Minor do of px

CHAPTER ONE
ABNORMAL PREGNANCY
BY GEBREMARYA TEMESGEN BSC MW 1

MINOR DISOEDERS OF
PREGNANCY
BY GEBREMARYA TEMESGEN BSC MW
2

Minor Disorders of Pregnancy
• Are only minor and are not life threatening
• But may escalate and becomes serious.
complications of pregnancy( e.g. hyperemisis
gravidarum can arise from morning sickness).
Causes of minor disorders can be divided in to:
1. Hormonal changes: e.g. Nausea & vomiting
2. Accommodation change: e.g. frequency of
micturition
BY GEBREMARYAM TEMESGEN BSC MW 3

Minor cont..
3. Metabolic changes: e.g. pica and
4. Postural changes: e.g. back ache
Note: Every system of the body adjusts and is
affected by pregnancy
A. Digestive System
1. Nausea & Vomiting (Morning Sickness)
– Complicates about 70% of all pregnancies.
– Present b/n 4th and 16th week of pregnancy
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Minor cont…
- Associated with high level of human chorionic
gonaodotropin hormone (hCG), estrogen and
progestron.
- Not confined to early morning, can occur at
any time in the day
- Can persist and become hyperemisis
gravidarum.
NB: Beware to rule out other causes of vomiting
e.g. appendicitis.
5

Minor cont…
Treatment of Nausea & Vomiting
• Reassure the mother that the symptoms will soon
settle.
• Advise to eat small and frequent meals and to
avoid fatty foods.
• Advise to eat dry foods before getting out of bed.
E.g. ‘Kollo’
• Avoid liquid with meals.
• Rise slowly from lying or sitting.
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Minor cont…
2. Heart Burn
Is a burning sensation in the mediastianal region
resulted from:
• Relaxation to smooth GI muscles and cardiac
sphincter of the stomach allowing gastric
reflux of stomach contents to the lower
esophagus.
• Displacement of stomach and duodenum by
enlarging uterus (30 – 40 weeks)
7

Minor cont…
Treatment of Heart burn
• If the heart burn is occasional advise the
woman to:
– Avoid bending over while house keeping
– Avoid kneeling to clean the bath
– Eat small and frequent meals
– Seep with extra pillows
– Avoid fried or spicy foods
– Avoid citrus fruits
8

Minor cont…
Treatment of Heart burn cont..
• If the heart burn is persistent:
– The above advise plus anti acids e.g. MTS(Magnesium
trisilicate). Do not give Al2(OH) as it can cause or
exacerbate constipation.
3. Constipation
Cause: Relaxed gut smooth muscles due to the
effect of the hormone progesterone decreased
peristalsis delay in emptying  much water is
re absorbed  constipation.
Oral iron can exacerbate
9

Minor cont…
Treatment of constipation
• Increase intake of water(6 – 8 glasses per day)
• High residue diet(fresh vegetables)
• A glass of warm water in the morning
• Exercise. E.g. walking
NB: Constipation can aggravate hemorrhoids
10

Minor cont…
4. Excessive Salivation (Ptyilsm)
Cause: Difficulty in swallowing caused by the
nausea and not because of the excess production
of saliva
• Occurs from 8 weeks
Treatment:
- Practice good oral hygiene - Suck hard candy
- Avoid excessive starch intake
- Eat Kollo
11

Minor cont…
5. Pica:
Is a persistent carving and compulsive consumption
of substances such as coal, soup, or clay etc.
Causes: Many theories
1. Nutritional deficiency
2. Cultural
Rx: Advise the mother that the act can harm her
and her fetus( electrolyte imbalance, metabolic
disturbance may occur)
12

Minor cont…
6. Gingivitis
Cause:
Hypertrophy of gums due to estrogen effect
Rx:
• Tooth brush
• Oral hygiene
• Reassurance
13

Minor Cont…
7. Hemorrhoids
Cause: Progesterone related
Treatment: Avoid constipation
B. Musculoskeletal System
1. Back ache
Cause: Softened ligaments due to progesterone
and relaxin effect.

Minor cont…
Treatment of back ache
• Correction of posture( advise to sleep on a
firm mattress and sit on upright chair).
• Avoid high heeled shoes.
• Use leg muscle while lifting objects.
• Avoid lifting heavy objects.
• Reassurance and rest.
NB: Rule out UTI and onset of labour.
15

Minor Cont…
2. Leg Cramps:
Cause: Unknown may be de to change in PH
Management: Advise the mother to:
• Raise the foot of the bed about 25 cm.
• Keep legs warm.
• Get regular exercise, walking.
• Stand on the affected leg to strengthen
muscles.
16

Minor Cont….
C. Genitourinary System
1. Frequency of maturation:
• Occurs early pregnancy from 6 – 12 weeks and
in late pregnancy after lightening has occurred.
Cause: Pressure on the urinary bladder from the
growing utters or fetal head.
Rx: Reassure the woman
NB: exclude other causes. E.g. UTI.
17

Minor Cont…
Genitourinary cont..
2. Leucorrhoea: This is a term used to describe increased,
white, non offensive, non itchy vaginal discharge in
pregnancy.
Cause: Desquamation of the superficial cells of the
vagina.
Rx: -Reassurance
- Personal hygiene, washing with plain water 2x per
day. Do not use soap.
- Cotton underwear , avoiding tights, exclude other
causes.
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Minor Cont…
D. Circulatory System
1. Fainting
Cause:
i. In early pregnancy: Vasodilatation before the
compensatory increase in blood volume
ii. In late pregnancy: laying flat on back( Supine
hypotensive syndrome)
Rx: - Avoid long period of standing
-Avoid laying on back except during abdominal
exam
19

Minor cont…
1. Management of fainting cont…
- Turn the mother quickly to the left lateral side
when she feels faint during abdominal
examination.
- Avoid sudden change in position.

