Digestive Problems In Pregnancy
Disorders That Can Develop In Pregnant Women

Pregnancy Complications

acid reflux in pregnancy

Digestive Problems In Pregnancy

Contents

Teeth Problems
Heartburn
Peptic Ulcer
Appendicitis
Internal Obstruction
Hernia and Pregnancy
Ulcerative Colitis



Related Guides


Pregnancy Complications
Bowel Disorders
Abdominal Problems
Teeth Problems

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.

Heartburn

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.

Peptic Ulcer

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

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.

Abdominal pain on the right side during pregnancy can to be due to appendicitis, but it could be caused by many other conditions including: pyelonephritis (kidney infection), ectopic pregnancy, twisting of an ovarian cyst, degeneration of a fibroid, colic or kidney stones. A small right-sided hemorrhage from abruptio placentae could however simulate appendicitis. The most frequent error made by doctors is to confuse pyelonephritis with appendicitis; in every case a urine sample needs to be carefully examined.

The symptoms of appendicitis are little altered during pregnancy, but the site of the pain and of maximum tenderness may be higher than usual because the cecum (a pouch portion of the large intestine) and appendix are displaced upwards. If appendicitis is diagnosed, an appendicectomy should be performed in spite of the pregnancy. The surgeon will aim to make an incision at the site of maximum tenderness and every effort will be made to avoid touching the uterus.

Internal Obstruction

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.

The especial danger of intestinal obstruction during pregnancy is the delay that often elapses before the diagnosis is made, the symptoms so often being attributed to the pregnancy. The classic symptoms of pain, vomiting and constipation will be present but the physical sign of abdominal bloating is masked by the pregnant uterus. A scar on the abdomen of a patient whose chief complaint is vomiting should always suggest the possibility of intestinal obstruction. Pyelonephritis, appendicitis, hyperemesis gravidarum, ureteric calculus and torsion of an ovarian cyst would all need to be considered in making the diagnosis.

When the diagnosis has been made laparotomy is performed without delay. Intravenous infusion of saline and gastric suction is started before the operation. Laparotomy for the relief of obstruction can be a difficult operation even without pregnancy and if the patient is near term and the bulk of the uterus interferes seriously it may have to be emptied by caesarean section before the operation for relief of obstruction can proceed.

Hernia and Pregnancy

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).

Ulcerative Colitis

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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WOMENS HEALTH ADVICE: ABOUT PREGNANCY COMPLICATIONS
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