Common Problems in Pregnancy

Deidre Young, PGY-2

Overview

Why this topic?Nausea and VomitingConstipationHeartburnCommon ColdUrinary Tract Infections

Why this topic?

Personal interestLots of prenatalsLots of morbidity from these problemsFear and uncertainty about medications in pregnancy

Nausea and Vomiting

How big a problem?50 – 90% of pregnancies affected35% lose time from workCited as a reason for terminating pregnanciesSeverity can be comparable to that of cancer patients receiving chemotherapy

What can we do about it?

Lifestyle and Dietary ModificationsGingerAccupuncture and AccupressurePharmacological Interventions

Lifestyle and Dietary Modifications

No proven benefit but lots of anecdotal evidencePatient should be encouraged to eat what she can, when she canEncourage folic acid, even if other prenatal vitamins not well-toleratedSmall, bland meals often encouragedAvoid sensory stimuli, e.g. strong odorsAvoid fatigue, can exacerbate symptoms

Ginger

Has been shown in an RCT to be effective but its safety has not been thoroughly testedLarge 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 yearsNo concerns about safetyAccupressure (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 symptomsThe 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 trimestersCan be extremely uncomfortableCan lead to hemorrhoids due to straining

Constipation

Encourage patient to drink lots of water, can be a problem with N/VExercise regularly, just walking can be beneficialStop iron supplements if necessaryEat a high-fibre dietTry prunes, flax seedColace doesn’t help much, try to avoid laxatives

Heartburn

Occurs in late second and third trimestersDue to relaxation of the esophageal sphincterLifestyle modifications include: avoiding spicy foods, smaller meals, extra pillowsAntacids are generally recommended with the liquid kind generally giving better relief than tabletsIf 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 pregnancyTry 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 choiceAntitussives – 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-eclampsiaPrompt treatment importantE. 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 7-day course. A repeat urine culture is recommended 2 weeks after the treatment has been completed.