Exam 3 - Common Discomforts of Pregnancy

Question 1

When is morning sickness most common during pregnancy?

Answer 1

First trimester

• Peaks at 11 weeks and lasts 5-6 weeks
  
  • Can go into second trimester
  • Can progress past 20 weeks if multiple gestations
• Resolves around 14-16 weeks

Question 2

What is thought to be the cause of morning sickness?

Answer 2

Rising hCG levels in early pregnancy, usually subsides after first trimester when hCG levels drop

Question 3

Non pharmacological interventions for morning sickness

Answer 3

• Small frequent meals
• Eat crackers, toast, Cheerios before getting out of bed
• Carbonated drinks (e.g. ginger ale)
• Acupuncture, ginger
• Skip prenatal vitamins and just take folic acid

Question 4

Medications used to treat morning sickness

Answer 4

• Vitamin B6 (pyridoxine) supplement
• Doxylamine (Unisom) - antihistamine
  
  • Used during first trimester
  • Has been reformulated to Diclegis - only FDA approved med for N/V
    
    • Requires prescription - expensive

Question 5

Can zofran be used to treat morning sickness?

Answer 5

“Off label” use

• Recent evidence found use in first trimester showed increase risk of heart defects and orofacial malformations
• Remains category B

Question 6

What causes pregnant women to be constipated?

Answer 6

• Decreased peristalsis
• Decreased physical activity
• Iron supplements

Question 7

How to prevent constipation during pregnancy?

Answer 7

• Take bulk forming laxatives and stool softeners (e.g. colace, milk of magnesia, metamucil)
• Increase fluid intake
• High fiber diet

Question 8

What should constipated pregnant women NOT take for treatment?

Answer 8

Avoid stimulant laxatives

Question 9

What is leukorrhea?

Answer 9

Profuse, thin (or thick), clear to milky white, no odor vaginal discharge produced by epithelial cells in vagina and cervix

Question 10

What causes leukorrhea during pregnancy?

Answer 10

Due to hormone levels

Question 11

When do patients first notice leukorrhea during pregnancy?

Answer 11

Begins during second trimester

Question 12

What can leukorrhea form during pregnancy?

Answer 12

Forms mucus plug to protect bacteria from entering cervix

• Mucus plug lost when cervix begins to soften and prepares for labor

Question 13

Relief methods for leukorrhea

Answer 13

• Avoid douching or using feminine hygiene products to clean perineum or vagina
• Unscented cotten panty liners
• Wear cotton underwear

Question 14

What causes round ligament pain?

Answer 14

Ligaments pan through inguinal canal –> during pregnancy, ligaments hypertrophy as the uterus grows –> pain because ligament is lengthening and pressure from enlarging uterus

Question 15

How can you relieve round ligament pain?

Answer 15

Stretching

Question 16

What can round ligament pain also be confused for?

Answer 16

Preterm labor, appendicitis, inguinal hernia, muscle strain, GI pain (e.g. constipation, gas)

Question 17

When is lower back pain most prevalent for pregnant women?

Answer 17

Last half of pregnancy

• Intensifies with progression of pregnancy d/t increasing weight of uterus and relaxation of sacroiliac ligaments

Question 18

When is upper back pain most prevalent in pregnant women?

Answer 18

Early in pregnancy d/t increased size and heaviness of breasts –> muscle strain if breasts are not adequately supported

Question 19

Relief measure for back pain

Answer 19

• Education about proper body mechanics
  
  • Stoop rather than bend, lift legs and not back, spread feet apart and place one foot slightly in front of other when stooping
• Wear supportive low heeled shoes
• Apply local heat, massage therapy, ice
• Supportive mattress and bra
• Acetaminophen (avoid NSAIDs)
• Stretching, exercise, yoga, swimming

Question 20

What is supine hypotensive syndrome?

Answer 20

Lightheadedness and dizziness that occurs when lying in supine position d/t weight of uterus resting on IVC

• Venous blood return inhibited
• Reduced blood filling of heart
• Lowers CO

Also compresses aorta –> decreases arterial pressure

Question 21

Supine hypotension syndrome relief measures

Answer 21

Have patient turn on left side or sit up

Question 22

What causes pregnant women to have numb and/or tingling fingers?

Answer 22

Due to change in center of gravity, pulling shoulders, neck, head out of normal alignment

• Places pressure/traction on nerve and arm –> paresthesia of fingers
• Physiologic edema can also exert pressure on nerve supplying hands and cause carpal tunnel syndrome

Question 23

Are symptoms of numbness and tingling bilateral or unilateral?

Answer 23

Bilateral

Question 24

When do symptoms of numbness and tingling normally occur during pregnancy?

Answer 24

Begins in second or third trimester of pregnancy

• Usually resolves spontaneously during postpartum period

Question 25

Treatment for numbness and tingling in fingers during pregnancy

Answer 25

• Wrist splints
• Keep wrist in neutral position
• Wear splint while sleeping or during waking hours