PREGNANCY DISCOMFORTS/ MINOR DISORDERS OF PREGNANCY:

Minor disorders are only disorders that occur during pregnancy and are not life threatening. Symptoms of discomfort due to pregnancy vary from woman-to-woman. However, each mother-to-be may experience symptoms differently or not at all. Causes of minor disorders can be divided into hormonal changes, accommodation changes, metabolic changes and postural changes. Every system of the body ad usts and is affected by pregnancy. !he following are some common discomforts" NAUSEA AND VOMITING" !his presents between # and $% wee&s gestation. Hormonal influences are listed as the most li&ely causes. 't is usually occurs in the morning but can occur any time during the day, aggravated by smelling of food. 'f vomiting is severe, causing a woman to lose fluids and weight, it may indicate a condition called hyperemesis gravidarum. Hyperemesis can lead to dehydration and may re(uire hospitali)ation for intravenous fluids and nutrition. Management: *eassure the mother Small fre(uent meals +dry meals, *educe fatty and fried containing foods. *est - diet high in complex carbohydrates +such as whole wheat bread, pasta, bananas, and green, leafy vegetables, may also help reduce the severity of the nausea. HEART BURN" !his is a burning sensation in the mid chest region. .rogesterone relaxes the cardiac sphincter of the stomach and allows reflex of gastric contents into esophagus. Heart burn is most troublesome at /0-#0 wee&s gestation because at this stage is under pressure from the growing uterus.

Management: Small and fre(uent meal Sleeping with more pillows than usual. 1or persistence2sever case2 prescribe antacids.

EXCESSIVE SALIVATION (PTYALISM : !his occurs from 3 wee&s gestation and is thought to be caused by the hormones of pregnancy. 't may accompany heartburn. Management: Explanation and attentive listening are helpful.

PICA" !his is the term used when mother craves certain foods of unnatural substances such as coal, soil...etc. !he cause is un&nown but hormones and changes in metabolism are blamed. Management: See& medical advice if the substance craved is potentially harmful to the unborn baby.

CONSTIPATION: ! .rogesterone causes relaxation and decreased peristaltic activity of the gut, which is also displaced by the growing uterus. Management: 'ncrease the inta&e of water, fresh fruit, vegetables and whole meal or roughages in the diet. Exercise is helpful especially wal&ing. -perients are considered only as a last resort.

HEMORRHOIDS:! 4ecause of increased pressure on the rectum and perineum, and the increased li&elihood of becoming constipated as the pregnancy progresses, hemorrhoids are common in late pregnancy.

Management: -voiding constipation and straining may help to prevent hemorrhoids.

BAC"ACHE: !he hormones sometime soften the ligaments to such a degree that some support is needed. Management: -dvice the mother to sleep on firm bed. -dvice support mechanisms of the bac&.

-ntenatal exercises such as pelvic tilting and hip up drawing.

LEG CRAMP: !he cause of leg cramp in pregnancy is un&nown. 't may be due to ischemia or result from changes in the pH or electrolyte status. Management: -dvice the mother to dorsiflex the foot and to raise the foot of the bed about 56cm. 't may be helpful to ma&e gentle leg movements whilst in a warm bath prior to settling for night.

FRE#UENCY OF URINATION: !his occurs in the early wee&s of pregnancy when the growing uterus is still situated within the pelvis and competes for space re(uired by the bladder. 'n the later wee&s the head usually enters the pelvis and reduces the space available. Management: *eassure the mother, exclude other causes of bladders irritability such as infection. She may also be explained that the problem will be resolved by $5 wee&s when the uterus rises in to abdomen.

LEUCORRHOEA: !his is the term used for the increased white, non-irritant vaginal discharge in pregnancy. Management: -dvice the mother on personal hygiene. 7ear cotton underwear and avoid tights. 7ashing with plain water twice a day.

FAINTING: ! 'n early pregnancy fainting may be due to the vasodilatation occurring under the influence of progesterone before there has been a compensatory increase in blood volume. 8ater in the pregnancy the mother may feel faint while lying flat on her bac&. !he weight of the uterine contents presses on the inferior vena cava and slows the return of blood to the heart. Management: -void long period of standing.

Sit or lie down (uic&ly when she feels slight di))iness. She would be wise not to lie on her bac& except during abdominal examination.

VARICOSITIS:! .rogesterone relaxes the smooth muscles of the veins and result in sluggish circulation. !he valves of the dilated veins become insufficient and varicosities result. 't occurs in legs, anus +hemorrhoids, and vulva. Management: Exercising the calf muscles by rising on the toes Elevate the leg and rest on the table. Support tights increase comfort and should be put on before rising or after resting with the legs elevated. -void constipation by fiber rich diet and ade(uate fluid inta&e. Sanitary pad give support for vulva varicosities.

S"IN CHANGES"9ue to fluctuations in hormone levels, including hormones that stimulate pigmentation of the s&in. 'f ma$% &' ()egnan*+, or *,-&a$ma &**.)$/ which is a brown, blotchy patches may occur on the face, forehead, and2or chee&s. !his is often disappears soon after delivery. .igmentation may also increase in the s&in surrounding the nipples, called the a)e&-a. 'n addition, a dar& line fre(uently appears down the middle of the abdomen, L0nea n0g)a1 Sometimes there is a generali)ed itching which often starts over the abdomen. !his is thought to have some connection with the liver:s response to the hormones in pregnancy and with raised bilirubin levels. Management: *eassurance. 8ocal applications for irritability.

CARPAL TUNNEL SYNDROME: ! !he mother complaints of numbness and ;pins and needles: in her fingers and hands. !his usually happens in the morning but can occur at any time of the day. 't is caused by fluid retention which creates edema and pressure on the median nerve. Management: 7earing a splint at night with hand resting high on two or three pillows may bring relief.

!he doctor may prescribe diuretics but the conservative approach is favoured.

INSOMNIA: ! !his must never be dismissed lightly. !here are physical reasons for sleep disturbances such as nocturnal fre(uency and difficulty in getting comfortable in bed due to the growing fetus. !he increased blood supply to uterus on lying down sometimes causes the baby to move a lot, ust as the mother wish to sleep. Management: <oing to bed earlier in the hope that the baby will have active time earlier and allow the mother to sleep when she wants to. -void long hours sleep during day time.

DISORDERS 2HICH RE#UIRE IMMEDIATE ACTION: Most minor disorders can be advanced into a more serious complication of pregnancy. !he disorders re(uire 0mme30ate a*t0&n$ a)e a$ '&--&4$ (Dange) $0gn$ &' ()egnan*+ =aginal bleeding *educed fetal movements 1rontal or recurring headaches Sudden swelling *upture of the membrane .remature onset of contractions Maternal anxiety for whatever reason