Bladder problems

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Urinary complaints are common and range from an increased frequency of micturition in early pregnancy to the acute urinary retention occasionally seen with a retroverted uterus incarcerated in the pelvis. The association between urinary tract complications in pregnancy and the occurrence of preterm labour makes this investigation and prompt treatment of particular importance.

Management

If the bladder problems are related to the pressure exerted by the baby and pregnancy then changing position and maintaining good tone is the best you can do until the baby is born, when the symptoms should resolve. If you have symptoms that suggest you may have a urinary tract infection e.g. pain passing urine, blood in the urine, fever, please consult your midwife or doctor as soon as possible for further investigation and treatment.

Breast pain

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Breast pain (mastodynia) is occasionally an early symptom of pregnancy. A less uncomfortable tingling sensation is more usually seen, and resolves spontaneously.

Management

As your breasts typically increase in volume by 25% please ensure you have a bra that fits you correctly in pregnancy and after childbirth. This is very important when you are keeping fit and exercising.

Cessation or reduction of fetal movements

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Management

Reduced or altered fetal movement can be assessed with the use of ultrasound of the fetus and a fetal heart rate trace. If the fetus is well grown, moving well, with normal amniotic fluid levels and fetal heart rate pattern the expectant mother can be reassured that the change in movements does not indicate any deterioration on the condition of the fetus.

Generalized itch or jaundice

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Generalised itch is commonly a symptom associated with skin disorders of pregnancy. Women with persistent itch should have their liver function checked, as this symptom also occurs with cholestasis of pregnancy, which in turn can have an adverse effect on the fetus.

Management

Abundant moisturizer cream applied liberally will help itch secondary to dry skin. If there is a suggestion of obstetric cholestasis (generalised itch) then liver function tests including bile acid levels is recommended.

Headaches

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While the vast majority of headaches are related to tension, this can be the first symptom of impending pre-eclampsia. An assessment of blood pressure is always recommended with the first symptoms, and again if any circumstances change. Collapse and convulsions are clearly ominous, and require urgent attention. Eclampsia, haemorrhagic shock, and pulmonary embolus may present in this way.

Management

As Headaches are typically caused by tiredness, dehydration and low sugar levels the obvious steps are to take paracetamol, fluids and nutrition and get some rest. Persistent headaches or pain in unusual areas of the head require further evaluation by your doctor and possibly a neurologist. While the vast majority of headaches are related to tension, in later pregnancy this can be the first symptom of impending pre-eclampsia, an assessment of blood pressure is always recommended with the first symptoms, and again if any circumstances change. Collapse and convulsions are clearly ominous, and require urgent attention. Eclampsia, haemorrhagic shock, and pulmonary embolus may start with this presentation.

Leg (calf) swelling

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Venous Thromboembolism

Some ankle swelling is very common in the second half of pregnancy. If you develop pain and swelling in one calf, compared with the other, you should seek medical advice, as it may be the first sign of a leg clot (same problem as economy class syndrome). A clot in the leg is more likely to occur after birth.

Management

There are a number of ways to assess the possibility of a DVT, D-dimers and blood flow (Doppler) assess of the legs or area causing concern. If a DVT is diagnosed an anticoagulant is used to reduce the risk of more clots and manage the current DVT.

Rupture of membranes

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Premature rupture of the membranes, presenting as leakage of fluid from the genital tract, is another key symptom in pregnancy. If this occurs before 20 weeks gestation, the risk of premature delivery, lung hypoplasia (failure to develop) and limb deformity, are very high.

Later in pregnancy the risk of an associated of concurrent infection (chorioamnionitis) is a constant concern, because of the poor outcome for both mother and child in these circumstances.

Management

Premature rupture of the membranes is managed expectantly, unless there is evidence of infection or impending infection. In these circumstances antibiotic cover and delivery will be recommended. When the membranes rupture at term management is again expectant for the first 24 or 48 hours. Because of the risk of ascending infection (chorioamnionitis) induction and delivery is recommend after this time.

Vaginal bleeding

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Vaginal bleeding, or antepartum haemorrhage as it is called if it occurs after the 24th week of pregnancy up to delivery of the child, should always be investigated promptly, particularlay to exclude the possibility of a placental abruption (usually associated with pain) or placenta praevia. If the mother is Rhesus negative, Anti – D should be administered, to minimise the risk of Rhesus iso-immunisation. New evidence suggests that universal prophylaxis against Rhesus iso-immunisation for all women can further reduce the risks of iso-immunisation.

Management

It is important not to assume the origin of vaginal bleeding so a careful history and examination is essential. A speculum examination can confirm that the cervix is healthy and not the source of the bleeding. A careful history will determine if there is associated pain, which is very important in deciding how best to manage the bleeding.

If the bleed is substantial admission to hospital, intravenous lines and blood may all be required. With minor bleeding bed rest in the first instance is recommended, slowly returning to a normal life as the bleeding resolves. If there is a placenta praevia or abruption close medical care will be recommended until the delivery.

If the mother is Rhesus negative, Anti – D should be administered, to minimise the risk of Rhesus iso-immunisation. New evidence suggests that universal prophylaxis against Rhesus iso-immunisation for all women can further reduce the risks of iso-immunisation.