INTRODUCTION

➢ PREGNANCY:

▪ Pregnancy is a period of time when a fetus develops inside a woman's uterus, and it
usually lasts about 40 weeks or a little over 9 months.
▪ Pregnancy begins with conception, when an egg is fertilized by sperm, and ends with
delivery or abortion.
▪ Pregnancy is divided into three trimesters.
1. First trimester: Weeks 1–12, fertilization and major organ development
occur.

2. Second trimester: Weeks 13–27, the fetus grows and develops

rapidly
3. mature. Third Weeks 28–40, the fetus's weight increases and its
▪ During trimester: organs
pregnancy, the mother's body goes through many changes to support the growing fetus.
These changes affect all of her organ systems
▪ A pregnant women faces many problems & complications during pregnancy or even
after giving birth.
▪ Problems such as:
1. Heart burn
2. Nausea & vomiting
3. Leg cramps
4. Weight gain(>10kg)
5. Oedema
6. Morning sickness etc ▪ Complications such as:
1. Anemia
2. GDM (Gestational Diabetes Milletus)
3. UTI (Urinary Tract Infection)
4. Ectopic pregnancy
5. Eclampsia & pre-clampsia etc

➢ Problems during pregnancy

[Link] burn:
▪ Heartburn is a burning sensation that feels like it’s in your heart, but isn’t really. It’s in
your esophagus, the swallowing tube that runs alongside your heart. The feeling is
caused by acid refluxing up from your stomach.
 ▪ Heartburn, also known as indigestion or acid reflux, is common during pregnancy. It's
caused by a combination of hormonal changes and the growing baby pressing on your
stomach:
1. Hormones
Pregnancy hormones, especially progesterone, relax the esophageal sphincter, the muscle
that separates the stomach and esophagus. This allows stomach acid and partially digested
food to flow back up into the esophagus. Progesterone also slows down digestion, which
can lead to heartburn.
2. Uterine pressure
As the fetus grows, the uterus puts pressure on the stomach, which can cause stomach
acid to flow up into the esophagus. This is why heartburn is more common in the third
trimester.

➢ Symptoms:
1. A burning sensation in the chest and throat, especially after eating
2. Regurgitation, or bringing up stomach contents
3. A feeling of pain under the ribs
4. A knotted stomach
5. Difficulty swallowing

➢ Prevalence:
✓ Heartburn is a common gastrointestinal symptom during pregnancy, affecting 17–45%
of pregnant women.
✓ Heartburn is more common in the second and third trimesters, and can increase from
22% in the first trimester to 39% in the second trimester and 60–72% in the third
trimester.

➢ Risk factor:
✓ Some risk factors for heartburn include non-vegetarianism and frequent
consumption of aerated beverages.

2 .Nausea & Vomiting:

▪Nausea . It is often
is feeling an urge to vomit called "being
sick to your
stomach."
▪Vomiting or throwing-up forces the contents of the stomach up through the food
pipe (esophagus) and out of the mouth
Nausea and vomiting during pregnancy, also known
common and usually doesn't harm the baby as morning sickness, is very
 .
It often starts around 5 to 6 weeks of pregnancy, but can occur at any time of day or
night. For most women , morning sickness improves or stops by weeks 12 to 20, but
some women experience it throughout their pregnancy
Mild nausea and vomiting usually doesn't require medical treatment, but you should
still let your doctor know. If you're experiencing severe vomiting or can't keep food
down, you should contact your doctor or hospital as soon as possible.

➢ Causes:
✓ Nausea and vomiting during early pregnancy may signal the rise in hormones
within the body that's needed for a healthy pregnancy. nausea and vomiting
during pregnancy might be due to the effects of a hormone made
by the placenta. That hormone is called human chorionic
gonadotropin (HCG).

➢ Symptoms:

✓ Decreased appetite
✓ Low-level nausea
✓ Vomiting
✓ Cramping
✓ Upper abdominal pain
✓ Pain under your ribs on the right side
✓ Dizziness
✓ Fatigue etc

➢ Prevalence risk factor:

▪ Nausea and vomiting during pregnancy (NVP) is common,
affecting 70–80% of pregnant women. Symptoms can range
from mild to severe, and most women experience them
during the first trimester. There is a chance of developing a severe
form of pregnancy sickness called hyperemesis gravidarum.
[Link] cramps
▪ Leg cramps are painful muscle contractions that typically affect the calf, foot or both.
They are common during pregnancy, often happening at night during the second and
third trimesters. ▪ This happens when acid builds up in your muscles.

➢ Causes:
 • Leg cramps are common during pregnancy and can occur due to a number of possible
reasons, including:
1. Low
2. calcium.
3. Vitamin Electrolyte imbalances:
4. Circulation
deficiencies
5. changes:
6. Dehydrati Muscle fatigue and weight gain: etc
on

➢ Prevalence:
▪ Leg cramps can significantly affect daily activities, quality of life and sleep patterns.
The prevalence of leg cramps among pregnant women peaking in the third trimester
has been estimated to be between 47.8 and 64.4%.