Minor Cont…
Circulatory cont…
2. Varicosities:
Cause:
• Progesterone relaxes the smooth muscles of
the veins and results in sluggish circulation.
• The valves of the dilated veils becomes
inefficient + pressure from the gravid uterus
and results in varicosities.
21

Minor Cont…
Usual sites of Varicose vein:
• Legs
• Anus (Hemorrhoids)
• Vulva
- Hemorrhoids can be complicated by constipation
- Woman with family history of varicose vein, and
those doing work which demands long period of
standing or sitting are at high risk to develop
varicosities.
22

Minor Cont…
Management of Varicosities:
• Avoid long period of standing
• Elevate legs when sitting
• Wear support tights or stockings
• Avoid sitting on the edge of the bed or chair
• Hospital delivery for vulval and hemorrhoids.
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Minor Cont…
• E. Intrigumentary System
1. Skin Changes
– Linea nigra
– Chloasma
– Areola
Management
- Reassure the mother that they are signs of
pregnancy and settle soon after delivery
24

Minor Cont…
Intrigumentary cont…
2. Itching of the skin
• Often starts over the abdomen
• May be due to the liver hormones responding
to pregnancy hormones
• Clear as soon as the baby born
Rx: Antihistamines e.g. chloropheniramine.
For vulval itching R/O candidiasis
25

Minor cont..
F. Nervous System
1. Carpal tunnel Syndrome/CTS/
• Is a sensation of numbness and pins’ and
needles’ in the fingers and hands.
Cause: Pregnancy hormone(progestron)  fluid
retention  edema pressure on the
median nerve numbness.

Minor Cont…
Management of CTS
1. Anti pain
2. Wearing of split at night with hands resting
high on two or three pillows may bring relief.
3. Diuretics may e needed
It usually resolves spontaneously following
delivery.

Minor Cont…
CNS Cont..
2. Insomnia(Sleeplessness)
Causes:
A. Physical Reasons
– Nocturnal frequency
– Difficulty in getting comfortable in bed b/s of the
growing uterus
B. Psychological reasons: Anxiety
C. Hormonal reasons: May contribute to
depression
28

Minor Cont..
Management of Insomnia
• Never dismiss lightly
• Ask what she has been dreaming and discuss
and reassure
• Small pillow under the abdomen and lying in
the lateral position
• Consider psychiatric unit if it seems
‘abnormal’
29

Hyperemesis gravidarum (HEG)
30

Hyperemisis gravidarum
• Hyper emesis gravidarum
Definition: Vomiting that starts before 20th
week of pregnancy, severe enough to cause
electrolyte, metabolic and nutritional
imbalance in known as hyperemisis
gravidarum
• It is a rare case but can cause
– Dehydration
– Electrolyte imbalance
– Keto - acidosis
– Weight loss.
31

HEG Cont..
Incidence:
1 in 1000 pregnant women.
Causes:
• The cause is unknown but can be associated with
condition of high HCG and estrogen level
– Multiple pregnancy
– Hydatidiform mole
– A history of unsuccessful pregnancy and
– First pregnancy
Note - A women who experience hyper emesis
gravidarum will have a recurrence in subsequent
pregnancy.

HEG Cont...
Assessing the mother condition
• Ask the women whether normal diet has been
resumed & tolerated.
• Identify any event producing stress or anxiety
as these may exacerbate any vomiting.
• Ascertain whether the nausea or vomiting is
accompanied by pain of the location of any
pain should be elicited.
33

HEG Cont........
• Dryness or inelasticity of the skin
• The mothers weight will be less than expected
for gestation
• The pulse rate will be weak & rapid & the
blood pressure will be low.
• Urine will be scant & dark in color & contain
acetone
34

HEG Cont…
S/S of HEG:
• Rapid pulse rate
• Low BP
• Dry and furred tongue
• Her breath smells like Acetone
• The pt becomes weak
• Sunken eyes
• Elevated HCT
• Ketonuria
• Wt loss
• Inelastic skin teeth covered by sordes
35

HEG Cont...
Management:
• Keep the woman NPO
• Reassurance
• Correct the electrolyte imbalance by intravenous fluid therapy (Na+
& K+ level)  continuous the infusion until hydration & electrolyte
returns to normal.
• Glucose to correct Ketoacidosisis
• Anti emetics like promethazine may be used if vomiting persists
• Sedatives to produce rest
• Administer vitamin B12, C, Folic acid & iron to correct the anemia.
• Observe the BP, Pulse rate & To at least 4hrly
36

HEG Cont.....
• Order urine test twice/ day for - specific gravity
– Acetone,
– Sugar &
– Protein
• Measure intake & out put of fluid, includes vomits
Note:
• If vomiting is ceased for 24 hrs oral fluid can be started
& if this is tolerated a high carbohydrate diet may
follow
• Then normal food is gradually introduced & IV therapy
will be discontinued.
37

HEG Cont…
DDx:
• UTI, Appendicitis acute polyhydramnious,
preeclampsia, acute intestinal obstruction,
torsion of the ovarian cyst etc…
NB: Beware to exclude obstetric causes like
• Multiple pregnancy and
• Hydati form mole
38

Minor do of px

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