DE LA SALLE HEALTH SCIENCES INSTITUTE COLLEGE OF MEICINE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY STUDENT AUDIO VISUAL PROJECT: Common

Complaints of Pregnant Women

SESSION PLAN

Presented to: Dr. Soledad Chu-Crisostomo

Presented by: Group 5 Maravilla, Rachelle Mendoza, Christian Julius Mendoza, Rigel Nazareno, Christine Pacifico, Priscilla Ridao, Hanna Vergara, Renn Miguel Villarin, Lilia

SESSION PLAN A. PROJECT TOPIC: Common Complaints of Pregnant Women B. PARTICIPANTS: The video is intended for all women who are within the reproductive age range (15 44 years old) and most especially to gravid patients, particularly to those who are primigravida patients in the De La Salle University Medical Center Obstetrics and Gynecology Out Patient Department. C. TIME AND TIME ALLOTMENT: The educational video will be 8 minutes long and will be played on March 6, 2012 (Tuesday), from 10:00 am to 12:00 noon and on March 10, 2012 (Saturday) for the Annual Buntis Day Celebration at the DLSU Medical Center Out Patient Department. D. VENUE: 2nd year - Section B classroom, College of Medicine Building, De La Salle Health Sciences Institute and De La Salle University Medical Center Out Patient Department. E. SESSION OBJECTIVES : 1. To participate and contribute toward achieving the Goal 5 of the Millenium Development Goals to improve maternal health by achieving universal access to reproductive health by information dissemination and education and by providing possible first aid measures to relieve the common complains in pregnancy. This will be executed by: a. Enumerating the different complaints/ symptoms of women during pregnancy and explaining the mechanism behind each symptom; b. Identifying which among the said complaints is the most common and the least common through conducting a survey around the De La Salle University Medical Center - Obstetrics and Gynecology Outpatient Department 2. To create a systematic effective plan of relaying the information and knowledge regarding the common complains in pregnancy among the pregnant patients of the DLSUMC OB-GYNE OPD. This will be executed by:

a. Creating a multimedia apparatus that can explain the mechanism behind each symptom in ways that a non-medical individual can fully comprehend; b. Creating a multimedia apparatus which is responsible for dissemination of factual information to pregnant mothers who lack education on proper management of the different symptoms experienced during the course of pregnancy F. CONTENT: I. INTRODUCTION Perhaps one of God's greatest gifts to women is their capacity to bring new life into the world. While many women are left feeling wonderfully blessed with the knowledge that a baby is growing in their wombs, this doesn't alter the reality of the many physical changes and drawbacks happening to their bodies. In this video, the group will be presenting some of the most common complaints women have over pregnancy, its accompanying misconceptions and the proper ways to best handle these said problems.
II. COMMON COMPLAINTS/HEALTH CONCERNS OF PREGNANT WOMEN a. NAUSEA WITH OR WITHOUT VOMITING i. Definition Nausea pertains to the sensation of being about to vomit while vomiting is the expelling of undigested food through the mouth. It is colloquially termed as the morning sickness, even though it is actually worse in the morning, it is still misleading because the symptoms not only happen in the morning, but may also last for the whole day. ii. Pathophysiology There is still no well-established cause for nausea and vomiting in pregnancy, however, studies suggest that a combination of factors such as genetic, endocrine, gastrointestinal, psychosocial and evolutionary adaptations contribute to these symptoms. Human Chorionic Gonadotropin and Estrogenthat are active during pregnancy are involved. Several studies have shown that an increase in the said hormones is closely associated with nausea and vomiting of pregnancy. iii. Management Nausea and vomiting in pregnancy are usually self-limited. May reduce the discomfort through changes in diet and lifestyle.

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Small frequent meals are highly recommended. Although pregnant women are encouraged to eat whatever it is that appeals to them, fatty foods and foods with strong odors should be avoided. Ginger supplements have also been reported to be beneficial, however, large quantities should not be used as treatment. Vitamin supplements should be taken especially vitamin B-complex.

