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Common Patient Concerns

Common Patient Concerns

Risk of birth defects

Birth defects , both major and minor, occur in 2 to 4 percent of liveborn infants. Both genetic and environmental factors play a role in the causes although most causes are unknown and not because of something “ you have done”. An ultrasound scan by an experienced sonographer in the first and second trimester can detect many of these defects.

Work during pregnancy

if you have an uncomplicated pregnancy and are working, there are no greater potential hazards than those encountered in your routine daily life and you may continue to work without interruption until the onset of labor. However, workplace safety and the physical demands of the your job should be considered. Many women choose to stop work from 34-36 weeks but there is much individual variation depending on your work and own personal circumstances.

Sexual activity

Sex during pregnancy is safe and in the absence of pregnancy complications (eg, vaginal bleeding, ruptured membranes, threatened preterm delivery), there is no reason to recommend against sexual intercourse during pregnancy.

Travel

Pregnant women who travel need to consider several issues, including:

  • the risk of pregnancy complications away from your usual medical care, as well as the availability of medical resources and medical insurance coverage at your destination.
  • the increased risk of venous thromboembolism during pregnancy and with prolonged immobility during the trip.
  • the potential risk of exposure to infectious diseases (eg, travelers’ diarrhea, malaria, Zika virus). Given the association between Zika virus during pregnancy and abnormal brain development, you should consider postponing travel to areas with mosquito-borne Zika virus transmission.

Airline travel

Most airlines allow women to fly up to 34 weeks of gestation, although individual policies may vary. Commercial airline travel is generally safe if you have an uncomplicated pregnancies. A normal baby’s heart rate is not affected during flight.

You should maintain hydration and periodically move your lower extremities to reduce the risk of venous thrombosis; use compression stockings and avoidance of restrictive clothing may also be helpful. Seat belts should be worn continuously to protect against injury from unexpected turbulence.

Hair dyes and other cosmetic products

Exposure to hair dyes or hair grooming/styling products results in very limited systemic absorption, unless the integrity of scalp skin is compromised by disease. Therefore, these chemicals are unlikely to cause adverse effects and can be used during pregnancy.

Your skin may be more sensitive in pregnancy and respond differently to cosmetics used during pregnancy compared to prior to pregnancy. Nail polish can be applied and removed.

Shortness of breath

Progesterone is a hormone secreted in pregnancy that causes changes to respiration and the feeling of shortness of breath. This is usually of a gradual onset. If you have a sudden onset of cough, wheeze, chest pain, fever, or coughing blood you need to see a doctor as this is not likely to be from pregnancy and needs to be more fully checked.

Use of insect repellants

pregnant women are advised to take precautions to reduce their risk of acquiring insect bourne infections (eg, Zika virus,) by avoiding mosquito bites through use of protective clothing and DEET (N,N-diethyl-3-methylbenzamide)-based repellents. Topically- applied DEET does not pose hazards to the developing fetus, regardless of gestational age.

Nausea and vomiting

See “Nausea and vomiting in pregnancy’

Constipation

Constipation is common in pregnancy. Increasing dietary fibre and fluids or using bulk-forming laxatives is the preferred treatment of constipation during pregnancy since these agents are not absorbed. If this doesn’t work, occasional use of lactulose, coloxyl and other “ over the counter” agents is probably not harmful. Castor oil can stimulate uterine contractions and excessive use of mineral oil can interfere with absorption of fat soluble vitamins, so these agents are generally avoided.

Difficulty sleeping

Sleep during pregnancy, especially late pregnancy, is often broken and characterized by increased waking after sleep onset, greater amounts of light sleep, and less deep sleep. Sleep may be broken because you need to pass urine, have gastric reflux, anxiety, restless legs or leg cramps, low back pain, physical limitations in achieving a comfortable position, and sometimes obstructive sleep apnea. Sometimes it is related to the steroid type effect of the hormones of pregnancy.

In the absence of treatment for a specific medical condition, such as reflux, sleep may be improved by having a regular sleep schedule in a low stimuli environment; cutting down on the amount of liquids in the hours before bedtime; avoiding caffeine after noon; exercising regularly for at least 20 minutes at least a few hours before bedtime; placing pillows between the knees, under the abdomen, and behind the back to take pressure off thelower back; putting a night light in the bathroom to avoid turning on a bright light, which tends to increase wakefulness; using relaxation techniques; and avoiding naps late in the day.

Sleeping position

From the third trimester ( around 28-30 weeks) you should avoid sleeping flat on your back. The suggested preferred position is titled towards the left side. This doesn’t have to be exactly on your side and use of a small pillow behind you to achieve the tilt should be sufficient. Sleeping flat on your back in late pregnancy can obstruct the the blood returning to your heart and may make you feel like you will faint. It may also be associated with airway obstruction.

Swelling

Water retention is a normal change in pregnancy, with an average increase at term of 3 L. Water retention is clinically evident as swelling of the ankles and legs, a normal finding in a large number of pregnant women near term unless accompanied by high blood pressure. You can reduce swelling by not standing for long periods of time, resting/ sleeping on the left side, wearing support hose or compression stockings, and water immersion.

Varicose veins

Pregnancy is a risk factor for development of varicose veins, which may become very painful anytime during pregnancy or after delivery. Compression stockings do not prevent varicose veins, but may relieve symptoms.

Urinary frequency and nocturia

Frequent urination during the day and over night is one of the most common pregnancy-related complaints, affecting 80 to 95 percent of women at some point during pregnancy. Avoiding caffeine and avoiding consumption of fluids two to three hours before bedtime may help reduce the frequency.

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