple discharge are abnormal findings and
should be reported to the physician right away.
Colostrum, a thin watery fluid, can be expressed from
the nipple.
• H. Skin
• - Linea negra, mask pf pregnancy
(melasma/chloasma), spider nevi, palmar erythema are
common findings. Pallor, jaundice, rashes and skin
lesions are abnormal findings.

• I. Back
• - Exaggerated lumbar curve late in pregnancy
occurs as a result of the shifting of the pregnant
woman’s center of gravity.

• J. Rectum
• - Hemorrhoids may be present especially in the
last months of pregnancy.
• K. Extremities
• - Ankle swelling is a normal finding in the 2nd half
of pregnancy. Leg edema especially in the late
afternoon is common to pregnant women. Waddling
gait is due to relaxation of pelvic joint. Edema of
upper extremities, face and hands are danger signs.

• III. Abdominal Palpation: Leopold’s Maneuver

• - Abdominal palpation of pregnant women or

Leopold’s Maneuver is preferably performed after 24
weeks gestation when fetal outline can already be
palpated.
• Preparations for Leopold’s Maneuver:

• 1. Cardinal Rule: Instruct woman to empty her

bladder.
• 2. Place woman in a dorsal recumbent position to
relax abdominal muscles. Place a small pillow under
the head for comfort.
• 3. Drape properly to maintain privacy.
• 4. Explain procedure to gain patient’s cooperation.
• 5. Warm hands first by rubbing them together
before placing them over the woman’s abdomen. Cold
hands may stimulate uterine contraction.
• 6. Use palm for palpation not fingers.
 MANEUVER PROCEDURE FINDINGS

I. Fundic Grip Place both hands in the If the nurse-midwife feels

upper quadrants of the the head which is round,
c. To determine fetal patient’s abdomen smooth with transverse
groove of the neck, the
part lying in the
Using both hands, feel for fetus is in breech
fundus
the fetal part lying in the presentation.
b. To determine fundus.
If the nurse-midwife feels
presentation
the buttocks which is soft
and angular, it means the
fetus is in vertex
presentation.
I. Umbilical Grip Place both hands in the Small fetal parts feel
paraumbilical regions. nodular with numerous
c. To identify location angular nodulations.
of fetal back One hand is used to steady
the uterus on one side of Fetal back feels smooth,
e. To determine the the abdomen while the other hard, like resistant plane.
hand on the other side.
position
Moves from top to the lower
segment of the uterus to
feel for the fetal back and
small fetal parts. Use
gentle but deep pressure.
I. Pawlik’s Grip The 3rd maneuver is The presenting part is
suprapubic palpation with a engage if it is not movable.
c. To determine single dominant hand.
engagement of It is not yet engage if it is
presenting parts and Using the thumb and finger, still movable.
to estimate fetal grasp the lower portion of
station. the abdomen above
symphisis pubis, press in
e. To determine slightly and make gentle
movements from the side.
presentation.
I. Pelvic Grip The 4th maneuver involves If descended deeply, only a
palpation of the lower small portion of the fetal
c. To determine quadrants using both hands. head will be palpated.
degree of flexion of
fetal head. Facing foot part of the If cephalic prominence or
woman, palpate fetal head brow of the baby is on the
e. To determine pressing downward about 2 same side of the small fetal
inches above the inguinal parts, the head is flexed.
attitude or habitus
ligament.
If cephalic prominence is on
the same side of the fetal
back, the head is extended.
• IV. Internal Examination or Vaginal Examination

• Purpose:

• A. During the 1st clinic visit, IE is used to confirm

pregnancy and gestation.

• B. After 34 wks., IE is performed to assess

consistency of cervix, length and dilation, fetal
presenting part, bony architecture of the pelvis,
anomalies of the vagina and perinium, including
rectocele, cystocele and lesions.
• Preparation for IE:

• 1. Provide explanation
• 2. Let woman empty her bladder
• 3. Provide good lighting
• 4. Place woman in lithotomy position with buttocks
extended slightly beyond examining table.
• 5. Drape properly.
• 6. Let support person stay at the head of the bed.
• 7. Instruct woman not to:
• - hold or squeeze your hand or that of her
husband
• - hold her breath
• - close eyes tightly
• - clench fist
• - contract perineal muscles
• 8. Explain the procedure. It may be slightly
uncomfortable.
• 9. After the procedure, provide tissue to wipe
perineum of lubricant.

