Charity Callis Prenatal Problems that Can Occur at Any Time - #8

Holistic Midwifery I pages 945 – 1066

A client calls you and asks if what she is seeing/experiencing/feeling is normal. Is it a problem? How do you deal with it? Why is it happening? What happens if you do nothing? The answer to these questions depend on what “it” is. The major things that can go wrong have been covered either in this course or in other courses you have already taken. What about everything else? As an experienced midwife you will have seen and dealt with quite a lot; some issues will simply be second-nature to you after a while. This assignment covers many of the things you will see in pregnant women that have little to do with how far along they are or how old the baby is. They can happen at any time, and as such you need to know the symptoms, treatments, and reasons behind them. Read through these issues and take notes of things that stick out to you. Then, when you are finished, answer the following:

1. Give three reasons from the readings that women may experience abdominal pain in . Explain what is happening and how to know if this is the cause of the pain.

1. Threatened miscarriage a. Symptoms - vaginal spotting or bleeding, pain or cramping in your abdomen or lower back, fluid or tissue passing from your vagina b. Treatments – Often, there's nothing you can do to prevent a miscarriage. Focus on taking good care of yourself and your baby by seek regular prenatal care, avoid known miscarriage risk factors (smoking, drinking alcohol, drug use), take a daily multivitamin, limit your caffeine intake. c. (potential) Reasons - fetus isn't developing normally, uncontrolled diabetes, infections, hormonal problems, uterus or cervix problems, thyroid disease 2. UTI a. Symptoms – sometimes none, strong, persistent urge to urinate, burning sensation when urinating, passing frequent/small amounts of urine, urine that appears cloudy, urine that appears red/bright pink or cola-colored (sign of blood in the urine), strong-smelling urine, pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone i. Types – 1. Kidneys – upper back and side/flank pain, high fever, shaking and chills, nausea, vomiting 2. Bladder (cystitis) – pelvic pressure, lower abdomen discomfort, frequent, painful urination, blood in urine 3. Urethra – burning with urination, discharge b. Treatments – drink plenty of water, DMannose w/cranberry supplement, antibiotics if the other remedies don’t work c. Reasons – bacteria enters the urinary tract through urethra and begin to multiply in the bladder. 3. Food poisoning a. Symptoms – nausea, vomiting, watery/bloody diarrhea, abdominal pain and cramps, fever b. Treatments – let your body process, drink plenty of fluids (broth, water or with electrolytes), may lose a lot of fluids (dehydrated), a doctor visit for an IV may c. Reasons – contamination of food during production (growing, harvesting, processing, storing, shipping and preparing)

2. Explain round-ligament pain. p. 953 The pair of round ligaments are connected at the from of the uterus to the groin region. As pregnancy progresses, they become softer and might stretch, sometimes caused by the tightening or spasm of the ligaments or irritation of nearby nerve fibers. Discomfort is usually on the right side but can also occur on the left or both sides. May happen during a walk, rolling over on the bed, rapid or vigorous movements. To relieve, gently stretch and change position, avoid rapid or repetitive movements, flex hips before coughing or sneezing, St John’s Wort tincture (20drops/dose), massage area with caster oil, cover with plastic and apply heating pad for 30min. No medication necessary. Taking acetaminophen (Tylenol, others) may help. Discern and confirm the cause before taking any meds.

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Charity Callis Prenatal Problems that Can Occur at Any Time - #8

3. What are common causes of leg cramps in pregnancy? What are treatments? p. 955

Some possible causes for leg cramps: imbalance in electrolytes, build up of lactic acid, inadequate salt, calcium magnesium and potassium intake, potential presence of a blood clot (see a doctor if the pain increases and one leg swells greater than the other), potential blood flow changes, carrying additional weight as the pregnancy changes.

Feels like anything from mild twitches or a sudden, sharp, stabbing pain in the back of the calf.