For pharmacological therapies, doxylamine-pyridoxine combination has been proven to be safe and effective in the treatment of nausea and vomiting. b. BACKPAINS i. Definition Backache with soreness, stiffness, and pain is one of the most common pregnancy symptoms. And, unfortunately, backache often starts early on in your pregnancy and persists (or worsens) until you give birth (when Pregnancy Backache is replaced by Postpartum Back Pain). ii. Pathophysiology Increased hormone levels released during pregnancy softens the ligaments and loosens the joints to prepare the mother for parturition. These two occurrences then lessen the support to the mother's back. A woman's center of gravity will gradually move forward as she approaches term due to the expansion and growth of the uterus and the baby, respectively. This will then cause her posture to change. During pregnancy, the baby will become an additional weight that the mother's back must support. If a woman has poor posture, stands excessively or bends over, she is more prone to trigger/increase the intensity of her back pains. iii. Management Exercise can reduce the strain of the growing fetus as it prevents the muscles that support a pregnant woman's back from weakening. Massage Good Posture Heat from a warm bath or a hot compress can lessen the discomfort brought about by back pains.

c. ROUND LIGAMENT PAIN i. Definition

It is a sharp, shooting pain in the abdomen which is more on the right side than left and is a common complaint in pregnancy often starting in the second trimester.

ii. Pathophysiology The round ligaments hold the uterus in suspension within the abdomen. As the uterus grows in size and weight, the ligaments become very long and thin stressing and tensing like rubber bands. The ligaments pull and tug on nearby nerve fibers and sensitive structures, causing pain. Ligament spasm, an involuntary contraction or cramp, usually triggers the sharp pain. These spasms are found more frequently on the right side than the left because of the normal tendency of the uterus to turn to the right. May also be brought on by exercise iii. Management Consult doctor if it is indeed a round ligament pain Activity modification avoid sudden movements, shifting positions slowly may provide relief. Brace abdomen when coughing/sneezing since coughing and sneezing can trigger round ligament paint Rest Analgesia d. VARICOSITIES AT LOWER EXTREMITIES AND VULVA i. Definition
Varicose veins are abnormally enlarged superficial veins usually seen in the thigh and leg. In the majority of cases, these large superficial veins are of a cosmetic nuisance. These veins connect with the deep veins of the leg and play a minor role in the transfer of blood to the heart.

ii. Pathophysiology
Linked to increase pressure in the veins, due to the gain of weight and volume that promotes stasis of blood, thereby increasing pressure in the veins of the extremities

 Valves in the veins which prevent the back flow of blood back into the legs. When these valves become damaged/defective, the blood flows backwards and causes swelling and engorgement of the veins. Further the female sex hormones are thought to weaken the walls of the veins and make them lax- thus causing them to engorge with blood. Female retains a lot of weight and fluid during pregnancy. In addition, the baby in utero may also compress some parts of the pelvis (lower abdomen) and lead to an engorgement of the veins in the lower extremities, including the veins in vulva/vagina. Interplay of various risk factors: prolonged standing, increase in sex hormone estrogen and excess weight & pressure carried by the extremities

iii. Management Elevation of the legs Avoid standing for prolonged periods Wear elastic support stockings Walk or exercise daily as this stimulates the muscles which can
push the blood away from the leg

Weight management Avoid tight clothing that can compress the waist or groin e. HEMORRHOIDS i. Definition
Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus. This may cause great discomfort and pain to the pregnant patient and may even bleed.

ii. Pathophysiology Growing fetus puts pressure on the pelvic veins and inferior vena cava, causing stasis of blood in the veins of the lower half of the body, increasing the pressure in the veins below the uterus and causing them to dilate. Aggravated by constipation which is also commonly experienced by pregnant women due to increased progesterone levels, causing a decrease in bowel motility, and compression of the uterus to the intestinal structures. Straining due to hard bowel development of hemorrhoids. iii. Management movement causes

