SEMINAR

Shalini joshi
M.Sc. Nsg 1st year
S.C.O.N. Dehradun
 Minor
Disorder of
Pregnancy
and its
Management
 WHAT IS MINOR AILMENTS OF
PREGNANCY
• The anatomical physiological and biochemical
adaptations to pregnancy are profound. These
changes that the female body undergoes during
pregnancy begin soon after fertilization and continue
through gestation.

These changes occur in response to physiological stimuli

provided by the fetus and placenta. These changes
may be unpleasant as well as worrying but they are
rarely a cause for alarm as most of these changes are
usually normal. These so-called minor disorders or
ailments of pregnancy can be troublesome on a day
to day basis
 MEANING
Pregnancy is a very exciting time,
but often the minor ailments
associated with Pregnancy can
cause discomfort. The
discomfort can be overcome by
making small adjustments to your
lifestyle, thereby ensuring that
you have a healthy and
comfortable pregnancy.
During the course of pregnancy period many changes
occur in a woman’s body as a result of hormonal
influences and adaptation to the gestational
process. Thereby, they experience a variety of
physiological and psychological symptoms such as
nausea, vomiting, backache , giddiness , heartburn
and anxiety etc. These are termed as minor
ailments or discomforts of pregnancy.
 THE FOLLOWING ARE THE MINOR
AILMENTS OF PREGNANCY:

• Backache • Leg cramps

• Constipation • Vaginal discharge
• Syncope
• Nausea and
vomiting • Insomnia or
sleeplessness
• Heartburn
• Pain over round
• Ankle oedema ligament
• Varicose veins • Urinary frequency
• Haemorrhoids  
 BACKACHE:
• backache usually lasts from 20
weeks to term.
• During pregnancy there is laxity
(relaxin, estrogen) of the spinal
ligaments which along with the
weight of pregnancy puts a strain
on the joints of the lumbo-sacral
spine and pelvis resulting in lumbar
lordosis and anterior tilt of the
pelvis consequent backache.
 MANAGEMENT AND ADVICE
• Maintenance of correct posture
• Avoiding lifting heavy objects
• Avoid high heels
• Regular physiotherapy
• Firm mattress to sleep on
• Enough rest particularly in later pregnancy.
• Swimming often soothes backache.
• Watch weight gain.
• Avoiding standing for long hours of time.
 Constipation
Can last entire pregnancy.
• Various factors contribute to
constipation during pregnancy,
which include-effect of
progesterone on gut motility,
physical weight of the gravid
uterus on the rectum and the
use of iron tablets.
 MANAGEMENT
Plenty of fruits, green
leafy vegetables and
fibre in diet (Isabgul)
Plenty of water to
drink
Laxatives (surface
acting)
Regular exercises
Swimming
 NAUSEA AND VOMITING
• Usually last 4-16 weeks.
• It is usually common in primigravidae and usually appears
following first or second missed period and subsides by
the end of first trimester. Vomiting occurs soon after
getting out of bed.

• 50% women have both nausea and vomiting, 25% have

nausea only and 25% unaffected.

• The cause of vomiting is not clear but increased

chorionic gonadotropin has been implicated. Psychological
background has also been implicated to play a major role
MANAGEMENT AND ADVICE
• Small frequent feeds, especially
crackers, dry toast and cereals.
• Avoid spicy and greasy foods
• Protein diet
• Anti-emetics are better avoided.
• Pre-natal vitamins with iron are
avoided for the first 12 weeks.
• Avoiding slouching after meals.
 HEARTBURN (PYROSIS)

• From 20 weeks to term.

• This common complaint is the result of reflux of acid
contents of the stomach.
• The relaxation of the esophageal sphincter due to the
effect of progesterone and the weight effect of the
pregnant uterus preventing stomach emptying are the
causes for this reflux of acid contents.
• Over-eating, late eating alcohol and spicy foods
contribute to the problem.
• Hiatus hernia which is common during pregnancy is
another cause of heartburn.
•  
MANAGEMENT

• Propped up position
after meals
• Smaller meals more
often
• Antacids
• Avoiding aggravating
factors
ANKLE OEDEMA
• Usually after 28 weeks.

• As pregnancy advances the patient may

notice swelling of their feet and
ankles. This is due to the impediment
of venous return from the lower limbs
due to the pressure effect of the
gravid uterus on the lower limb veins.