Treatment – adjust diet to include bananas, grapefruit, orange, cottage cheese, yogurt, salmon, sardines, dark greens, seaweeds, soybeans, almonds and sesame seeds, straighten out the cramping leg, with heel outstretched first. Flex your ankle and toes back toward the shins, then wiggle toes and gently massage the calf muscle.

4. Why might constipation occur during pregnancy? What are safe remedies? p. 961

Causes: due to increase in progesterone that relax the intestinal muscle causing food and waste to move slower through the system, worry, anxiety, minimal physical exercise, low-fiber diet may cause constipation as well, potentially iron supplements may play a role in creating constipation in a pregnant mama

Remedies: high fiber diet (20-30 grams/day) from fruits, veggies, drink LOTS of water/fluids (10-12 cups/day), regular exercise, prune juice, stimulate system by drinking a hot drink then a cold drink, OTC Metamucil, change/reduce/eliminate iron supplement

5. Why might a pregnant mom have heartburn? What could you suggest to help? p. 964

Changing hormone levels which might effect muscles of the digestive tract, cause lower esophageal sphincter valve to relax, allowing stomach acids to flow back up into the esophagus. Enlarged uterus can crowd abdomen, pushing stomach acids upwards. Suggest, eating several small meals each day vs. three large ones, eat slowly, avoid fried, spicy or rich/fatty foods, don’t smoke/drink alcohol, drink less while eating, don’t lie down directly after eating, rest your head higher at top of the bed vs. your feet higher, loose fitting clothing, drink milk before and after meals, digestive enzyme tablets, plain baked potatoes, thoroughly chewed raw almonds, cashews or filberts, a tablespoon of cream or milk may help coat the stomach

6. What are three problems associated with pregnancy that relate to teeth and gums? Describe them and tell what can be done to prevent and treat them. p. 969

Pregnancy Gingivitis – gums that are inflamed, swollen and tender, may bleed a little when brushing or flossing. Low vitamin C levels contribute. Make a paste using hydrogen peroxide baking soda to brush with daily. Can also use the paste to massage into the gums 2x daily. Dip dental floss into Myrrh tincture or hydrogen peroxide before using it. Dentist may recommend frequent cleaning for prevention, use a softer bristled toothbrush.

Tooth decay – pregnant women more prone to cavities (possibly increase in carb intake, morning sickness increase amount of acid in the mouth which eats away at tooth enamel). Maintaining brushing teeth 2x/day and flossing. If X-ray and lidocaine are necessary to diagnosis and treatment, (esp. in the first three months) then detox using ½ pound of sea salt, ¼ pound baking soda in a bath of hot water. It is also helpful to eat extra miso, sodium alginate rich seaweeds, kelp, buckwheat grass and niacin supplements for several weeks. Sodium alginate attracts radioactive materials and carries them out of the body. Homeopathic X-ray (30C or 200C) can also help minimize harmful effects.

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Epulis of pregnancy – “pregnancy tumors” that appear on the gums, often in the end of the first trimester/second trimester. Not cancerous, just a swelling that happens between the teeth, bleed easily, have a raw-looing raspberry-like appearance. Usually disappear after baby is born.

7. Discuss the issues relating to anemia in pregnancy. Ensure to cover problems, treatments, and causes. p. 972

Causes – blood doesn’t have enough healthy red blood cells to carry oxygen to the tissues/baby, deficiencies in iron, folate and B-12

Symptoms — pale skin, lips and nails, dizziness, shortness of breath, rapid heartbeat, trouble concentrating, feeling tired and weak, but if left untreated can lead to increased risk of complications like preterm delivery

Treatments – start taking iron, vitamin B12 supplements and/or folic acid in addition to prenatal vitamins, increase foods that are high in iron and folic acid (dark leafy greens/veggies), beans, lentils, nuts, seeds, pairing foods that help the iron absorb into the system

8. What is hypoglycemia? How can a pregnant woman treat this? p. 972

Abnormally low levels of glucose is a main cause for dizziness, lightheadedness and faintness. Usually results in a lack of oxygen to the brain before someone faints. Postponing a meal in pregnancy can cause symptoms of low blood sugar, including spilling ketones in the urine. Remedy is to feed mama IMMEDIATELY. Protein and unrefined carbs will gradually stabilize the blood sugar. Fruit or juice can be used to elevate levels quicker if the mama is passing out. Follow with protein or unrefined carbs to stabilize.

