very important topic for obg speciality of m.sc nursing 1st year.

1. PRACTICE
TEACHING ON
MINOR AILMENTS
DURING
PREGNANACY

2. INTRODUCTION
• MANY WOMEN EXPERIENCE SOME MINOR DISORDER DURING PREGNANCY
• THESE DISORDER SHOULD BE TREATED ADEQUATELY AS THEY MAY
ESCALATE AND BECOME LIFE THREATENING.
• MINOR DISORDERS MAY OCCUR DUE TO HORMONAL
CHANGES,ACCOMODATION CHANGES, METABOLIC CHANGES AND POSTURAL
CHANGES.
• EVERY SYSTEM OF BODY MAY AFFECTED BY PREGNANCY

3. MINOR AILMENTS OF PREGNANCY
• DURING PREGNANCY ANATOMICAL, PHYSIOLOGICAL AND BIOCHEMICAL
ADAPTATIONS ARE PROFOUND
• THE FEMALE BODY UNDERGOES THESE CHANGES DURING ONSET OF
PREGNANCY AND CONTINUE THROUGH GESTATION.
• THESE CHANGES OCCUR DUE TO SOME PHYSIOLOGICAL STIMULI PROVIDED
BY THE FETUS AND PLACENTA.
• THESE CHANGES MAY BE UNPLEASANT AND AS WELLAS WORRYING.

4. • DURING THE COURSE OF PREGNANCY PERIOD MANY CHANGES OCCUR
IN A WOMAN’S BODY AS A RESULT OF HORMONAL INFLEUNCES AND
ADAPTATIONS TO THE GESTATIONAL PROCESS. THEREBY, THEY
EXPERIENCE A VARIETY OF PHYSIOLOGICALAND PSYCHOLOGICAL
SYMPTOMS SUCH AS NAUSEA, VOMITING, BACKACHE, GIDDINESS,
HEARTBURN, AND ANXIETY ETC. THESE ARE TERMED AS MINOR
AILMENTS OR DISCOMFORT OF PREGNANCY.

5. NAUSEAAND VOMITING:-
• ESPECIALLY IN THE MORNING, SOON AFTER GETTING OUT OF BED.
• USUALLY COMMON IN PRIMIGRAVIDAE.
• 50% WOMEN HAVE BOTH NAUSEA AND VOMITING, 25% HAVE NAUSEA
ONLY AND 25% ARE UNAFFECTED.
• MOST COMMONLY OCCURS DURING THE FIRST 10 WEEKS.
• RELATED TO HIGHER LEVELS OF HCG.

6. MANAGEMENT:-
• DIETARY CHANGES.
• BEHAVIOR MODIFICATION.
• HOSPITALIZATION MAY BE NECESSARY TO CORRECT FLUID AND ELECTROLYTE
IMBALANCE.
• EXPLANATION, REASSURANCE, AND SYMPTOMATIC RELIEF ARE SUFFICIENT.
• AVOID: DISAGREEABLE ODORS AND RICH, SPICY, OR GREASY FOODS.
• DRINK WATER OR OTHER FLUIDS BETWEEN MEALS TO AVOID DEHYDRATION AND
ACIDOSIS.
• MEDICATION: WELL –KNOWN OVER-THE- COUNTER DRUGS SHOULD BE
ADMINISTERED ONLY WHEN ABSOLUTELY INDICATED AND PRESCRIBED.

7. CONSTIPATION:-
• QUITE COMMON AILMENT.
• 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.

8. MANAGEMENT:-
• REGULAR BOWEL HABIT MAY BE RESTORED.
• EMPHASIZE AMPLE FLUIDS AND LAXATIVE FOODS AND PRESCRIBE A
STOOL SOFTENER.
• PURGATIVES SHOULD BE AVOIDED BECAUSE OF THE POSSIBILITY OF
INDUCING LABOR.
• EXERCISE AND GOOD BOWEL HABITS ARE HELPFUL.
• MINERAL OIL IS CONTRAINDICATED BECAUSE IT ABSORBS FAT-
SOLUBLE VITAMINS FROM THE BOWELAND LEAKS FROM THE ANUS.