 Pain and swelling are usually relieved by topically applied anesthetics, warm soaks, and stool-softening agents. The patient should consult her doctor and ask for a safe and effective anesthetic or medicated suppository to alleviate the pain. The patient may also soak her bottom in a water tub for 10 to 15 minutes few times each day, or position it over a basin full of warm water. The patient is also suggested to modify her diet and take a high fiber diet and many glasses of water daily to avoid straining and constipation. To prevent worsening the hemorrhoids, the patient is advised to avoid standing and sitting for long continuous periods of time and to lie down on her left side a few times a day to relieve the pressure from her rectal veins. She is also expected to avoid lifting heavy objects or doing heavy work. Kegel exercises is also suggested which can ease pregnancy symptoms including hemorrhoids. She may also use petroleum jelly on the area of the hemorrhoids to ease bowel movements. Finally, a good hygiene must be kept by the patient at all times to avoid any incidence of infections. f. HEARTBURN i. Definition
It is a burning substernal sensation, usually reported as a result of excess gastroesophageal reflux of acid1. It is common in late pregnancy2.

ii. Pathophysiology
Since pregnancy causes the upward displacement and compression of the stomach by the uterus, the tendency of the acidic contents of the said organ is to move to the most dependent site, the lower esophagus.

Progesterone, a hormone produced in pregnancy in large

amounts, brings about the relaxation of the esophageal sphincter. This event also caters to the introduction of acid to the lower esophagus, causing the pain to be felt under the sternum2.

iii. Management
Advised to take smaller, yet more frequent meals.

 Refrain from lying flat or bending over so as not to encourage the movement of acids to the esophagus, instead they should keep their head and part of their upper torso slightly elevated (especially when resting). Relief can also be provided by antacids such as Aluminum Hydroxide, Magnesium Trisilicate, or Magnesium Hydroxide. These medications may be given alone or in combination. Omeprazole is considered safe for pregnancy as well. However, Cimetidine or Ranitidine can only be given to pregnant patients in cases of persistent and severe symptoms of heartburn. Misoprostol is contraindicated for it stimulates labor2.

g. FATIGUE i. Definition ii. Pathophysiology During pregnancy, a pregnant woman's body has to work twice as hard due to the accelerating fetal growth this includes increase in hormone production, increase in metabolism as well as increase in blood flow leading to easy fatigability. The increase in blood flow is needed for the growing fetus to get the nutrients it needs. -The increase of levels of progesterone also plays a role in fatigue in pregnancy. Nausea and vomiting can make a pregnant woman tired. Anemia is usually associated with fatigue during the early stages of pregnancy. iii. Management h. HEADACHE i. Definition Common early in pregnancy, it is characterized by a squeezing pain or an ache on the sides of the head or the back of the necl. But the pain can appear in other areas as well. It may cause snap throbbing pain or a dull ache. ii. Pathophysiology Take frequent rest breaks during the day Scale back on nonessential activities and responsibilities Eat a balanced diet Drink plenty of water Sleep early

 May result from sinusitis or ocular strain caused by refractive errors During midpregnancy, most headaches decrease in severity or disappear. They may be a consequence of hypertensive disorders later in pregnancy Pregnant women can also experience headaches due to stress, fatigue, caffeine withdrawal, lack of sleep, dehydration and low blood sugar. iii. Management Eat well-balanced meals Apply cold or heat packs to your head For sinus headache, apply a warm compress around your eyes and nose For tension headache, apply a cold compress or ice pack at the base of your neck Maintain your blood sugar by eating smaller, more frequent meals. Massaging your shoulders and neck is an effective way to relieve pain Rest in a dark room and practice deep breathing Warm shower or bath Avoid eating o Chocolate o Alcohol o Yogurt o Aged cheese o Peanuts o Breads with fresh yeast o Preserved meats o Sour cream i. LEUKORRHEA i. Definition
Increased vaginal discharge that is (often) not pathologic but instead is caused by the increased mucus formation by the cervical glands in response to high levels of estrogen in the body.

ii. Pathophysiology Should it happen that the discharge is irritating and is accompanied by an itching and burning sensation, certain pathologic causes must already be considered, such as trichomonas vaginalis, candida albicans and gardnerella vaginalis.