9. Discuss issues of edema. What are the different types? What causes it and what are danger signs? How can edema be treated? p. 977

Increased blood volume and hormonal changes cause a normal increase of fluids in the tissues. Can be in any part of the body but more visible on hands, arms, feet, ankles and legs. As pregnancy progresses, there is more pressure on mama’s veins causing blood flow to slow down. Can be caused by sitting or staying in one position for too long or eating too much salty food. Symptoms include swelling/puffiness of the tissue, stretched or shiny skin, skin that retains dimples (pits) after being pressed several seconds, increased abdominal size. Different types include:

Salt depletion (sweating in the summer months) short-term imbalance in the protein/sodium ratio. Solution is to drink more fluids and eat more salt to taste.

Pathological (progressive increase) does not fluctuate throughout the day and tends to be generalized (head to toe) rather than primarily in the lower body. If blood vessels are not distended and vitals are normal cause is due to a protein/sodium ratio imbalance. Solution is to take inventory of the diet, increase protein, salt to taste and nutrient rich calories.

Medical conditions that may cause swelling include kidney disorders and heart failure. Hopefully in the initial exam these would be indicated to be risked out and not be a candidate for home birth. If there’s suspicion of underlying medical condition, get a consultation immediately.

10. The fetal heart rate is an important marker of the well being of the baby while in the womb. Understanding abnormalities is therefore important. When it comes to fetal heart rate, explain each of the following as well as how you can tell if this is an issue:

A. Bradycardia – FHT falling below 100 bpm. Variability will be reduced or absent, precedes imminent fetal death and an indication for immediate birth. Sometimes mama’s drug intake may be a cause— 3

Charity Callis Prenatal Problems that Can Occur at Any Time - #8

any maternal bradycardia will cause a fetal bradycardia, some hypertension drugs for mama can cause a bradycardia in the fetus. Maternal hypothermia is also another cause. Temporary FHT patterns that drop from 1 – 10 min then resolve may be due to fetus becoming entangled on the cord or the mama’s position putting pressure on the umbilical cord. Have mama change positions. If it continues then consider that fetus may be compromised, assess mama and her sense of what’s going on as well as fetal movement, ultrasound exam, consulting with a collaborating physician. If heart problems are found often the choice is the birth of a preterm baby.

B. Tachycardia – FHT exceeds 160 bpm. Tachycardia that lasts less than 10min is described as an acceleration. Potential causes:  Dehydration  overheating (hot baths or exercise) hot baths in a saline solution or waiting 30-45min after a bath to check may help heart rate.  oxygen deprivation  fever  infection or hyperthyroidism – Intrauterine infection may lead to fetal heart rate elevation before maternal fever begins. When infection is not in the uterus, fetal tachycardia is due to maternal fever.  drugs that inhibit labor  fetal hypoxia  Fetal factors could include: o anemia, blood loss o side effects of drugs administered to the fetus

Remedy by having mama drink 10oz of fluid in a 30-45min period then reassess heart rate. Supraventricular tachycardia is when the heart rate exceeds 180 bpm. If continuous, the fetus is at risk for congestive heart failure and should be delivered (if near term) or careful monitoring for signs of heart failure using real-time ultrasounds if premature.

C. Baseline Abnormality – some fetuses demonstrate consistent bradycardia have no apparent problems. Listening carefully throughout pregnancy and monitor to help differentiate a normal or an uncommon variation from a true problem.

