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common problems associated with pregnancy by Sailaja Reddy, M.Sc.(N), PGDHM, HAWASSA UNIVERSITY, ETHIOPIA

common problems associated with pregnancy by Sailaja Reddy, M.Sc.(N), PGDHM, HAWASSA UNIVERSITY, ETHIOPIA






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    common problems associated with pregnancy by Sailaja Reddy, M.Sc.(N), PGDHM, HAWASSA UNIVERSITY, ETHIOPIA common problems associated with pregnancy by Sailaja Reddy, M.Sc.(N), PGDHM, HAWASSA UNIVERSITY, ETHIOPIA Presentation Transcript

    • Common problems associated with pregnancy
    •  While a few lucky women sail through their pregnancies without even a twinge of morning sickness, most of us have to contend with a few (or maybe quite a few) pregnancy-related issues. Here's how to cope with some of the most common pregnancy problems.
    •            Heartburn Morning sickness Fatigue Frequent urination Constipation Sore back Stretch marks and itchy belly Gestational diabetes High blood pressure (pregnancy-induced hypertension) Teeth and gums problems in pregnancy Headaches              Severe vomiting Pelvic pain Piles Swollen ankles, feet and fingers Tiredness Vaginal bleeding Vaginal discharge Cramp Feeling faint Feeling hot Incontinence Skin and hair changes Varicose veins
    •  Indigestion – also known as dyspepsia – in pregnancy is partly caused by hormonal changes, and in later pregnancy by the growing womb pressing on your stomach.  As many as eight out of 10 women experience indigestion at some point during their pregnancy. The symptoms of indigestion can include feeling full, feeling sick or nauseous, and burping. The symptoms usually come on after eating food.
    •  Heartburn is a strong, burning pain in the chest that is caused by stomach acid passing from your stomach into your oesophagus (the tube that leads from your mouth to your stomach).  Here          are some ways to put out the fire: Eat small, frequent meals (this will also help with morning sickness). Stay away from greasy or fried food, coffee, cola, and smoking (which you should avoid during pregnancy anyway). Avoid alcohol to ease indigestion. Eat slowly and chew your food well. Drinking a glass of milk may relieve heartburn Don't lie down for at least half an hour after meals. Prop up your head and shoulders while you're asleep. Try calcium carbonate, an antacid that's also used as a calcium supplement. Don't take more than the dose recommended on the package, and don't treat yourself with any other over-thecounter medications (including other antacids) before checking with your doctor or pharmacist. Antacids & Alginates usuage.
    •  It’s thought that hormonal changes in the first 12weeks are probably one of the causes of morning sickness or a lack of vitamin B6 in the diet.  Risk           factors for morning sickness A number of different factors may mean you are more likely to have NVP. These include: Nausea and vomiting in a previous pregnancy Your unborn baby being a girl A family history of NVP or morning sickness A history of motion sickness, for example in a car A history of nausea while using contraceptives that contain oestrogen Obesity – where you have a body mass index (BMI) of 30 or more Stress Multiple pregnancies, such as twins or triplets First pregnancy
    •           Morning sickness: As any pregnant woman knows, "morning sickness" should really be called "all-day sickness." It usually gets better after the first trimester, but an unlucky few suffer right up until they deliver their baby. Here are a few ways to help that easy stomach: Have small, frequent meals. Don't let yourself get too hungry. Have small amounts of fluids several times a day. But don't drink fluids during or just before or after a meal. Before you get out of bed in the morning, eat a small nutritious snack like crackers or a granola bar (keep it by your bed), then rest in bed for 15 minutes. If certain scents or foods turn your stomach, steer clear! The most common offenders are fried, spicy, or fatty foods. If you're having trouble finding foods you can keep down, try bread, noodles, watermelon, crackers, cereal, mashed potatoes, clear soup, apple slices, pretzels, or pickles. Try having your food cold instead of hot to take away some of the smell. Try smelling lemons or ginger to calm your stomach. Have a few salty potato chips to ease nausea before your meal. Take your prenatal vitamin with food so it doesn't upset your stomach.