The specific cause can be identified via examination of a fresh smear under the microscope. Trichomonas vaginalis o Vaginal discharge: foamy Vaginal epithelium: with small punctuate, reddened areas (aka strawberry cervix) Candidiasis or Moniliasis o Vaginal discharge: cheesy white; tends to adhere to vaginal mucosa; accompanied by severe itching, burning sensation Vaginal epithelium: redness and chafing of the skin of the vulva and perineum Gardnerella vaginalis o At least three of the following criteria must be satisfied for one to make a diagnosis of gardnerella infection. iii. Management Consult a doctor and request for lab exams to identify which treatment should be given Observe proper hygiene G. H. TEACHING AND LEARNING ACTIVITIES* RESOURCES* *Refer to table below: G. TEACHING AND LEARNING ACTIVITIES
(1) Video Presentation Video presentations are always effective in Pictures presenting ideas since it is not boring. The Camera audience will be able to have fun watching Voice recorder and at the same time, absorb the message being presented in the video. It is one of the effective ways of making the audience sit through the whole presentation without

H. RESOURCES

falling asleep. Also, it is a good way of making them remember the message by having a catchy way of presenting it.

(2) Creative Props Best way of making the audience envision Visual Aids what is being talked about is through Drawings simulation. And what makes a simulation or Illustration Board demonstration more effective than creative Pictures props. It is one of the ways of letting the audience totally understand what is being taught by directly seeing how the instructions presented are done. There will also be less need for explanation since they can directly see what is being presented.

(3) Survey / interview This is the best way to know the common Survey forms complaints of pregnant women since we can Pamphlet/brochure relate to their complaints immediately, thus having the opportunity to address their curiosity regarding their complaints.

J.

EVALUATION The viewers will be given an evaluation sheet that will serve as a feedback on the presentation of the group. Listed are various points of evaluation based on the different aspects of the presentation. The viewer will be asked to shade a smiley face if she feels that the group was able to accomplish that particular parameter, otherwise, a sad face would indicate that the viewer felt that the group missed out on that parameter. At the end of the evaluation, a space is

also provided for any sentiments of the viewers that are not covered by the objective questions. Please shade the corresponding smiley / sad face if the following conditions were met:

Content is relevant and clearly explained Presentation is done orderly and at a rate that is understandable/comprehendable Language used was appropriate and understandable/ comprehendable Words and narration was clear and understood Music/Sound effects were appropriate for the overall presentation Images/Video clips were clear and appropriate for the overall presentation Video is presented in a creative, lively manner that enhanced learning and stimulated curiosity about the topic Video was informative and was able to answer questions and eliminate confusion regarding the topic Overall rating for the video

Comments and suggestions: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

K.

REFERENCES

1. Fauci, A., et. al. (2008). 4. Harrisons Principles of Internal Medicine (17th ed.). United States: The McGraw-Hill Companies, Inc.

2. Cunningham, F. G., et.al. (2010). Prenatal Care, and Medical and Surgical Complications. Williams Obstetrics (23rd ed., p. 211,1052). USA: The McGraw-Hill Companies, Inc. 3. Rodriguez, D. (2010, May 13). Myths and Facts About Heartburn - Digestive Health Center Everyday. Health Information, Resources, Tools & News Online - EverydayHealth.com. Retrieved January 31, 2012, from http://www.everydayhealth.com/digestive-health/myths-and-factsabout-heartburn.aspx