D. Variability – fluctuations of the fetal heart can be normal as changes occur in the fetus. It may be that the fetus is a awake, asleep, active, exposed to drugs, oxygenated or has a temperature.

11. Explain SGA and IUGR. What are the differences? What are the similarities?

Small for Gestational Age (SGA) refers to an infant born with a birth weight less than the 10th % or < 2500 g by 37 weeks gestation (5.5lbs)

Intrauterine Growth Restriction (IUGR) refers to a fetus that has not reached its growth potential because of genetic or environment factors. IUGR results in the birth of an infant who is SGA.

Differences is that SGA is more genetic vs. IUGR is a restriction/deficiency in growth. Similarities is that there is a potential restriction of blood flow through the placenta causing the fetus to receive less oxygen than normal, increasing the risks for the fetus during pregnancy, delivery and afterwards.

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12. Give four reasons for a baby that is small for dates. For each explain how this occurs and what it means for the baby. p. 990

Reasons why baby may be small for dates: 1. Fetal infection – caused by herpes, cytomegalovirus, rubella and toxoplasmosis can cause fetal damage making it impossible for the fetus to utilize nutrients. 2. Toxic exposures – concentrated exposure to chemicals and maternal poisoning from ingestion or lethal doses of drugs may lead to growth in babies. 3. Placental problems – poor nutrition, certain toxins, trauma or injury, placenta is malformed will deliver less nutrients to the fetus 4. Genetic malformation – genetic and congenital anomalies, abnormalities in cell replication, reduced cell numbers produce early onset of impaired growth that is symmetrical lead to IUGR because poor growth is part of the genetic picture

13. What is a large for dates finding? What are the most likely causes for this? What can be done? p. 993 Babies that are born weighing over 8lbs 5 oz are considered LGA. Women who eat well often carry babies that are larger than average. Most common reason for is that the EDD was not assessed properly and will do fine. If all factors are taken into account, a LGA is usually associated with gestational diabetes which can cause prolonged and difficult labor, in baby, hypoglycemia of baby after delivery, increased incidence of birth defects and respiratory distress.

14. What are fibroids? What are the different types? Describe each. Benign tumors or growths in the uterine cavity.

 Cervical – one that is located in the wall of the cervical passageway, producing urgency/frequency and urinary retention due to blockage at the junction of the urethra and bladder, pain due to pressure and shortening of the birth passageway, may obstruct labor, if near lower bowl—will create rectal pressure or constipation  Intramural (interstitial) – one that is located in the myometrium or uterine muscle wall, stay put as they grow and are the most common, rounded shape (even pressure), if extensive, interference with labor and possible postpartal hemorrhage, moderate risk for miscarriage  Subserosal – one that bulges from the uterine wall beneath the peritoneum on the outside of the uterus. May lead to twisting of the stem leading to tissue death/decay within the fibroid, adhesions to other pelvic structures, red degeneration (necrosis and edema) which may lead to bleeding from the vagina, least likely to cause miscarriage  Submucosal – one that is located beneath the endometrium and projecting into the uterine cavity, 5% of all fibroids, associated with tissue death/decay, severe menstrual bleeding leading to anemia, infection/discharge due to necrosis and sloughing of overlaying endometrium, red degeneration (necrosis and edema) which may lead to bleeding from the vagina, impedes implantation and most likely leads to miscarriage  Intraligamentous – one that is pushed into the broad ligament developing an entirely new blood supply  Pediculated – one that has developed a thin stem attaching it to the uterus  Parasitic – one that is completely extruded from the uterus and has developed an accessory blood supply

15. How do you examine for fibroids? Palpation, may feel like fetal parts, may impede labor, 20-50% of all fibroids cause symptoms

16. Name the common symptoms of fibroids. What are the risk factors? Abnormal heavy menstrual bleeding, pain and pressure, may increase incidence of miscarriage

