The care of a pregnant woman during pregnancy is challenging for the physician. A pregnancy results in structural and physiological changes in the body. Increased levels of circulating hormones, increased nutritional requirements due to a rise in the metabolic demands of the mother and the growing fetus affect the life of a lady in many ways. A lot of common problems arise in the first trimester and they should be treated so as to make her symptom-free and healthy.
Some of the common problems during the first trimester of pregnancy are as follows:
Hyperemesis gravidarum – Nausea and vomiting in pregnancy(commonly called morning sickness) are some of the most common early symptoms. It is usually worse in the morning and is related to rising levels of human chorionic gonadotropin (hCG), estrogens, or both. Nausea and vomiting vary in severity but are usually present within 8 weeks of the last menstrual period. Cessation of symptoms usually occurs by about 16 weeks. In some women, these symptoms may be excessive resulting in Hyperemesis gravidarum (excessive vomiting of pregnancy). It is seen in approximately 3.5/1000 pregnancies. It results in fluid and electrolyte imbalance and nutritional deficiency. Dietary modification in the form of small volume, frequent feeds, and supplementation of vitamin B6 and B12 may help. Severe cases require hospital admission, intravenous fluids, antiemetics (to prevent vomiting), and thiamine.
Constipation – This is seen in about one-third of pregnancies. As the pregnancy advances, this may reduce in severity. It is thought to be related in part to poor dietary fiber intake, reduction in colonic (large intestine) motility caused by rising levels of progesterone resulting in increased water absorption. An external compression over the rectum caused by the gravid uterus may also aggravate constipation. Increasing daily fluid intake, and daily intake of fiber (bran, wheat fiber isabgol husk) or stool softener (lactulose, liquid paraffin) supplementation results in relief. Persistent constipation may result in an anal fissure, adding to the problems, which is treated conservatively with stool softeners, warm water hip baths (sitz bath), and the local application of jelly for pain relief (lignocaine jelly).
Heartburn – This is also a common symptom in pregnancy. The patient develops a burning sensation in the central part of the chest. It may aggravate as the pregnancy advances; from 20% incidence in the first trimester to 75% in the third trimester. It is due to the increasing intra-abdominal pressure resulting from progressively enlarging the uterus along with the hormonal changes (progesterone effect) that lead to gastroesophageal reflux. Symptoms can be improved by maintaining an upright posture after meals, lying propped up in bed (head elevated), eating small frequent meals, and avoiding fatty foods. Antacids, H2 receptor antagonists, and proton-pump inhibitors are all effective and used when the above simple methods fail to work.
Varicose veins – occur frequently in pregnancy. They are usually temporary and are related to the progesterone effect. Compression stockings may help to tide over the duration of pregnancy and also help in preventing deep vein thrombosis.
Backache – It is common during pregnancy and is related to the hormonal effect of progesterone on ligaments (become more elastic during pregnancy) and altered biomechanics of the spine due to rapid weight gain. It aggravates as the pregnancy advances if proper care is not taken. It can be reduced by teaching a pregnant woman to squat rather than bend over, providing back support with a pillow while sitting, and avoiding high-heeled shoes. Adequate rest, local heat, and analgesic (paracetamol is safe) are helpful in providing relief.
Pregnancy is valuable as it involves the management of two lives in one. Extreme care should be taken, even for the smallest complaint of a pregnant woman who prepares herself over a period of over nine months to give her best to the world.
