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Minor disorders of
pregnancy
Shrooti Shah
Introduction
• Many women experience some minor disorders
during pregnancy.
• Every system of the body may be affected during
pregnancy. These disorders, however , are not
minor to the pregnant woman.
• Most of the disorder of pregnancy is a result of the
minor disorder that may occur due to hormonal
changes, accomodation changes , metabolic
changes and postural changes and are fairly
specific to each of the three trimester.
Common disorders or
discomforts during pregnancy
• Digestive system disorders
– Nausea/vomiting (morning sickness)
– Heartburn
– Excessive salivation/ptyalism
– Pica eating
– Constipation
– Hemorrhoid
Common disorders or
discomforts during pregnancy
• Musculoskeletal system
– Backache
– Cramping legs
• Genitourinary system
– Frequency of micturation
– Stress incontinence
– Leucorrhoea
Common disorders or
discomforts during pregnancy
• Circulatory system disorders
– Postural hypotension
– Fainting
– Varicosity
• Nervous system disorders
– Carpal Tunnel syndromes
– Insomnia
Common disorders or
discomforts during pregnancy
• Integumentary system disorders
– Skin changes
– Itching
• Respiratory system
– Shortness of breath
– Nasal stiffness and epistaxis
Morning sickness
• Common symotms of nausea and
vomiting usually during the first
trimester of pregnancy.
• It may occur usually in the morning
but may occur at any time during the
day.
• It occurs in over 50 to 85% of the
pregnancies.
• For 80% of sufferers, this condition
stops around t he time of the 12th-
14th week
•
• However, 20% will suffer from nausea
and vomiting for a loner period.
Causes
• Sudden rise of HCG and estrogen in the
blood stream, which stimulate the
chemoreceptor (trigger zone in the brain
and initiate nausea and vomiting
• Increased sensitivity to smell
• Smooth muscle relaxation
• Emotional factors
• Slower emptying of the stomach during
labour
• fatigue
Risk factors
• Twin pregnancy
• Previous history of nausea and
vomiting
• History of Motion sickness
• Genetic predisposition to nausea
during pregnancy
• History of migraine
Diagnosis
• Medical history
• Physical examination
Prevention
• Medication: well-known over-the-counter
drugs should be administered only when
absolutely indicated and prescribed.
• Drink water or other fluids between meals
to avoid dehydration and acidosis
• Avoid: Disagreeable odors and rich, spicy,
or greasy foods
• Explanation, reassurance, and
symptomatic relief are sufficient.
Prevention
• Eat dry crackers biscuits or dry bread 15
minutes before arising in the morning.
• Avoid personal triggering factors (including
smelling and cooking).
• Avoid overeating fried food, spicy, fried and
and fatty food.
• Eat small, frequent meals
• Avoid lying down immediately after eating
• Avoid brushing teeth after meal
Prevention
• When getting up from the bed, get up slowly
and avoid sudden movements.
• Keep room well ventilated
• Avoid warm places.
• Hospitalization may be necessary to correct
fluid and electrolyte imbalance
• Behavior modification
• Dietary changes
Constipation
• Constipation is a condition of infrequent,
irregular and difficulty in passing stool or
the passing of hard stool.
• It is quite common during pregnancy
• Most commonly occurs during the 2nd -3rd
trimester
Cause
• Atonicity of the gut due to the effect of
progesterone
• Diminished physical activity and
pressure of the gravid uterus on the
pelvic colon
• Sluggish bowel function are the
possible explanations.
• Lack of physical activity and exercise
• Decreased fluid intake
Management
• Mineral oil is contraindicated because it
absorbs fat-soluble vitamins from the bowel
and leaks from the anus.
• Exercise and good bowel habits are helpful
• Eat high fiber foods
• Get regular daily exercise
• Increased fluid intake at least 2000-3000
ml per day
Management
• Chew food thoroughly
• Avoid iron pills.
• Purgatives should be avoided because
of the possibility of inducing labor.
• Emphasize ample fluids and laxative
foods and prescribe a stool softener
• Regular bowel habit may be restored
Acidity and heartburn
• Heartburn is a burning or painful
sensation in the upper part in the
middle of the chest and radiates
upwards, often accompanied by bad
tests in the mouth.
• Common in all trimesters, with
increasing severity in last trimester.
Acidity and heartburn
• Due to relaxation of the esophageal
sphincter
• Most likely to occur when the patient is
lying down or bending over
• In late pregnancy, this may be aggravated
by displacement of the stomach and
duodenum by the uterine fundus
• Heartburn (pyrosis, acid indigestion) results
from gastroesophageal reflux disease
(GERD) in almost 10% of all gravidas
hiatus hernia
Management
• Advice on diet and lifestyle to prevent and
relieve heartburn in pregnancy
• Eat a balanced diet
• Eat small frequent meals
• Identifying foods, which causes heartburn
and avoid foods known to cause gastric
upset
• Not to go to bed immediately after the meal.
Keep her head higher than her stomach
when lying down or sleeping (propped up
position).
• Avoid overeating, eating and drinking
at the same time to reduce stomach
volume.
• Chewing food
• Drink milk and 6-8 glasses of water
daily
• Loose clothing
• Eating fruits such as apple, pineapple
and papaya with meals as they have
digestive enzymes that speed up
Pharmacological intervention
• Antacid preparation
• Calcium and magnesium based
antacid
Pica
• This is the term used when a mother craves
certain foods or unnatural substances such
as coal.
• Most commonly occurs during the 1st-3rd
trimester, and most in 1st trimester.
• Pica is the craving and intentional
consumption of substances not culturally
defined as food.
• The diagnosis of pica is based on an
individual’s report of craving and
intentional consumption of
substances not culturally defined as
food.
Causes
• Unknown
• Possibly influenced by tradition
• Change in the sense of test mouth
• Hormones and changes in metabolism
diagnosis
• History taking: questions asked in
nonjudgmental manner
Prevention and relief
measures
• Explaining the possible harmful effects on
pica on the fetus and suggesting the
alternative behaviors may help.
• If the substance craved is harmful to the
unborn baby, the mother must be helped to
seek medical advice.