9. ACIDITY AND HEARTBURN:-
• DUE TO RELAXATION OF THE ESOPHAGEAL SPHINCTER & HIATUS
HERNIA.
• HEARTBURN (PYROSIS, ACID INDIGESTION) RESULTS FROM
GASTROESOPHAGEAL REFLUX DISEASE ( GERD) IN ALMOST 10% OF
ALL GRAVIDAS.
• IN LATE PREGNANCY, THIS MAY BE AGGRAVATED BY DISPLACEMENT
OF THE STOMACH AND DUODENUM BY THE UTERINE FUNDUS.
• MOST LIKELY TO OCCUR WHEN THE PATIENT IS LYING DOWN OR
BENDING OVER.

10. MANAGEMENT:-
• TO AVOID OVER EATING AND NOT TO GO TO BED IMMEDIATELY AFTER
THE MEAL.
• LIQUID ANTACIDS MAY BE HELPFUL.
• SLEEPING IN SEMI- RECLINING POSITION WITH HIGH PILLOWS
• THIS HERNIA IS REDUCED SPONTANEOUSLY AFTER DELIVERY.
• SYMPTOMATIC TREATMENT, NOT SURGERY, IS RECOMMENDED.
• HOT TEAAND CHANGE OF POSTURE ARE HELPFUL.
• CALCIUM- CONTAINING ANTACIDS & THE HISTAMINE H2- RECEPTOR
ANTAGONISTS ARE PREGNANCY CATEGORY B(E.G,TUMS) TO REDUCE
GASTRIC IRRITATION.

11. EXCESSIVE SALIVATION(PTYALISM)
• INCREASED SECRETION OF SALIVA IS OBSERVED DURING PREGNANCY. IT
MAY BE ASSOCIATED WITH INCREASED INTAKE OF STARCH, THOUGH
ACTUAL CAUSE IS NOT KNOWN.
•MANAGEMENT-
• THIS PROBLEM IS USUALLY SELF- LIMITING AND MAY BE OVERCOME BY
DECREASING INTAKE OF CARBOHYDRATES.
• IT IS NOT ASSOCIATED WITH ANY ADVERSE PREGNANCY OUTCOME.

12. ABDOMINAL DISCOMFORT:-
• DUE TO PRESSURE, PELVIC HEAVINESS IS CAUSED BY THE WEIGHT OF THE UTERUS
ON THE PELVIC SUPPORTS AND THE ABDOMINAL WALL.
• ROUND LIGAMENT TENSION, TENDERNESS ALONG THE COURSE OF THE ROUND
LIGAMENT ( USUALLY THE LEFT) DURING LATE PREGNANCY, IS DUE TO TRACTION
ON THIS STRUCTURE BY THE UTERUS, WHICH IS DISPLACED BY THE LARGE BOWEL
TO BE ROTATED SLIGHTLY TO THE RIGHT.
• FLATULENCE AND DISTENSION CAN BE DUE TO LARGE MEALS, GAS FORMING
FOODS, AND CHILLED BEVERAGES. THESE ARE POORLY TOLERATED BY PREGNANT
WOMEN.

13. MANAGEMENT:-
• REST FREQUENTLY, PREFERABLY IN THE LATERAL RECUMBENT
POSITION.
• LOCAL HEAT AND CHANGE IN POSITION.
• DIETARY MODIFICATION
• REGULAR BOWEL FUNCTION SHOULD BE MAINTAINED, AND EXERCISE
IS BENEFICIAL.
• ACETAMINOPHEN 0.3-0.6, 2-3 TIMES DAILY MAY BE OF VALUE.
• INTRA ABDOMINAL DISORDERS MUST BE DIAGNOSED AND TREATED
APPROPRIATELY.

14. PICA:-
• THIS IS THE TERM USED WHEN THE MOTHER CRAVES CERTAIN FOOD
OR UNNATURAL SUBSTANCES SUCH AS COAL.
• THE CAUSE IS UNKNOWN BUT HORMONES AND CHANGES IN
METABOLISM ARE THOUGHT TO CONTRIBUTE TO THIS.
• IF THE SUBSTANCE CRAVED ARE HARMFUL TO THE UNBORN BABY,
THE MOTHER MUST BE HELPED TO SEEK MEDICAL ADVICE.

