2nd Revised Session Plan Group 5 OB - Appendix and References for Printing

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DE LA SALLE HEALTH SCIENCES INSTITUTE

COLLEGE OF MEDICINE

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

STUDENT AUDIO VISUAL PROJECT:

Common Complaints of Pregnant Women

SESSION PLAN

Presented to:

Dr. Soledad Chu-Crisostomo

Presented by: Group 5

Maravilla, Rachelle



F. APPENDIX

I. INTRODUCTION

Perhaps one of God's greatest gifts to women is their capacity to bring new life into the world. While

many women are left feeling wonderfully blessed with the knowledge that a baby is growing in their

wombs, this doesn't alter the reality of the many physical changes and drawbacks happening to theirbodies. In this video, the group will be presenting some of the most common complaints women have

over pregnancy, its accompanying misconceptions and the proper ways to best handle these said

problems.

II. COMMON COMPLAINTS/HEALTH CONCERNS OF PREGNANT WOMEN

1. NAUSEA WITH OR WITHOUT VOMITING

i. Definition

Nausea pertains to the sensation of being about to vomit, while vomiting is the expelling

of undigested food through the mouth. It is colloquially termed as the morning sickness,

even though it is actually worse in the morning, it is still misleading because thesymptoms not only happen in the morning, but may also last for the whole day.

ii. Pathophysiology

There is still no well-established cause for nausea and vomiting in pregnancy,

however, studies suggest that a combination of factors such as genetic,

endocrine, gastrointestinal, psychosocial and evolutionary adaptations

contribute to these symptoms.

Human Chorionic Gonadotropin and Estrogen—that are active during

pregnancy are involved. Several studies have shown that an increase in the said

hormones is closely associated with nausea and vomiting of pregnancy.

iii. Management

Nausea and vomiting in pregnancy are usually self-limited.

May reduce the discomfort through changes in diet and lifestyle.

o Small frequent meals are highly recommended.

o Although pregnant women are encouraged to eat whatever it is that

appeals to them, fatty foods and foods with strong odors should be

avoided.

o Ginger supplements have also been reported to be beneficial;

however, large quantities should not be used as treatment.

o Vitamin supplements should be taken especially vitamin B-complex.

For pharmacological therapies, doxylamine-pyridoxine combination has been

proven to be safe and effective in the treatment of nausea and vomiting.

2. BACKPAINS

i. Definition

Backache — with soreness, stiffness, and pain — is one of the most common pregnancy

symptoms. And, unfortunately, backache often starts early on in your pregnancy and

persists (or worsens) until you give birth (when Pregnancy Backache is replaced

by Postpartum Back Pain).

ii. Pathophysiology

Increased hormone levels released during pregnancy softens the ligaments and

loosens the joints to prepare the mother for parturition. These two

http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/landing.aspx


http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/postpartum-bachache.aspx

http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/postpartum-bachache.aspx





Exercise can reduce the strain of the growing fetus as it prevents the muscles

that support a pregnant woman's back from weakening.

Massage

Good Posture

Heat from a warm bath or a hot compress can lessen the discomfort brought

about by back pains.

3. ROUND LIGAMENT PAIN

i. Definition

It is a sharp, shooting pain in the abdomen which is more on the right side than left and

is a common complaint in pregnancy often starting in the second trimester.

ii. Pathophysiology

The round ligaments hold the uterus in suspension within the abdomen. As the

uterus grows in size and weight, the ligaments become very long and thin –

stressing and tensing like rubber bands.

The ligaments pull and tug on nearby nerve fibers and sensitive structures,causing pain.

Ligament spasm, an involuntary contraction or cramp, usually triggers the

sharp pain. These spasms are found more frequently on the right side than the

left because of the normal tendency of the uterus to turn to the right.

May also be brought on by exercise

iii. Management

Consult doctor if it is indeed a round ligament pain

Activity modification – avoid sudden movements, shifting positions slowly may

provide relief. Brace abdomen when coughing/sneezing since coughing and

sneezing can trigger round ligament paint Rest

Analgesia

4. VARICOSITIES AT LOWER EXTREMITIES AND VULVA

i. Definition

Varicose veins are abnormally enlarged superficial veins usually seen in the thigh and

leg. In the majority of cases, these large superficial veins are of a cosmetic nuisance.These veins connect with the deep veins of the leg and play a minor role in the transfer

of blood to the heart.

ii. Pathophysiology

Linked to increase pressure in the veins, due to the gain of weight and volume

that promotes stasis of blood, thereby increasing pressure in the veins of the

extremities

Valves in the veins which prevent the back flow of blood back into the legs.

When these valves become damaged/defective, the blood flows backwards and

causes swelling and engorgement of the veins.

