FACULTY OF HEALTH SCIENCES | COLLEGE OF
MEDICINE
COURSE CODE: NSC 542
Contents
Definition
of pregnancy
Minor
disorders of pregnancy
Conclusion
References
DEFINITION OF PREGNANCY
Pregnancy
is the fertilization and Development of one or more off spring, known as an
embryo or fetus, in a women’s uterus.
Pregnancy can also be defined as
being with child, the condition form conception to the expulsion of the fetus.
The normal period is 280 days or 40 weeks counted from the first day of the
last normal menstrual period.
Pregnancy test is used to demonstrate whether
conception has occurred. There detect the human chorionic gonadotrophin (HCG)
produced by the embryo 8 days after the first missed period.
Immunological laboratory tests are
more accurate and less likely to give false positive result than an over the
counter kit.
In a pregnancy, there can be
multiple gestations as in the case of twins or triplets. Childbirth usually occurs
about 38 weeks after conception, in women who have a menstrual cycle length of
four weeks, this is approximately 40 weeks from the start of the last normal
menstrual period (LNMP).
Conception can be achieved through
sexual intercourse or assisted reproductive technology. An embryo is the
developing offspring during the first 8 weeks following conception and
subsequently the term fetus is used hence forth until birth.
In many societies, medical or legal
definitions, human pregnancy is some what arbitrarily divided into three
trimester periods, as a means to simplify reference to the different stages of
prenatal development. The first trimester carries the highest risk of
miscarriage (natural death of embryo or fetus). During the second trimester,
the development of the fetus can be more easily monitored and diagnosed. The
beginning of the third trimester often approximates the point of viability, or
the ability of the fetus to survive, with or without medical help outside the
uterus.
Although pregnancy begins with
implantation, the process leading to pregnancy occurs earlier as the result of
the female gamete, or oocyte, merging with the male gamete, spermatozoon. In
medicine, this process is referred to as fertilization, in lay terms, it is
more commonly known as “conception”. After the point of fertilization, the
fused product of the female and male gamete is referred to as a zygote or
fertilized egg. The fusion of male and female gametes usually occurs following
the act of sexual intercourse, resulting in spontaneous pregnancy. However, the
advent of assisted reproductive technology such as artificial insemination and
in vitro fertilization have made achieving pregnancy possible with out engaging
in sexual intercourse. This approach may be under taken as a voluntary choice
or due to fertility.
Minor disorder of pregnancy
During pregnancy, a woman’s body
changes in many ways. There changes can sometimes be uncomfortable, but most of
the time they are normal. They can occur at any time during the pregnancy.
Therefore obstetric and
gynecological conditions are these conditions that occur due to pregnancy, labour
or puerperium or diseases affecting the female genital trait. They are
conditions that do not endanger life but may undermine the women’s health and
they include:
- Morning sickness
- Heartburn
- Backache
- Pruritus vulvae
- Varicose veins
- Constipation
- Fainting attacks
- Oedema
- Hemorrhoids (pile)
- Vaginal discharge
- Insomnia
- Itching of the skin
- Frequency of Urination
- Dysnoea (shortness of breath)
- Emotional factors
- Fatigue
MORNING SICKNESS
This comprises nausea, anorexia and slight vomiting
that usually occurs immediately after getting up in the morning, when retching
(strong voluntary effort or vomit) and vomiting of mucus. Sometimes
bile-stained, takes place. About 50% of women vomit between the 4th
and 5th week of pregnancy. If the condition is not nipped in the bud
hyperemesis gravidarum occurs as a complication.
CAUSES
- Hormonal-progesterone
relaxes the muscles and makes the sphincter weak and everything is ejected into
the abdomen.
- Sensitive nervous system
- Disturbance
in the metabolism of glucose with increased production of ketone bodies or low
intake of glucose at night.
- Psychological-
loves petting.
Treatment
Take
light diet before going to bed to aid easy digestion
Take
biscuits or freshly made tea preferably brought by the husband in the morning
before getting out of bed.
- Avoid getting out of bed quickly
- Avoid
taking of heavy meals or much fried food to avoid irritation of the GIT
- keep a way from oily food
- Drink extra glucose
- Psychotherapy
- Seek medical
aid if condition gets worse example hyperemesis gravidarum.
HEART BURN
A burning feeling or pain in the
stomach, or between the breast, is called indigestion or heart burn. Heart burn
happens because the growing baby crowds the Mothers stomach and pushes it
higher than usual. The acids in the Mothers stomach that help digest food are
pushed up into her chest, where they cause a burning feeling. Reassure her that
this is not dangerous and usually goes away after the birth.
