Common Complaints During Pregnancy

Clinical assessment

Diagnosis based on patient's reported symptoms typical for pregnancy after ruling out underlying pathology. Key is differentiating minor discomforts from signs of serious conditions (e.g., UTI vs frequency, pre-eclampsia vs physiological oedema, hyperemesis vs morning sickness, obstetric cholestasis vs mild pruritus).

Investigations

• Usually clinical diagnosis.
• Urinalysis: Exclude UTI if urinary frequency/dysuria/backache.
• Blood Pressure & Urine Protein: Exclude pre-eclampsia if significant oedema, headache, visual changes.
• Haemoglobin: Assess for anaemia if fatigue/pica.
• High Vaginal Swab (HVS): If abnormal discharge/vulval pruritus suggests infection (Candida, BV).

Diagnostic criteria

Clinical presentation consistent with common pregnancy discomforts after ruling out serious underlying or pregnancy-related complications.

Non-pharmacological management

• Reassurance and explanation of physiological basis.
• Morning Sickness: Frequent small, dry meals (crackers); avoid triggers (spicy/fatty foods, strong smells); ginger/lemon; acupressure bands.
• Backache: Posture advice (avoid slouching/high heels); supportive shoes; firm mattress; local heat; pregnancy support belt.
• Frequency: Reassurance (if UTI excluded); advise pelvic floor exercises.
• Swollen Feet: Elevate legs; avoid prolonged standing/sitting; comfortable shoes; adequate hydration (if pre-eclampsia excluded).
• Indigestion/Heartburn: Small frequent meals; avoid fatty/spicy foods, caffeine; avoid lying flat after eating; antacids (simple Mg/Al based).
• Constipation: Increase dietary fibre (fruits, vegetables, whole grains); increase fluid intake; gentle exercise.
• Ptyalism: Reassurance; frequent small sips of water; chew sugar-free gum.
• Pica: Ensure balanced diet; check/treat iron deficiency if soil craving.
• Pruritus (Mild): Reassurance; moisturizers; cool baths; loose cotton clothing (exclude obstetric cholestasis if severe/persistent).
• Vulval Pruritus/Discharge: Hygiene advice (avoid douching, irritants); loose cotton underwear.
• Leg Cramps: Stretching exercises (calf stretch); adequate hydration; possibly calcium/magnesium supplements (evidence weak).
• Fatigue: Adequate rest/naps; balanced diet; gentle exercise; ensure anaemia treated.

Pharmacological treatment

• Morning Sickness (if severe, unresponsive to non-pharma): Vitamin B6 (Pyridoxine) 10-25mg PO TID/QID. Consider antihistamines like Doxylamine (often combined with B6) or Promethazine 25mg PO/IM/PR PRN. Avoid others in 1st trimester unless hyperemesis (See OBS010).
• Constipation (Severe): Stool softeners (Lactulose, Macrogols). Avoid stimulant laxatives.
• Vulval Candidiasis: Clotrimazole pessaries or cream (7-day course preferred). Oral Fluconazole 150mg single dose if severe (avoid repeated/prolonged use, esp 1st trimester).
• Leg Cramps: Calcium lactate 600mg PO TID for 5 days (per UCG).
• Generalised Pruritus (Severe): Antihistamines (e.g., Chlorpheniramine) - use cautiously, prefer non-sedating if possible.
• Pain Relief (Backache): Paracetamol is safest.
• Antacids for Heartburn: Simple Magnesium/Aluminum/Calcium based.
• Avoid NSAIDs (esp. 3rd trimester), Steroids (unless specific indication), Anticholinergics.

Monitoring

Monitor symptom resolution. Reassess if symptoms worsen, persist, or new concerning symptoms arise.