Further, the female sex hormones are thought to weaken the walls of the veins

and make them lax—

thus causing them to engorge with blood.

Female retains a lot of weight and fluid during pregnancy. In addition, the baby

in utero may also compress some parts of the pelvis (lower abdomen) and lead



Walk or exercise daily as this stimulates the muscles which can push the blood

away from the leg

Weight management

Avoid tight clothing that can compress the waist or groin

5. HEMORRHOIDS

i. Definition

Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus. This

may cause great discomfort and pain to the pregnant patient and may even bleed.

ii. Pathophysiology

Growing fetus puts pressure on the pelvic veins and inferior vena cava, causing

stasis of blood in the veins of the lower half of the body, increasing the

pressure in the veins below the uterus and causing them to dilate.

Aggravated by constipation which is also commonly experienced by pregnant

women due to increased progesterone levels, causing a decrease in bowel

motility, and compression of the uterus to the intestinal structures.

Straining due to hard bowel movement causes development of hemorrhoids.

iii. Management

Pain and swelling are usually relieved by topically applied anesthetics, warm

soaks, and stool-softening agents.

The patient should consult her doctor and ask for a safe and effective

anesthetic or medicated suppository to alleviate the pain.

The patient may also soak her bottom in a water tub for 10 to 15 minutes few

times each day, or position it over a basin full of warm water.

The patient is also suggested to modify her diet and take a high fiber diet and

many glasses of water daily to avoid straining and constipation. To prevent worsening the hemorrhoids, the patient is advised to avoid standing

and sitting for long continuous periods of time and to lie down on her left side

a few times a day to relieve the pressure from her rectal veins.

She is also expected to avoid lifting heavy objects or doing heavy work.

Kegel exercises is also suggested which can ease pregnancy symptoms including

hemorrhoids.

She may also use petroleum jelly on the area of the hemorrhoids to ease

bowel movements. Finally, a good hygiene must be kept by the patient at all

times to avoid any incidence of infections.

6.

HEARTBURNi. Definition

It is a burning substernal sensation, usually reported as a result of excess

gastroesophageal reflux of acid. It is common in late pregnancy.

ii. Pathophysiology

Since pregnancy causes the upward displacement and compression of the

stomach by the uterus, the tendency of the acidic contents of the said organ is

to move to the most dependent site, the lower esophagus.

Progesterone, a hormone produced in pregnancy in large amounts, brings

about the relaxation of the esophageal sphincter. This event also caters to the

introduction of acid to the lower esophagus, causing the pain to be felt underthe sternum.

iii. Management



7. FATIGUE

i. Definition

Fatigue is the lost of energy and motivation that goes with a concomitant need to rest.

Though weakness and fatigue are usually used at the same time, they slightly mean

different things. Weakness is the lack of physical strength, requiring the affected

individual to exert extra effort to move various parts of the body whereas fatigue is a

feeling of tiredness or exhaustion due to lack of energy or strength.

ii. Pathophysiology

During pregnancy, a pregnant woman's body has to work twice as hard due to

the accelerating fetal growth this includes increase in hormone production,

increase in metabolism as well as increase in blood flow leading to easy

fatigability.

The increase in blood flow is needed for the growing fetus to get the nutrients

it needs. -The increase of levels of progesterone also plays a role in fatigue in

pregnancy.

Nausea and vomiting can make a pregnant woman tired. Anemia is usually associated with fatigue during the early stages of pregnancy.

iii. Management

Take frequent rest breaks during the day

Scale back on nonessential activities and responsibilities

Eat a balanced diet

Drink plenty of water

Sleep early

8. HEADACHE

i. Definition

Common early in pregnancy, it is characterized by a squeezing pain or an ache on the

sides of the head or the back of the neck. But the pain can appear in other areas as well.

It may cause snap throbbing pain or a dull ache.

ii. Pathophysiology

May result from sinusitis or ocular strain caused by refractive errors

During midpregnancy, most headaches decrease in severity or disappear.

They may be a consequence of hypertensive disorders later in pregnancy

Pregnant women can also experience headaches due to stress, fatigue, caffeine

withdrawal, lack of sleep, dehydration and low blood sugar.

iii. Management

Eat well-balanced meals

Apply cold or heat packs to your head For sinus headache, apply a warm compress around your eyes and nose

For tension headache, apply a cold compress or ice pack at the base of your

neck

Maintain your blood sugar by eating smaller, more frequent meals.