• V. Speculum Examination and Papanicolau Smear

• The purpose of the speculum examination is to

examine the internal genital tract and to obtain
specimen for cytological examination known as
Papanicolau Smear or Pap smear.
• Pap Smear
• A pap smear test is done to screen for cancerous and
precancerous cells of the cervix.

• Specimen Collected:
• - Endocervix Specimen
• - Ectocervical specimen – common site for malignancy
• - Vaginal pool specimen – specimen for posterior fornix.

• Findings:
• - Class I – normal findings
• - Class II - Normal with atypical cells present.
Atypical cells are often caused by inflammatory conditions
such as infection.
• - Class III - Suggestive of malignancy with
benign and pssibly malignant cells.
• - Class IV - Probably malignant, with signs of
malignancy present.
• - Class V - Definitely malignant cells are present.

• VI. Blood Tests

• A. Hematocrit (hct) and Hemoglobin (hb)

• - done at initial clinic visit and repeated at 28-32
wks. To detect anemia. During pregnancy blood
volume increases by 30-50%. Since plasma volume
increases more than red cell volume, Hb and Hct
levels fall, resulting in pseudoanemia.
• . Anemia during pregnancy is usually of iron-
deficiency type. A folic acid deficiency state may co-
exist with iron deficiency.
• - Normal Hb is between 12 – 16 mg/dl.
• - Normal hct is between 37 – 47%

• - Mild Anemia is Hb less than 11 gm/dl (hct 27 –

33%)
• - Severe Anemia is Hb less than 9 gm/dl. (hctless
than 27%)

• B. Leukocyte Count
• - done to screen and rule out leukemia and
possible infection. Nonpregnat value are 5,000 –
10,000 but may reach 16,000 in pregnancy
• C. Differential smear
• - done primarily to identify the types of
leukocytes, erythrocytes, abnormalities and adequacy
of platelets.

• D. VDRL
• - screen for maternal syphilis. Untreated syphilis
in the 2nd trimester can infect the fetus and result to
congenital abnormalities. If woman is (+) for an STD,
recommend testing and treatment of partner.

• E. HIV screen
• - if the woman belongs to the high risk group,
HIV screening may be done by enzyme linked
immunosorbent assay (ELISA) testing.
• If the result is (+), the diagnosis is confirmed usually
by Western blot test. Women with HIV are treated
with Zidovudine (AZT) during pregnancy to decrease
the risk of the fetus acquiring the infection. HIV
screening is recommended to women:
• - who are IV users
• - with multiple sexual partners
• - with sexual partners (+) for HIV or who belong
to the high risk group (homosexual, IV drug users,
hemophiliacs)
• - who received blood transfusion between 1977 to
1985 when HIV testing for blood products is not yet
routinely conducted.
• F. Antibody screen
• - conducted for the purpose of screening the
pregnant woman’s serum for antibodies formed from
exposure to major or minor blood group antigens.

• G. Rubella antibody titer

• - determines a woman’s degree pf protection
against German measles. A test result of 1:8 or less
indicates that the mother is at risk or susceptible of
acquiring the infection during pregnancy. Since
Rubella vaccine cannot be given during pregnancy, the
pregnant woman must avoid exposure to the infection.
• H. DM Universal screening
• - conducted to screen women who have high
probability of developing gestational DM. A 50 gm
oral glucose tolerance test is conducted at 24 – 28
wks. gestation irregardless of the time of the day and
meals taken, ideally for all pregnant women. If test
results shows a plasma value that is more than 140
mg/dl after one hour, 100 gms three hours oral
glucose tolerance test (OGTT) is performed to
confirm the result. The following risk factors can be
used to select patients for DM screening:
• - age more than 25 yrs. Old
• - family history
• - glycosuria
• - history of unexplained pregnancy losses
• - Previous fetal or neonatal death
• I. Maternal Serum Alphafetoprotein
• involves drawing a small amount of blood from the
mother to check for the level of alpha-fetoprotein. -
previous infants with congenital anomalies
• - large infants more than 4,000 gms.
• - polyhydramnois

• Alpha-fetoprotein is produced by the fetal liver and

is excreted through the placenta into the mother’s
blood. This test is best conducted between 15 – 17
wks. A high amount could indicate that the baby has
a neural tube defect such as spina bifida (open spine)
or anencephaly (absence of the brain). If the value is
low, it could be indicative of Trisomy 21 or Down’s
syndrome.
• A genetic condition in which there is an extra
chromosomes #21 and carries many physical defects as
well as varying degrees of mental retardation. To
confirm diagnosis, chromosomal study of fetal cells
taken by amniocentesis may be performed.

