SCHOOL OF MEDICINE AND COMMUNITY HEALTH SCIENCES

DEPARTMENT OF NURSING

TOPIC: MINOR ALIMENT IN PREGNANCY

GROUP: 3
PROGRAM: BSC NURSING
YEAR: THREE (3)
MODULE: MIDWIFERY
GROUP MEMBERS
1. Francis A. Bayoh 2. Agnes Baindu Amara
3. Mosbeth Amos Kamara 4. Kadiatu T. Bangura
5. Rukiatu Kargbo 6. Francess l. Sei
7. Fanta Sillah 8. Ezabella Saidu
9. Christiana M.B.Tucker 10. Victoria E. F. Koroma
11. Marina Edwards 12. Abdulai Kallon
13. Francis Mattars 14. Yatta Lansana
15. Tommy Harding 16. Kumba Jimmy
17. James Conteh 18. Emmanuel Yambasu
INTRODUCTION –

Many women experience some minor ailments during pregnancy. These disorders should be
treated adequately as they may cause life threatening conditions in progress of pregnancy.

Minor ailments may occur due to hormonal changes, accommodation changes, metabolic
changes & postural changes. Every system of the body is affected by pregnancy. The mother

needs knowledge to cope with the experience of pregnancy.

These ailments of pregnancy are those presentations and conditions that result from
pregnancy but do not significantly interfere with the activities of daily living or any significant
threat to the health of the mother or baby, in contrast to pregnancy complications.

DEFINITION –

“The minor ailments of Pregnant woman that occur due to physiological alterations of
hormones ( oestrogen, progesterone, Prolactin ) and other causative factors which can be
managed without medical interventions”

DIGESTIVE SYSTEM

1. Nausea &vomiting:

It is a common disorder seen in about 50%women between 4th& 16th week of gestation.
Hormonal influences are thought to be the most likely cause. Human chorionic
gonadotropin that is present in large amounts in the 1st trimester, oestrogen&
progesterone are all contribute to this. The sickness is confined to “early morning” but
can occur at any time in the day. The smell of certain cooking food will cause the
symptom.

Management:

The midwife should encourage the mother to look positively towards the resolution of
the problem.

• Salads & light snacks are given than full meals.

• Carbohydrate snacks at bed time can prevent hypoglycaemia.
• Dry toast or biscuits are given on waking up &breakfast after half an hour.

If vomiting becomes severe the mother may lose weight& becomes dehydrated this
condition is called hyperemesis gravidarum& specialized care & appropriate referral should
be needed.
2. Constipation:

This is due to smooth muscle relaxant effect of progesterone causing decreased peristalsis
of gut. Pressure of the gravid uterus on the colon near term makes it worse as the colon
gets displaced. It is usually overcome by adjusting diets.

Management:

The women may be advised to:

➢ Increase the intake of water.

➢ Add green leafy vegetables, fruits & bran cereals to her diet.
➢ Take a glass of warm water in the morning before tea or breakfast which would
activate the gut & help regular bowel movements.
➢ Do exercise by regular walking.

3. Acidity & heartburn:

This is a burning pain in the mediastinal position caused by reflux of stomach contents into
the oesophagus. It occurs because the cardiac sphincter relaxes during pregnancy due to the
effect of progesterone. The condition tends to worsen as pregnancy advances because the
stomach is displaced upward by the enlarging uterus.

Heart burn is most troublesome at about 30th to 40th week of gestation because at this stage
the stomach is under pressure from the growing uterus.

Management:

The advice given according to the severity of the condition:

❖ If the heartburn is occasional the reflux can be prevented by avoiding bending &
kneeling while doing household works.
❖ Advice to take small meals which will be more easily digested.
❖ Fried & fatty foods should be avoided.
❖ Sleeping with more pillows & lying on right lateral side can be helpful.
❖ For persistent heartburn antacids may be prescribed by the physician.

4. Excessive salivation ( Ptyalism ):

This occurs from 8th week of gestation which is caused due to the hormones of pregnancy.

