MINOR ALIMENT

IN PREGNANCY
AND ITS
MANAGEMENT

Submitted To- Submitted By-

Mrs. Madhusmita Nayak Itismita Biswal

Assistant Professor M. Sc. Nursing (1st Yr)

Obstetrics & Gynaecology Department Obstetrics & Gynaecology Department

Sum Nursing College, Bhubaneswar Sum Nursing College, Bhubaneswar

INTRODUCTION –

Many women experience some minor ailments during pregnancy. These disorders should be
treated adequately as they may cause life threatening conditions in progress of pregnancy.

Minor ailments may occur due to hormonal changes, accommodation changes, metabolic
changes & postural changes. Every system of the body is affected by pregnancy. The mother
needs knowledge to cope with the experience of pregnancy.

These ailments of pregnancy are those presentations and conditions that result from
pregnancy but do not significantly interfere with the activities of daily living or any
significant threat to the health of the mother or baby, in contrast to pregnancy
complications.

DEFINITION –

“The minor ailments of Pregnant woman that occur due to physiological alterations of
hormones ( oestrogen, progesterone, Prolactin ) and other causative factors which can be
managed without medical interventions”

DIGESTIVE SYSTEM

1. Nausea &vomiting:

It is a common disorder seen in about 50%women between 4th& 16th week of gestation.
Hormonal influences are thought to be the most likely cause. Human chorionic
gonadotropin that is present in large amounts in the 1st trimester, oestrogen&
progesterone are all contribute to this. The sickness is confined to “early morning” but
can occur at any time in the day. The smell of certain cooking food will cause the
symptom.

Management:

The midwife should encourage the mother to look positively towards the resolution of
the problem.

 Salads & light snacks are given than full meals.

 Carbohydrate snacks at bed time can prevent hypoglycaemia.
 Dry toast or biscuits are given on waking up &breakfast after half an hour.

*If vomiting becomes severe the mother may lose weight& becomes dehydrated this
condition is called hyperemesis gravidarum& specialized care & appropriate referral should
be needed.
2. Constipation:

This is due to smooth muscle relaxant effect of progesterone causing decreased peristalsis
of gut. Pressure of the gravid uterus on the colon near term makes it worse as the colon
gets displaced. It is usually overcome by adjusting diets.

Management:

The women may be advised to:

 Increase the intake of water.

 Add green leafy vegetables, fruits & bran cereals to her diet.
 Take a glass of warm water in the morning before tea or breakfast which would
activate the gut & help regular bowel movements.
 Do exercise by regular walking.

3. Acidity & heartburn:

This is a burning pain in the mediastinal position caused by reflux of stomach contents into
the oesophagus. It occurs because the cardiac sphincter relaxes during pregnancy due to the
effect of progesterone. The condition tends to worsen as pregnancy advances because the
stomach is displaced upward by the enlarging uterus.

Heart burn is most troublesome at about 30th to 40th week of gestation because at this stage
the stomach is under pressure from the growing uterus.

Management:

The advice given according to the severity of the condition:

 If the heartburn is occasional the reflux can be prevented by avoiding bending &
kneeling while doing household works.
 Advice to take small meals which will be more easily digested.
 Fried & fatty foods should be avoided.
 Sleeping with more pillows & lying on right lateral side can be helpful.
 For persistent heartburn antacids may be prescribed by the physician.

4. Excessive salivation ( Ptyalism ):

This occurs from 8th week of gestation which is caused due to the hormones of pregnancy.

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.
5. 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.

Management:

 Provide rest frequently, preferably in the lateral recumbent position.

 Local heat should be applied and change of position frequently.
 Dietary modifications should be needed.
 Regular bowel function should be maintained, and exercise is beneficial.
 Acetaminophen 0.3–0.6, 2–3 times daily may be given to reduce discomfort.
 Intra abdominal disorders must be diagnosed and treated appropriately.

6. Pica:

This the term used when the mother craves certain foods or unnatural substances such as
coal. The cause is unknown but hormones & changes in metabolism are thought to
contribute to this. If the substances craved are harmful to the unborn baby, the mother
must be helped to seek medical advice.

MUSCULO-SKELETAL SYSTEM

1. Fatigue:

The pregnant patient is more subjected to fatigue during the last trimester pregnancy
because of altered posture & extra weight carried.

Management:

 Frequent rest period should recommended.

 Anemia & other systemic diseases should be ruled out.

