Routine Problems of Pregnancy

Back Pain

• Common, particularly in the third trimester when the patient's center of gravity has shifted.
• Treatment: mild exercise, gentle massage, heating pads, Tylenol, (severe) muscle relaxants or narcotics

Constipation

• Caused by: decreased bowel motility secondary to elevated progesterone (normal in pregnancy), which can lead to greater absorption of water.
• Treatment: increased PO fluids, stool softeners, bulking agents Drinking plenty of water and eating fruit and fibre enriched foods often help

Complication: Some pregnant women report sudden defecation and any issue related to this embarassing symptom must see their doctor or obstetrician.

Contractions

• occasional, irregular contractions that occur several times per day are perfectly normal and are known as Braxton Hicks contractions
• Caused by: dehydration
• Treatment: fluid intake
• regular contractions (every 10-15 min) is a sign of preterm labor and should be assessed by cervical exam.

Dehydration

• Caused by: expanded intravascular space and increased third spacing of fluids
• Treatment: fluid intake
• Complication: uterine contractions (Cause is that dehydration causes body release of ADH, which is similar to oxytocin in structure. Oxytocin itself can cause uterine contractions and thus ADH can cross-react with oxytocin receptors and also cause contractions.)

Edema

• Caused by: compression of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities.
• Treatment: raising legs above the heart, patient sleeps on her side

Gastroesophageal Reflux Disease (GERD)

• Caused by: relaxation of the lower esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy)
• Treatment: antacids, multiple small meals a day, avoid lying down within an hour of eating, H2 blockers, proton pump inhibitors

Hemorrhoids

• Caused by: increased venous stasis and IVC compression leading to congestion in venous system along with increased abdominal pressure secondary to constipation.
• Treatment: topical anesthetics, steroids, treatment of constipation

Pica

• cravings for nonedible items such as dirt or clay. Commonly, patients will be placed on ice chips to chew on instead of these nonedible items.

Lower abdominal pain

• Caused by: rapid expansion of the uterus and stretching of ligaments such as the round ligament.
• Treatment: Tylenol

Increased urinary frequency

• Caused by: increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus. Patients are advised to continue fluid intake despite this. Urinalysis and culture should be ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by dysuria (pain when urinating).

Varicose veins

• Caused by: relaxation of the venous smooth muscle and increased intravascular pressure.
• Treatment: elevation of the legs, pressure stockings

See also

• List of obstetric topics
• Maternal death

Obstetrics | Pregnancy

Complications de la grossesse