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17. What is gestational diabetes? Gestational diabetes is diabetes that develops during pregnancy, an increase of blood glucose, blood sugar is too high, decreased glucose tolerace

18. Give different methods for testing for gestational diabetes.

 Initial glucose challenge test. You'll drink a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L) indicates gestational diabetes. A blood sugar below 140 mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary by clinic or lab. If your blood sugar level is higher than normal, you'll need another glucose tolerance test to determine if you have the condition. Follow-up glucose tolerance testing. This test is similar to the initial test — except the sweet solution will have even more sugar and your blood sugar will be checked every hour for three hours. If at least two of the blood sugar readings are higher than expected, you'll be diagnosed with gestational diabetes.  Alternatives to the Glucola test  6 ounces of organic grape juice + a banana.  1 cup milk + 1.5 cups cereal.  Pancakes with 1/4 cup maple syrup  Natural soda or drink with 50 grams of total sugar  16-ounces orange juice.

19. What problems can gestational diabetes pose? How can you treat gestational diabetes? For the mother may cause increased thirst and more frequent urination, high blood sugar levels, high BP, possible c-section, future diabetes. For fetus excessive birth weight, , serious breathing difficulties, low blood sugar, obesity and type 2 diabetes later in life, stillbirth. Treatment: eat healthy foods, keep active, monitor blood sugar levels, take meds/insulin, reduce refine sugar and carb intake

20. What are the two most common causes of headaches in pregnancy? Hypoglycemia and dehydration

21. What questions should you ask related to headaches? What do the answers for each of these tell you?

 Have you ever had these headaches before? This question helps to determine whether the symptoms are a relatively mild aggravation or a new issue to be worried about. Make notes of how they fee, frequency, etc. to get a baseline. If it’s the first time the headaches are appearing then ask the following questions:  What does the headache feel like, where is the pain? A sudden onset of headaches may indicate a severe underlying problem. Monitor the mama for accompanying symptoms that get progressively worse.  How frequent are the headaches? Headaches that appeared during the pregnancy and are getting worse, closer together my mean there is an underlying issue. Women with persistent headaches after the 24th week must be evaluated for toxemia.  Are there associated symptoms? Other systems such as nasal congestion, emotional stress, eye strain, fatigue, unexpected anger and the need to have more time/space to herself can all precipitate headaches.

22. What are normal hemoglobin levels during pregnancy? 12.5 or higher in the first trimester with a 2 gram drop by he 28th and 30th week due to increased blood volume

23. When should low hemoglobin levels be treated? How do you treat this issue? Should be treated when the levels are 12 or less. To treat evaluate mama’s diet, physical exam, lab analysis, encourage dark green veggies, prunes,

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Charity Callis Prenatal Problems that Can Occur at Any Time - #8 grape juice, iron supplements, yellow dock tincture, alfalfa, nettles. Follow up in the third trimester with another blood test to see if her #s are improved.

24. what is hypertension? What is pregnancy induced hypertension? Hypertension is high blood pressure. Pregnancy induced hypertension is when BP levels are normal however begin to rise after the 20th week gestation.

25. Why is hypertension in pregnancy an issue? HIP is a problems because there is a restriction of blood flow, that means there’s a risk for mom and baby to get the nutrients and oxygen in the blood needed to sustain life. May exhibit the following symptoms:  Being 20 or more weeks pregnant with a blood pressure that is 140/90 or higher.  Blurry vision (cannot see clearly).  Breathing problems.  Decrease in how much urine you are passing.  Feeling very sluggish.  Gaining 3 to 5 pounds (1.4 kg to 2.3 kg) in 1 week (7 days).  Having very bad pain over your stomach (belly) or under your ribs.  Seeing spots in your eyes or having light flashes before your eyes.  Sudden swelling of your face, hands, or feet.  Swelling of your ankles or feet that does not go away after resting for 12 hours.  Swelling of your face, hands, or feet.  Very bad headaches.  Vomiting (throwing up).

