Antidepressants Blog

Leg cramps

Very uncomfortable cramps in the lower limbs are common, and this may take place during the latter stages of pregnancy. The cause is unknown, and treatment is not very satisfactory.

Often the use of calcium lactate tablets, either 2 g at bedtime, or 2 x 300 mgm tablets with each meal, can yield considerable relief.

Massaging may help sometimes. Others find that keeping the bedclothes off the limbs by various ingenious methods can produce a marked reduction in discomfort. By making up a cube measuring about 30 cm in all dimensions (approximately 12 inches), and placing this between the lower limbs at the lower part of the bed, the bed clothing can be arranged so that it does not press on the limbs. It is a simple measure and the advocates claim it is worth the small amount of effort involved. At least it is worth a try if this is your problem.

Some women find that an increase in the milk intake also increases their calcium intake, and this can also assist.

Sleeplessness

During the latter stages of pregnancy, many women find the summation of their problems a little overwhelming. There may be leg cramps and discomfort in the back. The added mass in the abdomen limits the positions in which they can sleep. Often insomnia gains a foothold.

Some doctors prescribe mild sedatives to be taken from time to time. There is an increasing swing away from the use of regular sedatives at night. But for a short time, if they are the only way of gaining a good night’s repose, then they will do little harm.

But simple measures such as a hot glass of milk, or a malt-based drink will often have a mildly sedating effect also. It is worth a trial. It is best to avoid tea and coffee at night, for the caffeine content tends to have a stimulating effect, the reverse of what is being sought.

Swelling of the feet

This is technically known as oedema. It is common during pregnancy, due to the increased pressure in the blood-vessels of the lower limbs, together with their distension brought about by circulating hormones. It is worsened in hot weather, and long hours spent in the upright position.

The treatment is similar to that for varicose veins.

However, the sudden onset of ankle oedema, especially in conjunction with elevated blood pressure and protein in the urine, may be a serious sign. It could indicate the onset of the pregnancy complication called pre-eclampsia. So if you suddenly awaken with swollen ankles, report it to the doctor promptly.

Perspiring and feeling hot

The circulating hormones often cause the blood-vessels in the skin to dilate. Thus a feeling of heat, and sweating more than usual is common, especially in the latter months of pregnancy. Hot days will aggravate it.

Drinking more fluid, trying to keep cool, reducing physical activity, taking more rest periods, having frequent cooling baths and showers can often give symptomatic relief.

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For most women, the days of pregnancy are happy and relatively free from discomfort and trouble. However, it is inevitable that a few abnormalities occur from time to time. After all, major changes are taking place in the lower pelvic area. A rapidly growing mass is developing there, and with the passage of time, gradually pushes up into the abdominal region. When this happens, organs are forced to move to make way. In addition, certain unusual pressures and stresses are produced.

Besides this, the massive production of extra chemicals by the pelvic organs often has a profound effect on the entire system. Although women automatically adjust to these altered circumstances in a very remarkable manner, some produce symptoms which tend to cause them some worry. The majority are self-limiting, and are cured without interference. But some suggestions can assist in alleviating other symptoms.

Here are the main symptoms that may produce some temporary discomfort, together with some recommendations as to how they can be overcome.

Heartburn

The small valve at the lower end of the food passage (the oesophagus) leading to the stomach tends to become lax. For this reason acids from the stomach can readily regurgitate or “reflux” into the lower end of the oesophagus.

This produces a burning sensation commonly referred to as heartburn. It is merely a name, and has nothing to do with the heart muscle itself. It has no sinister connotation, and is not indicative of disease.

A sensible approach to eating often brings relief. Avoiding stimulants can do much to help. Ceasing the intake of spices, condiments, sauces and pickles, and reducing the intake of strong tea or coffee will minimize the problem. Small, frequent meals of a bland, non-stimulating nature assist. An increase in the intake of milk and milk products is often useful.

Sometimes the use of antacid mixtures and tablets can bring relief if distress is severe. Alginic acid compound in the form of granules seems to assist some. These are innocuous preparations.