• Risk factor:
▪ Risk factors for leg cramps include:
1. 2. Leg swelling:
3. Gastrointestinal (GI) problems:
4. Weight gain: Carrying extra weight can stress leg muscles.
5. Circulation changes: Poor blood flow to muscles can cause leg cramps. Vitamin or
mineral
deficiencies: Low levels of certain vitamins and minerals can cause leg cramps, etc.

[Link] gain(>10kg)

▪ Weight gain occurs when your body weight

▪ increases.
It occurs when more energy (as calories from food and beverage consumption) is
gained than the energy expended by life activities, including normal physiological
processes and physical exercise.
▪ The amount of weight a pregnant woman should gain depends on her body mass
index
➢ (BMI) before pregnancy.
Underweight:
▪ Women with a BMI of less than 18.5 should gain between 12.5 and 18 kilograms.
➢ Normal weight:
▪ Women with a BMI of between 18.5 and 24.9 should gain between 11.5 and 16
kilograms.
➢ Overweight:
▪ Women with a BMI of between 25 and 29.9 should gain between 7 and 11.5 kilograms.
➢ Obese:
▪ Women with a BMI of greater than 30 should gain between 5 and 9 kilograms.
 • Causes:
▪ Weight gain during pregnancy is caused by a number of factors,
including:
✓ The growth of the baby. ✓ Increased Breast tissue.
✓ Fat stores in the body.
✓ Hormonal
✓ changes. High intake of processed or
sugary food, etc

➢ Symptoms:
▪ The main symptom of this pregnancy-related condition is high blood pressure,
sometimes accompanied by nausea, headaches and dizziness too.

➢ Prevalence:
▪ In the most recent full decade (2010-2019), global prevalence of maternal obesity was
estimated as 16.3% (95% confidence interval (CI): 15.1-17.5%), or approximately one
in six pregnancies.

➢ Risk factor:
▪ Some risk factors for excessive weight gain during pregnancy include:
1. PIH (Pregnancy Induced Hypertension).
2. Eclampsia & Preclampsia.
3. Macrosomia (fetus is larger than average, excessive birth weight) etc.

➢ Complications during pregnancy :

[Link]:
▪ Anemia is a problem of not having enough healthy red blood cells or hemoglobin to
carry oxygen to the body's tissues. Hemoglobin is a protein found in red cells that
carries oxygen from the lungs to all other organs in the body.
▪ Anemia is preventable and treatable.
▪ . Anemia in pregnancy is a worldwide health challenge affecting low-, middle-, and
high-income countries with several impacts on health and socio-economic progress. It
was approximated that nearly 40.1% of pregnant mothers develop anaemia globally. 1
As defined WHO, anemia in pregnancy develops when hemoglobin (Hb)
concentration reduces to <11g/dL with haematocrit of <0.33/L.

➢ Classification:
▪ Based on hemoglobin levels less than 11.0g/dL
1. mild anemia: (Hb levels 9 to 10.9g/dL), 2.
moderate anemia: (Hb levels 7 to 8.9g/dL), 3.
severe anemia (Hb levels less than 7g/dL).

➢ Causes:

1. Iron deficiency: The most common cause of anemia during pregnancy, iron
deficiency can be caused by not getting enough iron in your diet, losing blood during
menstruation or previous pregnancies, or increased demand for iron during pregnancy.

2. Vitamin B12 deficiency: A deficiency in vitamin B12 can cause anemia and may
also harm the baby's nervous system. Pregnant women should consume 2.6 mcg of
vitamin B12 daily.

3. Folate deficiency: A deficiency in folate can cause anemia.

Pregnancy itself: Pregnancy can cause anemia due to the increase in blood volume.

4. Other diseases: Certain diseases, such as sickle cell anemia and thalassemia, can
cause anemia during pregnancy.

5. Heavy menstrual flow: A heavy menstrual flow before pregnancy can increase the
risk of anemia during pregnancy.
6. Morning sickness: Frequent vomiting due to morning sickness can increase the risk
of anemia during pregnancy.

➢ Symptoms:
✓ Fatigue: Feeling tired or weak
✓ Paleness: Skin, lips, nails, palms, or the underside of the eyelids may appear pale
✓ Shortness of breath: You may experience labored breathing
✓ Dizziness: You may feel dizzy or experience vertigo
✓ Rapid heartbeat: Your heart may beat faster than normal
✓ Trouble concentrating: You may have difficulty concentrating. etc

➢ Prevalence:
▪ The prevalence of anemia in pregnant women varies by
region and other factors, but here are some estimates:
• India: About 50% of pregnant women in India are affected by
anemia. Anemia is associated with factors such as geographical
location, wealth index, and education level.