    •         Get plenty of rest and fresh air. Try acupressure wrist bands (available at your local pharmacy). Ask your doctor about taking Diclectin® (doxylamine/pyridoxine), a prescription antinausea medication for pregnant women. avoiding foods or smells that make you feel sick avoiding drinks that are cold, tart (sharp) or sweet asking the people close to you for extra support and help – it helps if someone else can cook but if this isn’t possible, go for bland, non-greasy foods, such as baked potatoes or pasta, which are simple to prepare distracting yourself as much as you can – often the nausea gets worse the more you think about it wearing comfortable clothes without tight waistbands
    • When to see a doctor for morning sickness  If you are vomiting and can’t keep any food or drink down, there is a chance that you could become dehydrated or malnourished. Contact your GP or midwife immediately if you:  have very dark-coloured urine or do not pass urine for more than eight hours  are unable to keep food or fluids down for 24 hours  feel severely weak, dizzy or faint when standing up  have abdominal (tummy) pain  have a high temperature (fever) of 38°C (100.4°F) or above  vomit blood 
    •   Some pregnant women experience excessive nausea and vomiting. This condition is known as hyperemesis gravidarum and often needs hospital treatment. Hyperemesis gravidarum isn’t common but it can be severe. It's much worse than morningsickness. If you're being sick all the time and can't keep food down, tell your midwife or doctor as soon as possible.  Symptoms       of hyperemesis gravidarum Excessive vomiting in pregnancy is much worse than the nausea and vomiting of morning sickness. Signs and symptoms of hyperemesis gravidarum include: Prolonged and severe nausea and vomiting Dehydration Ketosis – a serious condition that is caused by a raised number of ketones in the blood and urine (ketones are poisonous acidic chemicals that are produced when your body breaks down fat, rather than glucose, for energy) Weight loss Lowblood pressure (hypotension) when standing up
    •   The symptoms not only make your life a misery but may lead to further health complications, such as depression. The nausea and vomiting are usually so severe that it's impossible to keep any fluids down, and this can cause dehydration and weight loss. Dehydration is when you don’t have enough fluids in your body. Causes    of hyperemesis gravidarum It is thought that a lack of vitamin B6 in the diet may be a cause hyperemesis gravidarum. You should be able to get enough vitamin B6 through a healthy, balanced diet. It's present in lots of foods including cereals, wholemeal bread, cod, potatoes, milk and bananas. Vitamin B6 supplements may ease your symptoms, but don't take them without speaking to your doctor first as it's not clear how safe it is to take vitamin B6 supplements during pregnancy.
    •  Treating   Hyperemesis gravidarum needs specialist treatment, and you will usually need to be admitted to hospital so that doctors can assess your condition and give you the right treatment. This can include intravenous fluids given through a drip to treat the ketosis and treatment to stop the vomiting. Hyperemesis gravidarum is unpleasant with dramatic symptoms, but the good news is it's unlikely to harm your baby. However, if it causes you to lose weight during pregnancy there is an increased risk that your baby may be born smaller than expected.  Blood  hyperemesis gravidarum clots and hyperemesis gravidarum Because hyperemesis gravidarum can cause dehydration, there's also an increased risk of having deep vein thrombosis (a blood clot).
    •  Considering the enormous amount of work your body is doing right now, it's not unusual to feel completely exhausted. The best solution: rest! Give yourself permission to get the sleep you need, even if this means adjusting your schedule and asking for help with household chores.
    •  In the first trimester, those frequent bathroom trips are due to the pregnancy hormone human chorionic gonadotropin (hCG), which causes increased urination. In the second trimester, you usually get a bit of a break from bathroom time. But in the third trimester, bathroom breaks are back with a vengeance as the growing uterus puts pressure on the bladder.