2. Backache:

The gradual weight gain & the changes in the body’s center of gravity combined with the
stretching of weak abdominal muscles often lead to hollowness of lumbar spine. There is a
tendency for back muscles to shorten as the abdominal muscles stretched & extra strain is
put on the ligaments this results in backache.
Management:

 Excessive weight gain should be avoided.

 Rest with elevation of legs to flex the hips may be helpful.
 Improvement of posture with well fitted pelvic girdle belt may be reduce the pain.
 Advice the mother to wear low healed shoe.
 Apply local heat or light massage is helpful.
 Recommended sleep on a firm mattress.
 Provide back exercise under the supervision of physician.
 Give acetaminophen 0.3-0.6 g orally.
3. Leg cramps:

These are quite common & worsen at night. The cause is not known but has been attributed
to deficiency of vit-B1 & decreased level of calcium. It may be due to ischemia or changes in
pH or electrolyte level.

Management:

 Make gentle leg movements, massage the leg & also apply local heat which may be
beneficial.
 Sleep with foot end of the bed elevated by 20-25cm.
 Take Vit-B complex & calcium supplements.

4. Round ligament pain:

Stretching of the round ligament during movement in pregnancy may cause sharp pain in
the groins which may be unilateral or bilateral. It is usually felt in 2 nd trimester onwards. This
is more common in right side as a result of dextro-rotation of uterus. Pain may be awaking
at night time because of sudden roll over movements during sleep.

Management:

 Pain may be reduced by making movements gradual instead of sudden.

 Local heat application is helpful.
 Analgesics may be needed.

CIRCULATORY SYSTEM

1. Varicose vein:

Progesterone relaxes the smooth muscles of veins & results in slow circulation, the valves of
the dilated veins become inefficient & varicosities results. It generally occurs in legs, anus&
vulva. The mothers with a family history of varicose vein & those doing work with long
period of standing & sitting usually develop varicose veins.
Management:

 Exercising the calf muscles by rising onto the toes or making circular movements
with the ankles.
 Resting with the legs vertical against the wall for a short time.
 Wearing support tights before rising or after resting with legs elevated.
 Avoid forceful massage & point-pressure over legs.

2. Hemorrhoids:

It may cause due to any complications like bleeding & get prolapsed that produce severe
pain.

Management:

 Prevent constipation first for that use laxatives.

 Apply hydrocortisone ointment to reduce pain & swelling.
 Advice for sitz bath.

3. Syncope (Fainting):

In early pregnancy fainting may occur due to vasodilation under the influence of
progesterone. It may subside following the compensatory increase in blood volume.

Management:

 Avoid long period of standing as well as sitting or lying down when she feels slightly
faint.
 In later pregnancy advice the mother not to sleep with her back except during
abdominal examination because this can cause venacaval compression which leads
to slow return of blood to heart.
 Encourage the mother to eat small meals rather than large one.

4. Ankle Oedema:

It develops in at least two thirds of women in late pregnancy but mainly occur in 2nd&3rd
trimesters. It is the results of venous & lymphatic stasis, as well as occurs due to changes
in osmotic pressure of blood & tissue fluids & altered capillary permeability.

Management:

 No treatment is required for physiological or orthostatic oedema.

 Elevate the legs while sleeping & sleep in left lateral position & avoiding sitting with
the feet hanging down.
 Restrict excessive salt intake & provide elastic support for varicose veins.
  Diuretics should not be given.

NERVOUS SYSTEM

1. Insomnia:

It is relatively common in late pregnancy owing to discomfort caused by fetal movements,

frequency of micturition & difficulty in finding a comfortable position. It may also be due to
some deep seated anxiety or fear.

Management:

 Take rest in 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 fears & anxieties so that she can have a sense of normality &
lightness.

2. 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 pre-eclampsia and eclampsia.

Management:

 Advice the mother to take adequate rest.

 If there is any pregnancy induced hypertension then symptomatic management

should be done.

3. Carpal tunnel syndrome:

Mothers complain of numbness & pins & needles in their fingers & hands. This usually
happens in the morning, but it can occur at any time of the day. It is caused by fluid
retention which creates oedema& pressure on the median nerve.

Management:

 Wearing a splint at night with the hands resting on 2or 3 pillows.