Extra pillows permitting sleep in a semi-upright position help to keep the acid in the stomach where it belongs. Some have found placing a brick under the head of the bed (producing a similar sleeping position) a good idea. However, others find this uncomfortable, and there is a tendency to slip down toward the foot of the bed. (Husbands often complain loudly and most bitterly about this!)

Constipation

Constipation is common during pregnancy, particularly in the latter stages. The intestinal system has a lowered “tone,” and tends to become lax. Later on, the added pressure of the large womb also aggravates the situation.

An increased fluid intake helps (preferably by the use of fruit juices or plain water, not increased amounts of tea, coffee or sugary aerated beverages or alcohol-laced drinks).

Endeavour to re-establish normal bowel movements. The usual time for these is after a meal. Set a time each day, say after breakfast, and concentrate on this, and results are often successful.

In recent times the increasing value of adding bulk to the bowel has become well recognized. Adding one to three tablespoonful of simple unprocessed bran to the food at each meal can produce excellent results. Bran absorbs fluid. This increases bowel bulk, and greatly reduces ‘ ‘transit time,” the length of time material stays in the bowel.

Bran can conveniently be taken with other foods high in natural fibre. Breakfast foods such as muesli may have bran added. It is also a good idea to add chopped-up dates, dried figs, sultanas and raisins. Add a little milk, or water, and honey if desired.

Muesli is composed of natural grains. The total picture is a meal of relatively high nutritional value. At the same time, it is almost a written guarantee of normal bowel actions.

Using this simple system, the need for laxatives and cleansing enemas – the alternative -is usually quite unnecessary.

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Technically, several different kinds of abortions are recognized by the doctor. But from a practical point of view, it doesn’t matter too much about the technical features. What matters most is that a sudden halt occurs in the normal progression of the pregnancy. Often this requires prompt medical attention to avert serious consequences.

The first indication that all is not well is that vaginal bleeding commences. This may be any time during the first twenty-eight weeks of pregnancy, but more commonly in the six- to ten-week period.

The bleeding might commence as brown spotting which may gradually or rapidly increase in volume and nature. It may become red, and be associated with cramp-like pains in the lower abdominal regions. The amount may be small or it may be profuse.

If it starts off red then gradually reduces and becomes brown, the chances are fairly high that it will settle down. If the brown discharge continues, the risk of abortion increases. If brownish discharge increases and becomes bright red, then there is a far greater risk of the embryo aborting.

Many cases settle down, and proceed thereafter to term. But many gradually continue, and finally abort completely. The patient may suddenly feel as though she “is passing something” (a common expression). This may be accompanied by several severe cramp-like pains, more bright-red bleeding, then a reduction in both. Sometimes the products of conception are self-delivered at the lower end of the vagina. At other times, they become stuck part way, and the bleeding and discomfort continue.

Whatever happens, bleeding with or without pain is certainly an urgent recommendation for prompt medical assistance. A proper examination will enable the doctor to advise whether simple measures are likely to allow the impending abortion to settle down, or whether surgical intervention is necessary to avoid further risk and blood loss to the patient.

In the latter instance, of course, prompt hospital admission is arranged, and the correct procedures undertaken forthwith, before further haemorrhaging takes place. Many women are upset when an abortion prematurely ends a pregnancy they had wanted. However, most doctors take the sensible view and endeavor to explain the position to their patients. This is usually nature’s way out of a situation that could produce later problems to the parents.

When this is pointed out, a different complexion is usually given to the whole picture, and most patients are then quite satisfied and indeed glad that it ended in this way, rather than face possible difficulties in the future.

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Heart disease

A certain number of women who become pregnant suffer from heart disease. The figure is small, being around 1 per cent or less. Most have suffered from rheumatic disease in earlier life, and this is the cause of their cardiac problems.

Heart disease is a progressive disorder, and each pregnancy will throw an extra burden on this system.

Provided the patient is sensible, carries out her doctor’s instructions, and attends for adequate prenatal visits at intervals which will be more frequent than her healthy counterpart, a satisfactory outcome is usual.

Greater efforts to avoid abnormal weight increases, commonsense care in regard to eating habits, adequate periods of rest, and not performing activities in excess of her ability, all help to keep her fit throughout the term of pregnancy.

