Minor Disorders in Pregnancy
Pregnancy is a time when a woman’s body will go through numerous adaptations in order to accommodate the fetus. During these physiological adaptations, the organs such as spleen and liver and systems such as the endocrine and circulatory systems will be affected. A woman can experience minor disorders that are most likely the result of hormonal changes on the smooth muscle and connective tissues.
This paper endeavours to describe some of the minor disorders in pregnancy in particular, heartburn (reflux oesophagitis), constipation, haemorrhoids, dermatoses and epistaxis.
The major physiological reason for heartburn (reflux oesophagitis) in pregnancy is due to the relaxation of the LES(lower esophageal sphincter) and the decreased tone and mobility of the smooth muscles, which is caused from increased progesterone. As the fetus increases in size, pressure in the abdomen compounds, decreasing the angle of the gastroesophageal junction. This allows for oesophageal regurgitation, less time for the stomach to empty and reverse peristalsis (Blackburn 2007; Stables & Rankin 2010).
The main symptoms of heartburn are a “burning sensation” in the chest or back of the throat. Other symptoms may include eructation, difficulty in swallowing, and an acid or metal taste in the mouth. In terms of advice, there are some standard measures that can alleviate symptoms. These include examining the woman’s diet and eliminating foods that might aggravate, eating smaller portions and more frequently, sleeping in upright positions and avoidance of eating closer to bedtime (Law et al. 2010; Vazquez 2010).
Constipation is known to affect more that 40% of women during their pregnancy (Derbyshire, Davies & Detmar 2007). In looking at the physiological reason for constipation, increasing levels of progesterone affects bowel motility and reduces the peristaltic movement of the gastrointestinal tract. This is turn then increases the time food is passed through the gut causing increases in electrolyte and subsequent absorption of water in the large intestine. Motilin a hormone that assists faeces to pass through the colon is also decreased by the levels of progesterone (Derbyshire, Davies & Detmar 2007).
Constipation could also be the result of hyperemesis gravidarum (pernicious vomiting in pregnancy), or ingestion of prescribed iron tablets for anaemia (Tiran 2003). A diet rich in fibre and increasing fluid intake can help to ease some of the associated problems with constipation. Laxatives should only be used when dietary changes do not assist. In addition women should be advised that ignoring signs for defecation will compound symptoms (Jewell & Young 1996; Vazquez 2010). The levels of fibre and fluid consumed should be noted by healthcare professionals when attending to women (Derbyshire, Davies & Detmar 2007).
Haemorrhoids occurs in pregnancy in 25 – 35% of women and in some populations it can reach 85% (Staroselsky et al. 2008). Haemorrhoids occur due to progesterone causing vasodilation in the ano-rectal area. In some cases there is a direct relationship between constipation and the formation of haemorrhoids. Main symptoms are itching, burning, swelling around the anus and bleeding. Pain with bowel movements and bleeding are often the first signs of haemorrhoids. As there is a close relationship between constipation and haemorrhoids, the advice given to women with regards to treatment would be similar to constipation.
In (Staroselsky et al. 2008) it is stated that topical treatments and the use of laxatives can reduce symptoms. The integumentary system is no different to any of the other systems affected by physiological changes in pregnancy. There are a number of skin irritations that can cause discomfort to a woman during her pregnancy, but these do not harm the fetus. Melanocyte-stimulating hormone is increased by progesterone and oestrogen levels. Chloasma or “pregnancy mask” is one of the conditions to arise from hormone increases (Stables & Rankin 2010).
Hyperpigmentation is the most common skin alteration in pregnancy. About 90% of women will develop linea nigra which is found running from the xiphoid process to the pubis. A common dermatoses found in pregnancy is a condition called PUPP (pruritic urticarial papules and plaques) The development of PUPP in pregnancy is 1 in 160 (Sachdeva 2008). This usually occurs in the primagravida in the third trimester and in rare cases in the first and second. In (Brzoza et al. 2007; Roth 2009) the reasons for PUPP is unclear but suggestions are made that maternal weight gain in primiparous women is the cause.
Interestingly statistics show that 2. 9% of twin pregnancies and 14% of triplet pregnancies develop PUPP. It is thought, that abdominal distension, hormonal, autoimmune and change in partners (implication of paternal antigens) could attribute to the condition. Conditions such as Pemphigoid gestationis (PG), Intrahepatic cholestasis of pregnancy (ICP), and Atopic eruption of pregnancy ( AEP) require the monitoring from dermatologists, obstetricians, midwives and other relevant healthcare practitioners as they do pose high risks to mother and baby (Brzoza et al. 007; Sachdeva 2008). With PUPP the main symptoms women complain of is an intense itching usually around the abdomen and in some cases breasts, upper thighs and arms. In the case of PUPP’s, the application of topical steroids, emollient creams and ointments may be applied and in severe cases oral treatments may be sought (Roth 2009). Epistaxis (nosebleeds) is considered a minor disorder but in one study has proven to be life threatening. Oestrogen rises, which causes hyperactivity of the parasympathetic nervous system which in turn causes nasal congestion.