 Restriction of salt intake & flexing the fingers while the arm is held above the head.
 It usually resolves spontaneously.
GENITO URINARY SYSTEM

1. Leucorrhoea

This is the increased white non irritant vaginal discharge in pregnancy. If the mother finds
the discharge disturbing, it needs management.

Management:

 Advice her to maintain personal hygiene.

 Frequently wash the vulva i.e.3-4 times per day with plain water.
 Advice her to wear cotton underwear & avoid tights.
 Educate her about the possibility of infections such as Thrush & Trichomonas.

2. Urinary symptoms/ frequency of micturition

This occur in the 1st trimester when there is pressure on the gravid uterus on the urinary
bladder. It is spontaneously relieved when the uterus rises up in the abdomen. It may recur
in late pregnancy when the fetal head descends into pelvis.

Management:

 Advice her to take adequate rest.

 Advice her to maintain proper perineal hygiene.

RESPIRATORY SYSTEM

1. Breathlessness

It is not actual dyspnea which is occurs due to progesterone effects. It occurs as early as in
12th week of pregnancy & most women have it up to 30th week.

Management

 There is no effective management but rest will helpin reducing the condition.

INTEGUMENTARY SYSTEM

1. Skin

Some mothers complain of generalized itching that starts over the abdomen. This occurs
due to livers response to certain hormones in pregnancy & with raised bilirubin level.

Management

 It clear soon after the baby is born & comfort can be gained from local application.
 An anti-histamine can be prescribed.
  If the mother complain irritation or infection then washing with mild soap & cotton
underwear might help to reduce the irritation.

ABSTRACT

1. Leg cramp is the painful contraction of the muscles that often occurs at night. Pregnancy is the
most common cause of muscle cramps that usually occur in the second trimester of pregnancy.
Although the reasons of the spasms had not been determined, the imbalance between the
absorption and elimination of serum electrolytes such as Ca, Mg and potassium and also
insufficiency of some vitamins and probably the changes in activities of motor neurons of spinal
cord, can be the source of these problems. The aim of this study was the evaluation of frequency
and predisposing factors of leg cramps. Methods: In a cross sectional descriptive analytic study, a
group of 400 women in the third trimester of pregnancy were asked to record the symptoms of leg
cramp. Their education level and job recorded and their total serum level of Ca and Mg was
measured in the first visit. Exclusion criteria included systemic medical conditions such as thyroid
disease, diabetes, osteoporosis and prenatal disorders such as gestational diabetes mellitus and
preeclampsia and patient cooperation. Results: In our study the prevalence of leg cramp was
54.75%. There was a statistically significant relationship between leg cramp and serum level of
magnesium (p=0.04). There was no relation between calcium serum level and leg cramp (p=0.294).
The women's age, their nutritional habits and individual characteristics were not signifycantly
related to occurrence of leg cramp. Conclusion: Leg cramp is a common symptom in pregnancy and
in patients with low serum levels of magnesium, a magnesium supplement can be
helpful.(Sohrabvand, (2009))