    •  How to reduce the need to pass urine avoid caffeine  avoid fluids in the early evening and before bedtime – drink more fluids during the rest of the day to make up for this  go to the bathroom when you feel the urge  when you urinate, lean forward to help the bladder empty more   When to get help  If you have any pain while passing water or you pass any blood in your urine, you may have a urine infection, which will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours of first noticing these symptoms.
    •  During pregnancy, food moves more slowly through the body to give you a better chance to absorb nutrients. Iron supplements can also make you constipated.  What  Eat can you do to stay regular? high-fibre foods like fruit, vegetables, beans, and whole grains  Get plenty of fluids  Stay active  Go to the bathroom when you feel the urge – don't wait
    • Piles, also known as haemorrhoids, are enlarged and swollen veins in or around the lower rectum and anus. Anyone can get piles – they don't just happen in pregnancy. When you're pregnant, piles can occur because hormones make your veins relax.  Piles may itch, ache or feel sore. You can usually feel the lumpiness of piles around your anus. They may also bleed a little and can make going to the toilet uncomfortable or painful. You may also notice pain when passing a stool (faeces, poo) and a discharge of mucus afterwards. Sometimes you may feel as though your bowels are still full and need emptying. 
    • How to ease piles Constipation can cause piles and if this is the case try to keep your stools soft and regular.  You can help ease piles, and prevent them, by making some changes to your diet and lifestyle:  Eat plenty of food that is high in fibre, like wholemeal bread, fruit and vegetables, and drink plenty of water – this will prevent constipation, which can make piles worse (find out more about healthy eating in pregnancy)  Avoid standing for long periods  Take regular exercise to improve your circulation  You may find it helpful to use a cloth wrung out in iced water to ease the pain – hold it gently against the piles 
    • If the piles stick out, push them gently back inside using a lubricating jelly  Avoid straining to pass a stool as this may make your piles worse  After passing a stool, clean your anus with moist toilet paper instead of dry toilet paper  Pat , rather than rub, the area  There are medicines that can help soothe inflammation around your anus. These treat the symptoms but not the cause of piles. Ask your doctor, midwife or pharmacist if they can suggest a suitable ointment to help ease the pain. Don't use a cream or medication without checking with them first. 
    •          A growing uterus, a shifting center of gravity, and loosening ligaments add up to back pain for many pregnant women, especially in the third trimester. Here are a few ways to ease back pain: Choose your shoes wisely. Opt for a low heel with good arch support. Lift with your legs, not your back. And don't lift heavy objects – ask for help. If you have to stand for a long time, put one foot up on a step stool or box. When picking things up, squat down and keep your back straight instead of bending from the waist. When getting up, roll onto your side first, then use your hands to push up. Apply a heating pad or ask for a back rub. Choose chairs with good lumbar support or put a little pillow behind the small of your back when sitting. Stay active – try water exercises and walking.
    • There's no sure-fire way to prevent or get rid of stretch marks. But you can reduce your risk by trying to gain no more than a healthy amount of weight: 25 to 35 pounds (11 kg to 16 kg) for most women. Use lotion to keep your skin well hydrated and to avoid "itchy belly." After the baby is born, the stretch marks will likely fade.  Stretch marks are narrow pink or purplish streaklike lines that can develop on the surface of the skin. They're also known as stria or striae. If you get them, they usually appear on your tummy or sometimes on your upper thighs and breasts as your pregnancy progresses. The first sign you notice might be itchiness around an area where the skin is becoming thin and pink. 
    • What causes stretch marks?  Stretch marks are very common in the general population and don't just affect pregnant women. They can happen whenever the skin is stretched, for example when we're growing during puberty or when putting on or losing weight, but hormonal changes in pregnancy can affect your skin and make you more likely to get stretch marks.  Our skin is made up of three main layers – the epidermis (the outer layer), the dermis (the middle layer) and the sub cutis (the inner layer). Stretch marks happen in the middle layer, when the skin is stretched quite a bit over a short time. This stretching can break the dermis in places, forming stretch marks.