One of the other reasons is systemic blood pressure increases in pregnancy. Complications from nosebleeds is rare, but if not monitored could lead to haemorrhage (Hardy, Connolly & Weir 2008). In this study a woman presented at 26 weeks with epistaxis but 48 hours later continued to bleed and surgery was the outcome. There is also evidence that chronic rhinosinusitis can lead to epistaxis. One study 44% of women between the ages of 26-30 and presenting in the third trimester appeared to have the highest incidence of epistaxis.
It must be noted that though this study was conducted in a third world country where nourishment, hygiene and education are an issue, there are potential risks of epistaxis in pregnancy. (Purushothaman 2010) Maternal morbidity in pregnancy is very well researched and evidence based, but the impacts that minor disorders have on a woman’s family or her emotional state is not well documented. However, there is one such Australian study stating the impact on women. In (Gartland et al. 2010) it showed that 68% experienced multiple disorders which had a cumulative effect and therefore greater impact.
What is interesting in the study was that women aged between 18-24, had a poor perception of health, socio-economic and education issues. In comparison to those older women who had stable relationships, well educated and better perception of health. The study demonstrated that a woman’s support network, access to professional advice and education can greatly impact her wellbeing and those around her. This assignment has explained the physiology and reasons for minor disorders in pregnancy. It is important that midwives and relevant healthcare professionals monitor women so as to prevent further complications to mother and child.
The health and wellbeing of a mother and her unborn child is always the utmost priority of healthcare professionals. . References Blackburn, S. T. 2007, Maternal, fetal & neonatal physiology : a clinical perspective, 3rd edn, Saunders Elsevier, St. Louis, Mo. Brzoza, Z. , Kasperska-Zajac, A. , Oles, E. & Rogala, B. 2007, ‘Pruritic urticarial papules and plaques of pregnancy’, Journal of Midwifery & Women’s Health, vol. 52, no. 1, pp. 44-8. Derbyshire, E. J. , Davies, J. ; Detmar, P. 2007, ‘Changes in Bowel Function: Pregnancy and the Puerperium’, Digestive Diseases and Sciences, vol. 2, no. 2, p. 324. Gartland, D. , Brown, S. , Donath, S. ; Perlen, S. 2010, ‘Women’s health in early pregnancy: Findings from an Australian nulliparous cohort study’, Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 50, no. 5, pp. 413-8. Hardy, J. J. , Connolly, C. M. ; Weir, C. J. 2008, ‘Epistaxis in pregnancy – not to be sniffed at! ‘, International Journal of Obstetric Anesthesia, vol. 17, no. 1, pp. 94-5. Jewell, D. ; Young, G. 1996, Interventions for treating constipation in pregnancy, John Wiley ; Sons, Ltd.
Law, R. , Maltepe, C. , Bozzo, P. ; Einarson, A. 2010, ‘Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy’, Can Fam Physician, vol. 56, no. 2, pp. 143-4. Purushothaman, L. P. a. P. K. 2010, ‘Analysis of Epistaxis in Pregnancy’, European Journal of Scientific Research, vol. 40, no. 3, pp. 387-96. Roth, M. -M. 2009, ‘Specific Pregnancy Dermatoses’, Dermatology Nursing, vol. 21, no. 2, pp. 70-81. Sachdeva, S. 2008, ‘The dermatoses of pregnancy. (Review Article)’, Indian Journal of Dermatology, vol. 3, no. 3, p. 103. Stables, D. ; Rankin, J. 2010, Physiology in childbearing : with anatomy and related biosciences, 3rd edn, Bailliere Tindall, Edinburgh. Staroselsky, A. , Nava-Ocampo, A. A. , Vohra, S. ; Koren, G. 2008, ‘Hemorrhoids in pregnancy’, Can Fam Physician, vol. 54, no. 2, pp. 189-90. Tiran, D. 2003, ‘Product focus. Self help for constipation and haemorrhoids in pregnancy’, British Journal of Midwifery, vol. 11, no. 9, pp. 579-81. Vazquez, J. C. 2010, ‘Constipation, haemorrhoids, and heartburn in pregnancy’, Clinical Evidence.