• Eat a balanced diet
Indigestion
• Indigestion often occurs after eating
too much of heavy or greasy food or
drinking too much alcohol
• Discomfort or a burning feeling in the
midchest characterizes it
Causes
• Eating too much of heavy or greasy
food or drinking too much alcohol
Prevention and relief
measures
• Eat digestible food
• Avoid overeating fatty, greasy and
spicy food
• Eat small frequent meals
• Avoid alcohol, coffee and cigarette
• Eat boiled food
Excessive salivation
• Increased secretion of salivation is observed
during pregnancy.
• Some women experience ptyalism or
excessive salivation that is unpleasant and
embarrassing.
• Most commonly occurs during the 1st-3rd
trimester
Cause
• Unknown
• Excessive salivation appears to the
stimulation of the salivary gland by eating
an increased intake of starch
Preventive and relief measure
• Use astringent mouthwashes
• Chew gum or suck hard candy
• Limit intake of foods containing starch
Musculoskeletal system
Cramping leg
• Cramp is spasm that occurs when a muscle
contracts too hard.
• A muscle cramp is acute and painful
• They usually occur in the leg, calf muscles
• Mostly occurs at night
• Mostly common in the second and third trimester
and during labour
Causes
• Unknown
• Contributing factors:
– Inadequate calcium intake
– Altered balance in calcium and phosphorous
ratio in the body
– Fatigue, chilling or tense body posture
– Poor circulation to lower extremities due to
pressure to the enlarged uterus on the pelvic
vessels leading to the legs.
– The pressure on the enlarged uterus on the
pelvic nerve leading to the legs
Preventive and relief
measures
• Take enough calcium, eat balanced dier,
make sure include plenty of magnesium,
potassium, folate and vitamin rich well in
diet and supplementary calcium therapy.
• Take frequent breaks from sitting or
standing for long periods
• Take warm bath at bed time
Preventive and relief
measures
• Rest frequently during the day
• Apply a warm cloth or heating pad to the
painful area
• Regular exercises especially walking
• Avoid fatigue and cols
• Change positions frequently during labour
Preventive and relief
measures
• If cramp: straighten the leg, point or
pull toes upward toward the knees.
• Gently massage the cramped muscle.
Walk around when able
Backache
• Many women (45-50%) experience
pregnancy related low back or pelvic girdle
pain, with more than 80% of these women
experiencing difficulties in daily living and
upto 30% requiring bed rest.
• Pelvic girdle pain 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
• Common in second and third trimester
• Pain may be in the lower back and radiate
in legs
Causes
• Physiological changes
– Relaxation of the sacroiliac joint when it
is due to increased hormones
(progesterone) resulting in relaxed the
ligaments and joints in the lower back
and pelvis.
– Shifting of the center of gravity or
increased curvature of the lumbosacral
verterbra caused by enlarged uterus
Causes
• Faulty posture and high heel shoes, muscle
spasm, urinary infection or constipation
• Fatigue, muscle spasm or postural back
strain most often is responsible
• Too much standing in one place or leaning
forward,or hard physical work can cause
pain
Causes
• Pain is aggravated during standing,
walking, sitting , twisting, climbing of
stairs and turning while in bed
• Lifting heavy objects
• Poor sitting position
Diagnosis
• History of back pain
• Physical examination
Prevention and relief
measures
• Improvement in posture is often achieved
by the wearing of low-heeled shoes.
• To achieve proper posture, the abdomen
should be flattened, the pelvis tilted
forward, and the buttocks tucked under to
straighten the back.
• Improvement of posture, well-fitted pelvic
girdle belt which corrects the lumbar
lordosis during walking and rest in hard
Prevention and relief
measures
• Rest with elevation of the legs to flex
the hips may be helpful.
• Excessive weight gain should be
avoided.
Management
• Apply local heat and light massage to relax
tense, taut back muscles.
• Recommend sleep on a firm mattress.
• Back exercises under the supervision of a
rehabilitation physician, an orthopedist, or
a physical therapist.
• Massaging the back muscles, analgesics
and rest
Management
• Maintain correct postures and good body
mechanisms.
• The women should lie in the lateral
recumbent position, with her knees and
hips bent. A pillow can be used to support
the weight of the uterus.
• Encourage the woman’s family members or
friends to massage the woman’s back
Management
• Excessive weight gain should be
avoided,
• Avoid excessive twisting, bending
stretching and standing over a long
period of time.
• Avoid situations that aggravate the
conditions
Management
• Obtain orthopedic consultation if
disability results.
• Note neurological signs and symptoms
indicative of prolapsed intervertebral
disk syndrome, radiculitis.
• Give acetaminophen 0.3–0.6 g orally
or equivalent.
Urinary frequency
• Urinary frequency is a common complaint
throughout pregnancy, especially in the first and
last months because of increased bladder
sensitivity and pressure of the enlarging uterus on
the bladder.
• The condition subsides for a while when the uterus
moves out of the pelvic area into the abdominal
cavity around the 12th week. Frequency reoccurs in
the last trimester as the enlarging uterus begins to
press on the bladder again.
Causes
• Increased intravascular volume, elevated
GFR and an increase in water exertion by
the kidneys in early pregnancy.
• Enlargement of the uterus in pelvis causing
pressure on the bladder.
• Pressure from the fetal presenting part on
the bladder during the third trimester.
Prevention and relief
measures
• Void when urge is felt
• Increased fluid intake
• Perform kegel exercise
• Lean forward when voiding to help
empty the bladder completely
• Limit intake of fluids containing
natural diuretics
Stress incontinence
• Leaking of urine when sneezing,
coughing or laughing.
• Cause
– During pregnancy pelvic floor is stretched
and sometimes damaged. This can lead to
stress incontinence.
– Enlarging uterus and pressure on the
presenting part on the bladder
Prevention and relief
measures
• Do pelvic floor exercises or kegel
exercise
• Encourage the mother to wear
perineal pads
• Lean forward when voiding to help
empty the bladder completely
Leukorrhoea
• White mucoid nonirritant discharge with a
faint musty odor. This copious mucoid fluid
occurs in response to cervical stimulation
by estrogen and progesterone.
• High level of estrogen in pregnancy result in
increased thick, white vaginal discharge
from marked shedding of superficial
mucosal cells in the vagina.
Leukorrhoea
• With the higher levels of estrogen, the
normal bacteria (lactobacillus acidophilus)
in the vagina increased activity, lactic acid
byproducts and vaginal acidity, which
provides some protection against
pathogens, but increases the risk for
candida albicans and Trichomonas
vaginalis.