TREATMENT OR MANAGEMENT
- keep
her stomach less full by eating smaller meals more often, and by eating foods
and drinking liquids separately.
- Avoid
eating spicy or greasy foods, drinking coffee, or smoking cigarettes, as all of
them can irritate the stomach.
- Regularly
eat papaya or pineapple, which have enzymes (special chemicals) that help the
stomach to digest food.
- Keep
her head higher than her stomach when lying down or sleeping. This will keep
her stomach acids in the stomach and out of her chest.
- Calm the
acids in the stomach by drinking milk, or taking a low-salt antacid
(stomach-calming liquid or tablets) that contains no aspirin, but advise her to
try other methods before using drugs like antacids.
BACK ACHE
Any
pain in the back, usually the lower part.
CAUSES
- Stretching
of the back when progest erone relaxes the muscles and tissue causing pain.
- The
increased lumber curve (which causes Lordosis) gives rise to strain of the
muscles of the back, leading to fatigue and backache (therefore the growing
uterus presses on the sciatic nerve causing pain).
- Lax
abdominal muscles produce anterior obliquity of the uterus which throw the
shoulders too far back in order to support the uterus and to keep her balance.
Treatment
- Explain
the condition to the patient to allay her anxiety and reassure her.
- Teach
her different postures to sit, stand, lie down and get up (good posture).
- Not to walk for a long distance
- Rest is needed
- Put on a firm supporting maternity corset.
- put on good shoes
- lie in a comfortable bed that does
not sag.
- seek medical advice if backache is severe
and persistent
PRURITUS VULVAE
This
is itching in the vulvae owing to the action of progesterone on the secretary
organs. Most of the excess fluids are passed via the vulvae.
Causes
- Irritation form vaginal discharge
- Lack of cleanliness
- Glycosuria (Common in diabetic
patients
- Vaginal thrush (monoliasia) or
trichomoniasis.
Treatment
-
Investigate and
treat the cause. Take history, test urine, if diabetic, treat it or any other
infection”
-
Advise on
personal hygiene especially if no pathological cause.
-
Take vaginal swab
to laboratory
-
Apply Nystatin
ointment
VARICOSE VEIN
There
are swollen, dilated, twisted (tortuous) veins of the legs mostly (varicosities
of the Legs) also of vulva, anus, abdomen, ankles, popliteal areas, vagina and
groins. About 10% of pregnant mothers have this especially varicosities of the
legs. Parturition subsides it but succeeding pregnancy aggravates it.
Causes
Action
of progesterone on the blood vessels causing relaxation, making them more
circular with sluggish blood flow.
Treatment
- Advise
patient on rest and raising her legs on pillow while lying on bed or chair
while sitting down on the same level with the body always to encourage, venous
drainage or return.
- Do not put
tight bands that would impede cancellation to the lower limbs.
- Avoid
standing for a long period
- wear
elastic stockings or tight to support the column of blood, relieve aching and
give comfort.
SIGNS AND SYMPTOMS OF VARICOSE VEINS
- The
venous return from the lower limbs is impeded in the common iliac veins by the
increased flow of blood form the uterus
- Dull aching pain in her limbs
- Engorgement of the superficial veins
- Oedematous limbs in severe cases.
COMPLICATIONS OF VARICOSE VEIN
- Rupture of the blood vessels causing
hemorrhage
- Infection can lead to ulceration
- Injury can cause bleeding
- Vein thrombosis
THE WORK OF THE NURSE/MIDWIFE IN VARICOSE
VEIN.
- Protect the patient from in jury
- Do not apply elastic or tight bandage
- Give patient a crepe bandage on
discharge,
- Teach her how to apply it for equal
pressure
- She should apply it while on standing
and not while on bed.
- In server cases, doctor does legation
of legs.
CONSTIPATION
Incomplete
or frequent action of the bowels with consequent fitting of the return with
hard stool.
Causes
- Pressure of the enlarged uterus
- Effect
of progesterone causing relaxation of and relaxation of and retarded
peristaltic movement of hard stool and strain
Treatment
- Take increased amount of fruits
vegetables and roughage in diet.
- If
condition is not improved, give mild aperient example Senokot, Dulcolax.
- Seek medical aid if severe or
persistent.
HAEMORROIDS (PILE)
They
are veins around the anus. They may burn, hurt, or itch. Some times they bleed
when the woman passes a stool, especially if she is constipated. Sitting or
standing a lot can make hemorrhoids worse,
TREATMENT
- Doctor
gives anusol suppository or mild a patient to avoid strain on defecation.