15. FATIGUE-
• THE PREGNANT PATIENT IS MORE SUBJECT TO FATIGUE DURING THE LAST
TRIMESTER OF PREGNANCY BECAUSE OF ALTERED POSTURE AND EXTRA
WEIGHT CARRIED
•MANAGEMENT-
•ANEMIA AND OTHER SYSTEMIC DISEASES MUST BE RULED OUT.
•FREQUENT REST PERIODS ARE RECOMMENDED.

16. BACKACHE-
• COMMON PROBLEM (50%) IN PREGNANCY.
• PHYSIOLOGICAL CHANGES THAT CONTRIBUTE TO BACKACHE ARE: JOINT
LIGAMENT LAXITY (RELAXIN,ESTROGEN), WEIGHT GAIN, HYPERLORDOSIS AND
ANTERIOR TILT OF THE PELVIS.
• MAY BE DUE TO FAULTY POSTURE AND HIGH HEELS SHOES, MUSCULAR SPASM,
URINARY INFECTION OR CONSTIPATION.
• FATIGUE, MUSCLE SPASM, OR POSTURAL BACK STRAIN MOST OFTEN IS
RESPONSIBLE

17. MANAGEMENT-
• EXCESSIVE WEIGHT GAIN SHOULD BE AVOIDED.
• REST WITH ELEVATION OF THE LEGS TO FLEX THE HIPS MAY BE HELPFUL.
• IMPROVEMENT OF POSTURE, WELL-FITTED PELVIC GIRDLE BELT WHICH CORRECTS
THE LUMBAR LORDOSIS DURING WALKING AND IN HARD BED.
• IMPROVEMENT IN POSTURE IS OFTEN ACHIEVED BY THE WEARING OF LOW-
HEELED SHOES. TO ACHIEVED PROPER POSTURE, THE ABDOMEN SHOULD BE
FLATTENED, THE PELVIS TILTED FORWARD, AND THE BUTTOCKS TUCKED UNDER TO
STRAIGHTEN THE BACK.
• MASSAGING THE BACK MUSCLES, ANALGESICS AND REST.

18. Cont..
• BACK EXERCISES UNDER THE SUPERVISION OF A REHABILITATION
PHYSICIAN, AN ORTHOPEDIST, OR A PHYSICAL THERAPIST.
• RECOMMEND SLEEP ON A FIRM MATTRESS.
• APPLY LOCAL HEAT AND LIGHT MASSAGE TO RELAX TENSE, TAUT BACK
MUSCLES.
• GIVE ACETAMINOPHEN 0.3-0.6G ORALLY OR EQUIVALENT.
• OBTAIN ORTHOPEDIC CONSULTATION IF DISABILITY RESULTS. NOTE
NEUROLOGICAL SIGNS AND SYMPTOMS INDICATIVE OF PROLAPSED
INTERVERTEBRAL DISK SYNDROME, RADICULITIS.

19. LEG CRAMPS-
QUITE COMMON, USUALLY IN THE LEG.
•WORST AT NIGHT.
•THE CAUSE OF LEG CRAMPS IN PREGNANCY IS NOT KNOWN BUT IT
MAY BE DUE TO DEFICIENCY VITAMIN B1 AND OF DIFFUSIBLE SERUM
CALCIUM OR ELEVATION OF SERUM PHOSPHORUS.
•IT MAY DUE ISCHEMIAAND CHANGES IN PH OR ELECTROLYTE STATUS.

20. MANAGEMENT-
• SUPPLEMENTARY CALCIUM THERAPY IN TABLETS OR SYRUP AFTER
THE PRINCIPAL MEALS MAY BE EFFECTIVE.
• MASSAGING THE LEG, APPLICATION OF LOCAL HEAT AND INTAKE OF
VITAMIN B1 (30MG) DAILY MAY BE EFFECTIVE.
• SLEEP WITH THE FOOT AND ELEVATION BY 20 TO 25 CM. ONCE THE
CRAMPS IS OCCUR GENTLE KNEADING IS EFFECTIVE.

21. ROUND LIGAMENT PAIN-
• STRETCHING OF THE ROUND LIGAMENTS DURING MOVEMENTS IN
PREGNANCY MAY CAUSE SHARP PAIN IN THE GROINS. THIS PAIN MAY
BE UNILATERAL OR BILATERAL.
• IT IS USUALLY FELT IN SECOND TRIMESTER ONWARDS. THIS IS MORE
COMMON IN RIGHT SIDE AS A RESULTS OF DEXTROROTATION OF
UTERUS.
• PAIN MAY BE AWAKENING AT NIGHT TIME BECAUSE OF SUDDEN ROLL
OVER MOVEMENTS DURING SLEEP.