Causes
• Hypertrophy and thickening of vaginal
mucosa and increase production of mucus
by the endocervical gland due to the
increase in estrogen levels and effect of
progesterone.
Prevention and relief
measures
• Women should be informed that an
increase in vaginal discharge is a common
physiological change that occurs during
pregnancy.
• Tell the patient to use a perineal pad and
change them frequently
• Using proper clean and hygiene techniques
• Wear cotton underwear and avoid tights
• Avoid douching
• Clean vulva atleast once a day
Alert signs
• If it is associate with itching, soreness,
offensive , smell or pain on passing
urine there may be an infective cause
and investigation should be
considered.
Supine hypotension
• When the pregnant woman is in the supine
position, particularly in the second and
third trimesters, the weight of the gravid
uterus partially occludes the venacava and
the descending aorta.
• The occlusion impedes the return of blood
from the lower extremities and therefore
reduces cardiac return, cardiac output and
blood pressure. This supine hypotension
syndrome is also called venacaval
syndrome.
Causes
Causes
• During late pregnancy, the gravid
uterus produces a effect on the
inferior venacava and part of
descending aorta when the patient is
in the supine position.
• Therefore reduced circulating blood
flow to the right side of the heart.
• The reduced blood flow causes
reduced oxygenation to the brain and
therefore can lead to a faint.
Prevention and relief
measures
• Turning to a lateral recumbent position if
supine hypotension.
• Rest in a side lying position to prevent
supine hypotension (preferably on the left
side).
• Get up slowly from resting position
• Avoid prolonged standing in a warm
environment
Dizziness or fainting
• When fainting arises early in pregnancy, it
is probably caused by the progesterone
induced, general vasodilatation of
pregnancy.
• fainting may occur in late pregnancy as a
result of pressure on the aorta and the
inferior venacava by enlarged uterus.
Causes
• Drop in blood pressure caused by changes
in position
• Blood pools in vessels in lower legs and feet
• Other possible causes include:
– Stress
– Hunger
– Lack of sleep
– Fatigue
– Overexertion
– hyperventilation
Prevention and relief
measures
• Get up slowly from a sitting or lying
position
• When lying down, lie on the left side
• Eat smaller, more frequent meals
• Avoid standing in warm places
• Lie down or sit down if she starts to feel
dizzy.
Varicose veins
• Dilated veins that appear in the legs are
called varicosities or varicose veins.
• The varicose veins are defined as elongated,
dilated and turtuous superficial veins.
Causes
• The exact cause is unknown
• The increase in blood volume during
pregnancy and the effect of progesterone
relaxing the muscular walls of the veins
caused increased pressure on the veins.
• The condition is aggravated during
pregnancy due to the enlarging uterus,
causing pressure on the great abdominal
vein, which interfered with return blood
flow from the lower extremities, statis of the
blood exerts pressure that gradually
weakens the walls of the veins.
Clinical features
• Asymptomatic
• Symptomatic:
– Leg pain
– Discomfort especially after prolonged
standing, itching
Prevention and relief measures
• Avoid sitting and standing for a
prolonged period.
• Elevate the legs when sitting.
• Avoid wearing high heels.
• Regular exercise improves the calf
muscle pump.
• Encourage the use of compression
stockings
Prevention and relief
measures
• Avoid crossing legs at the knees.
• Avoid tight clothes around the legs
• Wear supportive bandage during the day
but remove when at rest and at night
• If vulval varicosities: wear sanitary pads
• During delivery: gentle care
Hemorrhoids
• Dilated veins around the anus, resulting from an
impaired venous return, straining associated
with constipation.
• They may burn, hurt or itch.
• Usually, it occurs in the second and third
trimester.
Causes
• The etiology of hemorrhoids is similar to
varicose veins (increased venous pressure and
constipation) with veins becoming distended as
the walls stretch, from increased blood volume,
gravid uterus and reduced venous return ,
resulting in hemorrhoids.
• Progesterone and gravid uterus decrease
intestinal motility, further affects hemorrhoid
formation.
Prevention and relief
measures
• Eat plenty of high fibrous food and fluids
• Avoid standing for long periods
• Take regular exercise
• Sleep with the foot of the bed slightly
raised
• Prevent constipation and straining
• Stool softeners
• Warm baths
Edema
Edema
• Edema of the feet and ankles is a common
condition in late pregnancy, occuring in about
40% of pregnant women.
• It occurs during the second and third trimesters
• Increasing venous return from the lower
extremities
• Standing for prolonged periods aggravate the
condition
Causes
• Reduced blood circulation in the lower
extremities as the gravid uterus puts pressure on
the large vessel
• Leads to increase in hydrostatic pressure in the
lower extremities
• Increased levels of sodium due to hormonal
influences and antidiuretic hormone release and
the osmotic threshold for thirst decrease in
parallel resulting in water retention.
Causes
• High estrogen level may make blood
vessels more fragile and leaky
• Increased blood volume together with the
distension of the veins
• Prolonged standing, sitting and warm
weather increase edema.
Prevention and relief
measures
• Elevate legs two or three times daily for 20
minutes when sitting or resting
• Lying down is even better than standing
• Avoid standing for longer time
• Don’t cross leg while sitting
• Don’t stay for long time in hot temp.
• Increase intake of fluids 2-3 litres a day
Alert signs
• Edema complicated with signs of preeclampsia
and severe eclampsia needs treatment.
• Localized pain over a vein swelling of the
affected limb, which may indicate superficial
thrombophlebitis.
• Calf muscle tenderness, swelling of the affected
limb, may indicate DVT
Nervous system
Carpal tunnel syndrome
• Carpal tunnel syndrome refers to the complex
symptoms and signs brought on by compression
of the median nerve as it travels through the
carpal tunnel.
• When compression of the median nerve occurs,
ischemia and mechanical disruption of the nerve
follows.
Carpal tunnel syndrome
• Usually presents in the second or third
trimester and is caused by excess fluid
compressing the median nerve in the
wrist.
Causes
• Alteration in fluid balance
• It is caused by fluid retention
• Aggravated by repetitive hand movement
Clinical features
• Numbness, tingling, pain or burning in the fleshy
part of the palm near the thumb and finger.
• Mild hand weakness, this usually happens in the
morning, but, it may occur at any time during the
day.
• Commonly bilateral, but may be pronounced in
the dominant hand.
Prevention and relief measures
• Avoid extreme flexion and extension
• Avoid prolonged exposure to repetitive actions
• Physiotherapy
• Wrist splinting
• Corticosteroid therapy or surgical
decompression is rarely needed.
