minor disorders of pregnancy are complaints that are not life threatening like morning sickness, pica, fatigue, heart burn, leg cramp, pelvic pain, leg edema etc.

1. MINOR DISORDERS OF
PREGNANCY
(By Shegaye Y.)
August, 2021
16-Mar-20 1

2. Minor Disorders of Pregnancy
• These are disorders that only occur during
pregnancy and are not life threatening.
16-Mar-20 2

3. Common minor discomforts of pregnancy
1. Nausea/vomiting (1st TM)
2. Urinary frequency (1st & 3rd TM)
3. Heartburn
4. Pica.
5. Fatigue (1st & 3rd TM
6. Low Back pain & Pelvic Girdle Pain
7.. Leg cramps
8. Fainting
9. Constipation/ hemorrhoids
10. Varicose Veins And Leg Edema
11.Sleep Disturbance
6-Mar-20
3

4. 1. Morning sickness/Nausea and vomiting
• Presents between 4 and 12 weeks gestation (the 9th
wk↑→ the 12th wk↓).
• The Nausea is probably related to rapidly rising serum
levels of HCG hormone and delayed gastric emptying
(Progesterone )
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5. 1.Nausea &Vomiting/morning sickness
(cont’d)
– It is usually most severe in the morning but can occur
at any time.
– Precipitated by cooking odors & pungent smells.
– Extreme Nausea & Vomiting may be a sign of
multiple gestation or molar pregnancy.
– Protracted vomiting associated with DHN and
ketonuria (hyperemesis gravidarum) may require
hospitalization.
16-Mar-20 5

6. 1.Nausea &Vomiting/morning sickness
(cont’d)
Management
• Small & frequent meals
• Eat slowly
• Emotional support.
• Addition of high-dose vitamin B6 therapy
• Reduce fatty and fried containing foods.
• Drink soups & liquids b/n meals to avoid stomach
distention & DHN.
• Avoid offensive foods or cooking odors
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7. 1.Nausea &Vomiting/morning sickness
(cont’d)
• Eat a few bites of soda cracker or dry toast before
getting out of bed in the morning
• Get out of bed slowly
• Pharmacological treatment may be required if
non-pharmacological methods are unsuccessful.
Antiemetic medications
 Pyridoxine (vitamin B)
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8. 2. Urinary Tract
 Urinary frequency
• Bladder Irritability
• Occur b/c of increased bladder circulation and pressure
from the enlarging uterus.
 UTI
• Must always be ruled out b/c pregnant women are more
likely than Non Pregnant women to have significant
bacteriuria which may be asymptomatic.
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9. 2. Urinary Tract (cont’d)
Asymptomatic bacteriuria can also lead to
pyelonephritis, which is associated with
• Miscarriage
• Preterm birth
• Intrauterine fetal demise
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10. 2. Urinary Tract con’t…
 Management of Urinary Frequency
• Minimizing and Promoting Elimination
– Instruct the woman to limit fluid intake in evening
and void before going to bed.
– Encourage to void when she feels urge & after
sexual intercourse.
– Encourage to wear loose-fitting cotton underwear.
– Caffeine should be avoided.
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11. 3. Heart burn/ Gastro- Esophageal Reflux
• It is a burning sensation in the mid chest region due
to the effect of hydrochloric acid on the esophagus
• It is common in pregnancy and can occur in all
trimesters, with increasing severity in later pregnancy.
• Progesterone relaxes the cardiac sphincter of the
stomach.
• Allows reflex of gastric contents into esophagus.
• It can lead to a burning or painful sensation in the
upper part of the digestive tract and the throat.
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12. 3. Heart burn con’t…
Management:
• Small and frequent meal/avoid over-distension
of the stomach
• Sleeping with more pillows than usual.
 Lying on the left side has been shown cause less
frequent reflux
 Encourage an upright position where possible,
 Avoiding lying down after meals
 For persistence/sever case/ prescribe antacids
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13. 4. Pica
• Mother craves certain foods of unnatural
substances such as coal, soil...etc.
• The cause is unknown
• But hormones & changes in metabolism are
blamed.
Management:
• Seek medical advice if the substance craved is
potentially harmful to the unborn baby.
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14. 5. Fatigue
– Fatigue in the first TM is due to increased
Progesterone and its effects on the sleep center.
– Fatigue in the third TM is due mainly to carrying in
increased weight of the pregnancy.
– Teach the woman reasons for fatigue, and have her
plan a schedule for adequate rest.
– Inability to sleep may be due to excessive fatigue
during the day.
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15. 5. Fatigue (Cont’d)
• In the latter months of pregnancy, sleeping on the
side with a small pillow under the abdomen may
enhance comfort.
• Frequent 15 to 30-mins rest periods during the day
are important to avoid over fatigue.
• The woman should avoid standing for prolonged
periods, especially during the third trimester.
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16. 6. Low Back pain & Pelvic Girdle Pain
• The hormones sometime soften the
segments to such a degree that some support is
needed.
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17. 6. Low Back pain &Pelvic Girdle Pain
• It refers to pain in the symphysis pubis and/or pain in
the region of one or both of the sacroiliac joints, and
pain in the gluteal region.
• Pain is often aggravated during standing, walking,
sitting, twisting and turning while in bed.
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18. 6. Low Back pain &Pelvic Girdle Pain
Management
• Advice the mother to sleep on firm bed.
• Advice support mechanisms of the back.
• Teach the woman to wear comfortable, low-heeled
shoes (Wear flat shoes)
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19. 7. Leg Cramps
• Leg cramps and restless leg syndrome can occur at
any time, but usually occur at night
• It may effect up to 30% -50% of pregnant women,
especially in the third trimester.
• The cause of leg cramps in pregnancy remains
unclear, although suggested reasons include
metabolic disorders, inactivity or excessive
activity, imbalances of electrolytes, vitamin
deficiency or hyperactive lower motor neurons.
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20. 7. Leg Cramps (cont’d)
Management
• Currently no evidence on alternative therapies
(massage, stretching, relaxation or heat),
• For some women, calcium, magnesium or
vitamin B supplementation may be effective
• Instruct the woman to Dorsiflex the foot while
applying pressure to the knee to straighten the leg
for immediate relief of leg cramps.
16-Mar-20 20