The key symptoms that all is not well are breathlessness with activity, and cough. These must be reported to the doctor, particularly if they tend to worsen at any time.

The doctor will want to see the patient every second week from the moment she conceives until the twenty-eighth week. After this, visits will be weekly, or even more often if the doctor has any question. Be guided entirely by his advice. It is most important.

Diabetes

Many diabetics are not diagnosed until adult life, often in the early forties. These are called maturity-onset diabetics; however, some people are born with the condition, or develop it in early life or adolescence. Another group, usually older people, is called “pre-diabetics.” They may develop into maturity-onset diabetics. But under certain circumstances, they swing over into the diabetic pattern.

A diabetic is a person with a disorder of the pancreas. This reduces his normal supply of insulin, so he is unable to adequately store circulating sugar. The doctor will check your urine regularly for sugar, for some pre-diabetics will suddenly reveal this in their urine.

Treatment of the pregnant diabetic is usually quite straightforward for the first twenty-eight weeks. But after this, she becomes progressively more difficult to care for. In practice, the best place for these patients is in centers equipped with facilities for caring both for diabetics as well as pregnancies. Many major units in larger cities are equipped along these lines.

The patient is admitted to hospital at about the thirty-second week. This is often essential to enable the sugar levels to be stabilized, to guarantee adequate rest, and to help check other complications which are more likely (mainly pre-eclampsia).

Many patients can be adequately controlled by diet alone. Others may require anti-diabetic medication, and still others may need insulin by injection on a regular basis. On some occasions if the mother’s well-being is in danger, termination of the pregnancy may become essential. But others will be allowed to go on until the thirty-eighth week, when induction of labour takes place. In some cases, delivery by Caesarean section is preferred by the obstetrician.

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Bleeding from the vagina at any time during pregnancy is a symptom that must be reported immediately to the doctor. In the early stages of pregnancy it could indicate an impending miscarriage.

But from the twenty-eighth week on, it could mean a serious complication which demands instant and expert medical care.

1. Placenta Praevia. Placenta praevia means that the placenta (later to become the afterbirth at the confinement) is located low down in the womb. Usually it is high up in the upper part. But sometimes it settles in this abnormal situation. Problems can occur if any parts of the placenta encroach on the outlet from the womb.

This means that when labour commences and it is time for baby to be born, the placenta must come first. This, of course, is quite impossible, and serious haemorrhaging, jeopardizing the life of both infant and mother, could result.

Therefore any bleeding occurring from the twenty-eighth week on must be regarded with care and suspicion. Usually there is no pain.

The doctor will admit you to hospital at once. If pregnancy is in the time segment between the twenty-eighth and thirty-sixth weeks, every effort will be made to let the pregnancy continue before any interference is made. This gives baby an improved chance of survival. Bed rest and medication is the regular method of treatment. Many cases settle down until the vital thirty-sixth or thirty-seventh week has been reached.

At this stage, the patient is taken to the theatre, given a general anaesthetic, and the pelvic area is examined. It is then frequently necessary to deliver the baby by means of a surgical operation called Caesarean section. This is through an incision in the lower part of the abdomen. The results of this operation are usually excellent, and it can be a life-saving measure for both mother and her baby. A blood transfusion is generally given, but recuperation afterwards is generally rapid.

2. Accidental Haemorrhage. This occurs very occasionally, in about 2 per cent of pregnancies, compared with the frequency of placenta praevia which is around 1 per cent.

The placenta (afterbirth) is located in the normal situation. For reasons that are not clearly understood, the placenta starts to come away from its usually firm adhesion to the wall of the womb. As this happens, bleeding must occur. Some appears via the vagina as a haemorrhage.

The degree varies, and the treatment also varies accordingly. In mild cases, if the pregnancy has not advanced to the thirty-seventh week, hospital care is given and every effort made to let the pregnancy continue. Blood transfusions are given, and medication ordered according to the patient’s condition.

When the thirty-seventh week has been reached and baby has a fair chance of surviving, labour may be induced, and a happy result is often the outcome. Sometimes, in more urgent cases, surgical intervention and a Caesarean section operation become essential.

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