• Inform CTS normally resolves within 2 weeks of
birth
Headache
Headache
• Headache is common in pregnancy but
are usually harmless.
• Causes
– Changes in blood pressure
– Bad posture and stress
– Dehydration, low blood sugar, fatigue, stress
Prevention and relief measures
• Eat a balanced diet
• Gentle exercise reduces stress, balances
sugar and improves breathing
• Correct posture
• Deep breathing relaxation exercises
• Going for short walk in the fresh air
• Massaging
Alert signs
• If headache complicated with signs of
preeclampsia and impending eclampsia
needs treatment
Insomnia
• Sleep and rest are essential during pregnancy
• But, there are many conditions both physical and
psychological, which may cause disruption in
sleep pattern
• Common in third trimester
• Up to 90% report sleep problems.
Causes
• Anxiety, hormonal changes and physical
discomfort.
• Common in late pregnancy owing to the
discomfort caused by fetal movements,
frequency of micturation and difficulty in finding a
comfortable position.
• Discomfort caused by enlarged uterus
Causes
• Nocturnal gastroesophageal reflux
• Leg cramps
• Low back pain
Prevention and relief measures
• Warm bath at bed time
• Mild physical exercise before sleep may help
• Drink a glass of warm milk at bedtime
• Placing pillows between the knees, under the
abdomen, and behind the back to take pressure
off the lower back
• Talk about fear and anxiety
Prevention and relief measures
• Do not eat a large meal within 2-3 hours of
bedtime
• Avoid caffeine after noon
• Decrease noise, low stimuli environment and
lights
• Keep a regular sleep schedule
• Use bed only for sleep
• Use relaxation techniques and avoid naps late in
the day, massage, heat and support for lower
back pain
Fatigue
• Most women have some fatigue during
pregnancy, especially during first and third
trimester.
• Pregnancy puts a lot of strain on the body
causing a sharp drop in energy level during early
stages of pregnancy
• Later in pregnancy growing fetus and loss of
sleep
Causes
• Lower blood pressure
• Lower blood sugar level
• Hormonal changes due to effect of
progesterone
• Physiological anemia
• Emotional stress
• Imsomnia
Prevention and relief measures
• Proper rest and sleep
• Eat a well balanced diet
• Perform muscle relaxation and strengthening for
the legs and hips joint exercise regularly
• Do not take extra activities and responsibilities
Integumentary system disorder
itchiness
• It is quite common complaint in pregnancy to
have generalized itching which is not due to
systemic disease or skin lesion
• Very frustrating and it may lead to disturb sleep
• Most common during first and third trimester
Causes
• Enlarged uterus causes stretching and
tightening of the skin across the abdomen
• Familial tendency
Prevention and relief measures
• Wear loose clothing
• Washing with mild soap
• Good hygiene
• Well balanced diet
• Use cotton underwear
• Use topical antipruritics and mosturizing
creams.
• If no relief , antihistamines
Alert signs
• Skin lesions such as papules, macules or
pustules which may indicate dermatitis.
• Loss of appetite, nausea or vomiting, intolerance
to fatty foods, which may indicate gall bladder
disease.
Perspiration increased
• Most commonly occurs during the 2nd-3rd
trimester, increasing throughout pregnancy.
• Causes :
– Hormonal changes
– Increase in thyroid activity
– Increase in body weight and metabolic activity
Prevention and relief measures
• Wear light, loose fitting clothing
• Increase the intake of fluids 2-3 litres a
day
• Bath more frequently
Alert signs
• Rapid heartbeat, tremor, hyperactivity,
weight loss and/or heat intolerance which
may indicate hyperthyroidism.
• Palpitations, nervousness, tightness in the
chest, dry mouth : anxiety
Stretch marks (striae gravidarum)
• Reddish or whitish streaks on breast, abdomen
or upper thighs.
• Initially these are pinkish but after delivery, scar
tissue contract and obliterate the capillaries and
they become glistening white in appearance and
are called striae albicans.
• Commonly occurs during 2nd-3rd trimester.
Causes
• Hormonal changes
• Production of steroid hormones by the
adrenal glands
• Familial tendency
Prevention and relief measures
• Wear well fitting, supportive garments for
breasts and abdomen.
• If itching is severe, use topical emollients or
antipruritics.
Increased pigmentation
• Increased pigmentation may begin as early as
the second month when levels of melanocyte
stimulating hormone become elevated because
of the effect of the estrogen and progesterone.
• Most of these skin changes disappear on their
own after childbirth.
Chloasma and linea nigra
• Areas of pigmentation include brownish patches
called chloasma, which usually involve the
forehead cheeks and bridge of the nose.
• A dark line of pigmentation may also extend
from the umbilicus to the symphysis pubis.
Prevention and relief measures
• Reassurance
• To avoid skin darkening, cover the skin or
use nonallergenic sun blocking cream
when in the sun.
Respiratory system
shortness of breath
• Shortness of breath is actually very common
during pregnancy in last trimester.
• Causes
– Gravid uterus pressing upwards on the diaphragm
and decreased vital capacity of lungs
– Hormonal changes cause lower levels of carbon
dioxide and higher levels of oxygen . Hyperventilation
help maintain normal levels.
Prevention and relief measures
• Eat a balance diet
• Eat a diet rich in iron and vitamin .
• Gentle exercise
• Get some fresh air
• Sleep on additional pillows for relief if a
problem occurs at night
• Avoid overeating
Alert signs
• Severe breathlessness, chest pain, palpitations,
rapid pulse.
• Cough, production of sputum, wheezing, which
may indicate a respiratory disorder e.g. asthma
• Shortness of breath that worsens on exertion,
chest pain, palpitations may indicate heart
disease.
Nasal stuffiness and epistaxis
• Common during pregnancy, secondary to
vascular congestion caused by increased
estrogen and progesterone levels.
• Bleeding may be spontaneous or may be
brought about by overheating or forceful nose
bleeding
Causes
• Elevated estrogen and progesterone causes
increase in blood flow to the capillaries and
dilatation of the veins.
• Increased blood flow to mucous membranes.
• Nasal bleeding may result from local trauma or
nasal polyps.
Prevention and relief measures
• If blowing a nose: do gently and try to
avoid large sneezes.