- Take warm site baths of magnesium
sulphate crystals to reduce engorgement
- Avoid
constipation
- Nupercainal
ointment is effective when painful
- Ice packs
may be used.
- Prolapsed Haemorrhoids,
are cleaned with antiseptic lotion (Salvon or habitant in water) and lubricated
and pushed back gently into the rectum via the anus.
Fainting
attack (syncope)
A simple faint or temporary loss of consciousness due
to cerebral ischemia caused by dilatation of the peripheral blood vessels and a
sudden fall in B.P.
CAUSES
- Instability
of the vaso-motor centre in the medulla which controls arterial tone.
- Rapid fall in blood pressure
- Pressure
of the uterus on the inferior vena cava (spine hypotensive syndrome) reducing
venous return to heart.
- Sudden changes in posture example
recumbent to upright position.
- standing for long periods mostly in
ho weather
- Fatigue or excitement
- Stuffy room or crowdy halls
- Wearing of light corsets
- Overacting
or overloading the stomach on meals that cause flatulence.
Treatment
- Get up slowly from bed and change
position
- Avoid dorsal position but lie
laterally
- avoid wearing tight corsets
- Avoid meals that over load the
stomach or that causes flatulence.
OEDEMA
An
excessive amount of fluid in the body tissues characterized by putting of an
affected part on pressing.
CAUSES
Pressure
of the uterus haemo-dilution (addition of water to dilute the blood).
Treatment
- Avoid long standing
- Elevate (raise legs while sitting or
ling down).
VAGINAL DISCHARGE
Excessive
increase in normal leucorrhea (a viscid, whitish discharge from the vagina)
Causes
Effect
of progesterone which make the secretory organs to secret/produce more fluid
which flows via the vulva.
Treatment
- Good personal hygiene
- Vulval swabbing to prevent infection
- Vulval swab to the laboratory and
treat any infection
Insomia
The
is when the woman or the pregnant woman is unable to sleep at night
Causes
- Discomforts
- Active fetus at right with many fetal
kicks
- Heavy uterus
- Cramps
Treatment
- Treat cause
- Warm drink and warm bath are needed
- Reassurance
INCHING OF THE SKIN
Skin
irritation especially that of the abdomen, breasts which may become generalized
over the whole body.
Causes
- Idiopathic (unknown)
- Endocrine
- Toxic
- Nervous element
Treatment
- Reassurance
- Application of lanoline or cold cream
- Soothing substances such as calcimine
solution is helpful.
- Wear non-irritating clothing next to
the skin
- Take water freely
- Keep bowel open.
Frequency of urination
Urinary frequency is a common compliant through out
pregnancy, especially in the first and last months this happens because the
growing fetus and uterus presses against the bladder. It will stop once the
body is born. If urinating hurts, itches, or burns, the woman may have bladder
infection.
DYSPNOEA (shortness of breath)
Many
women get short of breath (can not breath as deeply as usually) when they are
pregnant. This condition is called dyspnoea.
MANAGEMENT
Reassure
women who are breathless near the end of pregnancy that this is normal. But if
a woman is also weak and tire, or if she is short of breath all of the time,
she should be checked for signs of sickness, heart problems, anemia, or poor
diet. Get medical advice if you think she may have any of these problems.
CONCLUSION
A woman’s body charges during
pregnancy. These changes can sometimes cause discomfort, but mostly they are
normal and will resolve themselves after the baby is born. You can minimize
most of the minor disorders during pregnancy with advice on diet, exercise and
with simple home remedies that are known to be safe and help women feel better.
Some times these minor problems may become more serious, or signal a serious
underlying health problem that needs referral to a health facility.
Some remedies (e.g migraine
medicine) are dangerous for pregnant women and may hurt the baby as well as the
mother. Minor disorders of pregnancy that you may encounter in dealing with
pregnant women can be categorized according to which of the body system is
involved.
Gastrointestinal disorders include
nausea and vomiting, dislike of some foods, heart burn, pica (food cravings),
constipation and hemorrhoids (piles).
Cardiovascular disorder includes
varicosities, and dyspnoea (shortness of breath). Genitourinary disorders
include frequency of urination and vaginal discharge (wetness from the vagina).
Nervous system disorders include insomnia, headaches, emotional changes worry
and fear.
REFERENCES
Embryo definition, medicine Net, Inc. 27 April 2011
Gynecology Department of, al obstetrics, the Johns
Hopkins university school of medicine, Baltimore, mary land, editors K. Joseph
Hurth—(et (2010-1221). The johns Hopkins manual of gynecology and obstetrics.
Uwa. N. (2009) a-z of material and child health (MCH)
Nursing, page 92
Myles textbook for midwifes, 14th edition.