• Globally: A meta-analysis found that the overall prevalence of

anemia in pregnant women is 36.8%. The prevalence is highest in
Africa at 41.7%, and in the third trimester of pregnancy at 48.8%.
• Rural vs urban: Anemia is more prevalent in rural areas than in
urban areas.

• Socioeconomic factors: Anemia is more prevalent in women from

poorer households, those with no formal education, and those who
smoke, use tobacco, or drink alcohol.

• Age: Anemia is more prevalent in teenage pregnant women.

➢ Risk factor:
✓ Severe or untreated iron-deficiency anemia during pregnancy can increase your risk
of
havin A preterm or low-birth-weight baby . A blood transfusion (if you lose a
g:
significant amount of blood during delivery) Postpartum depression.

[Link] (Gestational Diabetes Milletus)

▪ Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when
the body can't use insulin effectively. This happens because the placenta produces
hormones that block the body from using insulin effectively.
▪ It is disease in which the body does not control the amount of glucose (a type of
sugar) in the blood and the kidneys make a large amount of urine.
▪ Gestational diabetes is a type of diabetes.
▪ GDM can lead to complications for both the mother and the baby, but it's usually
possible to manage it with diet, exercise, and medication.

➢ Causes:
• Weight: Being overweight or obese increases the risk of GDM.
• Family history: A first-degree relative with diabetes increases the
risk of GDM.
• High cholesterol: High cholesterol before and during pregnancy
increases the risk of GDM.
• Egg intake: Egg intake before and during pregnancy increases the
risk of
GDM. Etc

➢ Symptoms:
• Increased thirst, needing to pee more often than usual, a dry mouth, tiredness, blurred
eyesight, genital itching or thrush.
 ➢ Prevalence:
• The prevalence of GDM in India varied by state, with some states seeing an increase in
prevalence and others seeing a decrease. For example, the prevalence of GDM in
Telangana decreased from 1.57% in 2015–16 to 0.69% in 2019–21, while the
prevalence in Meghalaya increased from 0.15% to 2.33% in the same time period. A
review found that the prevalence of GDM was slightly lower in rural areas
(10.0%) than in urban areas (12.0%).

➢ Risk factor:
✓ History of large newborn: Having previously given birth to a baby weighing more
than 9 pounds .
✓ Prediabetes: Having a history of higher-than-normal blood glucose .
✓ Hypertension: Having high blood pressure .

[Link] (Pregnancy Induced Hypertension)

▪ Pregnancy-induced hypertension (PIH) is a type of high blood pressure that can occur
Gestational during pregnancy. It's also known as toxemia or preeclampsia. PIH can
affect 6–10% of pregnancies and is a major health problem that can lead to serious
complications for both the mother and baby.
• It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is
chronic hypertension--high blood pressure that is present before pregnancy begins
▪ Hypertension can develop into preeclampsia.

➢ Classification:
1. Mild (SBP 140-149 and DBP 90-99 mmHg),
2. Moderate (SBP 150-159 and DBP 100-109 mmHg) and
3. Severe (SBP ≥ 160 and DBP ≥ 110 mmHg)

➢. Causes:
▪ The exact causes of pregnancy-induced hypertension (PIH) are not fully
understood,
1.
2. but it's likely caused by a combination of
factors:

Abnormal placental development or inadequate blood flow.

A typical immune system.
➢ Symptoms:
o Increased blood pressure, protein in the urine, edema (swelling), visual changes such as
blurred or double vision, nausea, vomiting, urinating small amounts.

➢ Prevalence:

o The prevalence of pregnancy-induced hypertension (PIH)

varies by location, but is generally around 5–8% of pregnant
women. o India: A 2017 survey found that 8–10% of pregnancies were
complicated by PIH

o Nepal: A study found that 5–22% of pregnancies were affected by PIH.

➢ Risk factor:
• Obesity: Women who are overweight or obese are more likely to have PIH.
• Multiple gestation: Being pregnant with more than one fetus increases the risk of PIH.
• Placental abnormalities: Complications associated with placental dysfunction, such as
small for gestation age, placental abruption, or stillbirth, increase the risk of PIH. et

[Link] Pregnancy:

▪ An ectopic pregnancy occurs when a fertilized egg implants and grows outside the
main cavity of the uterus. An ectopic pregnancy most often occurs in a fallopian tube,
which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is
called a tubal pregnancy.
▪ An ectopic pregnancy usually needs to be removed with medicine or surgery.
 ➢ Causes:
✓ Smoking: Smoking can increase the risk of ectopic pregnancy by
damaging the cilia
that help move the egg through the fallopian
✓ tubes.
Age:
The risk of ectopic pregnancy increases with age, especially for pregnant
women aged 35–40.
✓ Fertility Treatement:Taking medicine to stimulate ovulation can increase
the risk of ectopic pregnancy

➢ Symptoms:
o Vaginal bleeding. Vaginal bleeding tends to be a bit different to your regular period.

o Tummy pain. You may experience tummy pain, typically low down on one side. ...

o Shoulder tip pain. Shoulder tip pain is an unusual pain felt where your shoulder ends
and your arm begins. ...
o Discomfort when going to the toilet.