• to stop a nosebleed
• For nasal stuffiness: use normal saline
drops
Alert signs
• High blood pressure, if bleeding not stopped
after 20 minutes.
• Pain over the sinuses with purulent nasal
discharge, headache which may indicate acute
sinusitis.
• Stuffiness with headache, watery eyes, may
indicate allergies.
Minor disorders of pregnancy

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Minor disorders of pregnancy

  • 2. Introduction • Many women experience some minor disorders during pregnancy. • Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman. • Most of the disorder of pregnancy is a result of the minor disorder that may occur due to hormonal changes, accomodation changes , metabolic changes and postural changes and are fairly specific to each of the three trimester.
  • 3. Common disorders or discomforts during pregnancy • Digestive system disorders – Nausea/vomiting (morning sickness) – Heartburn – Excessive salivation/ptyalism – Pica eating – Constipation – Hemorrhoid
  • 4. Common disorders or discomforts during pregnancy • Musculoskeletal system – Backache – Cramping legs • Genitourinary system – Frequency of micturation – Stress incontinence – Leucorrhoea
  • 5. Common disorders or discomforts during pregnancy • Circulatory system disorders – Postural hypotension – Fainting – Varicosity • Nervous system disorders – Carpal Tunnel syndromes – Insomnia
  • 6. Common disorders or discomforts during pregnancy • Integumentary system disorders – Skin changes – Itching • Respiratory system – Shortness of breath – Nasal stiffness and epistaxis
  • 7. Morning sickness • Common symotms of nausea and vomiting usually during the first trimester of pregnancy. • It may occur usually in the morning but may occur at any time during the day. • It occurs in over 50 to 85% of the pregnancies.
  • 8. • For 80% of sufferers, this condition stops around t he time of the 12th- 14th week • • However, 20% will suffer from nausea and vomiting for a loner period.
  • 9. Causes • Sudden rise of HCG and estrogen in the blood stream, which stimulate the chemoreceptor (trigger zone in the brain and initiate nausea and vomiting • Increased sensitivity to smell • Smooth muscle relaxation • Emotional factors • Slower emptying of the stomach during labour • fatigue
  • 10. Risk factors • Twin pregnancy • Previous history of nausea and vomiting • History of Motion sickness • Genetic predisposition to nausea during pregnancy • History of migraine
  • 11. Diagnosis • Medical history • Physical examination
  • 12. Prevention • Medication: well-known over-the-counter drugs should be administered only when absolutely indicated and prescribed. • Drink water or other fluids between meals to avoid dehydration and acidosis • Avoid: Disagreeable odors and rich, spicy, or greasy foods • Explanation, reassurance, and symptomatic relief are sufficient.
  • 13. Prevention • Eat dry crackers biscuits or dry bread 15 minutes before arising in the morning. • Avoid personal triggering factors (including smelling and cooking). • Avoid overeating fried food, spicy, fried and and fatty food. • Eat small, frequent meals • Avoid lying down immediately after eating • Avoid brushing teeth after meal
  • 14. Prevention • When getting up from the bed, get up slowly and avoid sudden movements. • Keep room well ventilated • Avoid warm places. • Hospitalization may be necessary to correct fluid and electrolyte imbalance • Behavior modification • Dietary changes
  • 15. Constipation • Constipation is a condition of infrequent, irregular and difficulty in passing stool or the passing of hard stool. • It is quite common during pregnancy • Most commonly occurs during the 2nd -3rd trimester
  • 16.
  • 17. Cause • Atonicity of the gut due to the effect of progesterone • Diminished physical activity and pressure of the gravid uterus on the pelvic colon • Sluggish bowel function are the possible explanations. • Lack of physical activity and exercise • Decreased fluid intake
  • 18. Management • Mineral oil is contraindicated because it absorbs fat-soluble vitamins from the bowel and leaks from the anus. • Exercise and good bowel habits are helpful • Eat high fiber foods • Get regular daily exercise • Increased fluid intake at least 2000-3000 ml per day
  • 19. Management • Chew food thoroughly • Avoid iron pills. • Purgatives should be avoided because of the possibility of inducing labor. • Emphasize ample fluids and laxative foods and prescribe a stool softener • Regular bowel habit may be restored
  • 20. Acidity and heartburn • Heartburn is a burning or painful sensation in the upper part in the middle of the chest and radiates upwards, often accompanied by bad tests in the mouth. • Common in all trimesters, with increasing severity in last trimester.
  • 21. Acidity and heartburn • Due to relaxation of the esophageal sphincter • Most likely to occur when the patient is lying down or bending over • In late pregnancy, this may be aggravated by displacement of the stomach and duodenum by the uterine fundus • Heartburn (pyrosis, acid indigestion) results from gastroesophageal reflux disease (GERD) in almost 10% of all gravidas hiatus hernia
  • 22. Management • Advice on diet and lifestyle to prevent and relieve heartburn in pregnancy • Eat a balanced diet • Eat small frequent meals • Identifying foods, which causes heartburn and avoid foods known to cause gastric upset • Not to go to bed immediately after the meal. Keep her head higher than her stomach when lying down or sleeping (propped up position).
  • 23. • Avoid overeating, eating and drinking at the same time to reduce stomach volume. • Chewing food • Drink milk and 6-8 glasses of water daily • Loose clothing • Eating fruits such as apple, pineapple and papaya with meals as they have digestive enzymes that speed up
  • 24. Pharmacological intervention • Antacid preparation • Calcium and magnesium based antacid
  • 25. Pica • This is the term used when a mother craves certain foods or unnatural substances such as coal. • Most commonly occurs during the 1st-3rd trimester, and most in 1st trimester. • Pica is the craving and intentional consumption of substances not culturally defined as food.
  • 26. • The diagnosis of pica is based on an individual’s report of craving and intentional consumption of substances not culturally defined as food.