26. What is “white coat hypertension”? when BP levels are normal at home, however when in a medical setting (doctor’s office, clinic, etc.) the BP levels are increased due to anxiety

27. If left untreated, what effects can hypertension in pregnancy cause? If left untreated, hypertension can cause uncomfortable symptoms and signs of the body not doing well during the pregnancy. Could lead to preeclampsia or , possible death of mama or baby.

28. What is metabolic toxemia? Explain this condition and its effects. Aka as preeclampsia -- High blood pressure and protein in the urine and/or swelling of your face, hands, or feet. You may have mild or very severe pre- eclampsia.

29. What is a hydatidiform mole? an abnormality during pregnancy; chorionic villi around the fetus degenerate and form clusters of fluid-filled sacs; usually associated with the death of the fetus

https://image.slidesharecdn.com/hmolesrd-190102152314/95/hydatidiform-mole-approach-and-management-4-638.jpg?cb=1546442812

30. What is hyperemesis gravidarum? a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance

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31. What is sciatic pain? How can you treat this? refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body. Treatment: Hot and cold packs, yoga, and gentle movement/exercise, stretching, massage therapy, turmeric (golden milk), heating pads, ice pack, capsaicin cream, valerian, white willow bark, fenugreek seeds, garlic, spinal manipulation, alexander technique, McKenzie exercises, physiotherapy, elderberry, celery, Epson salt, horseradish may help to soothe sciatica symptoms. (https://trueremedies.com/home-remedies-for-sciatica/)

32. What are stretch marks? What can be done to help the mom reduce them? happen when your skin changes shape rapidly due to growth or weight gain. Here prevention and early treatment gets better results. Moisturize the skin using coconut oil, vitamin A, sugar as a microdermabrasion, aloe vera, hyaluronic acid may help as the skin stretches.

33. What is the “mask of pregnancy”? The mask of pregnancy () appears when a steep rise in estrogen and progesterone levels stimulates excess melanin production, also known as . Skin, freckles and moles may look darker, there's probably a dark line down the center of your abdomen (the linea nigra) and your areolas could be a deeper shade, is especially common in darker-skinned women, or those of Asian and African descent, who have more pigment in their skin than fair-skinned people. Exposure to sunlight can make it worse. Discoloration is temporary and usually disappears after delivery or, in some cases, after you finish breastfeeding.

34. What is ketonuria? Explain the types of findings and what they mean. changing pregnancy hormones can prevent the cells from using up the glucose, leading to a glucose deficiency. In case of the deficiency of this element, the body starts using up the fat reserves to attain the required energy. This condition leads to the production of ketones. Possible causes: Dehydration, diet lacking in nutrition or a low-carb diet, skipping snacks or meals during pregnancy, not eating meals on time or taking long gaps between meals, pregnancy symptoms like severe vomiting, metabolic disorders, fasting while pregnant, development of insulin resistance during pregnancy. If present in small amounts, ketones don’t pose a risk to the pregnancy. But high levels of ketones can lead to pregnancy complications like ketonuria. Higher levels of ketones in the urine may also be indicative of diabetic ketoacidosis (DKA). Some studies indicate that babies born to mothers with high ketone levels may develop learning disabilities. Prevention: eating a balanced and nutritious diet throughout. Avoid fasting and have meals on time. Refrain from taking long gaps between meals. Instead, satiate your hunger with healthy snacks. While you’re pregnant, it’s important to keep yourself hydrated by drinking plenty of water.

35. What is proteinuria? If you detect this, what does it mean? Proteinuria documented before pregnancy or before 20 weeks' gestation suggests preexisting renal disease. Urinary protein excretion is considered abnormal in pregnant women when it exceeds 300 mg/24 hours at anytime during gestation, a level that usually correlates with 1+ on urine dipstick.

