Pregnancy

Definition

Pregnancy is defined as the period of time when a woman carries a growing fetus and is essentially the state from the time of conception up to delivery. This is the highly complex period when the fetus develops in the uterus for approximately for approximately 40 weeks until delivery. The woman develops multiple signs and symptoms due to the many physical and emotional changes during the period of pregnancy. However, pregnancy is not a disease but a physiological state. Pregnancy is possible after the onset of menses (menarche) up to the time of cessation of menstruation (menopause).

Symptoms

Common symptoms of pregnancy are:

  • No menses (amenorrhea).
  • Nausea.
  • Vomiting or morning sickness due to steep rise in estrogen. Hyperemesis gravidarum is a problem associated with severe and excessive vomiting.
  • Bladder irritability with urinary frequency.
  • Headaches, palpitations and fainting are common.
  • Sweating and hot flashes.
  • Abdominal enlargement (distension).
  • Abdominal pain.
  • Breathlessness.
  • Constipation and sometimes episodes of diarrhea.
  • Acid reflux marked by heartburn.
  • Backache mainly in the third trimester.
  • Itchy rashes which are common.
  • Ankle swelling (edema).
  • Leg cramps.
  • Dark brown patchy pigmentation on areas like the (melasma).
  • Breast engorgement.
  • Nipple enlargement which darkens at 12 weeks of gestation.
  • Sebaceous glands on nipple become prominent.
  • Increased redness of vulva.
  • Cervix softens and looks bluish at 4 weeks.

Causes of symptoms

Pregnancy is a result of a sperm cell from a male fertilizing the egg cell (ovum). Most of the symptoms seen in pregnancy are caused due to hormonal changes during pregnancy. Sweating and hot flushes are caused due to increased peripheral circulation. Increased urinary frequency is seen due to pressure of fetal head on the bladder in later pregnancy. Ligament stretching causes abdominal pain. Reduced gut motility possibly associated with hormones and pressure on the gut causes constipation. Relaxation of the pyloric sphincter causes irritant bile to reflux into the stomach cause reflux esophagitis and heart burn. Pelvic pain and back pain is present in the third trimester due to pelvic muscle and ligament relaxation. Increased abdominal girth put pressure of veins and lymphatics going down the leg cause edema of ankle.

Treatment

Pregnancy is not a disease and does not need treatment. Even the symptoms of pregnancy are usually not treated medically unless it is severe and unbearable for the mother or poses a risk to both mother and child.

  • Nausea and vomiting usually responds to taking frequent small meals, reassurance and a stress free environment.
  • If hyperemesis gravidarum is present the patient is admitted to the hospital for monitoring. Antiemetics and prokinetics may be prescribed.
  • Reassurance is often helpful in dealing with any of these symptoms.
  • Headaches, palpitations, dehydration and fainting episodes can be relieved by increased fluid intake and showering.
  • Swelling of ankles can be relieved by resting with the feet up and properly worn elastic stockings.
  • Adequate fluids and high fiber diet is advised in constipation.
  • Small meals and antacids help, and the patient is advised to use more pillows and in a semi-recumbent position.
  • Backache of the third trimester is usually at night and can be relieved by using a firm mattress.
  • Flat shoes and standing with the back straight and pelvic support from physiotherapy can help.
  • Emollients and weak topical steroids provide relief for any rashes. More aggressive treatment for melasma is not advisable during pregnancy.

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