  • 27. Causes • Unknown • Possibly influenced by tradition • Change in the sense of test mouth • Hormones and changes in metabolism
  • 28. diagnosis • History taking: questions asked in nonjudgmental manner
  • 29. Prevention and relief measures • Explaining the possible harmful effects on pica on the fetus and suggesting the alternative behaviors may help. • If the substance craved is harmful to the unborn baby, the mother must be helped to seek medical advice. • Eat a balanced diet
  • 30. Indigestion • Indigestion often occurs after eating too much of heavy or greasy food or drinking too much alcohol • Discomfort or a burning feeling in the midchest characterizes it
  • 31. Causes • Eating too much of heavy or greasy food or drinking too much alcohol
  • 32. Prevention and relief measures • Eat digestible food • Avoid overeating fatty, greasy and spicy food • Eat small frequent meals • Avoid alcohol, coffee and cigarette • Eat boiled food
  • 33. Excessive salivation • Increased secretion of salivation is observed during pregnancy. • Some women experience ptyalism or excessive salivation that is unpleasant and embarrassing. • Most commonly occurs during the 1st-3rd trimester
  • 34. Cause • Unknown • Excessive salivation appears to the stimulation of the salivary gland by eating an increased intake of starch
  • 35. Preventive and relief measure • Use astringent mouthwashes • Chew gum or suck hard candy • Limit intake of foods containing starch
  • 36. Musculoskeletal system Cramping leg • Cramp is spasm that occurs when a muscle contracts too hard. • A muscle cramp is acute and painful • They usually occur in the leg, calf muscles • Mostly occurs at night • Mostly common in the second and third trimester and during labour
  • 37. Causes • Unknown • Contributing factors: – Inadequate calcium intake – Altered balance in calcium and phosphorous ratio in the body – Fatigue, chilling or tense body posture – Poor circulation to lower extremities due to pressure to the enlarged uterus on the pelvic vessels leading to the legs. – The pressure on the enlarged uterus on the pelvic nerve leading to the legs
  • 38. Preventive and relief measures • Take enough calcium, eat balanced dier, make sure include plenty of magnesium, potassium, folate and vitamin rich well in diet and supplementary calcium therapy. • Take frequent breaks from sitting or standing for long periods • Take warm bath at bed time
  • 39. Preventive and relief measures • Rest frequently during the day • Apply a warm cloth or heating pad to the painful area • Regular exercises especially walking • Avoid fatigue and cols • Change positions frequently during labour
  • 40. Preventive and relief measures • If cramp: straighten the leg, point or pull toes upward toward the knees. • Gently massage the cramped muscle. Walk around when able
  • 41. Backache • Many women (45-50%) experience pregnancy related low back or pelvic girdle pain, with more than 80% of these women experiencing difficulties in daily living and upto 30% requiring bed rest.
  • 42. • Pelvic girdle pain 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 • Common in second and third trimester • Pain may be in the lower back and radiate in legs
  • 43. Causes • Physiological changes – Relaxation of the sacroiliac joint when it is due to increased hormones (progesterone) resulting in relaxed the ligaments and joints in the lower back and pelvis. – Shifting of the center of gravity or increased curvature of the lumbosacral verterbra caused by enlarged uterus
  • 44. Causes • Faulty posture and high heel shoes, muscle spasm, urinary infection or constipation • Fatigue, muscle spasm or postural back strain most often is responsible • Too much standing in one place or leaning forward,or hard physical work can cause pain
  • 45. Causes • Pain is aggravated during standing, walking, sitting , twisting, climbing of stairs and turning while in bed • Lifting heavy objects • Poor sitting position
  • 46. Diagnosis • History of back pain • Physical examination
  • 47. Prevention and relief measures • Improvement in posture is often achieved by the wearing of low-heeled shoes. • To achieve proper posture, the abdomen should be flattened, the pelvis tilted forward, and the buttocks tucked under to straighten the back. • Improvement of posture, well-fitted pelvic girdle belt which corrects the lumbar lordosis during walking and rest in hard
  • 48. Prevention and relief measures • Rest with elevation of the legs to flex the hips may be helpful. • Excessive weight gain should be avoided.
  • 49. Management • Apply local heat and light massage to relax tense, taut back muscles. • Recommend sleep on a firm mattress. • Back exercises under the supervision of a rehabilitation physician, an orthopedist, or a physical therapist. • Massaging the back muscles, analgesics and rest
  • 50. Management • Maintain correct postures and good body mechanisms. • The women should lie in the lateral recumbent position, with her knees and hips bent. A pillow can be used to support the weight of the uterus. • Encourage the woman’s family members or friends to massage the woman’s back
  • 51. Management • Excessive weight gain should be avoided, • Avoid excessive twisting, bending stretching and standing over a long period of time. • Avoid situations that aggravate the conditions
  • 52. Management • Obtain orthopedic consultation if disability results. • Note neurological signs and symptoms indicative of prolapsed intervertebral disk syndrome, radiculitis. • Give acetaminophen 0.3–0.6 g orally or equivalent.
  • 53. Urinary frequency • Urinary frequency is a common complaint throughout pregnancy, especially in the first and last months because of increased bladder sensitivity and pressure of the enlarging uterus on the bladder. • The condition subsides for a while when the uterus moves out of the pelvic area into the abdominal cavity around the 12th week. Frequency reoccurs in the last trimester as the enlarging uterus begins to press on the bladder again.
  • 54. Causes • Increased intravascular volume, elevated GFR and an increase in water exertion by the kidneys in early pregnancy. • Enlargement of the uterus in pelvis causing pressure on the bladder. • Pressure from the fetal presenting part on the bladder during the third trimester.
  • 55. Prevention and relief measures • Void when urge is felt • Increased fluid intake • Perform kegel exercise • Lean forward when voiding to help empty the bladder completely • Limit intake of fluids containing natural diuretics
  • 56. Stress incontinence • Leaking of urine when sneezing, coughing or laughing. • Cause – During pregnancy pelvic floor is stretched and sometimes damaged. This can lead to stress incontinence. – Enlarging uterus and pressure on the presenting part on the bladder
  • 57. Prevention and relief measures • Do pelvic floor exercises or kegel exercise • Encourage the mother to wear perineal pads • Lean forward when voiding to help empty the bladder completely
  • 58. Leukorrhoea • White mucoid nonirritant discharge with a faint musty odor. This copious mucoid fluid occurs in response to cervical stimulation by estrogen and progesterone. • High level of estrogen in pregnancy result in increased thick, white vaginal discharge from marked shedding of superficial mucosal cells in the vagina.
  • 59. Leukorrhoea • With the higher levels of estrogen, the normal bacteria (lactobacillus acidophilus) in the vagina increased activity, lactic acid byproducts and vaginal acidity, which provides some protection against pathogens, but increases the risk for candida albicans and Trichomonas vaginalis.
  • 60. Causes • Hypertrophy and thickening of vaginal mucosa and increase production of mucus by the endocervical gland due to the increase in estrogen levels and effect of progesterone.