• Caused of elevated AFT

• - underestimated gestational age
• - open NTDs
• - fetal nephrosis and cystic hygroma
• - GI obstruction, omphalocele, gastroschisis
• - Prematurity, low birth weight, IUGR
• - abdominal pregnancy
• - multiple fetuses
• - fetal demise
•
• Cause of low AFP
• - overestimated gestational age
• - missed abortions
• - molar pregnacies
• - chromosomal abnormalities (including Down
syndrome)

• VI. Urinalysis

• 1. Collect urinary specimen by midstream or clean

catch technique.
• 2. A complete urinalysis should be conducted on the
1st clinic visit and repeated at 28 – 30 wks.
• - Benedict’s test – detect glycosuria
• - Acetic Acid test – detect proteinuria.
• 3. Microscopy
• - can identify bacteria, leukocytes, and
erythrocytes, which may indicate infection. Casts
and/or RBC may indicate chronic pyelonephritis.
Asymptomatic bacteruria can lead to abortion early in
pregnancy and can cause premature labor late in
pregnancy.

• 4. Glucose
• - Glycosuria may occur in pregnancy because of
increased glomerular filtration rate. However, it may
also indicates carbohydrate intolerance. If urine is
• Positive for glucose further testing is necessary to
confirm diagnosis.

• 5. Protein
• - A value of 1+ is abnormal. The cause should be
identified with further testing (UTI, PIH, renal
disease)

• 6. Leukocyte
• - is helpful in identifying patient with significant
leukocyturia. Current opinion is that the test strip
could reduce screening costs by replacing microscopy.
 FETAL ASSESSMENT
• I. Fetal Heart Rate
• - fetal heart rate can be 1st heard between 16 –
19 wks. Gestation
• - FHT is audible at about 16 wks or 4 months in
multiparas and 2o wks or 5 months in primiparas.
• - 80% of pregnant women, FHT is audible at 20
wks, 95% at 21 wks. And at 22 wks; FHT can be heard
in all pregnant women.
• - After it has been initially auscultated, it should
be auscultated every clinic visit primarily to
determine if the fetus is alive.
• II. Amniocentesis

• - Amniocentesis is the removal of fluid from the

amniotic cavity by needle puncture. An ultrasound is
performed first to determine the safe site where the
needle can be inserted.

• - A long, 2o to 22 gauge spiral needle is inserted

into the mother’s uterus and into the amniotic sac to
aspirate 5 to 20 ml. of amniotic fluid.

• - During the procedure, the fetus is continuously

monitored by ultrasound to ensure the well-being.
• - The mother may experience minor side effects,
including cramping, leakage of fluid and minor
irritation around the entry site. Amniocentesis
carries a slight risk of miscarriage, ranging from 1 in
400 to 1 in 200. Other risk include trauma to fetus
or the placenta and bleeding into the maternal
circulation.

• A. Amniotic Fluid Analysis

1. Karyotyping and detection of fetal abnormalities

early in pregnancy.
2. To determine fetal lung maturity.
• A. L/S ratio
• - L/S ratio result of 2:1 is generally accepted as a
sign of pulmonary maturity that would enable the fetus
to survive extrauterine life.

• B. Lung Profile
• - is the study of all surfactants not only the lecithin
and sphingomyelin. These other surfactants are equally
important indicators of fetal lung maturity.

• 3. Amniotic Fluid Bilirubin

• - is usually analyzed with a spectrophotometer that
measures the optical density of the amniotic fluid
specimen against the characteristic absorption peak at
450 mm.
• To protect the amniotic fluid specimen, it is
important to use amber glass container or if these
are not available, nurse can cover a clear glass
container with occlusive tape.

• A. Rh Incompatibility
• - amniotic fluid can be assessed for bilirubin
levels repeatedly in RH incompatibility during
pregnancy to monitor the progression of the disease
and the fetal condition.

• B. Fetal Maturity
• - it is expected that during the 2nd half of
pregnancy the concentration of amniotic fluid
bilirubin decreases until it virtually disappears during
• the last month of gestation.

• 4. For detection of certain infection.