22. MANAGEMENT-
• PAIN MAY BE REDUCED BY MAKING MOVEMENTS GRADUAL INSTEAD
OF SUDDEN.
• LOCAL HEAT APPLICATION IS HELPFUL.
• ANALGESICS ARE RARELY NEEDED.

23. VARICOSE VEIN-
• IN THE LEGS AND VULVA (VARICOSITIES) OR RECTUM (HEMORRHOIDS)
MAY APPEAR FOR THE FIRST TIME OR AGGRAVATE DURING
PREGNANCY
• USUALLY IN THE LATER MONTHS.
• DUE TO OBSTRUCTION IN THE VENOUS RETURN BY THE PREGNANT
UTERUS.
• DUE TO SMOOTH MUSCLE RELAXATION, WEAKNESS OF THE
VASCULAR WALLS, AND INCOMPETENT VALVES.

25. MANAGEMENT-
• FOR LEG VARICOSITIES, ELASTIC CREPE BANDAGE MOVEMENTS AND ELEVATION OF
THE LIMBS DURING REST CAN GIVES SYMPTOMATIC RELIEF.
• ELEVATE LEGS ABOVE THE LEVEL OF HER BODY AND CONTROL EXCESSIVE WEIGHT
GAIN.
• AVOID FORCEFUL MASSAGE( ESPECIALLY DOWNWARDS, I.E., AGAINST VENOUS
RETURN) AND POINT-PRESSURE OVER THE LEGS.
• IN MORE SEVERE LEG OR VULVAR VARICOSITIES, HOWEVER, A JOBST-TYPE
LEOTARD GARMENTS MAY BE NECESSARY TO OBTAIN VENOUS COMPRESSION.
• INJECTION OR SURGICAL CORRECTION OF VARICOSE VEINS USUALLY IS NOT
RECOMMENDED DURING PREGNANCY.

26. HEMORRHOIDS-
• IT MAY CAUSE ANNOYING COMPLICATIONS LIKE BLEEDING OR MAY
GET PROLAPSED.
• MAY CAUSE CONSIDERABLE DISCOMFORT.
• STRAINING AT STOOL OFTEN CAUSE HEMORRHOIDS, ESPECIALLY IN
WOMEN PRONE TO VARICOSITIES.

27. MANAGEMENT-
• REGULAR USE OF LAXATIVE
• LOCALAPPLICATION OF HYDROCORTISONE OINTMENT.
• SURGICAL TREATMENT IS BETTER TO BE WITHHELD AS THE CONDITION
IMPROVES FOLLOWING DELIVERY.
• TREAT CONSTIPATION EARLY.
• DO NOT SUTURE. SITZ BATH, RECTAL OINTMENTS, SUPPOSITORIES, AND
MILD LAXATIVES ARE INDICATED POSTOPERATIVELY OR POST DELIVERY.
• INJECTION TREATMENTS ARE CONTRAINDICATED.

28. SYNCOPE ( FAINTNESS)-
• THE WOMAN PRESENTS WITH DIZZINESS OR LIGHT HEADEDNESS ON
STANDING UPRIGHT ABRUBTLY OR FOLLOWING STANDING FOR A
PROLONGED PERIOD.
• FOLLOWING PROLONGED STANDING OR STANDING UPRIGHT ABRUBTLY.
• DUE TO POOLING OF BLOOD IN THE VEINS OF THE LOWER EXTREMITIES &
COMPRESSION OF THE PELVIC VEINS BY GRAVID UTERUS.
• OTHER CAUSES MAY BE DEHYDRATION, HYPOGLYCEMIA OR
OVEREXERTION.

