Common Problems in Pregnancy

Common Problems in Pregnancy

During pregnancy, drugs have to be prescribed with great caution as some drugs can harm the developing foetus while others can affect the course of pregnancy. Some of the common problems women can face during pregnancy and the guidelines for managing these situations are listed below:

Nausea and vomiting

Nausea and vomiting are the most frequent symptoms in pregnancy and can be quite distressing though these symptoms usually disappear by the fourth month. Women should be reassured and advised to take smaller, more frequent meals and to avoid large volume drinks. Nausea in the first three months of pregnancy does not normally require drug therapy. On some occasions when the symptoms are severe or prolonged, antiemetics such as doxylamine or prornethazine can be given.

Heartburn

For heartburn, antacids are widely prescribed in all trimesters. There is no evidence of foetal abnormalities.

Constipation

The inclusion of more fibre and fluids in the diet may be sufficient to relieve constipation. Laxatives should only be used when dietary changes prove ineffective. Bulk forming laxatives should be first tried such as Ispaghula. Stimulant laxatives such as senna are best avoided. Bisacodyl, Lactulose and docusate are all thought to be safe during pregnancy.

Asthma

The drug treatment of Asthma is essentially unchanged by pregnancy. There is no evidence that the commonly used drugs by asthmatics harm the foetus and women. Inhaled medication should be preferred. There is no evidence that the inhaled corticosteroids are harmful to the foetus. Short courses of systemic steroids may also be given.

Vaginal discharge

For vaginal discharge, topical agents are to be preferred over oral medications. Discharge due to candida can be treated with clotrimazoleTopical clindamycin is effective in bacterial vaginosis and may be considered for women in the first trimester. Oral metronidazole can be given if required during second and third trimester if trichomonas infection is confirmed. However, it should not be administered during first three months. Oral antifungal drugs such as fluconazole and itraconazole should be avoided.

Allergy

Promethazine and chlorpheniramine are the antihistamines of choice in pregnant women with allergic rhinitis and urticaria. Non- sedating compounds such as cetirizine are best avoided because of lack of experience in pregnancy. Use of loratidine is contraindicated during pregnancy.

Antibiotics

Urinary tract infections are the most common reason for prescribing antibiotics during pregnancy, although they are frequently needed for many other infections.

Class of Antibiotic Commonly used Drugs Safety in Pregnancy
Penicillins Ampicillin, Amoxycillin, Cloxacillin, Penicillin No evidence of problems.
Cephalosporins Cephalexin No evidence of problems.
Macrolides Erythromycin No evidence of problems.
Aminoglycosides Gentamycin, Netilmicin Avoid- Risk of Foetal toxicity
Tetracycline Oxytetracycline, Tetracycline, Minocycline Avoid- exposure at or after 12 weeks of gestation can affect developing teeth and bones.
Quinolones Ciprofloxacin, Norfloxacin, Ofloxacin Avoid – Insufficient evidence of safety
Other Antibiotics Nitrofurantoin No evidence of problem
Metronidazole No evidence of increased foetal risk. However to be used with care in the first trimenster.
Trimethoprim Avoid in the first trimester. However no evidence of increased foetal risk.

Pain

For pain, paracetamol is the analgesic of choice. Aspirin is not recommended as it can cause bleeding in late pregnancy. At present there is insufficient evidence of safety to recommend the use of ibuprofen in pregnancy. NSAID painkillers are best avoided in late pregnancy as they can cause premature closure of ductus arteriosus (foetal heart opening).

Hypertension

Hypertension is fairly common during pregnancy. Severe hypertension in the mother carries a risk of cerebrovascular accident and cardiac problems. It can lead, to eclampsia (convulsions) during pregnancy.

If a pregnant woman’s blood pressure is sustained greater than 160 mm Hg systolic and/or 110 mm Hg diastolic at any time, lowering the blood pressure quickly with rapid-acting agents is indicated for maternal safety.

Most of the antihypertensive drugs are excreted into human breast milk, but most are excreted to a negligible degree. All antihypertensive medications are believed to be compatible with breastfeeding, but using medications with a well-established record is reasonable. Atenolol, as well as the other beta-blocking agent’s nadolol and metoprolol, appear to be concentrated in breast milk. Labetalol and propranolol do not share this property and are preferred agents if a beta-blocker is indicated.

ACE inhibitors should be avoided during pregnancy, as they are associated with fetal renal dysgenesis or death when used in the second and third trimesters, as well as with increased risk of cardiovascular and central nervous system malformations when used in the first trimester.

Diuretics do not cause fetal malformations but are generally avoided in pregnancy, as they prevent the physiologic volume expansion seen in normal pregnancy. They may be used in states of volume-dependent hypertension, such as renal or cardiac disease.

Pregnant Women ~ need to know

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This entry was posted in Diseases & Conditions and tagged by Manbir & Gurpreet. Bookmark the permalink.

About Manbir & Gurpreet

Gurpreet Kaur’s journey in this world .... Gurpreet Kaur was a Musician. She was a singer and a composer of music. Her interest was composing and singing Gurbani Shabads in Indian Classical style. She sang Shabads in All the Raags mentioned in Sri Guru Granth Sahib Ji. She also taught Gurmat Sangeet at Gurmat Gian Missionary College, Jawadi, Ludhiana. Elder child to Pushpinder Kaur and Dr. Brig. Harminder Singh, was born in Amritsar on 13th Jan 1962. She attended various convent schools as a child because her father would get frequent Army postings as a dental surgeon. She graduated with Music Honors from Govt. College for Women, Chandigarh. Music was her hobby and she composed and sang Raag based Gurbani Shabads. Doing Kirtan was part of growing up nurtured by her parents. She learned music from her father Dr. Brigadier Harminder Singh who was a dental surgeon in Indian Army and a very good singer himself. Gurpreet’s Bhua (father’s sister), Ajit Kaur retied as a Head of Department of Music from Govt. College for Women Ludhiana, and was a renounced Punjabi singer of her time. Gurpreet Kaur also learned nuances of Indian Classical Music from Pandita Sharma. She was a mother of three children, and a grandmother. Her daughter Keerat Kaur is a Computer Engineer. Her two sons Gurkeerat Singh and Jaskeerat Singh are doctors in USA. Her daughter Keerat Kaur too was part of her group ~ Gurmat Gian Group. Gurpreet Kaur left this world at the age of 54yrs on 12th Sept 2016 in Baltimore USA. She had recorded around 25 cds of Gurbani Keertan. 'Raag Ratan' Album (6 CDs) is a Compilation of Shabads in All the 31 Sudh Raags of Sri Guru Granth Sahib Ji. 'Gauri Sagar' Album (3 CDs) is a Compilation of All forms of Raag Gauri in Sri Guru Granth Sahib Ji. 'Nanak Ki Malhaar' ~ ((3 CDs) is an album of Raag Malhar Shabads in various forms of Malhar. 'Gur Parsaad Basant Bana' ~ (3 CDs) is an album of Shabads in Raag Basant sung in various forms of Raag Basant. Har Ki Vadeyai Sarni Aayea Sewa Priya Kee Preet Piyaree Mohan Ghar Aavho Karo Jodariya Mo Kao Taar Le Raama Taar Le Tere Kavan Kavan Gun Keh Keh Gawan Mera Baid Guru Govinda Saajanrraa Mera Saajanrraa

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