Download Common Problems in Pregnancy

Common Problems in
Pregnancy
Deidre Young, PGY-2
Overview
Why this topic?
Nausea and Vomiting
Constipation
Heartburn
Common Cold
Urinary Tract Infections
Why this topic?
Personal interest
Lots of prenatals
Lots of morbidity from these
problems
Fear and uncertainty about
medications in pregnancy
Nausea and Vomiting
How big a problem?
50 – 90% of pregnancies affected
35% lose time from work
Cited as a reason for terminating
pregnancies
Severity can be comparable to that of
cancer patients receiving chemotherapy
What can we do about it?
Lifestyle and Dietary Modifications
Ginger
Accupuncture and Accupressure
Pharmacological Interventions
Lifestyle and Dietary Modifications
No proven benefit but lots of anecdotal
evidence
Patient should be encouraged to eat what she
can, when she can
Encourage folic acid, even if other prenatal
vitamins not well-tolerated
Small, bland meals often encouraged
Avoid sensory stimuli, e.g. strong odors
Avoid fatigue, can exacerbate symptoms
Ginger
Has been shown in an RCT to be
effective but its safety has not been
thoroughly tested
Large quantities (>1000 mg/day) of
ginger should not be recommended in
pregnancy
Accupuncture and Accupressure
Stimulation of the P6 point, three
finger breadths proximal to the wrist
has been used for thousands of years
No concerns about safety
Accupressure (seabands) has been
shown to work in non-RCT trials
Pharmacological
If non-pharmacological interventions
have not succeeded, therapy should
be initiated as soon as possible to
alleviate symptoms
The SOGC has developed an algorithm
for the treatment of nausea and
vomiting in pregnancy, based on
evidence-based treatments
Constipation
Common in first and third trimesters
Can be extremely uncomfortable
Can lead to hemorrhoids due to
straining
Constipation
Encourage patient to drink lots of water,
can be a problem with N/V
Exercise regularly, just walking can be
beneficial
Stop iron supplements if necessary
Eat a high-fibre diet
Try prunes, flax seed
Colace doesn’t help much, try to avoid
laxatives
Heartburn
Occurs in late second and third trimesters
Due to relaxation of the esophageal
sphincter
Lifestyle modifications include: avoiding
spicy foods, smaller meals, extra pillows
Antacids are generally recommended with
the liquid kind generally giving better
relief than tablets
If necessary, can progress to Ranitidine
Common Cold
Pretty common!
Can usually go without treatment but
if symptoms lead to fatigue – can
exacerbate other problems of
pregnancy
Try usual non-pharmacological
approaches such as fluids, rest,
humidified air
Pharmacological
Decongestants – Pseudoephedrine OK in
second and third trimesters, beware of
other ingredients (e.g. Advil Cold and Sinus
contains ibuprofen)
Antihistamines – chlorpheniramine
(Sinutab) considered the antihistamine of
choice
Antitussives – Dextromethorphan appears
to be safe but limited data, use with
caution
Urinary Tract Infections
UTIs in pregnancy can lead to
complications such as low birth
weight, preterm labour, pre-eclampsia
Prompt treatment important
E. coli most commonly responsible
Antimicrobial Treatment for the Pregnant
Patient with Bacteriuria
Amoxicillin 500 mg three times a day
Ampicillin 250 mg four times a day
Cephalosporin 250 mg four times a day
Nitrofurantoin 100 mg four times a day
Sustained release nitrofurantoin 100 mg two
times a day
The agent of choice should be given for a 3- to 7day course. A repeat urine culture is recommended
2 weeks after the treatment has been completed.