This is a slide presentation of minor ailments/discomfort that is experienced by women during pregnancy. I only focus on changes in genitourinary system as I was assigned on the system. There are a few of nursing management in the slide. Hopefully my slide can help the other medical student (especially nursing) to get some ideas from it.

1. BSCN 3014
OBSTETRIC & GYNAECOLOGY
MINOR AILMENTS
“GENITOURINARY SYSTEM”
Prepared by:
Nur Amira Binti Ahmad
3067141001
Bachelor of Science In Nursing (Hons)
KPJ Healthcare University College
Lecturer:
Madam Norjana 1

2. Learning Objectives:
At the end of this presentation, student should be able to:
1) Understand the normal anatomy and physiology of genitourinary system
2) Discuss the changes of genitourinary system during pregnancy
3) Discuss the expected changes of genitourinary system during pregnancy
4) Explain the minor ailments of genitourinary system changes during
pregnancy
5) State the complications of genitourinary changes during pregnancy
6) Discuss the nursing management
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3. Introduction
■ Every pregnancy is a unique experience for that woman and each
pregnancy that the woman experiences will be new and uniquely
different.
■ “Davis (1996) has stated that the majority of discomforts experienced
during pregnancy can be related to either hormonal changes or the
physical changes related to the growing uterus.” (Myles Textbook for
Midwives, 14th Edition)
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4. Anatomy & Physiology of GU
system
The kidneys are powerful chemical factories that
perform the following functions:
1. Remove waste products from the body
2. Remove drugs from the body
3. Balance the body's fluids
4. Release hormones that regulate blood pressure
5. Produce an active form of vitamin D that promotes
strong, healthy bones
6. Control the production of red blood cells
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5. Changes of GU system during
pregnancy
■ During pregnancy, a striking anatomical changes are seen in the kidneys
and ureters. The kidneys increase in weight and lengthen by 1 cm in order
to compensate with the increase of the demand to kidney to filter the
mother’s waste product and also the fetus.
■ “A degree of hydronephrosis and hydro-ureter exist” (Fetal and Maternal
Physiology, 7th Edition).
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6. Changes of GU system during pregnancy
■ Hydronephrosis is the swelling of a kidney due to a build-up of urine. It
happens when urine cannot drain out from the kidney to the bladder from a
blockage or obstruction.
■ Under the influence of the hormone progesterone, the calyces and renal
pelvis dilates. “The ureters also dilate and lengthen in size and are thrown
into curves of varying sizes. The dilated collecting system can hold 200 to
300mL of urine, leading to urinary stasis. This will increase the risk of
hydronephrosis in pregnant women.” (The National Kidney Foundation,
2017)
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7. (A) Normal kidneys (B) Hydroneprosis and hydroureter GU system
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8. Body system changes
■ Numerous factors affect renal function in pregnancy, including:
■ Increased plasma volume, increased glomerular filtration rate (GFR), increased renal
plasma flow and alterations in hormones such as adrenocorticotrophic hormone (ACTH),
ADH, aldosterone, cortisol, thyroid hormone and HCG. (Steinfeld & Wax 2001)
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9. Body system changes cont…
■ The increase in blood flow is caused by vasodilation in the urinary tract (Campbell & Lees
2000).
■ Early in pregnancy renal blood flow increases to levels 25-50% above non-pregnant values.
Although the increase in blood flow is mainly responsible for the 50% increase in GFR, the
decrease in plasma oncotic pressure and enhanced permeability also increase glomerular
filtration. This cause the pregnant women to urinate more than usual.
■ The GFR returns to non-pregnant values close to term. As tubular reabsorption is unaltered the
clearance of many solutes from the bloodstream is increased.
■ The increased GFR coupled with impaired tubular reabsorption capacity for filtered glucose
results in excretion of glucose (glycosuria) at some time during pregnancy in 50% women.
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10. Body system changes cont...