➢ Prevalence:Ectopic pregnancies (EP) occur in about 1–2% of pregnancies. In India,

the incidence of EP is reported to be between 0.91% and 2.3%.

➢ Risk factor:
✓ Previous pregnancy: If you've had an ectopic pregnancy before, you're more likely
to have another one.
✓ Fallopian tube issues: Damage or abnormalities in the fallopian tubes can increase
the risk of an ectopic pregnancy.
 [Link] & Preclampsis:

▪ Preeclampsia and eclampsia are pregnancy-related conditions that can affect a

mother's health and the health of her baby:
▪ A rare but serious complication of preeclampsia that occurs when a pregnant woman
with preeclampsia develops seizures or coma. Eclampsia usually occurs after 20
weeks of pregnancy, but can occur earlier in multi-gestational or molar pregnancies, or
within six weeks after delivery.
▪ Most women who experience preeclampsia make a full recovery within one to two
days after delivery. However, there is still a risk of complications during this time, and
some women are at greater risk of recurrence.

✓ Causes:
o The exact cause of preeclampsia and eclampsia is unknown, but scientists are
investigating many possible factors:
• Placental abnormalities: Such as insufficient blood flow to the placenta.

• Genetic factors: Family history of preeclampsia is a risk factor.

• Environmental exposures: Obesity is a major risk factor.

✓ Symptoms:
o Severe headache, Difficulty breathing, Nausea or vomiting, Abdominal pain,
Blurred vision seeing double or loss of vision, Swelling of the hands, face or
ankles.

✓ Prevalence:
o Globally:The prevalence of preeclampsia is estimated to be 4.6%, and the prevalence
of eclampsia is estimated to be 0.3%.

o In hospital practice in India, the incidence of preeclampsia is estimated to be 5– 15%,

and the incidence of eclampsia is estimated to be about 1.5%.

➢ Risk factor:

✓ Chronic hypertension or renal disease

✓ Pregestational diabetes
✓ Connective tissue disease
✓ Thrombophilia
✓ Obesity or insulin resistance. Etc
✓
[Link] (Urinary Tract Infection):
▪ A urinary tract infection (UTI) is a common bacterial infection that affects any part of
the urinary tract, which includes the kidneys, ureters, bladder, and
urethra. UTIs are
often caused by bacteria from the skin or rectum that enter the
urethra.
▪ An infection of the urethra, the hollow tube that drains urine from the
bladder to the

▪ outside of the body. Cystitis: A bacterial infection in the bladder that often
has moved
up from the urethra.
▪
Urinary tract infections (UTIs) are common during pregnancy and can have
serious consequences for both the mother and baby.
The anatomy of the urinary tract undergoes significant changes during
▪ pregnancy, with hormonal and mechanical factors contributing to ureteral
dilation, dilation of the renal calyces, and urinary stasis, all of which
predispose pregnant patients to urinary tract infections (UTIs).
Women are at greater risk of developing a UTI than are men

➢ Causes:
o Anatomy and function changes: Pregnancy causes changes to the
urinary tract, including kidney enlargement, ureter compression, and
bladder compression. This can lead to urinary stasis, increased
residual urine in the bladder, and vesicoureteral reflux.
o Hormonal changes: Progesterone relaxes smooth muscles, which can
contribute to UTIs.

➢ Symptoms:
➢ a need to pee more often than usual.
➢ pain or discomfort when peeing.
➢ sudden urges to pee.
➢ feeling as though you're unable to empty your bladder fully.
➢ pain low down in your tummy.
➢ urine that's cloudy, foul-smelling or contains blood.
➢ feeling generally unwell, achy and tired.

➢ Prevalence:
 o The prevalence of urinary tract infections (UTIs) varies depending on age, sex,
and other factors:
o Women: About 50–70% of women will have a UTI at some point in their lives,
and 20–30% of women who have had a UTI will have another one. By age 32,
half of all women have had at least one UTI.
o Men: The prevalence of UTIs in men is lower than in women.

o Age: The prevalence of UTIs is highest in the age group 20–29.

o Risk factor:
o Pregnancy. o Obesity. o A personal or family

history of urinary tract infections. o Using

spermicide and/or a diaphragm as birth control.

o Having frequent sexual encounters.

o Urinary incontinence.

o Sexually transmitted infections.

o Enlarged prostate.