• However eclampsia, underlying cardiac

or renal impairment is to be excluded.
 MANAGEMENT
• Frequent periods of rest with limb
elevation for at least 15 minutes each
time
• Avoiding long periods of standing or
sitting.
• Diuretics should not be used.
 
VARICOSE VEINS
• 16 weeks to term.

• Varicose veins in the legs and vulva may

appear for the first time or aggravate during
pregnancy. It is due to the obstruction of
the venous return by the weight of pregnant
uterus on the inferior vena cava.

• It is also thought to be due to the relaxant

effect of progesterone on the vascular
smooth muscles.
•  
 MANAGEMENT
• Applying elastic stockings or crepe bandages
for leg varicosities
• Elevation of limb during rest.
• Usually disappear delivery
• No surgical intervention is required.
 HAEMMORRHOIDS
• 24 weeks to term.
• Constipation during pregnancy tends
to aggravate the varicosity of the
veins in the rectum. Straining at
stool, prolonged sitting and spicy
food aggravate the condition.
 MANAGEMENT
• High fibre diet and Use of laxatives to keep the
bowel soft.
• Local anaesthetic /anti irritant creams can be used
• Replacement of prolapsed piles is essential
 LEG CRAMPS:
• This is due to the deficiency of
diffusible serum calcium or
elevation of serum phosphorous.

Management includes
•Supplementary calcium therapy and
Vit. B1 (30 mcg) daily.
•Application of local heat and
massage
•High doses of Vit. E (400 mg) BD
often proves beneficial.
• 
 VAGINAL DISCHARGE
• This is due to the increased
transudation of fluids as a
result of increased vascularity
and hyperestrogenic state
during pregnancy. The
• and
discharge is clear and white Management includes:
do not have unpleasant smell.
• Assurance to the mother.
• Local cleanliness.
• Rule out any infection.
• Metronidazole 200mg
thrice daily for 7 days,
high up in the vagina at
bed time.
 SYNCOPE
• The enlarging gravid uterus compresses the veins
in the pelvic brim, impending venous return and
causes pooling of blood in the lower limbs which
in turn leads to decreased oxygen supply to the
brain leading to syncope.
• In later pregnancy the gravid uterus compresses
the inferior vena cava in the dorsal supine
position causing supine hypotension.
 Management
• Avoiding prolonged standing
• Getting up slowly after lying or
sitting down.
• Left lateral tilt with a wedge
below the right hip alleviates the
problem.
SLEEPLESSNESS OR
INSOMNIA:
• 28 weeks to term.

• It has been attributed

to the hormonal changes
that occur during
pregnancy and can be a
major cause of anxiety
in a pregnant mother.
 Management
• Take rest in the afternoon.
• Drink a glass of warm milk at bed time.
• Tuck a pillow under the abdomen when
lying in a lateral position.
• Daily exercise. Plenty of fresh air.
• Avoid caffeine & multivitamin before
sleep.
• Warm milk drink or a warm bath help
to allay anxiety & hence insomnia
•  
 URINARY FREQUENCY
2nd trimester to term.
• The pressure of the growing gravid uterus
during the early part of pregnancy, and the
pressure of the fetal head when it engages
the pelvic brim near full term cause irritation
of the bladder base and predispose to urinary
frequency.
OTHER MINOR
AILMENTS AND
MANAGEMENT
 ITCHING OF BODY

• Some mothers complain of generalized the itching ,which

often starts over the abdomen.
• This occur due to liver’s response to the hormones in
pregnancy with raised bilirubin level.
• It clears after the baby is born and comfort can be
gained from focal applications

Management
• An anti-histamine is prescribed .
• Washing with mild soap and wear cotton underwear
 
 CHLOASMA GRAVIDUM
• (Mask of pregnancy) a butterfly pigmentation on the cheeks
& nose. It usually disappear few months after labor.
 
LINEA ALBICANS & STRAIEGRAVIDUM
• Pigmentation in the lower abdomen, flanks, inner thigh,
buttocks & breasts increases as pregnancy advances.

• It starts pink (straie rubra) then becomes pale to become

white (straie albicans) after delivery, white persists.
• In Primigravida, the straie rubra present only.

• In multigravida, both striae rubra & striae albicans present.