36. What is glucosuria? Outline the steps you take when you get this finding. when you pass blood sugar (blood glucose) into your urine. Although type 2 diabetes is a lifelong condition, gestational diabetes typically resolves after childbirth. Possible treatment and management:

 Getting at least 30 minutes of physical activity every day.  Developing a diet plan that provides you with enough nutrients while also decreasing sugar or fats intake. May include eating more whole grains, vegetables, and fruits.  Taking medications to help your body use insulin more effectively. These can include metformin (Glumetza), which allows your body to respond better to insulin, or sulfonylureas (Glyburid), which helps your body make more insulin.

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 Keeping track of your blood sugar levels so that you can better understand how your body reacts to certain foods, activities, or therapies.

37. What is hematuria? What do you do when you get this reading? Blood in the urine. When getting this reading consider first thought, worst thought and differential diagnoses.

38. What is a urinary tract infection? What causes it? What can you do about it? Urinary Tract Infection (bacterial infection of the urinary tract)  Causes: possible toilet habits (not wiping correctly), sexually active, people with suppressed immune systems, using a diaphragm, pregnant  Symptoms: pain and a burning sensation when urinating or unable to urinate, muscle aches, cloudy urine, and abdominal pain, blood in urine  Treatment: Drink Plenty of Fluids, urinate often, stay clean and dry, avoid using spermicides, probiotics, cranberry, garlic, D-Mannose, vitamin C, clove oil, myrrh oil, oregano oil

39. What is acute pyelonephritis? What are the symptoms? What do you do if you find this? a kidney infection usually caused by bacteria that have traveled to the kidney from an infection in the bladder. Symptoms include: pain in one flank, the area just beneath the lower ribs in the back, and fever. The pain can travel around the side toward the lower abdomen. There also can be shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul-smelling. You may need to urinate more often than normal and urinating may be painful or uncomfortable. Consult a physician for antibiotics.

40. What are varicose veins? What causes them in pregnancy? What can be done about them? p. 1057 occur when veins just below the skin's surface are damaged, become swollen and fill with too much blood. Causes may include genetics (it’s in the family), inherited weakness in the veins' walls or the valves inside veins that keep blood from backing up, pregnancy (blood volume increase). During pregnancy, the volume of blood increases causing veins to expand. Also, occupations that require uninterrupted standing (waitresses and waiters, nurses, mothers with young children) may force leg veins and valves to work against gravity for hours, increasing the risk of pressure-related vein and valve damage. Garters also can increase the risk of varicose veins if their tight elastics slow blood flow in the legs. Treatment: compressions stockings, staying off your feet, keeping legs elevated (above heart) throughout the day, nettle infusion, Collinsonia root tincture, vitamin c, vitamin e, Hawthorne berry extract, moist towels applied daily, avoid heavy lifting, drink PLENTY of fluids, witch hazel bark infusion

41. Explain what a hemorrhoid is. How do you treat them in pregnancy? are lumps or masses of tissue in the anus, which contain enlarged blood vessels. Any increase in abdominal pressure may produce hemorrhoids. This may be from:  Repeated straining to have a bowel movement, especially in people who suffer from frequent constipation.  Pregnancy.  Repeated episodes of diarrhea.  Obesity.

Treatment: fiber powder to soften stools, stool to elevate feet, yellow dock root tincture, vitamin e capsules, warm sitz baths, cold compress/icepack, petroleum jelly, OTC cream with lidocaine or hydrocortisone, or aloe vera gel to anus for relief, after every bowel movement clean anal area with witch hazel, if symptoms and discomfort persist, call the doctor for medical office treatments.

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42. If there is an increase in vaginal discharge during pregnancy, especially if there are other symptoms present, what should you rule out? p. 1066 – observe color of discharge assess whether it is chemical or allergic reaction, infection (yeast, chlamydia, bacterial, gonorrhea) warts on the vagina, lesions, dilation of cervix

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