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  • 22Apr

    What are the common problems during the first trimester of pregnancy?

    The care of a pregnant women during pregnancy is challenging for the physician. A pregnancy results in structural and physiological changes in the body. Increased level of circulating hormones, increased nutritional requirements due to rise in the metabolic demands of 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 following:

    • Hyperemesis gravidarum - nausea and vomiting in pregnancy (commonly called as morning sickness) is one 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 varies in severity but usually presents 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 the 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 the constipation. Increasing daily fluid intake, and daily intake of fiber (bran, wheat fiber  isabghol husk) or stool softener (lactulose, liquid paraffin) supplementation results in relief. A persistent constipation may result in anal fissure, adding to the problems, which is treated conservatively with stool softeners, warm water hip baths (sitz bath) and local application of jelly for pain relief (lignocaine jelly).
      Pregnancy results in structural and physiological changes in the body.

      Pregnancy results in structural and physiological changes in the body.

    • Heartburn - this is also a common symptom in pregnancy. The patient develops burning sensation in the central part of chest. It may aggravate as the pregnancy advances; from 20% incidence in first trimester to 75% in the third trimester. It is due to the increasing intra-abdominal pressure resulting from progressively enlarging uterus along with the hormonal changes (progesterone effect) that lead to gastro-esophageal 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 as they are related to 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 bio-mechanics of spine due to rapid weight gain. It aggravates as the pregnancy advances, if proper care is not taken. It can be reduced by teaching 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.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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