Digestive Problems In Pregnancy
Decayed teeth and gingivitis (inflammation of the gums) are often found during pregnancy or after delivery. The popular saying is 'for every child a tooth', and the fashionable belief is that the problems are caused by calcium deficiency. In reality, since the enamel is not vascularized (does not contain blood vessels, so calcium cannot be delivered via blood supply) decalcification is not possible. But if dentine (the inside of the teeth) has already been exposed then decay can progress more rapidly. Dental checkups and treatment should be carried out in pregnancy. Ideally any problems will have been fixed before becoming pregnant. If fillings or extractions are necessary in pregnancy, they should be performed under local anesthesia if possible. If a general anesthetic is required, 'gas' in a dental chair is more dangerous in pregnancy than at other times. A proper anesthetic, with every precaution must be taken.
During pregnancy the esophageal sphincter (the valve that acts as a door between the stomach and the esophagus - see the human body) is more relaxed than normal. As a result acid regurgitation, that is, where acid leaks from the stomach up into the esophagus may occur (also known as heartburn and acid reflux). Sometimes troublesome heartburn is due to a hiatus hernia (part of the stomach has squeezed through an opening in the diaphragm and into the chest. This prevents the esophageal sphincter from shutting properly). Relief may be obtained in both instances with alkalies in either tablet or liquid form. The symptoms are often worse if the patient lies flat.
Symptoms nearly always improve during pregnancy, probably because the level of gastric acidity falls and there is an increased secretion of protective mucus. Complications from peptic ulcers such as perforation (serious condition where an untreated ulcer burns through the stomach wall allowing gastric juices to leak into the body. It requires immediate surgery) or haematemesis (internal bleeding) are very rare during pregnancy.
Appendicitis is not common during pregnancy. The danger of the condition is enhanced because it is sometimes difficult to make an early diagnosis. If there is widespread peritonitis (inflammation of the tissue covering the wall of the stomach, signs include a sore tummy) a miscarriage can occur.
The most common cause of an intestinal blockage during pregnancy is a band of thickened tissue resulting from adhesions from a previous operation; the obstruction occurs because of altered positions of the internal organs brought about by the growth of the womb. Other causes of obstruction during pregnancy are hernias, volvulus (section of the bowel loops into a knot or twists abnormally), intussusceptions (one portion of the intestine slides into the next, much like the pieces of a telescope) and mesenteric thrombosis (blood clot in one of the veins supplying the bowels). Neoplasms (benign, pre-cancer or cancerous growths) of the bowel are rare.
As a general rule herniae are not made worse by, and do not affect the course of, pregnancy. The growing uterus usually pushes the bowel away from the herniae and eventually blocks access to them. Rarely these types of herniae first appear during pregnancy, but most sporadic swellings which appear in the groin area during pregnancy usually turn out to be varicoceles (swollen veins).
This disease is sometimes worse during pregnancy or ocassionally is first diagnosed in pregnancy. Women with active colitis should not become pregnant, but once the acute symptoms have subsided they may accept the risk of reactivation. The usual treatment, including steroids and prednisolone retention enemata, may be used during pregnancy but should be avoided if possible during the first trimester.
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