    •  It's thought that stretch marks affect up to around 80% of pregnant women. Whether or not you get stretch marks depends on your skin type, as some people's skin is more elastic. After your baby is born, the marks should gradually fade and become less noticeable, but they won't go away completely. Stretch marks are not harmful. They don't cause medical problems and there's usually no need to see your GP because there isn't a specific treatment for them. Over time, your skin will shrink and the stretch marks will fade into white-coloured scars.
    • Gestational diabetes: This is a type of diabetes that starts during pregnancy and usually disappears after the birth. The first sign is usually a high result on a routine pregnancy blood sugar test, usually done between 24 and 28 weeks of pregnancy. Your doctor will do more detailed blood sugar tests to confirm it. Being diagnosed with gestational diabetes usually means a few changes:  You'll need more frequent medical tests, such as blood sugar testing, ultrasounds, urine testing for protein, and blood pressure measurements.  You'll be asked to make some healthy diet changes and exercise more frequently. 
    •  You may need to use insulin injections if your blood sugar can't be controlled by exercise and eating changes alone.  Because women who had gestational diabetes during pregnancy are at a higher risk of diabetes later in life, your doctor will check your blood sugar about 6 weeks after the birth, and then yearly.  Gestational diabetes increases the risk of having a large baby, a C-section, or very low blood sugar levels in the baby after birth. But it can be controlled to help keep both you and your baby healthy.
    •  Some women develop high blood pressure during their pregnancies. Usually this happens in the last trimester (the last 3 months), and usually goes away after the birth. It can increase the risk of certain complications for both mother and baby. It may limit the blood flow to the placenta, which means the baby gets less oxygen and nutrients. It can also cause serious problems for the mother, such as seizures or decreased blood flow to the vital organs.
    •   Let your doctor know if you have a severe headache, vision changes, abdominal pain, decreased amounts of urine, or severe swelling of your hands or feet. If you develop high blood pressure during your pregnancy, your doctor will test your blood pressure, weight, and urine frequently. You may need medication, bed rest, and healthy eating to get your blood pressure down. If you are close to the end of your pregnancy and your blood pressure is quite high, you may need to deliver your baby before your due date. Delivering the baby is the only way to cure high blood pressure of pregnancy. This is not a complete list of all pregnancy-related problems. Talk to your doctor for advice of managing these and other pregnancy issues not listed here.
    •  Some women get swollen and sore gums, which may bleed, in pregnancy. Bleeding gums are caused by a build-up of plaque (bacteria) on the teeth. Hormonal changes during pregnancy can make your gums more vulnerable to plaque, leading to inflammation and bleeding. This is also called pregnancy gingivitis or gum disease.
    •  Keeping teeth and gums healthy in pregnancy  It's extra important to keep your teeth and gums as clean and healthy as possible while you're pregnant. The best way to prevent or deal with gum problems is to practice good oral hygiene. Go to the dentist so they can give your teeth a thorough clean and give you some advice about keeping your teeth clean at home.  Here's how you can help look after your teeth and gums:  Clean your teeth carefully twice a day for two minutes – ask your dentist to show you a good brushing method to remove all the plaque Brushing is best with a small-headed toothbrush with soft filaments – make sure it's comfortable to hold Avoid having sugary drinks (such as fizzy drinks or sweet tea) and sugary foods too often – try to keep them only to meal times  
    •  If you're hungry between meals, snack on vegetables and avoid sugary or acidic foods (get tips on healthy snacks)  Avoid mouthwashes that contain alcohol  Stop smoking, as it can make gum disease worse  If you have morning sickness and you vomit, rinse your mouth afterwards with plain water. This will help prevent the acid in your vomit attacking your teeth. Do not brush your teeth straight away as they will be softened by the acid from the stomach. Wait about one hour before doing so.