Management:

• This problem is usually self-limiting and may be overcome by decreasing intake of

carbohydrates.

• It is not associated with any adverse pregnancy outcome.

5. Abdominal discomfort:

□ Due to Pressure, pelvic heaviness, is caused by the weight of the uterus on the pelvic
supports and the abdominal wall.
□ Round ligament tension, tenderness along the course of the round ligament (usually
the left) during late pregnancy, is due to traction on this structure by the uterus,
which is displaced by the large bowel to be rotated slightly to the right.
□ Flatulence and distention can be due to large meals, gas-forming foods, and chilled
beverages. These are poorly tolerated by pregnant women.

Management:

❖ Provide rest frequently, preferably in the lateral recumbent position.

❖ Local heat should be applied and change of position frequently.
❖ Dietary modifications should be needed.
❖ Regular bowel function should be maintained, and exercise is beneficial.
❖ Acetaminophen 0.3–0.6, 2–3 times daily may be given to reduce discomfort.
❖ Intra abdominal disorders must be diagnosed and treated appropriately.

6. Pica:

This the term used when the mother craves certain foods or unnatural substances such as
coal. The cause is unknown but hormones & changes in metabolism are thought to
contribute to this. If the substances craved are harmful to the unborn baby, the mother
must be helped to seek medical advice.

MUSCULO-SKELETAL SYSTEM

1. Fatigue:

The pregnant patient is more subjected to fatigue during the last trimester pregnancy
because of altered posture & extra weight carried.

Management:

• Frequent rest period should recommended.

• Anemia & other systemic diseases should be ruled out.

2. Backache:

The gradual weight gain & the changes in the body’s center of gravity combined with the
stretching of weak abdominal muscles often lead to hollowness of lumbar spine. There is a
tendency for back muscles to shorten as the abdominal muscles stretched & extra strain is
put on the ligaments this results in backache.
Management:

✓ Excessive weight gain should be avoided.

✓ Rest with elevation of legs to flex the hips may be helpful.
✓ Improvement of posture with well fitted pelvic girdle belt may be reduce the pain.
✓ Advice the mother to wear low healed shoe.
✓ Apply local heat or light massage is helpful.
✓ Recommended sleep on a firm mattress.
✓ Provide back exercise under the supervision of physician.
✓ Give acetaminophen 0.3-0.6 g orally.

3. Leg cramps:

These are quite common & worsen at night. The cause is not known but has been attributed
to deficiency of vit-B1 & decreased level of calcium. It may be due to ischemia or changes in
pH or electrolyte level.

Management:

➢ Make gentle leg movements, massage the leg & also apply local heat which may be

beneficial.
➢ Sleep with foot end of the bed elevated by 20-25cm.
➢ Take Vit-B complex & calcium supplements.

4. Round ligament pain:

Stretching of the round ligament during movement in pregnancy may cause sharp pain in
the groins which may be unilateral or bilateral. It is usually felt in 2 nd trimester onwards. This
is more common in right side as a result of dextro-rotation of uterus. Pain may be awaking
at night time because of sudden roll over movements during sleep.

Management:

• Pain may be reduced by making movements gradual instead of sudden.

• Local heat application is helpful.
• Analgesics may be needed.

CIRCULATORY SYSTEM

1. Varicose vein:

Progesterone relaxes the smooth muscles of veins & results in slow circulation, the valves of
the dilated veins become inefficient & varicosities results. It generally occurs in legs, anus&
vulva. The mothers with a family history of varicose vein & those doing work with long
period of standing & sitting usually develop varicose veins.
Management:

□ Exercising the calf muscles by rising onto the toes or making circular movements
with the ankles.
□ Resting with the legs vertical against the wall for a short time.
□ Wearing support tights before rising or after resting with legs elevated.
□ Avoid forceful massage & point-pressure over legs.

2. Hemorrhoids:

It may cause due to any complications like bleeding & get prolapsed that produce severe
pain.