29. MANAGEMENT-
• SYNCOPE USUALLY RESOLVES RAPIDLY ON LYING IN LEFT LATERAL
POSITION.
• SYNCOPE IN SUPINE POSITION IS ALSO MANAGED BY RESTING IN
LATERAL RECUMBENT POSITION.
• RECURRENT SYNCOPE NEEDS CARDIOLOGICAL EVALUATION.
• ENCOURAGE THE PATIENT TO EAT SIX SMALL MEALS A DAY RATHER
THAN THREE LARGE ONES.
• STIMULANTS (SPIRITS OF AMMONIA, COFFEE, TEA) ARE INDICATED
FOR ATTACKS DUE TO POSTURAL HYPOTENSION

30. ANKLE EDEMA-
• EVIDENCED BY MARKED GAIN IN WEIGHT OR EVIDENCES OF
PREECLAMPSIA.
• DEVELOPS IN AT LEAST TWO THIRDS OF WOMEN IN LATE PREGNANCY.
• DUE TO WATER RETENSION AND INCREASED VENOUS PRESSURE IN
THE LEGS.
• GENERALIZED OEDEMA, ALWAYS SERIOUS, MUST BE INVESTIGATED.

32. MANAGEMENT-
• NO TREATMENT IS REQUIRED FOR PHYSIOLOGICAL OEDEMA OR ORTHOSTATIC
OEDEMA.
• OEDEMA SUBSIDES ON REST WITH SLIGHT ELEVATION OF LEGS.
• DIURETICS SHOULD NOT BE PRESCRIBED.
• TREATMENT IS LARGELY PREVENTIVE AND SYMPTOMATIC.
• THE PATIENT SHOULD ELEVATE HER LEGS FREQUENTLY.
• RESTRICT EXCESSIVE SALT INTAKE AND PROVIDE ELASTIC SUPPORT FOR VARICOSE
VEINS.
• DIURETICS MAY REDUCE EDEMA TEMPORARILY BUT MAY BE HARMFUL TO THE
MOTHER OR FETUS

33. INSOMNIA-
• THIS IS RELATIVELY COMMON IN LATE PREGNANCY OWNING TO THE
DISCOMFORT CAUSED BY THE FETAL MOVEMENTS, FREQUENCY OF
MICTURATION, AND DIFFICULTY IN FINDING A COMFORTABLE
POSITION.
• IT MAY ALSO DUE TO SOME DEEP- SEATED ANXIETY OR FEAR.

34. 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.
• TALK ABOUT HER FEAR AND ANXIETY SO THAT SHE CAN HAVE A SENSE
OF NORMALITY AND LIGHTNESS

35. HEADACHE-
• HEADACHE IN PREGNANCY IS COMMON AND USUALLY DUE TO
TENSION.
• REFRACTIVE ERRORS AND OCULAR IMBALANCE ARE NOT CAUSED BY
NORMAL PREGNANCY.
• SEVERE, PERSISTENT HEADACHE IN THE THIRD TRIMESTER MUST BE
REGARDED AS SYMPTOMATIC OF PREECLAMPSIA- ECLAMPSIA UNTIL
PROVEN OTHERWISE.

36. CARPAL TUNNEL SYNDROME-
• PAIN AND NUMBNESS IN THE THUMB, INDEX AND THE MIDDLE FINGER.
• WEAKNESS IN THE MUSCLES FOR THUMB MOVEMENTS.
• DUE TO COMPRESSION EFFECT ON THE MEDIAN NERVE.
• PHYSIOLOGICAL CHANGES IN PREGNANCY WITH RETENSION OF EXCESS FLUID ARE
THE COMMON CAUSE.

37. MANAGEMENT-
• TREATMENT IS MOSTLY SYMPTOMATIC.
• A SPLINT IS APPLIED DURING SLEEP TIME TO THE SLIGHTLY FLEXED
WRIST TO GIVE RELIEF.
• CORTICOSTEROID INJECTION OR SURGICAL DECOMPRESSION IS
RARELY NEEDED.
• IT RESOLVES SPONTANEOUSLY FOLLOWING DELIVERY

38. VAGINAL DISCHARGE-
• THIS IS DUE TO THE INCREASED TRANSUDATION OF FLUIDS AS A
RESULTS OF INCREASED VASCULARITY AND HYPERESTROGENIC
STATE DURING PREGNANCY. THE DISCHARGE IS CLEAR AND WHITE
AND DO NOT HAVE UNPLEASANT SMALL.