■ The expected changes of the body system during pregnancy is the increase in bladder pressure
and may result in reduced bladder capacity.
■ This can lead to stress incontinence in pregnant women. To compensate for this problem, the
urethra lengthens and intra-urethral pressure increases.
■ The muscles of the internal urethral sphincter relax, which, along with pressure from the
pregnant uterus on the bladder, causes a significant number of women to experience some
degrees of stress incontinence.
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11. Body system changes cont…
■ Water and sodium excretion are significantly reduced when the women is in the upright position or
changes from a recumbent to a supine position, owing to reduce venous return to the heart and
therefore reduced renal perfusion.
■ Posture does effect the circadian rhythms of sodium excretion.
■ Fluid retained in the legs and feet during the day (edema) is absorbed into the blood circulation when
her legs are raised in bed. The kidneys extract the excess fluid and turn it into urine, so the bladder
fills more quickly at night.
■ This reversal of the non-pregnant diurnal pattern of urinary flow causes nocturia and the urine is
more dilute because of the excretion of extracellular fluid of relatively low osmolality (Cunningham et
al 1997).
■ It follows therefore that increased rest during the day in the recumbent position will lead to excretion
of maximum amounts of urine in the middle of the day.
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12. Minor Ailments
■ Frequent urination
■ Needing to urinate often is normal, especially in the first and last months of pregnancy.
■ Growing uterus presses against the bladder.
■ In late pregnancy, a woman often has to get up during the night to urinate, because fluid
retained in the legs and feet during the day (edema) is absorbed into the blood circulation
when her legs are raised in bed.
■ The kidneys extract the excess fluid and turn it into urine, so the bladder fills more quickly at
night.
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13. Minor Ailments cont…
■ Nocturia, or nocturnal polyuria (Excessive urination during the night)
■ During sleep time, body produces less urine that is more concentrated. This means that most
people don’t need to wake up during the night to urinate and can sleep uninterrupted for six to
eight hours.
■ Pregnant women will feel the urge to go more often because of hormonal changes and
increased blood flow through the kidneys.
■ Antenatal tend to drink more fluids during pregnancy, which may also play a part.
■ Waking up needing micturition is most likely to disturb sleep pattern in the first trimester and
third trimester of pregnancy.
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14. Minor Ailments cont…
■ Urinary incontinence
■ This condition often has serious effects on the lives of many individuals who
suffer from embarrassment, stigma, physical discomfort and social isolation.
■ Stress incontinence are most common during pregnancy. It occurs while
lifting, exercising, laughing, sneezing and coughing which commonly occurs in
women, and presumptively the effect of pregnancy and childbirth; and/or
hormonal imbalance during menopausal stage.
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15. Complication
1) Urinary tract infection: Pregnancy increases the risk of urinary tract infection (UTI). Both
progesterone and estrogens levels also increase during pregnancy and these will lead to
decreased ureteral and bladder tone. An incontinence may result which lead to UTI.
Urethrocystitis which is a lower tract infections and pyelonephritis, infection of the upper urinary
tract may develop initially during pregnancy.
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16. NURSING MANAGEMENT
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17. 17
1. Teach the mother to lean forward while urinating
Leaning forward will help to empty out the bladder in a better
way and also makes it to the last urine drop by double-voiding.
2. Emphasize the mother to avoid diuretics beverages
Avoid beverages like tea, coffee or alcohol as they are diuretic
in nature.
3. Explain to the mother to not take excess fluids before
bedtime
Educate the mother to cut back on the fluids before going to
bed but make sure to drink more water during the day.
Frequent Urination

