Prenatal Pregnancy Visits #2

Common Complaints during Pregnancy

Most of the minor complaints during pregnancy can be minimized with patient education and prompt treatment.

Ptyalism

Excessive salivation (sialism, ptyalism) is an infrequent but troublesome complaint of pregnant women. The cause is unknown but it is strongly associated with severe nausea and vomiting of pregnancy.

Frequency of Urination

Urinary frequency is a common complaint throughout pregnancy. Vascular engorgement of the pelvis and hormonal changes are responsible for altered bladder function. Late in pregnancy, when pressure on the bladder by the enlarging uterus and the fetal presenting part decreases bladder capacity, urination becomes even more frequent.

Varicose Veins

Varicosities may develop in the legs or in the vulva. A family history of varicosities is often present. Pressure by the enlarging uterus on the venous return from the legs is a major factor in the development of varicosities. The physician should warn the patient early in pregnancy of the need for elastic stockings and elevation of the legs if varices develop. Specific therapy (injection or surgical correction) usually is contraindicated during pregnancy. Superficial varicosities may rarely signal deeper venous disease. These patients should be examined carefully for signs of deep vein thrombosis.

Joint Pain, Backache, & Pelvic Pressure

Although the main bony components of the pelvis consist of 3 separate bones, the symphysial and sacroiliac articulations permit practically no motion in the nonpregnant state. In pregnancy, however, endocrine relaxation of these joints permits some movement. The pregnant patient may develop an unstable pelvis, which produces pain. A tight girdle or a belt worn about the hips, together with frequent bed rest, may relieve the pain; however, hospitalization is sometimes necessary.

Improvement in posture often relieves backache. The increasingly protuberant abdomen causes the patient to throw her shoulders back to maintain her balance; this causes her to thrust her head forward to remain erect. Thus, she increases the curvature of both the lumbar spine and the cervicothoracic spine. A maternity girdle to support the abdominal protuberance and shoes with 2-inch heels, which tend to keep the shoulders forward, may reduce the lumbar lordosis and thus relieve backache. Local heat and back rubs may relax the muscles and ease discomfort. Exercises to strengthen the back are most rewarding.

Leg Cramps

The cause of leg cramps in pregnancy is unknown but may be the result of a reduced level of diffusible serum calcium or elevation of serum phosphorus. Treatment for this includes curtailment of phosphate intake (less milk and nutritional supplements containing calcium phosphate) and an increase of calcium intake (without phosphorus) in the form of calcium carbonate or calcium lactate tablets. Alternatively, a randomized trial showed that magnesium citrate, 300 mg/d, reduces leg cramps. Symptomatic treatment consists of leg massage, gentle flexing of the feet, and local heat. Tell the patient to avoid pointing toes when she stretches her legs (eg, on awakening in the morning) as this triggers a gastrocnemius cramp. She should also practice “leading with the heel” in walking.

Breast Soreness

Physiologic breast engorgement may cause discomfort, especially during early and late pregnancy. A well-fitting brassiere worn 24 hours a day affords relief. Ice bags are temporarily effective. Hormone therapy is of no value.

Source : Current Obstetrics and Gynecology, 2007