MINOR DISORDER AND GENERAL ADVISES
Leg cramps are common and can be annoying. Without solid evidence, these have been attributed to calcium deficiency, or elevated serum phosphorus. Treatment with calcium tablets or aluminium hydexide is advised. Leg cramps appears to be self limiting and rarely persists for more than a few weeks.
Heartburn is quite common in pregnancy, reduced movements and the relaxation of the muscles of the gastrointestinal tract in pregnancy due to the hormonal changes. Predispose to heartburn with regurgitation of stomach contents into the lower oesophagus.
Antacids can be helpful. Frequent intake of little meals and avoiding fried or fatty food also helps. Pregnant women who suffer it should be encouraged to sit up as much as possible even at night while sleeping.
Constipation is common during pregnancy because of reduced small bowel motility. It is good to reassure patients that it is common and physiological. It can be helped by a diet containing plenty of fluids, fruits, vegetables and fibre. Purgatives should be avoided.
This is more common in late pregnancy, particularly if the pregnant woman lies flat on her back and the pressure of the uterus reduces blood returns to heart.
Fainting may occur during the 1st 28 weeks, however it is often postural, such as when sitting up from recumbency or standing up from sitting position suddenly. Changing posture more slowly avoids the problem.
Frequency of Urine
Most women develop increased frequency of mictirition early in pregnancy. The urinary frequency is due partly to pressure on the bladder, from the enlarging uterus and partly to excessive fluid intake. No treatment is necessary but if pain during urination is associated, a urinary tract infection is likely.
The physiological, white vaginal discharge normally increases during pregnancy because of increased shedding of vaginal mucosal cells and because there is increased secretion from the cervix. If the discharge becomes yellow, offensive or associated with itching, vaginal infection is likely.
Vagina infection with Candida albicans or trichomonas could occur in pregnancy. A vaginal swab for culture and microscopy would detect it.
Varicose veins tend to develop in the legs or vulva, and often in women with a family history of varicose veins. Signs appears early in pregnancy and women should be encouraged to use supportive elastic stockings. Surgery for it during pregnancy is very unnecessary since it subsides after delivery.
These are common in pregnancy and can cause considerable discomfort. They are more likely to cause problems late in pregnancy or after delivery.
Pelvic Joint Pain
In the non pregnant states, the pelvic joints (symphisis and sacroiliac) are rigid and fixed. In pregnancy, hormonal changes can lead to relaxation of the ligaments guarding these joints. This can allow a little laxity in the joints which can be very painful. The pain may be mainly in the public symphisis area but in some women it may be in back sacroiliac joints. It is difficult to completely effectively treat in pregnancy.
Bed rest may help. Fortunately, the pain usually resolves rapidly a few days after delivery.
Numbness in Hands
Numbness and tingling of fingers is common in pregnancy and usually associated with traction of the nerves (brachial plexus) due to neck-shoulder arm syndrome. Discomfort is most common at night and early morning. The disorder is not serious and can be helped by exercises or physiotherapy.
Carpal Tunnel Syndrome
This is characterised by pain, numbness, tingling or burning in one or both hand in the area innervated by the median nerve. It is more frequent in late pregnancy than in the first 28 weeks.
Drugs:- Although the number of drugs associated with definite evidence of abnormality in pregnancy is small, however the following drugs should be avoided in early pregnancy.
- High doses of vit D
There should be a very good reason for prescribing any drug at anytime in pregnancy.
Cigarette smoking has important adverse effect in pregnancy. It is associated with increased incidence of low birth weight and prenatal mortality from pre-eclamepsia. Encouraging pregnant women not to smoke is an important part of health education and antenatal care.
The incidence of congenital abnormality is 32% in heavy drinkers. 14% in moderate drinkers and 9% in light drinkers. Whilst it is unlikely that any occasional drink taker during pregnancy has a serious effect on the fetus, the safest advise for pregnant women is that alcohol should be avoided altogether.
If abdominal cramps or vaginal bleeding follows coitus, sexual intercourse should be avoided. Sexual intercourse should be avoided in women with spontaneous rupture of membrane or antepartum haemorrhage.
In healthy women with normal pregnancy, every prohibition of sex is totally inappropriate.
Swimming is not contraindicated during normal pregnancy, but diving or surfing should be avoided because of possible trauma.
Exercise in moderation is acceptable and desirable during pregnancy. Potentially dangerous sports such as horse riding and indue physical stress should be avoided.
It is inadvisable for a woman to embark on long journey especially by air after 35 weeks of pregnancy or if she has had bleeding or any other complication likely to recur as an emergency.