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Common Problems in Pregnancy
Deidre Young, PGY-2
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Overview
Why this topic?Nausea and VomitingConstipationHeartburnCommon ColdUrinary Tract Infections
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Why this topic?
Personal interestLots of prenatalsLots of morbidity from these problemsFear and uncertainty about medications in pregnancy
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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
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What can we do about it?
Lifestyle and Dietary ModificationsGingerAccupuncture and AccupressurePharmacological Interventions
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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
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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
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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
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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
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Constipation
Common in first and third trimestersCan be extremely uncomfortableCan lead to hemorrhoids due to straining
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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
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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
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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
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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
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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
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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.