Massaging your shoulders and neck is an effective way to relieve pain

Rest in a dark room and practice deep breathing

Warm shower or bath

Avoid eating

o Chocolate

o Alcohol

o Yogurt

o Aged cheeseo Peanuts

o Breads with fresh yeast



Should it happen that the discharge is irritating and is accompanied by an itching and

burning sensation, certain pathologic causes must already be considered, such as

Trichomonas vaginalis, Candida albicans and Gardnerella vaginalis. The specific cause

can be identified via examination of a fresh smear under the microscope.

Trichomonas vaginalis

o Vaginal discharge: foamy

Vaginal epithelium: with small punctuate, reddened areas (akastrawberry cervix)

Candidiasis or Moniliasis

o Vaginal discharge: cheesy white; tends to adhere to vaginal mucosa;

accompanied by severe itching, burning sensation

Vaginal epithelium: redness and chafing of the skin of the vulva and

perineum

Gardnerella vaginalis

o At least three of the following criteria must be satisfied for one to

make a diagnosis of Gardnerella infection.

iii. Management

Consult a doctor and request for lab exams to identify which treatment should

be given

Observe proper hygiene

10. CONSTIPATION

i. Definition

Having bowel movements fewer than three times a week is considered as constipation.

It is usually characterized by hard, dry, and difficult to eliminate stools which are

typically small in size. Some people with this condition find it hard to have a bowel

movement, often experiencing straining, bloating, and a constant feeling of a full bowel.

ii. Pathophysiology

The pressure of your growing uterus on your rectum

The pregnancy hormone progesterone, which slows the transit of

food/increase transit duration through your digestive tract

Interplay of risk factors: worry, anxiety, minimal physical exercise, and a low-

fiber diet

iii. Management

Eat a healthy diet. Include high-fibre foods such as wholegrain cereals,

wholemeal bread and fresh fruit and vegetables every day.

Drink plenty of fluids.

Exercise





Pagkahilo o pagsusuka

Pananakit ng likod

Panlalabo ng mata

Pananakit sa singit

Paglitaw ng mga ugat sa

bandang hita, binti, at

vulva

Almoranas

Pamamanas

Palaging inaasam o

pinaglilihian pagkain

Pananakit ng dibdib o

heartburn

Pagpupuyat

Mabilis na pagkapagod

Pananakit ng ulo

Pangangati

Putting discharge mula sa

pwerta o white mens

Pagtitibi o konstipasyon

Paglalaway

Itugma ang mga complaints mula sa Column A sa mga sanhi mula sa Column B.

COLUMN A

___1. Paglitaw ng mga ugat sa hita, binti, at

vulva

___2. Paninikip ng dibdib o heartburn

___3. Mabilis na pagkapagod

___4. Almoranas

___5. Putting discharge mula sa pwerta o

white mens

COLUMN B

A. pagakyat ng asido mula sa tyan papunta

sa dibdib

B. naiipon na dugo sa mga ugat dahil sa

pagtaas ng timbang at pagdami ng tubig sa

katawan

C. naiipon na dugo sa mga ugat dahil sa

paglaki ng uterus; maaring palalain ng

pagtitibi o konstipasyon

D. pagbilis ng metabolismo ng buntis dahilsa lumalaking fetus

E. normal na pagdami ng sekresyon mula sa

cervix o pwerta dahil sa pagbabago sa

hormones

Itugma ang mga complaints mula sa Column A sa nararapat na management mula sa Column B.

COLUMN A

___1. Pagkahilo o pagsusuka A. Pag-aangat ng mga paa

___2. Pananakit ng likod B.Kegel exercise

___3. Pananakit sa singit C. Pag-inom nganalgesia ___4. Paglitaw ng mga ugat sa bandang hita, binti, at vulva D. Kumain ng sapat pero paunti-unti

___5. Almoranas E. Pag-ehersisyo

Itugma ang mga complaints mula sa Column A sa mga paglalarawan sa Column B.

COLUMN A

___1.Pananakit ng dibdib o heartburn A. Kulang o pagkawala ng lakas

III. Post Quiz

Alin sa mga sumusunod ang mga reklamo tungkol sa pag-dadalang tao ang mga na inilarawan sa video

na iyong napanood? Lagyan ng tsek ang iyong sagot.