18. 18
4. Encourage mother to do kegel exercises
Kegel exercises help to gain control over the urethra by
strengthening the pelvic floor muscle.
5. Teach the mother to empty the bladder
Try to clear out the bladder before going out or sleep.
6. Wear A Pad
Wear a sanitary pad especially if the mother have a cough or
sneeze. Coughing, sneezing or activities like lifting heavy
objects may sometimes cause leakage, and it may embarrass
and lowering self-esteem of the mother.
Frequent Urination

19. 19
1. Assessment for urinary incontinence:
Includes the number of times and frequency of micturation, characteristics of urine, to evaluate urinary
incontinence.
2. Promoting urinary continence:
Initiate bladder training by providing schedule with specified time for the patient to void. Other measures
can be helpful to promote voluntary urination are, suprapubic tapping or stroking of the inner thigh may
produce voiding by stimulating the voiding reflex arc. Listening to running water or perineal wash with
lukewarm water will also help.
3. Promoting hygiene, skin care and preventing infection:
Hygiene and skin care is strictly observed for patients with urinary incontinence. Skin care and perineal care
should be done every after voiding using non-allergenic soap with lukewarm water. Always pat dry the
perineal area.
Urinary Incontinence

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4. Provision of comfort:
When incontinence pads are used, they should wick moisture away from the body to minimize
contact of moisture and excreta with the skin. Wet incontinence pads must be changed
promptly, the skin cleansed, and a moisture barrier applied to protect the skin.
5. Promoting role performance, promoting body image and relieving anxiety and stress:
Privacy should be provided during voiding efforts. Promote positive feedback and optimistic
attitude to reinforce patient’s ego and esteem. Periods of continence and successful voidings
are positively reinforced.
Urinary Incontinence

21. 6. Maintaining hydration:
Monitoring intake and output is necessary to assess hydration. Signs and symptoms of good hydration and
dehydration should be assessed and monitored every shift. Sufficient fluid intake (2000 to 3000 mL/day
according to patient needs) must be ensured to maintain hydration.
7. Promoting sleep and rest:
Fluid intake should be consumed before evening to minimize the need to void frequently during the night
which can disturb the time to sleep and rest for the patient.
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Urinary Incontinence

22. Conclusion
■ Minor ailments are generally defined as conditions that will resolve on their own and
can be reasonably self-diagnosed.
■ The minor ailments or discomforts experienced by pregnant women such as urinary
frequency, nocturia and incontinency are probably a result of a combination of factors
such as the change in sleeping patterns, pressure effects of the enlarging uterus on
the bladder, reduced bladder capacity due to increased pressure and most
importantly the great effect of the hormonal changes, progesterone which causing
vasodilation and cause some internal structures to increase in size, including the
uterus.
■ The problems arising can be managed by the common method practiced to decrease
the urge of micturition like kegel exercise which help to strengthen the pelvic muscle,
emptying the bladder before bed time and the use of sanitary pad for stress
incontinence help to preserve the pregnant mother’s self-respect.
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23. References
■ Book
1) Fraser, D. and Cooper, M. (2003). Myles textbook for midwives. 14th ed. Edinburgh: Churchill Livingstone.
2) Hanretty, K., Ramsden, I. and Callander, R. (2010). Obstetrics illustrated. 1st ed. Edinburgh: Churchill
Livingstone Wordmark.
3) Willson, J., Carrington, E., Laros, R., Ledger, W. and Mattox, J. (1991). Obstetrics and gynecology. 1st ed. St.
Louis: Mosby-Year Book.
■ Internet
1) Das, M. and Das, M. (2017). Frequent Urination in Pregnancy - Kegel Exercises, Treatment. [online] Appletail.
Available at: http://appletail.com/articles/frequent-urination-in-pregnancy-kegel-exercises-treatment/
[Accessed 14 Jan. 2017].
2) George A. DeMaagd, T. (2017). Management of Urinary Incontinence. [online] PubMed Central (PMC). Available
at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411204/ [Accessed 14 Jan. 2017].
3) Healthline. (2017). Excessive Urination at Night (Nocturia). [online] Available at:
http://www.healthline.com/health/urination-excessive-at-night#Overview1 [Accessed 14 Jan. 2017].
4) NATIONAL ASSOCIATION FOR CONTINENCE | LEARN ABOUT INCONTINENCE CAUSES AND TREATMENTS.
(2017). NOCTURIA | CAUSES AND TREATMENTS. [online] Available at: http://www.nafc.org/nocturia/
[Accessed 14 Jan. 2017].
5) Patient. (2017). Stages of Pregnancy. First Stages and More. Pregnancy Info | Patient. [online] Available at:
http://patient.info/doctor/physiological-changes-in-pregnancy [Accessed 14 Jan. 2017].
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24. Thank you for “LISTENING”
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