 
 CARPAL TUNNEL SYNDROME

• Mothers complain of numbness & pins & needles in

their fingers & hands. This usually happen in the
morning, but it can occur at any time of the day.
It is caused by fluid retention, which creates
edema & pressure on the median nerve.
  
Nursing advice

• Wearing a spent at night, with

hands resting on two or three pillows
sometimes helps.
• Restriction of salt intake.
• Flexing the fingers while the arm is
held above the head can be
recommended.
• Carpal tunnel syndrome usually
resolves spontaneously following
delivery.
 BREAST SORENESS
• Increase in size and possibly some
tenderness very early during
pregnancy and this can last for the
entire pregnancy.
• Also some women will have a clear
to milky discharge from their nipples
and may need to use shields or
nursing pads to protect their clothing.
• Advise to wear larger and more
supportive bras.
 BRAXTON HICKS CONTRACTION
• Also known as 'false labour' is an uncomfortable,
irregular uterine contractions that occur periodically
towards the end of labour.
• This is a sign that uterus is preparing itself for
labour, generally these contractions begin at the top
of uterus and gradually spread downwards before
relaxing .In some women they are painless, however,
others can find them uncomfortable and even a little
painful.
 • Braxton Hicks contractions usually begin
around the 20th week of pregnancy but for a
first pregnancy may begin earlier. Generally,
this 'false labour' will fade with a warm bath.

• If mother finds it uncomfortable try practicing

the breathing exercises or any other coping
techniques which have learned for use in
labour.
• If the contractions persist and mother is not
near to full term then tell mother about the
contraction and difference between false and
true pain and contraction. If the contractions
become regular, every five minutes and last
sixty seconds each – advise mother to call
healthcare provider.
 EPISTAXIS
• Nosebleeds are quite common in pregnancy because of
hormonal changes. The nose bleeds are usually short but
can be quite heavy.

• To help the bleeding stop, press the sides of nose

together between thumb and forefinger, just below the
bony part of nose, for 10 minutes. Repeat for a further
10minutes if this does not work. As long as mother
doesn’t lose a lot of blood, there is nothing to worry
about.
If you have more than two bad
nosebleeds (or lots of little ones),
consult the Doctor.
 • Severe and frequent nosebleeds may
contribute to anaemia, or may be a sign of
underlying illness.
• Mother may also find that her nose gets more
blocked up than usual. The pregnancy
hormones may cause the lining of nose and
sinuses to swell, so mother feels continually
blocked up and stuffy.
 NURSING MANAGEMENT
AND ADVICE
To help with this and to avoid nosebleeds:

• Blow nose gently and try to avoid explosive sneezes.

• Try a steam inhalation, perhaps with a few drops of
tea tree oil in the water.

• If nose is blocked, mother will probably finds that she

breathe s through her mouth, especially while she
sleeps. This will give a very dry mouth, so keep a
glass of water handy for when wake and use Vaseline
to keep lips moist. she may start to snore. Sleeping
on side lying may relieve this.
 • If things get very bad, ask
doctor about safe decongestant
medications.
• Passing water frequently
• Needing to pass water often is
an early sign of pregnancy.
Sometimes, it continues right
throughout the pregnancy. In
later pregnancy, it is the result
of the baby’s head pressing.
 NASAL STIFFNESS
• Some mothers-to-be who develop “stuffy” or “snuffy”
noses find them difficult to get rid of.   The problem may
last until after the baby is born and may not be connected
with a cold at all

Advice
• Don’t take cold cures for it.
• Consult your Doctor if it is very irritating or
gets worse.
 
 EXCESSIVE SALIVATION

This occurs from 8th week of gestation and it is thought

that the hormones of pregnancy are the cause for it. It
may accompany heartburn.
 
PICA
• This is the term used when the mother craves certain
foods or unnatural substances such as coal.
• The cause is unknown but hormones and changes in
metabolism are thought to contribute to this.
• If the substances craved are harmful to the unborn
baby the mother must be helped to seek medical advice.
 SEQUELAE/EUPULIS & TENDER GUMS
  • Increased vascularity and hypertrophy of the
interdental papillae. It is improved usually after
pregnancy termination.
• Sequelae is an Increased tendency for bleeding.
• Retention of food debries predisposes to sepsis &
dental caries.
 
Nursing advice
 
• Proper dental hygiene.
• Cryosurgery for severe cases.