___2.Mabilis na pagkapagod B. non-pathologic o normal na pagtaas ng

mucus

___3.Pananakit ng ulo C. Pagdudumi ng hindi hihigit sa tatlong

araw sa isang linggo

___4.Putting discharge mula sa pwerta o white mens D.gastroesophageal reflux of acid

___5.Pagtitibi o constipation E.Squeezing pain

G. REFERENCES:

1. Arsenault, M., & Lane, C. A. (2002). The management of nausea and vomiting in pregnancy. SOGC Clinical Practice

Guidelines, (120), 7. Retrieved from http://www.sogc.org/guidelines/public/120E-CPG-October2002.pdf

2. Jarvis, S., & Nelson-Piercy, C. (2011). Management of nausea and vomiting in pregnancy. Retrieved

from http://www.bmj.com/content/342/bmj.d3606

3. Goodwin, T. M. (2002). Nausea and vomiting of pregnancy: An obstetric syndrome. American Journal of Obstetrics

and Gynecology, 186(5), S184-S189. Retrieved

from http://www.sciencedirect.com/science/article/pii/S0002937802800163

4. Sherrie. (March 25, 2011). Back Pain During Pregnancy and What to Do About IT. In herhealthworld Quality Women's

Health Blog. Retrieved January 31, 2012, fromhttp://www.herhealthworld.com/back-neck-pain/back-pain-during-

pregnancy-and-what-to-do-about-it/.

5. BabyCentre Medical Advisory Board. (2009, June). Baby Centre. Retrieved January 31, 2012 from Baby Centre Web

site: http://www.babycentre.co.uk/pregnancy/ antenatalhealth/physicalhealth/backache/

6. Round Ligament Pain. (March, 2007). American Pregnancy Association. Retrieved January 31, 2012

fromhttp://www.americanpregnancy.org/pregnancyhealth/ roundligament.htm

7. Glass, J. (2010, May 13). Migraine Headaches and Pregnancy. WebMD. Retrieved January 31, 2012 from

http://www.webmd.com/migraines-headaches/migraine-headaches-and-pregnancy.

8. Headaches during pregnancy. (October, 2011). BabyCenter, L.L.C. Retrieved January 31, 2012 from

http://www.babycenter.com/0_headaches-during-pregnancy_2035.bc. 9. Fatigue during pregnancy. (February, 2011). BabyCenter, L.L.C. Retrieved January 31, 2012 from

http://www.babycenter.com/0_fatigue-during-pregnancy_2911.bc.

10. Fatigue During Pregnancy-Topic Overview. (November 10, 2010). WebMD. Retrieved January 31, 2012 from

http://www.webmd.com/baby/tc/fatigue-during-pregnancy-topic-overview.

11. Your Pregnant body. (June, 2009). March of Dimes Foundation. Retrieved January 31, 2012, from

http://www.marchofdimes.com/pregnancy/yourbody_fatigue.html.

12. Fatigue During Pregnancy. (n.d.). More4Kids Inc. Retrieved January 31, 2012 from

http://pregnancy.more4kids.info/114/fatigue-during-pregnancy/.

13. Fatigue During Pregnancy. (n.d.). Women's Healthcare Topics. Retrieved January 31, 2012 from

http://www.womenshealthcaretopics.com/preg_fatigue_during.htm.

14. Alday-Singson, A. (2008). Prenatal care of the healthy woman. In W. Sumpaico, I. Ocampo-Andres, et al. (Eds.),

Textbook of obstetrics (pp. 257-278). Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics

and Gynecology, Inc.

15. Fauci, A., et. al. (2008). 4. Harrison’s Principles of Internal Medicine (17th ed.). United States: The McGraw-HillCompanies, Inc.

16. Cunningham, F. G., et.al. (2010). Prenatal Care, and Medical and Surgical Complications. Williams Obstetrics (23rd ed.,

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17. Rodriguez, D. (2010, May 13). Myths and Facts About Heartburn - Digestive Health Center - Everyday. Health

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http://www.everydayhealth.com/digestive-health/myths-and-facts-about-heartburn.aspx

http://www.webmd.com/migraines-headaches/migraine-headaches-and-pregnancy

http://www.babycenter.com/0_headaches-during-pregnancy_2035.bc

http://www.babycenter.com/0_fatigue-during-pregnancy_2911.bc

http://www.webmd.com/baby/tc/fatigue-during-pregnancy-topic-overview

http://www.marchofdimes.com/pregnancy/yourbody_fatigue.html

http://pregnancy.more4kids.info/114/fatigue-during-pregnancy/

http://www.womenshealthcaretopics.com/preg_fatigue_during.htm

http://www.womenshealthcaretopics.com/preg_fatigue_during.htm

http://pregnancy.more4kids.info/114/fatigue-during-pregnancy/

http://www.marchofdimes.com/pregnancy/yourbody_fatigue.html

http://www.webmd.com/baby/tc/fatigue-during-pregnancy-topic-overview

http://www.babycenter.com/0_fatigue-during-pregnancy_2911.bc

http://www.babycenter.com/0_headaches-during-pregnancy_2035.bc

http://www.webmd.com/migraines-headaches/migraine-headaches-and-pregnancy

Documents

2nd Revised Session Plan Group 5 OB - Appendix and References for Printing