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.

1. Minor disorders of
pregnancy
Shrooti Shah

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

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.

64. Causes

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

90. Headache

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.