39. MANAGEMENT-
• ASSURANCE TO THE PATIENT AND ADVICE FOR LOCAL CLEANLINESS
ARE ALL THAT ARE REQUIRED.
• PRESENCE OF ANY INFECTION ( TRICHOMONAS, CANDIDA, BACTERIAL
VAGINOSIS) SHOULD BE TREATED WITH VAGINAL APPLICATION OF
METRONIDAZOLE OR MICONAZOLE.

40. LEUCORRHEA-
• GRADUAL INCREASE IN THE AMOUNT OF NON IRRITATING VAGINAL
DISCHARGE DUE TO ESTROGEN STIMULATION OF CERVICAL MUCUS IS
NORMAL DURING PREGNANCY.
• SUCH VAGINAL FLUID IS MILKY, THIN, AND NON IRRITATING UNLESS
INFECTION HAS OCCURRED.
• PERSISTENT EXTERNAL MOISTURE DUE TO MUCUS MAY CAUSE MILD
PRURITUS, BUT ITCHING IS RARELY SEVERE WITHOUT INFECTION

41. MANAGEMENT-
• REASSURE THE PATIENT, AND SUGGEST PROTECTIVE PERINEAL PADS.
• EXCESSIVE LEUCORRHEA ACCOMPANIED BY PRURITUS OR
DISCOLORATION OF THE SECRETION MAY INDICATE BLEEDING OR
INFECTION, REQUIRING TREATMENT.

42. URINARY SYMPTOMS-
• URINARY FREQUENCY, URGENCY, AND STRESS INCONTINENCE IN
MULTIPARAS ARE COMMON, ESPECIALLY IN ADVANCED PREGNANCY.
• DUE TO INCREASED INTRA ABDOMINAL PRESSURE AND REDUCED
BLADDER CAPACITY.
• SUSPECT URINARY TRACT DISEASE IF DYSURIA OR HEMATURIA IS
PRESENT.

43. MANAGEMENT-
• WHEN URGENCY IS PARTICULARLY TROUBLESOME, LIMIT CAFFEINE,
SPICES AND POPULAR BEVERAGES.
• AN 8 OZ GLASS OF CRANBERRY JUICE ASSISTS IN BOTH MAINTAINING
URINARY ACIDITY AS WELLAS DECREASING URINARY TRACT
INFECTIONS.

44. BREATHLESSNESS-
• BREATHLESSNESS, NOT ACTUAL DYSPNEA, IS A PROGESTERONE
EFFECT.
• IN NON SMOKERS AND OTHERS FREE OF COUGH OR ALLERGIC
PROBLEMS, BREATHLESSNESS OCCURS AS EARLY AS THE 12TH WEEK
OF PREGNANCY, AND MOST WOMEN HAVE THIS SYMPTOM BY THE
30TH WEEK.

45. MANAGEMENT-
• THERE IS NO EFFECTIVE TREATMENT

46. 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 LOCALAPPLICATIONS

47. MANAGEMENT-
• AN ANTI- HISTAMINE IS PRESCRIBED.
• WASHING WITH MILD SOAPAND WEAR COTTON UNDERWEAR.
• IT CLEAN SOON AFTER THE BABY IS BORN AND COMFORT CAN BE
GAINED FROM LOCALAPPLICATIONS.
• IF A MOTHER COMPLAINT OF VULVAR IRRITATION, INFECTION SUCH
AS THRUSH, AND GLYCOSURIA AS A RESULT OF DIABETES MUST BE
EXCLUDED.

48. CHLOASMA GRAVIDUM-
• (MASK OF PREGNANCY) A BUTTERFLY PIGMENTATION ON THE
CHEEKS & NOSE. IT USUALLY DISAPPEAR FEW MONTHS AFTER LABOR
LINEAALBICANS & STRAIEGRAVIDUM-
• PIGMENTATION IN THE LOWER ABDOMEN, FLANKS, INNER THIGH,
BUTTOCKS & BREASTS INCREASE AS PREGNANCY ADVANCES.

49. Cont..
• 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.

50. DISORDERS THAT REQUIRES IMMEDIATE ACTION-
• Vaginal bleeding
• Reduced fetal movement
• Frontal or recurring headache
• Sudden swelling/edema
• Rupture of the membrane
• Premature onset of contraction
• Sudden nausea and sickness.
• Epigastric pain

51. •SUMMARY