• Nsg. Care during amniocentesis:

• 1. Assist client to empty her bladder before the

procedure
• 2. Place in supine position and drape properly.
• 3. Put rolled towel under right hip to tip body to the
left and remove pressure of uterus on vena cava.
• 4. Instruct not to take a deep breath and hold it
while needle is being inserted as it will shift the
uterus and needle may hit placenta or fetus.
• 5. Inform client that it is not painful because
anesthesia will be applied at the insertion site. She
may experience pressure sensation during the
insertion of the needle.
• 6. Monitor FHT before, during and in 30 min. after
the test.
• 7. Administer Rh immunoglobulin if the patient is Rh
negative. If the father is also Rh negative, this may
not be necessary.
• 8. Instruct patient to observe for:
• - infection
• - uterine cramping
• - vaginal bleeding
• III. Obstetric Ultrasound

• Purpose
• 1. Diagnosis and confirmation of early pregnancy
• 2. Vaginal bleeding in early pregnancy
• 3. Determination of gestational age and assessment
of fetal size
• 4. Diagnosis of fetal malformation and other
chromosomal abnormalities.
• 5. Placental location
• 6. Multiple pregnancies
• 7. Hydramnios and oligohydramnios
• 8. Other areas
• - confirmation of intrauterine death
• - confirmation of fetal presentation
• - evaluation of fetal tone, movement and
breathing
• - detection of uterine and pelvic abnormalities
during pregnancy such as fibromyomata and ovarian
cyst.

• IV. Fetoscopy
• procedure in which an endoscope is inserted
transabdominally into the amniotic cavity to directly
visualize the fetus. This procedure is performed
around 18 wks. gestation.
• V. Amnioscopy
• - is direct visualization of amniotic fluid through
the fetal membranes with cone-shaped hollow,
inserted through the cervix

• VI. Radiography
• - confirm pregnancy with identification of fetal
skeletal parts at 16 wks. During the 2nd half of
pregnancy, multiple pregnancies can be diagnosed and
in the 3rd trimester, anencephaly and hydrocephaly
can be seen.
• VII. Nonstress Test (NST)

• - This test relies on Fetal heart rate reactivity.

A NST assesses fetal well-being based on the
relationship between the baby’s heart rate and the
baby’s reactivity. The FHR pattern is assessed by
external monitoring without any stress or stimuli to
the fetus. The baby’s heart rate should accelerate,
by fifteen beats for at least 15 seconds, twice in a
twenty minute period. This is called a reactive NST
and is a good sign that the fetus is healthy. A
reactive NST indicates intrauterine survival for one
week
• VIII. Contraction Stress Test or Oxytocin Challenge
Test (CST)

• used to measure uteroplacental function or the

feto-placental respiratory reserve by observing the
response of fetal heart rate to uterine contractions
induced by oxytocin administration or nipple
stimulation.
 HEALTH TEACHING
• I. Schedule of Visit
• - 1st visit to 32 weeks – every 4 weeks
• - 32 weeks to 36 weeks - every 2 weeks
• - 36 weeks until delivery - every week

• II. Exercise
• the primary purpose of the exercise is to
strengthen the muscles to be used for labor and
delivery.
• Contraindicated:
• - PIH
• - PROM
• - PTL
• - incompetent cervix
• - vaginal bleeding
• - IUGR
 Exercise Benefit

Pelvic Rocking Relieve low backache

Strengthen the muscles of the
lower back.

- The woman must get on all

fours by hollowing the back and then
arching it upward to form a mound.
This may also be done by lying on
her back standing up.

- Thrust back outward with

buttocks tucked under. Hold for a
least 3 seconds and release. Repeat
5 times.
Tailor Sitting Stretch and strengthen perineal
muscles.
Improve circulation in the perineum.

- Sit flat on the floor with legs

outstretched; knees are gently
pushed to the floor until the perineal
muscles begin to stretch.

- Hold this position for increased

amounts of time each time
performed.
Abdominal Muscle Contraction Strengthen abdominal muscles in
preparation for labor pushing.
- Contract and relax the muscles of
the abdomen
- Repeat as often as desired and
gradually increase the time held.

Squatting The exercise stretches the perineal

muscles and increase blood flow to the
perineum.
- The woman must squat and keep her
feet flat on the floor.
- should be done 15 minutes per day.