    •  Headaches in women are often caused by hormones, and many women who are not pregnant notice a link with their periods. Menopause and pregnancy are also potential triggers.  Some pregnant women find they get a lot of headaches. Headaches can get worse in the first few weeks of pregnancy, but they usually improve or stop completely during the last six months. They don’t harm the baby but they can be uncomfortable for you.
    •  Coping with headaches in pregnancy Changes to your lifestyle may help to prevent headaches. Try to get more regular rest and relaxation. You could try a pregnancy yoga class. If you’re having problems sleeping, you can find out more about tackling this in tiredness and sleep in pregnancy.  Taking paracetamol in the recommended dose is generally considered safe for pregnant women. However, there are some painkillers that you should avoid in pregnancy, such as those containing codeine.  Speak to your pharmacist, midwife, GP, nurse or health visitor about how much paracetamol you can take and for how long. 
    •  When to seek help for headaches  If you often have bad headaches, tell your midwife or doctor so that they can advise you. Severe headaches can be a sign of high blood pressure and you should seek urgent advice, as this could indicate a serious condition called preeclampsia. Pre-eclampsia is a condition that affects some pregnant women during the second half of pregnancy or immediately after the delivery of their baby.  Women with pre-eclampsia have:  high blood pressure  fluid retention (oedema), and  protein in the urine (proteinuria)  If it's not treated, it can lead to serious complications. In the unborn baby, pre-eclampsia can cause growth problems.
    •  Some women develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PRGP) or symphysis pubis dysfunction (SPD).  Symptoms of pregnancy-related pelvic pain  PPGP is a collection of uncomfortable symptoms caused by a misalignment or stiffness of your pelvic joints at either the back or front of your pelvis. PPGP is not harmful to your baby, but it can cause severe pain around your pelvic area and make it difficult for you to get around. Different women have different symptoms, and in some women PPGP is worse than in others.
    •            Symptoms can include: pain over the pubic bone at the front in the centre pain across one or both sides of your lower back pain in the area between your vagina and anus (perineum) Pain can also radiate to your thighs, and some women feel or hear a clicking or grinding in the pelvic area. The pain can be most noticeable when you are: walking going upstairs standing on one leg (for example when you’re getting dressed or going upstairs) turning over in bed It can also be difficult to move your legs apart, for example when you get out of a car. There is treatment to help, and techniques to manage the pain and discomfort. If you get the right advice and treatment early on, PPGP can usually be managed and the symptoms minimised. Occasionally, the symptoms even clear up completely. Most women with PPGP can have a normal vaginal birth.
    • Who gets pelvic pain in pregnancy? It’s estimated that PPGP, or SPD as it's sometimes known, affects up to one in five pregnant women to some degree. It’s not known exactly why pelvic pain affects some women, but it’s thought to be linked to a number of issues, including previous damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby.  Factors that may make a woman more likely to develop PPGP include:  a history of lower back or pelvic girdle pain  previous injury to the pelvis, for example from a fall or accident  having PPGP in a previous pregnancy  a hard physical job 
    • When to get help for pelvic pain in pregnancy? Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort. Treatment by a physiotherapist usually involves gently pressing on or moving the affected joint, which helps it work normally again.  If you notice pain around your pelvic area, tell your midwife, GP or obstetrician. Ask a member of your maternity team for a referral to a manual physiotherapist who is experienced in treating pelvic joint problems. These problems tend not to get better completely until the baby is born, but treatment from an experienced practitioner can significantly improve the symptoms during pregnancy. 
