It covers all disorders of pregnancy according to body system with management....

1. MINOR DISORDERS DURING PREGNANCY &
ITS MANAGEMENT
PREPARED BY:
Pinal Darji
F.Y.M.Sc. Nursing,

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 disorder may occur due to hormonal
changes, accommodation changes, metabolic
changes and postural changes.
 Every system of body may affected by pregnancy.

3. DIGESTIVE SYSTEM
 Nausea and vomiting
 Constipation
 Acidity and heartburn
 Excessive salivation(Ptyalism)
 Abdominal discomfort
 Pica

4. NAUSEA AND 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

5. MANAGMENT
 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.

6. 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.

7. MANAGMENT
 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 bowel and leaks from the anus.

8. 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

9. MANAGMENT
 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 tea and change of posture are helpful.
 Calcium-containing antacids & the histamine H2-
receptor antagonists are pregnancy category B
(e.g., Tums) to reduce gastric irritation

10. 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.

11. 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 distention can be due to large
meals, gas-forming foods, and chilled beverages.
These are poorly tolerated by pregnant women

12. MANAGMENT
 Rest frequently, preferably in the lateral recumbent
position
 Local heat and change of position
 Dietary modifications
 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.

13. PICA
 This is 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.

14. MUSCULO-SKELETOL
SYSTEM
Fatigue
Backache
Leg cramps
Round ligament pain

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 heel shoes, muscular spasm,
urinary infection or constipation.
 Fatigue, muscle spasm, or postural back strain most often is responsible

17. MANAGMENT
 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 rest in hard
bed
 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.

18.  Massaging the back muscles, analgesics and rest
 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 0.3–0.6 g 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.
 Worse 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 phosphoru.
 It may due to ischemia and changes in ph or
electrolyte status.

20. MANAGEMENT
 Supplementary calcium therapy in tablet or syrup
after the principal meals may be effective.
 Massaging the leg, application of local heat and
intake of vitamin B1 (30 mg) daily may be effective.
 Sleep with the foot end 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 result 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. CIRCULATORY SYSTEM
 Varicose veins
 Hemorrhoids
 Syncope
 Ankle edema

24. VARICOSE VEINS
 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 during
movements and elevation of the limbs during
rest can give symptomatic relief.
 Elevate legs above the level of her body and
control excessive weight gain.
 Avoid forceful massage (especially downward, i.e.,
against venous return) and point-pressure over the
legs.
 In more severe leg or vulvar varicosities, however,
a Jobst-type leotard garment 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 causes hemorrhoids,
especially in women prone to varicosities.
 Management:
 Regular use of laxative
 Local application of hydrocortisone ointment
 Surgical treatment is better to be withheld as the condition
improves following delivery.
 Treat constipation early.
 Do not suture. Sitz baths, rectal ointments, suppositories,
and mild laxatives are indicated postoperatively or post
delivery.
 Injection treatments are contraindicated.

27. SYNCOPE(FAINTNESS)
 The woman presents with
dizziness or light headedness
on standing upright abruptly or
following standing for a
prolonged period.
 Following prolonged standing or
standing upright abruptly
 Due to pooling of blood in the
veins of the lower extremities &
compression of the pelvic veins
by the gravid uterus
 Other causes may be
dehydration, hypoglycemia or
overexertion

28. 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.

29. 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 retention and
increased venous pressure
in the legs
 Generalized edema, always
serious, must be
investigated

30. MANAGEMENT
 No treatment is required for physiological
edema or orthostatic edema.
 Edema subsides on rest with slight elevation of the limbs.
 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.

31. NERVOUS SYSTEM
 Insomnia
 Headache
 Carpal tunnel syndrome

32. INSOMNIA
This is relatively common in late
pregnancy owning to the discomfort
caused by the fetal movements,
frequency of mituration, and difficulty
in finding a comfortable position.
 It may also due to some deep- seated
anxiety or fear.

33. 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.

34. 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

35. CARPAL TUNNEL SYNDROME
(10%)
 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 retention
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. GENITOURINARY SYSTEM
 Vaginal discharge
 Leucorrhea
 Urinary symptomps

39. VAGINAL DISCHARGE
 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 nonirritating
vaginal discharge due to estrogen stimulation of
cervical mucus is normal during pregnancy.
 Such vaginal fluid is milky, thin, and nonirritating
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 leukorrhea accompanied by pruritus or
discoloration of the secretion may indicate bleeding
or infection, requiring treatment

42. URINARY SYMPTOMPS
 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 well as
decreasing urinary tract infections.

44. RESPIRATORY SYSTEM
BREATHLESSNESS:
 Breathlessness, not actual dyspnea, is a
progesterone effect.
 In nonsmokers 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.
 Management:
 There is no effective treatment.

45. INTEGUMENTARY SYSTEM
SKIN:
 Some mothers complaints of generalized
itching, which often starts over the abdomen.
 Due to have some connection with the liver's
response to the hormones in pregnancy and with
raised bilirubin levels.

46. MANAGEMENT
 It clean soon after the
baby is born and comfort
can be gained from local
applications.
 An anti-histamine is often
prescribed.
 If a mother complaint of
vulvar irritation, infection
such as thrush, and
glycosuria as a result of
diabetes must be
excluded.
 Washing with mild soap
and cotton underwear
might help to ease the
irritation.

47. DISORDERS THAT REQUIRE 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

48. SUMMARY
 Minor disorders during pregnancy
 Digestive system
 Musculoskeletal system
 Circulatory system
 Nervous system
 Genitourinary system
 Respiratory system
 Integumetary system
o Disorder that require immediate action

49. HAVE YOU ANY
QUESTION
?

50. THANK YOU 4 YOUR
COOPERATION &
ATTETION