Kegel Exercise Strengthen perineal muscles

- The patient should alternate
between tightening and relaxing the
perineal muscles.
- This can be done at any time and
should be repeated 75 to 100 times/day.
Calf Stretching Relieve leg cramps
Shoulder Circling Relieve upper backache and numbness of
arms and finger.
Modified knee chest Relieve hemorrhoids, vulvar varicosities
and low backache

Leg Elevation Relieve swelling, fatigue, varicosities of

lower extremities.
Leg Raising Strengthen abdominal muscles

Incidence where reduced physical activity is

recommended:

- PROM
- CHF
- Hemoglobinopathies
- Marfan’s Syndrome
- DM with multiple end-organ involvement
• - 2 previous pregnancies
• - incompetent cervix
• - fetal loss secondary to uterine anomalies
• - PIH
• - Multiple gestation
• - IUGR
• - severe heart disease
• - preterm labor

• III. Employment
• - pregnant women can continue working as long as
their job does not involve lifting heavy object,
standing and sitting for long periods of time,
excessive physical and emotional strain and expose to
toxic substances.
• IV. Dental Care
• - The pregnant woman should have a dental check-
up early in pregnancy to give plenty of time for
repairs and treatment of infected teeth and for
instructions on proper dental care.
• - dental x-ray is allowed as long as the woman
wears lead apron over her abdomen to protect the
fetus from the damaging effects of radiation.

• V. Maternity clothes
• - Lightweight, non-constrictive and loose fitting
• - absorbent and washable because of increase
perspiration
• - Reasonably priced because they will only be used
during pregnancy.
• - flat heeled shoes that provide good support are
recommended during pregnancy because of the
altered balance of the woman especially when the
abdomen has grown large enough.

• VI. Bathing
• - The woman perspires more heavily because she
needs to excrete the waste products of her body and
that of the fetus. Due to increased perspiration, the
pregnant woman is encouraged to have a daily bath to
keep fresh and clean.
• - Bathing is contraindicated when there is vaginal
bleeding and after the membranes have ruptured.
• VII. Breast Care
• - Well fitting and large size brassiere is
recommended for the increased breast mass and
pendulous breast. Bras should provide adequate
support, with wide straps and deep cups to prevent
loss of breast tone.
• - If woman plans to breastfeed, nipple rolling
between thumb and forefinger and drying of nipples
with rough towel is encourage to toughen the nipple.

• VIII. Immunization
• - Immunization with vaccines containing live
viruses is contraindicated during pregnancy because
of the danger of the virus crossing the placenta and
infecting the fetus.
• - The immunization recommended to all pregnant
women in the Philippines is Tetanus Toxoid vaccine
given in the following schedule:

• TT1 anytime during pregnancy

• TT2 1 month after TT1 (3 yrs. Protection)
• TT3 6 month after TT2 (5 yrs. Protection)
• TT4 1 year after TT3 ( give 10 yrs. Protection)
• TT5 1 year after TT4 (gives lifetime protection)

• IX. Travel
• - There are usually no travel restrictions during
pregnancy but it is advised that pregnant women avoid
long trips on the 3rd trimester. The best time to
travel is on the 2nd trimester because the woman is
• Most comfortable at this time and there is minimum
danger of abortion and preterm labor.
• - When traveling:
• - 15 to 20 mins. Rest period on long rides to
move about and empty bladder.

• X. Sexual Relation
• - 1st tri – decrease sexual desire due to
discomforts of pregnancy
• - 2nd tri - increase sexual desire because woman
has already adjusted to pregnancy and this is the
period when she is most comfortable.
• - 3rd tri - decrease sexual desire because of the
fear of hurting the fetus and the discomfort caused
by enlarged abdomen and deep penile penetration.
• XI. Alcohol
• - refrain from drinking alcohol because it may
cause fetal anomalies.
• - Alcohol increases the risk of:
• - midtrimester abortion
• - mental retardation
• - behavior and learning disorder
• - Fetal alcohol syndrome (SGA)

• XII. Smoking
• - nicotine causes vasoconstriction resulting in
decreased blood flow to the placenta which in turn
diminished oxygen supply to the fetus. Fetal hypoxia
leads to low birth weight.
• - Smoking increases the risk for:
• - poor lung development
• - asthma, and respiratory infection
• - increased risk of SIDS
• - physical growth deficiency
• - intellectual development deficiency
• - behavioral problems

• XIII. Medications
• - Classification of medication with regards to
adverse fetal effects (FDA)