  • 61. Prevention and relief measures • Women should be informed that an increase in vaginal discharge is a common physiological change that occurs during pregnancy. • Tell the patient to use a perineal pad and change them frequently • Using proper clean and hygiene techniques • Wear cotton underwear and avoid tights • Avoid douching • Clean vulva atleast once a day
  • 62. Alert signs • If it is associate with itching, soreness, offensive , smell or pain on passing urine there may be an infective cause and investigation should be considered.
  • 63. Supine hypotension • When the pregnant woman is in the supine position, particularly in the second and third trimesters, the weight of the gravid uterus partially occludes the venacava and the descending aorta. • The occlusion impedes the return of blood from the lower extremities and therefore reduces cardiac return, cardiac output and blood pressure. This supine hypotension syndrome is also called venacaval syndrome.
  • 65. Causes • During late pregnancy, the gravid uterus produces a effect on the inferior venacava and part of descending aorta when the patient is in the supine position. • Therefore reduced circulating blood flow to the right side of the heart.
  • 66. • The reduced blood flow causes reduced oxygenation to the brain and therefore can lead to a faint.
  • 67. Prevention and relief measures • Turning to a lateral recumbent position if supine hypotension. • Rest in a side lying position to prevent supine hypotension (preferably on the left side). • Get up slowly from resting position • Avoid prolonged standing in a warm environment
  • 68. Dizziness or fainting • When fainting arises early in pregnancy, it is probably caused by the progesterone induced, general vasodilatation of pregnancy. • fainting may occur in late pregnancy as a result of pressure on the aorta and the inferior venacava by enlarged uterus.
  • 69. Causes • Drop in blood pressure caused by changes in position • Blood pools in vessels in lower legs and feet • Other possible causes include: – Stress – Hunger – Lack of sleep – Fatigue – Overexertion – hyperventilation
  • 70. Prevention and relief measures • Get up slowly from a sitting or lying position • When lying down, lie on the left side • Eat smaller, more frequent meals • Avoid standing in warm places • Lie down or sit down if she starts to feel dizzy.
  • 71. Varicose veins • Dilated veins that appear in the legs are called varicosities or varicose veins. • The varicose veins are defined as elongated, dilated and turtuous superficial veins.
  • 72. Causes • The exact cause is unknown • The increase in blood volume during pregnancy and the effect of progesterone relaxing the muscular walls of the veins caused increased pressure on the veins. • The condition is aggravated during pregnancy due to the enlarging uterus, causing pressure on the great abdominal vein, which interfered with return blood flow from the lower extremities, statis of the blood exerts pressure that gradually weakens the walls of the veins.
  • 73. Clinical features • Asymptomatic • Symptomatic: – Leg pain – Discomfort especially after prolonged standing, itching
  • 74. Prevention and relief measures • Avoid sitting and standing for a prolonged period. • Elevate the legs when sitting. • Avoid wearing high heels. • Regular exercise improves the calf muscle pump. • Encourage the use of compression stockings
  • 75. Prevention and relief measures • Avoid crossing legs at the knees. • Avoid tight clothes around the legs • Wear supportive bandage during the day but remove when at rest and at night • If vulval varicosities: wear sanitary pads • During delivery: gentle care
  • 76. Hemorrhoids • Dilated veins around the anus, resulting from an impaired venous return, straining associated with constipation. • They may burn, hurt or itch. • Usually, it occurs in the second and third trimester.
  • 77. Causes • The etiology of hemorrhoids is similar to varicose veins (increased venous pressure and constipation) with veins becoming distended as the walls stretch, from increased blood volume, gravid uterus and reduced venous return , resulting in hemorrhoids. • Progesterone and gravid uterus decrease intestinal motility, further affects hemorrhoid formation.
  • 78. Prevention and relief measures • Eat plenty of high fibrous food and fluids • Avoid standing for long periods • Take regular exercise • Sleep with the foot of the bed slightly raised • Prevent constipation and straining • Stool softeners • Warm baths
  • 79. Edema
  • 80. Edema • Edema of the feet and ankles is a common condition in late pregnancy, occuring in about 40% of pregnant women. • It occurs during the second and third trimesters • Increasing venous return from the lower extremities • Standing for prolonged periods aggravate the condition
  • 81. Causes • Reduced blood circulation in the lower extremities as the gravid uterus puts pressure on the large vessel • Leads to increase in hydrostatic pressure in the lower extremities • Increased levels of sodium due to hormonal influences and antidiuretic hormone release and the osmotic threshold for thirst decrease in parallel resulting in water retention.
  • 82. Causes • High estrogen level may make blood vessels more fragile and leaky • Increased blood volume together with the distension of the veins • Prolonged standing, sitting and warm weather increase edema.
  • 83. Prevention and relief measures • Elevate legs two or three times daily for 20 minutes when sitting or resting • Lying down is even better than standing • Avoid standing for longer time • Don’t cross leg while sitting • Don’t stay for long time in hot temp. • Increase intake of fluids 2-3 litres a day
  • 84. Alert signs • Edema complicated with signs of preeclampsia and severe eclampsia needs treatment. • Localized pain over a vein swelling of the affected limb, which may indicate superficial thrombophlebitis. • Calf muscle tenderness, swelling of the affected limb, may indicate DVT
  • 85. Nervous system Carpal tunnel syndrome • Carpal tunnel syndrome refers to the complex symptoms and signs brought on by compression of the median nerve as it travels through the carpal tunnel. • When compression of the median nerve occurs, ischemia and mechanical disruption of the nerve follows.
  • 86. Carpal tunnel syndrome • Usually presents in the second or third trimester and is caused by excess fluid compressing the median nerve in the wrist.
  • 87. Causes • Alteration in fluid balance • It is caused by fluid retention • Aggravated by repetitive hand movement
  • 88. Clinical features • Numbness, tingling, pain or burning in the fleshy part of the palm near the thumb and finger. • Mild hand weakness, this usually happens in the morning, but, it may occur at any time during the day. • Commonly bilateral, but may be pronounced in the dominant hand.