2. Patients with unilateral severe varicose veins (group I, n = 7), mild varicose veins (group II, n = 8)
and healthy pregnant women (group III, n = 3). Groups I and II employed elastic stockings as
treatment, while group I additionally applied a ruscus-containing cream to the affected leg. In the
healthy women, in the unaffected leg in group II and in the cream treated leg in group I, the femoral
vein increased in diameter on average by 2.1 to 2.4 mm in the third term of pregnancy, while in the
affected leg of group II it increased by 3.6; in group I the increase in the leg not treated with cream
was about 4.5 mm. The differences in dilatation are significant (p less than 0.05). Apparently, the
venous tonic action of ruscus extract can considerably reduce venous dilatation during
pregnancy.(Berg, 1992)The majority of women vomit or feel nauseated in early pregnancy.
Symptoms usually begin before 9 weeks of gestation, and usually improve, resolving by 16 weeks of
gestation in 90% of women.Hyperemesisgravidarum is a diagnosis of exclusion characterized by
prolonged and severe nausea and vomiting, dehydration, ketosis, and body weight loss in
pregnancy.Complications are more likely in women with severe vomiting and include:Maternal —
weight loss, dehydration, hyponatraemia, vitamin deficiencies, Mallory-Weiss tear or oesophageal
rupture, increased risk of venous thromboembolism.Fetal — possible higher incidence of low
birthweight babies (if hyperemesis gravidarum).Conditions causing nausea and vomiting in
pregnancy include:Genito-urinary conditions such as urinary tract infection, pyelonephritis, ovarian
torsion.Endocrine conditions such as thyrotoxicosis, diabetic ketoacidosis, Addison's
disease.Gastrointestinal conditions such as gastritis, peptic ulcer, pancreatitis, bowel obstruction,
hepatitis, cholelithiasis, appendicitis.Neurological conditions such as vestibular disease,
migraine.Other pregnancy-related conditions such as acute fatty liver of pregnancy, pre-
eclampsia.Women with nausea and vomiting in pregnancy do not usually require laboratory
evaluation unless symptoms are severe, prolonged (in terms of overall duration during pregnancy),
or extended (in terms of frequency during each day).Management includes:Asking about the the
nausea and vomiting (e.g. onset, duration, frequency, effect of food, associated symptoms, co-
existing conditions, and effect of mood and quality of life).If nausea or vomiting is affecting fluid and
food intake, monitoring weight, checking for dehydration, testing the urine for ketones, and pelvic
ultrasound to assess for predisposing multiple or molar pregnancy.Offering appropriate self-care
advice (e.g. rest, adequate fluid intake, and small frequent meals). Some women find ginger or
acupressure helps symptoms.Considering the need for an oral anti-emetic (off-label use) if self-care
advice fails and the woman has persistent symptoms. All anti-emetics are unlicensed for treatment
of nausea and vomiting in pregnancy.Early treatment with an anti-emetic is likely to be more
effective and is essential to improve the woman's quality of life, symptoms, and reduce morbidity to
the fetus.Hospital admission should be arranged if:Symptoms are severe despite 24 hours of oral
anti-emetic drug treatment (e.g. inability to tolerate liquids without vomiting).There is evidence of
dehydration, ketones in the urine, or suspicion of medical complications.The following treatments
are not recommended for nausea and vomiting during pregnancy: acustimulation, acupuncture,
herbal remedies, homeopathy, hypnosis, hypnotherapy, psychotherapy, and multivitamins (including
pyridoxine). (Nausea/Vomiting in Pregnancy)(R., (1994))

3. Skin changes occur in about 90 % pregnant women in one form or the other. The various skin
changes maybe either physiological (hormonal), changes in pre-existing skin diseases or
development of new pregnancy-specific dermatoses. All of these dermatoses can be attributed to
the profound hormonal, vascular, metabolic, and immunological changes occurring during
pregnancy.\n\nCLASSIFICATION: Pregnancy-specific dermatoses have now been classified into
dermatoses which are definitively associated and dermatoses with uncertain association with
pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a
few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can
be treated conservatively but a few require intervention in the form of termination of
pregnancy.\n\nCONCLUSION: Careful history taking and examination will help us to identify each
condition clinically and appropriate management can be instituted for the well-being of the mother
and the fetus. (Sumit K. A.-0.-0.-z., 2012))

CONCLUSION

During pregnancy, hormones including oestrogen, progesterone and Prolactin rise rapidly. It turns
the womb into a suitable environment for the baby’s growth and at the same time, it could cause
discomfort to the mother. Most of these changes are normal. Most of the minor ailments in
pregnancy will spontaneously subside after delivery, therefore you do not need to worry too much.
(Whitworth, Cockerill, & Lamb, 2017)BIBLIOGRAPHY

1. Berg, D. (1992). Venous tonicity in pregnancy varicose veins. Fortschritte Der Medizin, 110(3),
67–68, 71–72.

2. Nausea/Vomiting in Pregnancy. (n.d.). Retrieved 2017, from National Institute for Care and
Excellence (NICE): https://doi.org/10.1002/14651858.CD007575.pub4

3. R., A. R. ( (1994)). Abdominal pain in pregnancy: Deciding when it’s serious. IM - Internal
Medicine, 15(1), 69–77.

4. Sohrabvand, F. &. ((2009)). Frequency and predisposing factors of leg cramps in pregnancy:A
prospective clinical trial. pp. 67(9), 661–664.

5. Sumit, K. A.-0.-0.-z. (2012)). Pregnancy and skin. Journal of Obstetrics and Gynecology of India.

6. Jacob Annamma;A Comprehensive Textbook Of Midwifery And Gynecological Nursing;jaypee

publishers, 3rd edition 2012,Pg.102-105.

7. DuttaD.C ;Text Book Of Obstertrics ; New Central Book Agency Ltd.Sixth Edition 2004.page no.-
151-52.