Management:

❖ Prevent constipation first for that use laxatives.

❖ Apply hydrocortisone ointment to reduce pain & swelling.
❖ Advice for sitz bath.

3. Syncope (Fainting):

In early pregnancy fainting may occur due to vasodilation under the influence of
progesterone. It may subside following the compensatory increase in blood volume.

Management:

• Avoid long period of standing as well as sitting or lying down when she feels slightly
faint.
• In later pregnancy advice the mother not to sleep with her back except during
abdominal examination because this can cause venacaval compression which leads
to slow return of blood to heart.
•

Encourage the mother to eat small meals rather than large one.

4. Ankle Oedema:

It develops in at least two thirds of women in late pregnancy but mainly occur in 2nd&3rd
trimesters. It is the results of venous & lymphatic stasis, as well as occurs due to changes
in osmotic pressure of blood & tissue fluids & altered capillary permeability.

Management:

➢ No treatment is required for physiological or orthostatic oedema.

➢ Elevate the legs while sleeping & sleep in left lateral position & avoiding sitting with
the feet hanging down.
➢ Restrict excessive salt intake & provide elastic support for varicose veins.
 ➢ Diuretics should not be given.

NERVOUS SYSTEM

1. Insomnia:

It is relatively common in late pregnancy owing to discomfort caused by fetal movements,

frequency of micturition & difficulty in finding a comfortable position. It may also be due to
some deep seated anxiety or fear.

Management:

✓ Take rest in afternoon.

✓ Drink a glass of warm milk at bed time.
✓ Tuck a pillow under the abdomen when lying in a lateral position.
✓ Talk about her fears & anxieties so that she can have a sense of normality &
lightness.

2. Headache:

Headache in pregnancy is common and usually due to tension. Refractive errors and
ocular imbalance are not caused by normal pregnancy. Severe, persistent headache in
the third trimester must be regarded as symptomatic of pre-eclampsia and eclampsia.

Management:

❑ Advice the mother to take adequate rest.

❑ If there is any pregnancy induced hypertension then symptomatic management

should be done.

3. Carpal tunnel syndrome:

Mothers complain of numbness & pins & needles in their fingers & hands. This usually
happens in the morning, but it can occur at any time of the day. It is caused by fluid
retention which creates oedema& pressure on the median nerve.

Management:

❖ Wearing a splint at night with the hands resting on 2or 3 pillows.

❖ Restriction of salt intake & flexing the fingers while the arm is held above the head.
❖ It usually resolves spontaneously.
GENITO URINARY SYSTEM

1. Leucorrhoea

This is the increased white non irritant vaginal discharge in pregnancy. If the mother finds
the discharge disturbing, it needs management.

Management:

• Advice her to maintain personal hygiene.

• Frequently wash the vulva i.e.3-4 times per day with plain water.
• Advice her to wear cotton underwear & avoid tights.
• Educate her about the possibility of infections such as Thrush & Trichomonas.

2. Urinary symptoms/ frequency of micturition

This occur in the 1st trimester when there is pressure on the gravid uterus on the urinary
bladder. It is spontaneously relieved when the uterus rises up in the abdomen. It may recur
in late pregnancy when the fetal head descends into pelvis.

Management:

✓ Advice her to take adequate rest.

✓ Advice her to maintain proper perineal hygiene.

RESPIRATORY SYSTEM

1. Breathlessness

It is not actual dyspnea which is occurs due to progesterone effects. It occurs as early as in
12th week of pregnancy & most women have it up to 30th week.

Management

❖ There is no effective management but rest will helpin reducing the condition.

INTEGUMENTARY SYSTEM

1. Skin

Some mothers complain of generalized itching that starts over the abdomen. This occurs
due to livers response to certain hormones in pregnancy & with raised bilirubin level.

Management

➢ It clear soon after the baby is born & comfort can be gained from local application.

➢ An anti-histamine can be prescribed.

➢ If the mother complain irritation or infection then washing with mild soap & cotton
underwear might help to reduce the irritation.