  • 89. Prevention and relief measures • Avoid extreme flexion and extension • Avoid prolonged exposure to repetitive actions • Physiotherapy • Wrist splinting • Corticosteroid therapy or surgical decompression is rarely needed. • Inform CTS normally resolves within 2 weeks of birth
  • 91. Headache • Headache is common in pregnancy but are usually harmless. • Causes – Changes in blood pressure – Bad posture and stress – Dehydration, low blood sugar, fatigue, stress
  • 92. Prevention and relief measures • Eat a balanced diet • Gentle exercise reduces stress, balances sugar and improves breathing • Correct posture • Deep breathing relaxation exercises • Going for short walk in the fresh air • Massaging
  • 93. Alert signs • If headache complicated with signs of preeclampsia and impending eclampsia needs treatment
  • 94. Insomnia • Sleep and rest are essential during pregnancy • But, there are many conditions both physical and psychological, which may cause disruption in sleep pattern • Common in third trimester • Up to 90% report sleep problems.
  • 95. Causes • Anxiety, hormonal changes and physical discomfort. • Common in late pregnancy owing to the discomfort caused by fetal movements, frequency of micturation and difficulty in finding a comfortable position. • Discomfort caused by enlarged uterus
  • 96. Causes • Nocturnal gastroesophageal reflux • Leg cramps • Low back pain
  • 97. Prevention and relief measures • Warm bath at bed time • Mild physical exercise before sleep may help • Drink a glass of warm milk at bedtime • Placing pillows between the knees, under the abdomen, and behind the back to take pressure off the lower back • Talk about fear and anxiety
  • 98. Prevention and relief measures • Do not eat a large meal within 2-3 hours of bedtime • Avoid caffeine after noon • Decrease noise, low stimuli environment and lights • Keep a regular sleep schedule • Use bed only for sleep • Use relaxation techniques and avoid naps late in the day, massage, heat and support for lower back pain
  • 99. Fatigue • Most women have some fatigue during pregnancy, especially during first and third trimester. • Pregnancy puts a lot of strain on the body causing a sharp drop in energy level during early stages of pregnancy • Later in pregnancy growing fetus and loss of sleep
  • 100. Causes • Lower blood pressure • Lower blood sugar level • Hormonal changes due to effect of progesterone • Physiological anemia • Emotional stress • Imsomnia
  • 101. Prevention and relief measures • Proper rest and sleep • Eat a well balanced diet • Perform muscle relaxation and strengthening for the legs and hips joint exercise regularly • Do not take extra activities and responsibilities
  • 102. Integumentary system disorder itchiness • It is quite common complaint in pregnancy to have generalized itching which is not due to systemic disease or skin lesion • Very frustrating and it may lead to disturb sleep • Most common during first and third trimester
  • 103. Causes • Enlarged uterus causes stretching and tightening of the skin across the abdomen • Familial tendency
  • 104. Prevention and relief measures • Wear loose clothing • Washing with mild soap • Good hygiene • Well balanced diet • Use cotton underwear • Use topical antipruritics and mosturizing creams. • If no relief , antihistamines
  • 105. Alert signs • Skin lesions such as papules, macules or pustules which may indicate dermatitis. • Loss of appetite, nausea or vomiting, intolerance to fatty foods, which may indicate gall bladder disease.
  • 106. Perspiration increased • Most commonly occurs during the 2nd-3rd trimester, increasing throughout pregnancy. • Causes : – Hormonal changes – Increase in thyroid activity – Increase in body weight and metabolic activity
  • 107. Prevention and relief measures • Wear light, loose fitting clothing • Increase the intake of fluids 2-3 litres a day • Bath more frequently
  • 108. Alert signs • Rapid heartbeat, tremor, hyperactivity, weight loss and/or heat intolerance which may indicate hyperthyroidism. • Palpitations, nervousness, tightness in the chest, dry mouth : anxiety
  • 109. Stretch marks (striae gravidarum) • Reddish or whitish streaks on breast, abdomen or upper thighs. • Initially these are pinkish but after delivery, scar tissue contract and obliterate the capillaries and they become glistening white in appearance and are called striae albicans. • Commonly occurs during 2nd-3rd trimester.
  • 110. Causes • Hormonal changes • Production of steroid hormones by the adrenal glands • Familial tendency
  • 111. Prevention and relief measures • Wear well fitting, supportive garments for breasts and abdomen. • If itching is severe, use topical emollients or antipruritics.
  • 112. Increased pigmentation • Increased pigmentation may begin as early as the second month when levels of melanocyte stimulating hormone become elevated because of the effect of the estrogen and progesterone. • Most of these skin changes disappear on their own after childbirth.
  • 113. Chloasma and linea nigra • Areas of pigmentation include brownish patches called chloasma, which usually involve the forehead cheeks and bridge of the nose. • A dark line of pigmentation may also extend from the umbilicus to the symphysis pubis.
  • 114. Prevention and relief measures • Reassurance • To avoid skin darkening, cover the skin or use nonallergenic sun blocking cream when in the sun.
  • 115. Respiratory system shortness of breath • Shortness of breath is actually very common during pregnancy in last trimester. • Causes – Gravid uterus pressing upwards on the diaphragm and decreased vital capacity of lungs – Hormonal changes cause lower levels of carbon dioxide and higher levels of oxygen . Hyperventilation help maintain normal levels.
  • 116. Prevention and relief measures • Eat a balance diet • Eat a diet rich in iron and vitamin . • Gentle exercise • Get some fresh air • Sleep on additional pillows for relief if a problem occurs at night • Avoid overeating
  • 117. Alert signs • Severe breathlessness, chest pain, palpitations, rapid pulse. • Cough, production of sputum, wheezing, which may indicate a respiratory disorder e.g. asthma • Shortness of breath that worsens on exertion, chest pain, palpitations may indicate heart disease.
  • 118. Nasal stuffiness and epistaxis • Common during pregnancy, secondary to vascular congestion caused by increased estrogen and progesterone levels. • Bleeding may be spontaneous or may be brought about by overheating or forceful nose bleeding
  • 119. Causes • Elevated estrogen and progesterone causes increase in blood flow to the capillaries and dilatation of the veins. • Increased blood flow to mucous membranes. • Nasal bleeding may result from local trauma or nasal polyps.
  • 120. Prevention and relief measures • If blowing a nose: do gently and try to avoid large sneezes. • to stop a nosebleed • For nasal stuffiness: use normal saline drops
  • 121. Alert signs • High blood pressure, if bleeding not stopped after 20 minutes. • Pain over the sinuses with purulent nasal discharge, headache which may indicate acute sinusitis. • Stuffiness with headache, watery eyes, may indicate allergies.