Published on 10/03/2015 by admin
Filed under Obstetrics & Gynecology
Last modified 10/03/2015
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Chapter 10 Minor complications of pregnancy
CHAPTER CONTENTS
The physiological and anatomical changes that occur during pregnancy may lead to complications which, although minor in medical terms, may cause considerable distress and discomfort to many pregnant women. They are listed below in alphabetical order.
Backache is common in late pregnancy and is felt over the sacroiliac joints. It is caused by relaxation of the ligaments and muscles supporting the joints, and is probably also induced by progesterone and, possibly, relaxin. It is usually worse at night and may prevent the woman from sleeping. Wearing flat-heeled shoes, avoiding heavy lifting, gentle exercise (including water-based exercise), physiotherapy and acupuncture are all beneficial.
The high levels of oestrogen in pregnancy may increase the eversion of the endocervical columnar cells so that they appear as a red ring around the external cervical os. The cells may secrete mucus when exposed to the vagina, causing a non-infective vaginal discharge. The condition has erroneously been called a cervical erosion.
The reduced gut motility associated with increased progesterone is aggravated in late pregnancy by the pressure of the enlarged uterus, making constipation common in pregnancy. Treatment consists of increasing dietary fibre (for example by eating wholemeal instead of white bread) and attempting to defecate after a meal. If the constipation is causing discomfort the woman may be prescribed oral sterculia with frangula bark granules (Normacol) or the contact laxative bisacodyl.
In 10% of women the uterus is normally retroverted; moreover, retroversion of the uterus does not hinder conception, and so when examined vaginally in the early weeks of pregnancy some women will be found to have a retroverted uterus. In nearly all cases the uterus becomes anteverted spontaneously, usually between the 9th and 11th weeks of pregnancy. Very rarely the uterus remains retroverted until after the 14th gestational week and becomes incarcerated in the cul-de-sac. If this occurs the woman complains of frequency of micturition and dysuria. If the position of the uterus is not corrected, the symptoms increase in severity and eventually there is retention of urine and an enormously distended bladder. Finally, retention of urine with overflow occurs. Examination shows a smooth, soft cystic tumour arising in the pelvis and palpable abdominally in the midline. Treatment entails inserting a catheter and decompressing the bladder slowly. When this is done the uterus usually becomes anteverted, but may need to be anteverted using the fingers by pushing up in the posterior fornix and manipulating the uterus to one side of the sacral promontory.
Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology
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