2. 1. NAUSEA AND VOMITING.
• Present between 4-16 weeks gestation.
• Causes:
• (a).Hormonal influences most likely.
• (b).Human chorionic gonadotrophin in
large amounts.
• (c).Estrogen and progesterone
contribute.
• (d).Hypoglycemia
3. Ct nausea and vomiting.
• Symptoms:
• May occur in morning or anytime
during the day.
• The smell of food and cooking may
worsen.
• Management.
• Explain probable reason.
• Give estimated duration.
4. Ct on mgt of nausea and
vomiting.
• Small frequent meals.
• Rest, lie down.
• Hard candy e.g. biscuits and roasted
maize.
• Pyridoxine ( vitamin B6) 10 to 25 mg tid or
50mg bd.
• Carbonated beverages.
• Investigations: malaria, food poisoning,
appendicitis. Need to rule out other
causes.
5. 2. BACKACHE.
• (a).Upper backache due to increase
size and heaviness of the breast. Use
well fitting and supportive bra.
• (b).Low back pain in lumbosacral
region.
• - Increases as pregnancy progresses.
• - Due to the shift in the mother’s
centre of gravity.
6. Management of backache.
• Massage.
• Application of heat or cold.
• Hydrotherapy.
• Good posture and body mechanics.
• Pillow in lumbar area when sitting or
between legs when lying on side.
• Use of exercises pelvic tilt.
8. 3. FATIGUE.
• First trimester no known reason or
cause.
• May be due to initial fall in the basic
metabolic rate.
• Usually disappears by the end of first
trimester.
• Management.
• Reassure that this is normal first
trimester problem and will pass.
9. Ct on mgt of fatigue.
• Mild exercise and good nutrition.
• Decrease activities and plan rest.
• Decrease fluid intake in the evening to
decrease the number of times getting
up to go to the bathroom.
10. 4. HEARTBURN.
• Most troublesome 30-40 weeks.
• Causes:
• - Progesterone relaxes the cardiac
spincter.
• - Reflux of gastric contents into the
oesophagus.
11. Management of heartburn.
• Small frequent meals.
• Decrease amount of fluid taken with
meals, drink fluid between meals.
• Fresh juice.
• Lying on the right side.
• Elevate head of the bed.
• Antacid may be prescribed for
persistent problems.
12. 5. CONSTIPATION.
• Causes:
• Progesterone causes relaxation and
decreased peristalsis of the gut.
• Displacement and compression of the
bowel by the growing uterus.
• Management:
• Increase fluid intake.
• Increase roughage.
13. Ct on management of
constipation.
• Fruit juices.
• Encourage exercise.
• Drink a warm beverage in the morning.
• Investigations:
• Cause may be related to intake of iron
tablets.
• Full rectum may cause delay in
engagement of fetal head.
14. 6. HEMORRHOIDS.
• Dilatation of veins in anal region.
• Causes:
• Proceeded by constipation.
• Progesterone causes relaxation of the
vein walls and of the large bowel.
• Increase pressure on the hemorrhoidal
vein from growing uterus.
15. Management of hemorrhoids.
• Avoid constipation.
• Elevate hips with pillow or knee-chest
position – help venous return.
• Do not strain while having bowel
movement.
• Compresses.
• Reinsert the hemorrhoid with a lubricated
finger.
• Analgesic ointments.
16. 7. PTYALISM.
• Excessive salivation.
• Occurs from 8 weeks gestation and
thought to be caused by hormones of
pregnancy.
• May be caused by an increase intake
of starch.
• Best treated by listening and explaining
cause, use dry candies.
17. 8. PICA.
• The craving of certain foods of
unnatural substances like coal.
• Cause unknown, by hormones and
changes in metabolism are possibilities.
• Management:
• Seek medical help if substance is harmful.
18. 9. VARICOSITIES.
• Dilated veins on external genitalia, or
legs.
• Cause:
• Progesterone relaxes smooth muscles
of the veins.
• Sluggish circulation.
19. Those at risk for varicosities.
• Family history.
• Work which demands long periods of
standing.
• Management.
• Supportive stockings or ace wraps
before rising in the morning.
• Avoid wearing constrictive clothing.
20. Ct Management of varicosities.
• Rest periods with legs elevated.
• Avoid crossing legs.
• Beware of risk from a ruptured vein
during delivery.
21. 10. LEG CRAMPS.
• Pain on legs.
• Causes unknown changes in ph or
electrolytes.
• Management:
• Massage the affected leg.
• Flex ankle to stretch calf ( dorsi flex
the foot ).
• Keep legs warm, walk exercise.
22. 11. FAINTING.
• Client may feel dizzy as well.
• Causes:
• Vasodilation due to progesterone.
• Laying flat on back in later pregnancy
due to pressure on the vena cava.
• Management:
• Change positions slowly.
• Increase fluids.
• Avoid lying flat on the back.
• Avoid prolonged standing or sitting.
23. 12. FREQUENCY OF
URINATION ( MICTURITION).
• Cause: Growing fetus still situated in
the pelvis pressure on bladder.
• In later weeks due to increase size
and pressure of uterus on bladder.
• Management:
• Explain causes, decrease fluids in the
evening, avoid caffeine, rule out infection
if other signs present.
24. 13. INSOMIA.
• Sleeplessness.
• Causes:
• Difficulty in getting comfortable due to
increase size.
• Movement of baby.
• Increased anxieties of pregnancy.
25. Management of insomnia.
• Warm bath.
• Warm drink at bedtime not caffeine.
• Relaxation before trying to sleep.
• Avoid oversleeping in daytime.
26. 14. PRURITIS.
• Itching.
• Cause thought to be due to the liver’s
response to hormones in pregnancy.
• Management:
• Explanation will be relieved with delivery.
• Local application of lotion.
• Piriton often prescribed.
• If complaint of vulval itching check for
signs of infection or glycosuria.
27. 15. CARPAL TUNNEL
SYNDROME.
• Tingling of hands and fingers.
• Usually happens in the morning, can
occur anytime.
• Cause: Fluid retention creates edema
and pressure on median nerve.
28. Management of carpal tunnel
syndrome.
• Good posture.
• Lying down.
• Rest and elevation of affected arm.
• Cold application.
• Wrist splints.
• Usually resolves spontaneously after
delivery.