    •  Treatments for pelvic pain in pregnancy Physiotherapy aims to relieve or ease pain, improve muscle function and improve your pelvic joint position and stability, and may include:  manual therapy to make sure the joints of your pelvis, hip and spine move normally  exercises to strengthen your pelvic floor, stomach, back and hip muscles  exercises in water  advice and suggestions including positions for labour and birth, looking after your baby, and positions for sex  pain relief, such as TENS  equipment if necessary, such as crutches or pelvic support belts 
    • Coping with pelvic pain in pregnancy          Your physiotherapist may recommend a pelvic support belt to help ease your pain, or crutches to help you get around. It can help to plan your day so that you avoid activities that cause you pain. For example, don’t go up or down stairs more often than you have to. The Association for Chartered Physiotherapists in Women’s Health (ACPWH) also offers this advice: Be as active as possible within your pain limits, and avoid activities that make the pain worse. Rest when you can. Get help with household chores from your partner, family and friends. Wear flat, supportive shoes. Sit down to get dressed – for example don’t stand on one leg when putting on jeans. Keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel. Sleep in a comfortable position, for example on your side with a pillow between your legs.
    •               Try different ways of turning over in bed, for example turning over with your knees together and squeezing your buttocks. Take the stairs one at a time, or go upstairs backwards or on your bottom. If you’re using crutches, have a small backpack to carry things in. If you want to have sex, consider different positions such as kneeling on all fours. ACPWH suggests that you avoid: standing on one leg bending and twisting to lift, or carrying a baby on one hip crossing your legs sitting on the floor, or sitting twisted sitting or standing for long periods lifting heavy weights, such as shopping bags, wet washing or a toddler vacuuming pushing heavy objects, such as a supermarket trolley carrying anything in only one hand (try using a small backpack)
    •  Ankles, feet and fingers often swell a little in pregnancy as your body is holding more water than usual. Towards the end of the day, the extra water tends to gather in the lowest parts of the body, especially if the weather is hot or if you have been standing a lot. The gradual swelling isn't harmful to you or your baby, but it can be uncomfortable.  Avoiding and easing swollen ankles  There are some steps you can take to prevent swollen feet and ankles. These can also help to ease the discomfort if your feet and ankles are feeling swollen already. Try to:  avoid standing for long periods  wear comfortable shoes – avoid tight straps or anything that might pinch if your feet swell  put your feet up as much as you can – try to rest for an hour a day with your feet higher than your heart, for example propped up with cushions as you lie on the sofa.
    •  Foot exercises   You can do foot exercises sitting or standing. They improve blood circulation, reduce swelling in the ankles and prevent cramp in the calf muscles: bend and stretch your foot up and down 30 times rotate your foot in a circle eight times one way and eight times the other way repeat with the other foot  When swelling can be serious  You should seek medical attention immediately if your face, feet or hands swell up suddenly. A pregnancy condition called pre-eclampsia can cause sudden swelling like this, although most women with swelling don't have pre-ecplampsia. If it happens to you, contact your midwife, doctor or hospital immediately. If you do have preeclampsia, you’ll need to be monitored carefully, as the condition can be serious for both you and your baby.   
    •  Bleeding during pregnancy is relatively common but it can be a dangerous sign, and you should always contact your midwife or GP immediately if it happens to you.  In early pregnancy you might get some perfectly harmless light bleeding, called 'spotting'. This is when the developing embryo plants itself in the wall of your womb. This often happens around the time that your first period after conception would have been due.
    •  Causes of bleeding in pregnancy in early pregnancy  During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy. However, many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.  Miscarriage   If a pregnancy ends before the 24th week of pregnancy, it's called a miscarriage. Miscarriages are quite common in the first three months of pregnancy and around one in five confirmed pregnancies ends this way. Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can be other causes of miscarriage, such as hormone or blood clotting problems. Most miscarriages occur during the first 12 weeks (three months) of pregnancy and, sadly, most cannot be prevented.
    •  Ectopic  Ectopic pregnancy pregnancies, when a fertilised egg implants outside the womb for example in the fallopian tube, can cause bleeding but are less common than miscarriages.  It's a dangerous condition because the fertilised egg can't develop properly outside the womb. The egg has to be removed – this can be through an operation or with medicines.