• - Category A - safe for fetus in human studies

(Vitamins)
• - Category B - adverse effect not demonstrated
in animal studies with no human studies; or adverse
effects shown in animal studies have not been
reproduced in human studies (penicillin).
• - Category C - no adequate animal or human
studies are available; or animal studies show adverse
fetal effects with no human data.
• - Category D - Evidence of fetal risk but
benefits believed to outweight the risk
(carbamazepine)
• - Category X - drugs with proved fetal risks that
outweight any benefits.
• Pregnancy medications that show no adverse effect
at the usual dose:
• - antihistamines
• - decongestants (pseudoepinephrine)
• - some antibiotics ( penicillin, ampicillin,
cephalosporins, erythromycin )
• - non-quinine antimalarial
• - gen. anesthetics
• - acetaminophen
• - Tuberculostatics ( INH, PAS, and Rif-ampin)
• - Metronidalose ( avoid in first tri if possible)
• - Steroids
• - Accidental use of clomiphene, bromocriptine,
birth control pills, vaginal spermicides)
 DRUGS TERATOGENIC EFFECTS
Androgen, estrogen, progesterone Masculinization of female infants
Thalidomide Phocomelia, cardiac and lung defect
Anticonvulsant (Dilantin) Cleftlip, palate, congenital heart
defects
Lithium Congenital heart defect
Tetracycline Yellow staining of teeth, inhibits bone
growth

Vit. K Hyperbilirubinemia
Salicylates (aspirin) Neonatal bleeding, decreased
intrauterine growth

Sodium Bicarbonate Fetal metabolic alkalosis

Streptomycin Nerve Deafness

Vit. A Central venous system defects

 DANGER SIGNS OF PREGNANCY
• 1. Vaginal bleeding of any amount
• 2. Persistent vomiting
• 3. Chills and fever
• 4. Sudden escape of fluid from the vagina
• 5. Swelling of the face and finger
• 6. Visual disturbance
• 7. Painful urination or dysuria
• 8. Abdominal pain
• 9. Severe or continuous headache
 MINOR DISCOMFORTS OF
PREGNANCY
• 1. Nausea and vomiting

• Management:
• A. Eat dry toast or crackers before rising from bed
• B. Eat small frequent meals rather than 3 large ones

• 2. Frequent urination

• Management:
• A. Limit fluid intake before bedtime
• B. Kegel exercise to improve tone of muscles that
controls urination.

• 3. Fatigue

• Management:
• A. Take at least 8 hours of sleep at night and
frequent rest periods during the day.
• B. Avoid standing for long periods, work while seated
as much as possible
• C. Eat a well balanced diet to provide enough energy

• 4. Breast tenderness and nipple irritation

• Management:
• A. Wash breast with water only, no soaps and alcohol
to prevent drying and irritation
• B. Wear supportive maternity brassiere

• 5. Leukorrhea

• Management:
• A. Proper perineal hygiene, flush perineu with water
after each voiding, no douching is necessary
• B. Use sanitary pad for excessive vaginal discharge

• 6. Nasal stiffness
• Management:
• A. Avoid allergen and smoked filled room
• B. Normal saline nose drops (1/4 salt in 1 cup water)
• C. Breathe steam from pot of boiling water

• 7. Heartburn or pyrosis

• Management:
• A. Take small meals rather that three large ones
• B. Bend at knees not at waist when picking objects
from the floor, avoid lying flat
• 8. Varicose Veins

• Management:
• 1. Leg varicosities
• a. Periodic rest with elevation of the legs, lie with
feet against the wall
• b. Avoid prolonged sitting or standing,
constricting garters, knee high socks
• c. Wear support hose
• d. Apply elastic bandage before getting up in the
morning starting at the distal ends but don’t wrap
toes
• 2. Vulvar Varicosities
• a. Rest with pillow under hips
• b. Modified knee chest position

• 3. Anal Varicosities or Hemorrhoids

• a. Sim’s position several times a day
• b. Avoid constipation
• c. Hot sitz bath 15 to 20 minutes
• d. Avoid bearing down
• e. Observe good bowel habit
• f. Use a topically applied anesthetics, use stool
softeners and warm soaks
• 9. Backache
•
• Management:
• A. Pelvic rocking exercise to relieve low backache
• 2. Frequent rest and avoidance of fatigue

• 10. Leg cramps

• Management:
• A. For immediate relief, push toe upward while
applying pressure on the knee to straighten the leg
• B. One quart of milk a day to meet calcium needs or
oral calcium supplements as prescribed by physician
• C. Exercise regularly but avoid pointing of toes

• 11. Headache
• headache is normal during the 1st trimester. Some
cases lead to sinusitis or ocular strain caused by
refractive errors.

• 2nd tri – less headache because the pregnant woman is

already adjusted

• 3rd tri - especially if frontal and accompanied by

visual disturbances should be investigated as this
maybe caused by pregnancy induced hypertension
(PIH)