Symptoms and signs in the first 10 weeks
Early symptoms are amenorrhoea, nausea, vomiting, and bladder irritability. Breasts engorge, nipples enlarge (darken at 12 weeks), Montgomery's tubercles (sebaceous glands on nipples) become prominent. Vulval vascularity increases and the cervix softens and looks bluish (4 weeks). At 6 10 weeks the uterine body is more globular. Temperature rises (<37.8 °C).
Headaches, palpitations, and fainting are all commoner in pregnancy. Sweating and feeling hot are also common, due to a dilated peripheral circulation. Management: Increase fluid intake and take showers.
Urinary frequency is due to pressure of the fetal head on the bladder in later pregnancy. Exclude UTI.
Abdominal pain
Breathlessness is common.
Constipation tends to occur as gut motility decreases. Adequate oral fluids and a high fibre diet help combat it. Avoid stimulant laxatives they increase uterine activity in some women. Increased venous distensibility and pelvic congestion predispose to haemorrhoids (if they prolapse, rest the mother head down, apply ice packs and replace them), and varicose veins. Resting with feet up, and properly worn elastic stockings help.
Reflux oesophagitis and heartburn occur as pyloric sphincter relaxation allows irritant bile to reflux into the stomach. Cigarettes and spices should be avoided, small meals taken, and antacids may be used. Use more pillows, and a semi-recumbent position.
Third trimester backache
Due to pelvic ligament and muscle relaxation, pain tends to be worse at night. A firm mattress, flat shoes, standing with back straight, and pelvic support from physiotherapy all help.
Carpal tunnel syndrome (p 714) in pregnancy is due to fluid retention. Advise wrist splints until delivery cures the problem.
Itch/itchy rashes are common (up to 25%) and may be due to the usual causes (OHCM p 76, check LFT see p 26) or to pruritic eruption of pregnancy (PEP = prurigo of pregnancy) an intensely itchy papular/plaque rash on the abdomen and limbs. PEP is most common in first pregnancies beyond 35 weeks' gestation. Emollients and weak topical steroids ease it. Delivery cures it. If vesicles are present, think of pemphigoid gestationis (PG): a rare (1:50,000) condition which may cause fatal heat loss and cardiac failure; the baby may be briefly affected; refer early (prednisolone may be needed). PG may recur in later pregnancies.
Ankle oedema
This is very common, almost normal manifestation of pregnancy. Measure BP and check urine for protein (pre-eclampsia, p 48). Check legs for DVT. It often responds to rest and leg elevation. Reassure that it is harmless (unless pre-eclampsia).
Leg cramps 33% get cramp, the latter half of pregnancy, severe in 5%, often worse at night. Raising the foot of the bed by 20cm will help.
Chloasma
This is a patch of darker pigmentation.
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