    •  Causes of bleeding in late pregnancy Cervical changes - can lead to bleeding, particularly after sex.  Vaginal infections  A 'show' - when the plug of mucus that has been in the cervix during pregnancy comes away signalling that the cervix is becoming ready for labour to start. It may happen a few days before contractions start or during labour itself.  Placental abruption - a serious condition in which the placenta starts to come away from the womb wall. Placental abruption usually causes stomach pain, and this may occur even if there is no bleeding.  Low-lying placenta (or placenta praevia) - when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low-lying placenta can be very heavy and put you and your baby at risk. You may be advised to into hospital for emergency treatment and usually a caesarean will be recommended. 
    •  Vasa praevia - a rare condition where the baby's blood vessels run through the membranes covering the cervix. Normally the blood vessels would be protected within the umbilical cord and the placenta. When your waters break, these vessels may be torn and cause vaginal bleeding. The baby can lose a lifethreatening amount of blood. It is very difficult to diagnose vasa praevia, but it may occasionally be identified before birth by an ultrasound scan. Vasa praevia should be suspected if there is bleeding and the baby's heart rate changes suddenly after the rupture of the membranes.
    •  Finding out the cause of bleeding in pregnancy To work out what is causing the bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels. Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness. Sometimes the cause of bleeding cannot be found.  If your symptoms are not severe and your baby is not due for a while, you will be monitored and, in some cases, kept in hospital for observation. How long you need to stay in hospital depends on the cause of the bleeding and how many weeks pregnant you are. Being in hospital enables staff to keep an eye on you and your baby so that they can act quickly if there are any further problems. 
    •  All women, whether they’re pregnant or not, have some vaginal discharge starting a year or two before puberty and ending after the menopause. How much discharge you have changes from time to time and it usually gets heavier just before your period.
    •  Is it normal to have vaginal discharge in pregnancy?     Yes. Almost all women have more vaginal discharge in pregnancy. This is quite normal and happens for a few reasons. During pregnancy the cervix (neck of the womb) and vaginal walls get softer and discharge increases to help prevent any infections travelling up from the vagina to the womb. Towards the end of pregnancy, the amount of discharge increases and can be confused with urine. In the last week or so of pregnancy, your discharge may contain streaks of thick mucus and some blood. This is called a 'show' and happens when the mucus that has been present in your cervix during pregnancy comes away. It's a sign that the body is starting to prepare for birth, and you may have a few small 'shows' in the days before you go into labour. Increased discharge is a normal part of pregnancy, but it's important to keep an eye on it and tell your doctor or midwife if it changes in any way.
    • When GP        to see your midwife or Tell your midwife or doctor if: the discharge is coloured it smells strange you feel itchy or sore Healthy vaginal discharge should be clear and white and should not smell unpleasant. If the discharge is coloured or smells strange, or if you feel itchy or sore, you may have a vaginal infection. The most common infection is thrush, which your doctor can treat easily. You should not use some thrush medicines in pregnancy. Always talk to your doctor, pharmacist or midwife if you think you have thrush. You can help prevent thrush by wearing loose cotton underwear, and some women find it helps to avoid perfumed soap or perfumed bath products.
    •  Find out more about vaginal discharge, preventing thrush and treating thrush.  You should also tell your midwife or doctor if your vaginal discharge increases a lot in later pregnancy.  If you have any vaginal bleeding in pregnancy, you should contact your midwife or doctor. Lots of women lose a small amount of blood during pregnancy, and this is usually nothing to worry about. However, it can sometimes be a sign of a more serious problem such as a miscarriage or a problem with the placenta.
    •  Cramp is a sudden, sharp pain, usually in your calf muscles or feet. It is most common at night. Nobody really knows what causes it, but there are some ideas about causes of cramp and why it can happen in pregnancy.  Avoiding cramp Regular, gentle exercise in pregnancy, particularly ankle and leg movements, will improve your circulation and may help to prevent cramp occurring. Try these foot exercises:  Bend and stretch your foot vigorously up and down 30 times  Rotate your foot eight times one way and eight times the other way  Repeat with the other foot 
    •  How  It to ease cramp usually helps if you pull your toes hard up towards your ankle or rub the muscle hard. You can find out more about treatment of cramp, but remember always to consult your midwife, GP or pharmacist before taking painkillers in pregnancy.