21. 8. Fainting
• Fainting could occur as a result of anemia, cardiac
impairment, sudden change in posture,
• In early pregnancy due to the vasodilatation under the
influence of Progesterone before there has been a
compensatory increase in blood volume.
• Wight of the uterine contents presses on the inferior
vena-cava & slows return of blood to the heart.
Management:
• Avoid long period of standing
• Sit or lie down when she feels slight dizziness
• She would be wise not to lie on her back except during
abdominal examination.
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22. 9. Constipation
• Progesterone causes relaxation & Decreased
peristaltic activity of the gut, which is also
displaced by the growing uterus.
Management:
– Increase the intake of fluid
– Fresh fruit, vegetables & ruphages in the diet daily
– Daily Exercise is helpful specially walking
– Establish regular patterns of elimination
– bulk-forming agents may be prescribed if indicated.
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23. 10. Varicose Veins And Leg Edema
• These are engorged superficial veins on the legs,
the vulva and the anus.
• The anal ones are known as hemorrhoids.
• The increase in blood volume during pregnancy
and effect of progesterone relaxing the muscular
walls of the veins causes increased pressure on the
veins.
• Prolonged standing tends to worsen varicose
veins.
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24. 10. Varicose Veins And Leg Edema (cont’d)
Management:
• Varicose veins often improve 3 to 4 months following
birth, and oedema generally reduces soon after birth.
• Exercising the calf muscles by rising on the toes
• Elevate the leg and rest on the table
• Support tights and legs
• Avoid constipation and advise adequate fluid intake.
• Sanitary pad give support for vulva varicosities
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25. 11. Sleep Disturbance
• It is more usual in late pregnancy.
• Result of some of the above disorders (e.g. leg
cramps, pelvic/back pain, reflux),
• 3
• Anxiety, nocturia, and fetal activity is that
sleep can be disturbed in pregnancy.
• Insomnia can be associated with hormonal and
mechanical changes in pregnancy.
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26. 11. Sleep Disturbance (Cont’d)
 Management
Forming sleep/wake habits and modifying
sleep environment
Avoiding caffeine and passive smoking
Relaxation techniques, massage, heat and
support for lower back pain
Limiting fluids in the evening.
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27. References:
1. Current 11th edition, common disorders of
pregnancy.
2. https://www.isalihospitals.com
3. https://www.kemh.health.wa.gov.au
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