Musculoskeletal pain and discomfort •
Low back pain and pelvic girdle pain – Pregnancy-related low back pain (PLBP) and pregnancy-related pelvic girdle pain (PGP) are common conditions occurring in an estimated 45% of pregnant women and 25% of postpartum women. Most of the literature does not distinguish between PLBP and PGP as since their precise definitions often overlap, however it is possible to differentiate them through history taking, clinical examination, provocative test maneuvers, and imaging. Pregnancy-related low back pain and pelvic girdle pain can occur together or separately. The pain is often dull, intermittent, worse in the evening, and usually occurs within 30 minutes of activities like walking, standing, or sitting. During pregnancy, the enlarged abdomen and gravid uterus place additional strain on lumbar muscles and shift the pregnant woman's center of gravity. These postural compensations culminate in an increased load on both lumbar spinal musculature and the sacroiliac ligaments, manifesting as low back pain and/or pelvic girdle pain. Land or water based exercise may both prevent and treat lower back and pelvic pain, yet current research in this area is of low quality. •
Carpal tunnel syndrome – Carpal tunnel syndrome can occur in up to 70% of pregnant women and typically has a benign course. It manifests as pain, numbness, and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger. The symptoms of carpal tunnel syndrome during pregnancy are usually mild and do not require treatment. However, if necessary, wrist splinting at night is the initial treatment that is recommended. Leg cramps typically last only for a few seconds, however they can be extremely painful and last for minutes. There is not clear evidence whether oral electrolyte and vitamin treatments (such as magnesium, calcium, vitamin B or vitamin C) are effective in treating leg cramps during pregnancy. •
Round Ligament pain – Round ligament pain commonly occurs in the second trimester and manifests as a sudden, sharp pain in the groin area or lower abdomen, on one or both sides. Typically the pain only lasts for a few seconds. During pregnancy, the growing uterus can put stress on the round ligament of the uterus, causing it to stretch and lead to pain.
Paracetamol (acetaminophen) is the recommended pain reliever for pregnant women with round ligament pain.
Fluid imbalance and kidney function •
Dehydration – Caused by expanded intravascular space and increased
third spacing of fluids. Complications include uterine contractions, which may occur because dehydration causes body release of
ADH, which is similar to
oxytocin in structure. Oxytocin itself can cause uterine contractions and thus ADH can cross-react with oxytocin receptors and cause contractions. •
Swelling/Edema – Swelling occurs when excess fluid accumulates in regions of the body, resulting in abnormal enlargement or "puffiness." This commonly occurs in the upper and lower extremities. Compression of the
inferior vena cava (IVC) and pelvic veins by the
uterus leads to increased hydrostatic pressure in the vasculature of the lower extremities. This increase in pressure shunts fluid from within the vasculature to the extracellular space. Treatment includes raising legs above the heart, advising patient to sleep on her side to prevent the uterus from compressing the inferior vena cava, reflexology, water emersion & compression stockings. •
Increased urinary frequency – Caused by increased intravascular volume, elevated GFR (
glomerular filtration rate), and compression of the
bladder by the expanding uterus. It may appear rather suddenly by
head engagement of the fetus into
cephalic presentation. Doctors advise pregnant women to continue fluid intake despite this.
Urinalysis and culture are ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by
dysuria (pain when urinating).
Gastrointestinal (GI) •
Heartburn – Heartburn (
Regurgitation) is a burning pain in the chest, behind the breastbone that occurs when stomach acid travel up the esophagus and causes irritation. This sometimes happens in pregnancy due to relaxation of the
lower esophageal sphincter (LES), which normally keeps acidic stomach contents in the stomach. Additionally, heartburn is worsened when the growing fetus increases intra-abdominal pressure, thereby compressing the stomach and pushing stomach contents through the relaxed lower esophageal sphincter (LES). The acidic contents of the stomach irritate the lining of the esophagus, resulting in a burning sensation in the mid chest. Regurgitation and heartburn in pregnancy can be at least alleviated by eating multiple small meals a day, avoiding eating within three hours of going to bed, and sitting up straight when eating. If diet and lifestyle changes are not enough,
antacids and
alginates may be required to control indigestion, particularly if the symptoms are mild. If these, in turn, are not enough,
proton pump inhibitors may be used. Constipation during pregnancy is thought to be due to decreased smooth muscle motility in the bowel caused by normal increases in progesterone. Treatment for constipation includes dietary modifications, including increased fiber and fluid intake, stool softeners, and laxatives. Treatment is symptomatic, including improving underlying constipation. Symptoms may resolve spontaneously after pregnancy, although hemorrhoids may remain in the days after childbirth.
Skin and vasculature changes •
Diastasis recti – During pregnancy, the growth of the fetus exerts pressure on the abdominal muscles. On occasion, women experience a separation of their
rectus abdominis. The rectus abdominis is divided centrally (mid-line) by the fibrous linea alba. In pregnancies that experience rapid fetus growth or in women with weak abdominal muscles, this pressure can cause the rectus abdominis muscle to separate along the linea alba, creating a split between the left and right sides of the rectus abdominis. Diastasis recti is common, and occurs more frequently as pregnancy progresses, up to and including labor. Elevated BMI, multiparity (twins, triplets, etc.), and diabetes have been identified as risk factors. Many cases of diastasis recti correct themselves after birth. In cases that persist, exercise may help, but sometimes surgery is needed to improve symptoms and prevent chronic problems. •
Varicose veins – Dilation of veins in legs caused by relaxation of smooth muscle and increased intravascular pressure due to fluid volume increase. Treatment involves elevation of the legs and pressure stockings to relieve swelling along with warm
sitz baths to decrease pain. There is a small amount of evidence that rutosides (a herbal remedy) may relieve symptoms of varicose veins in late pregnancy but it is not yet known if rutosides are safe to take in pregnancy. and are caused both by the skin stretching and by the effects of hormonal changes on fibers in the skin. They appear most commonly on the abdomen, breasts, buttocks, thighs, and arms, and may cause itching and discomfort. •
Generalized itching – It is a quite common complaint in pregnancy to have generalized itching which is not due to any systemic disease or any skin lesion. The itching is very frustrating and it may disturb sleep which leads to exhaustion and impaired
quality of life. There is no clear satisfying treatment for this symptom. More research is needed to define a possible, effective, and safe management. ==See also==