    •  Pregnant women often feel faint. This is because of the hormonal changes occurring in your body. Fainting happens if your brain is not getting enough blood and therefore not enough oxygen.  You are most likely to feel faint if you stand too quickly from a chair or out of a bath, but it can also happen when you are lying on your back.
    • Avoiding feeling faint  Here are some tips to help you cope:  Try to get up slowly after sitting or lying down  If you feel faint when standing still, find a seat quickly and the faintness should pass – if it doesn’t, lie down on your side  If you feel faint while lying on your back, turn on your side  It’s better not to lie flat on your back in later pregnancy or during labour. Find out more about the symptoms that might mean you're going to faint, such as a sudden, clammy sweat, ringing in your ears and fast, deep breathing.
    •  During pregnancy you’re likely to feel warmer than normal. This is due to hormonal changes and an increase in blood supply to the skin. You’re also likely to sweat more. It helps if you:  Wear loose clothing made of natural fibres, as these are more absorbent and breathe more than synthetic fibres  Keep your room cool – you could use an electric fan to cool it down  Wash frequently to help you feel fresh
    •  Incontinence is a common problem both during and after pregnancy. Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they cough, laugh or sneeze, or when they move suddenly, or just get up from a sitting position. This may be temporary, because the pelvic floor muscles (the muscles around the bladder) relax slightly to prepare for the baby's delivery. You can help to prevent incontinence by doing pelvic floor exercises.
    •  When to get help  In many cases incontinence is curable. If you have got a problem, talk to your midwife, doctor or health visitor.
    •  Urinating a lot in pregnancy  Needing to urinate (pass water, or pee) often may start in early pregnancy. Sometimes it continues throughout pregnancy. In later pregnancy it is the result of the baby’s head pressing on your bladder.  How to reduce the need to pass urine  If you find that you need to get up in the night to pass urine, try cutting out drinks in the late evening. But make sure you drink plenty of nonalcoholic, caffeine-free drinks during the day. Later in pregnancy, some women find it helps to rock backwards and forwards while they are on the toilet. This lessens the pressure of the womb on the bladder so that you can empty it properly.
    •  When  If to get help you have any pain while passing water or you pass any blood in your urine, you may have a urine infection, which will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours of first noticing these symptoms. You can find out more about:  Medicines without asking your midwife, doctor or pharmacist whether they are safe in pregnancy.
    •  Hormonal changes taking place in pregnancy will make your nipples and the area around them go darker. Your skin colour may also darken a little, either in patches or all over.  Birthmarks, moles and freckles may also darken. Some women develop a dark line down the middle of their stomach. These changes will gradually fade after the baby is born, although your nipples may remain a little darker.
    •  If you sunbathe while you are pregnant, you may find you burn more easily. Protect your skin with a high-factor sunscreen and don’t stay in the sun for a long time. Find out more about keeping skin safe in the sun.  Hair growth can also increase in pregnancy, and your hair may be greasier. After the baby is born, it may seem as if you are losing a lot of hair but you are simply losing the extra hair.
    • Varicose veins are veins that have become swollen. The veins in the legs are most commonly affected. You can also get varicose veins in the vulva (vaginal opening). They usually get better after the birth.  If you have varicose veins you should:  Try to avoid standing for long periods of time  Try not to sit with your legs crossed  Try not to put on too much weight as this increases the pressure  Sit with your legs up as often as you can, to ease the discomfort  Try support tights, which may also help to support your leg muscles – you can buy them at most pharmacies 
    •  Try sleeping with your legs higher than the rest of your body – use pillows under your ankles or put books under the foot of your bed do foot exercises and other antenatal exercises such as walking and swimming, which will all help your circulation  Try these foot exercises:  Bend and stretch your foot up and down 30 times  Rotate your foot eight times one way and eight times the other  Repeat with the other foot