Minor Ailments of Pregnancy
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Direct answer
Minor ailments of pregnancy are common hormonal and mechanical discomforts, including backache, heartburn, constipation, varicosities, haemorrhoids and supine hypotension, that respond to simple measures. Paracetamol, antacids, fibre and compression stockings are first line, while NSAIDs are avoided after 20 weeks. Supine hypotension, caused by aortocaval compression after about 20 weeks, is relieved by lying on the left side.
What you must remember
- Backache: caused by lumbar lordosis, ligamentous laxity and relaxin, and managed with physiotherapy, a support belt and paracetamol.
- Heartburn: progesterone relaxes the lower oesophageal sphincter, so antacids are the first remedy, with H2 receptor blockers added if needed.
- Constipation: progesterone slows bowel transit, so fibre, fluids and bulk-forming or osmotic laxatives are preferred over stimulant purgatives.
- Varicosities: vulval and leg varicose veins are common, graduated compression stockings help, and vulval varices usually regress after delivery.
- Haemorrhoids: straining and pelvic venous congestion cause them, and surgery is usually deferred until after delivery.
- Supine hypotension: the gravid uterus compresses the inferior vena cava after about 20 weeks, and a left lateral tilt restores venous return.
- NSAIDs: avoided from about 20 weeks because of fetal renal effects with oligohydramnios, and especially in the third trimester because of premature ductal constriction.
- Unilateral leg swelling: raises the possibility of deep vein thrombosis, which pregnancy makes more likely, and must be investigated.
Matching each ailment to its first-line measure
Most minor ailments respond to mechanical or dietary measures, because each is driven by a predictable change of pregnancy such as smooth muscle relaxation, venous pressure or mechanical compression. The table pairs each one with its first-line step and the main caution to remember.
| Ailment | First-line measure | Main caution |
|---|---|---|
| Backache | Physiotherapy, pelvic support belt, posture advice and paracetamol | Avoid NSAIDs after 20 weeks, given ductal constriction and oligohydramnios |
| Heartburn | Small frequent meals, upright posture after eating and antacids | Avoid lying flat soon after meals; reserve acid suppressants for failure |
| Constipation | Fibre, adequate fluids and bulk-forming or osmotic laxatives | Avoid stimulant purgatives, which are best avoided in pregnancy |
| Varicosities | Graduated compression stockings, leg elevation and regular walking | New unilateral swelling needs deep vein thrombosis evaluation |
| Haemorrhoids | Fibre, softeners, sitz baths and avoidance of straining | Surgery usually deferred until postpartum unless complicated |
| Supine hypotension | Left lateral tilt or a wedge under the right hip | Dizziness, sweating or bradycardia when lying flat |
Almost all of these respond to non-drug measures, so the drug choice should be checked against gestational age before any prescription. A drug judged safe in the first trimester may be unsuitable later, so the trimester must be stated before a prescription is written.
Viva angles that catch students out
Questions on minor ailments usually hinge on one drug or one position.
- Trap: Prescribing an NSAID for backache in late pregnancy Correct: paracetamol and physiotherapy are preferred, since NSAIDs are avoided after 20 weeks.
- Trap: Giving a fluid bolus first to a dizzy woman lying supine Correct: a left lateral tilt is the first step, because it relieves aortocaval compression.
- Trap: Dismissing one swollen, painful leg as varicose veins Correct: deep vein thrombosis must be excluded, because pregnancy raises its risk.
- Trap: Operating on haemorrhoids during pregnancy Correct: conservative measures come first, and surgery is usually postponed until after delivery.
Frequently asked questions
Which analgesic is safe for backache in pregnancy?
Paracetamol is the preferred analgesic for backache in pregnancy, used alongside physiotherapy, posture advice and a support belt. Non-steroidal anti-inflammatory drugs are avoided, particularly after 20 weeks, because of fetal ductal constriction and oligohydramnios.
What is supine hypotension syndrome in pregnancy?
Supine hypotension syndrome is a fall in venous return and cardiac output when a pregnant woman lies flat, caused by the gravid uterus compressing the inferior vena cava after about 20 weeks. It is relieved by a left lateral tilt, which restores venous return.
Why does heartburn occur in pregnancy?
Heartburn in pregnancy occurs because progesterone relaxes the lower oesophageal sphincter, while the enlarging uterus raises intra-abdominal pressure. Antacids and smaller meals usually control symptoms, and acid-suppressing drugs are added only if needed.
How should haemorrhoids be managed in pregnancy?
Haemorrhoids in pregnancy are managed with fibre, adequate fluids, stool softeners and avoidance of straining. Surgery is usually postponed until after delivery, because symptoms commonly settle once pelvic venous pressure falls.