Mens Health Blog. Medical Blog

Dark skin

Many women notice dark blotchy areas appear on the skin, and this may occur from an early date in pregnancy. Once more this is a side-effect of circulating hormones. The area surrounding the nipples and the nipple itself will become darker in colour.

It is usually more apparent in normally dark complexioned people and those with a normal olive-type skin. Exposure to the sun tends to aggravate it.

The forehead, cheeks and neck are frequently special at-risk areas. Scars and the midline area of the abdomen also seem to have a predilection for this pigmentation.

Generally, when the confinement is over and the hormonal levels revert to normal, many of these areas wane and disappear altogether. In some areas it persists, especially in the areola, the nipples, scars and the abdominal midline parts.

Women on the contraceptive pill (which contains similar types of hormones) often notice these dark markings. They are referred to as chloasma. A preparation called phiaquine creme is sometimes used with beneficial results in the more obvious parts. It is applied locally.

Vomiting

About 50 per cent of women experience nausea and possibly vomiting in the early stages of pregnancy. It often starts around the sixth week, and usually ceases by the twelfth week. In 45 per cent of cases it is mild; in 5 per cent of cases it is moderate, and only in about two cases in 1,000 does it reach serious proportions.

It may occur in the morning after gastric secretions have accumulated in the stomach overnight. But it can also occur at any time of the day. Emotional and psychological factors play a large part once it has become established. Tensions and anxieties can aggravate it. Travelling will often make it seem worse. Often it makes the patient feel miserable and unhappy. She tends to go off her food, which in turn aggravates the situation.

Eating small, dry meals (up to six a day or even more) can often bring relief. Avoiding fatty foods and spicy meals is recommended. Fluids are best taken between meals. The use of glucose-containing beverages may assist. Glucose is well known for its nausea-allaying powers, and it is also a readily absorbed and utilized food in itself.

If symptoms are causing considerable discomfort, the doctor may prescribe medication, although the fewer drugs taken during early pregnancy the better. No drug should be taken unless under specific medical advice. Many women probably remember a drug called Debendox which often dramatically reduced nausea, but this was removed from the market in 1983. However, an old-timer called pyridoxine, or Vitamin Be, nearly always successful, is now often used. It may be given as an injection by the doctor, and usually dramatically reduces nausea and vomiting. Being a natural vitamin it is perfectly harmless. Some doctors believe nausea is simply a symptom of a nutritional deficiency occurring during pregnancy, rather than an indication of any serious underlying pathology. Pyridoxine commonly produces a strange taste in the mouth, but doctors say this indicates that the body is receiving an adequate supply. It may be given with another member of the Vitamin  complex, aneurin, or Vitamin B1.

A severe form of persistent vomiting is called hyperemesis gravidarum. This may need hospitalization and more intensive medical measures. These cases are quite rare, averaging about two in each 1,000 pregnancies.

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Headaches, palpitations and fainting

The fainting heroine (who also happened to be pregnant) has been the clich? of thousands of old-time novels and movies. (The other one used and reused with monotonous regularity was the doctor delivering the baby at home. He needed buckets and buckets and more buckets of boiling water. Generations of modern-day doctors are still asking what he did with all that boiling water!)

However, as many pregnant women know so well, it is not uncommon to develop sensations of feeling faint. Or there may be recurring bouts of head pain, often mild, and seldom really severe. An awareness of the heart beating in the chest, with or without actual exercise is also quite common.

None of these symptoms is serious. Indeed, they may occur to a certain extent in most pregnant women. It is merely due to the altered nature of the body’s blood reservoirs.

With the advent of the pregnant womb, a large amount of blood is transferred from the usual body circulation to the pelvic regions where it is needed to succour the new, developing life.

For this reason, these other circulatory abnormalities tend to take place.

The symptoms are not serious. They are not dangerous. They do not indicate any sinister disease process. They are entirely self-limiting, and will phase out automatically in due course.

Varicose veins

The development of prominent blood-vessels, particularly in the lower limbs, is common during pregnancy. Indeed, very few women manage to escape this to some degree. In some cases it is very marked, and unfortunately these may persist after the confinement.

Frequently the limbs will ache, and the more prominent the veins, the greater the discomfort. They are aggravated by long hours of standing, especially on hard surfaces such as concrete floors. Many women who continue working during pregnancy and have to stand all day may find the complaint quite distressing.

Varicose veins are often an inherited factor, so if your parents had them severely, then you are most probably headed in a similar direction.

They are produced by the increasing mass in the pelvis pressing on the great veins as they return blood from the lower limbs. With the increased stress, the valves in the vessels that help the return of blood frequently break down, and this often produces lumpy nodules so characteristic of varicose vessels.

Much can be done to assist, however. Keeping off hard surfaces for prolonged periods of time is important.

Wearing elasticized stockings can often be very helpful. Special maternity fashions are available in many areas which provide both for this type of hosiery, as well as adequate room for the expanding abdomen. They are highly successful.

Whenever possible, keep the lower limbs elevated, preferably at a level equal to or higher than the hips. This assists the blood flow back to the body with the help of gravity. Some women find it helpful to lie on their backs on the floor and place their limbs at right angles to their body up against the wall. This has a similar mechanical beneficial effect. It can add greatly to personal comfort. Simple massaging of the limbs, using a soft, sweeping movement from the feet upwards, can also help.

Sometimes doctors may inject some of the more prominent veins, but this is best left until after the confinement. Many vessels will disappear at this time, and then the most persistent problems may be dealt with. But other doctors feel that varicose veins should not be tampered with until after the reproductive days are over permanently.

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Here are some of the more likely reasons as to why a legal termination may be considered by the gynaecologist:

• Severe heart disease. If pregnancy is complicated by severe forms of heart disease, and cardiac surgery to the mother is impractical, then termination may be the only way out for her, to save her own life.

• Chest disease. T.B. is rare today, but occasionally this may be a reason, particularly if the patient is unable to tolerate her medication.

• Kidney disease. If the kidneys are severely diseased, it may be imperative to terminate the pregnancy.

• Psychiatric conditions. Certain cases benefit from a termination. (Indeed, this is the aspect most openly abused. However, the doctor should genuinely assess each case that presents, and make a decision after carefully examining the full case-history.)

• Cancer. Malignant disease in young women is often rapidly growing, and may prove fatal in the event of pregnancy. Such a patient would be a certain candidate for termination.

• Disorders of pregnancy. Sometimes severe symptoms occurring in pregnancy warrant termination.

• Viral infections. Rubella contracted in the first twelve weeks of pregnancy is almost certain to yield severe congenital malformations. Termination is usually offered to these women. Some other viral infections are also possible reasons for interference.

• Rh disease. Certain severe cases of Rh disease warrant termination.

• ”Eugenic reasons.” Some high-risk pregnancies warrant termination, particularly when it is suspected with a high degree of accuracy (and this is often possible today with newer concepts of prenatal diagnosis) that the infant will be mentally defective or malformed. (Conditions in this category include Down’s syndrome – mongols, and infants with spina bifida, a serious malformation of the spinal system.)

• Sexual assault: Rape, incest, and similar forms of sexual assault are also considered to be suitable reasons for legal termination.

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During pregnancy there is a natural increase in the normal vaginal secretions. This is not serious, and should cause no worry.

However, there are two organisms which have a predilection for reproducing in the vagina of the pregnant woman.

(a) Candida albicans. This is a fungus, and is a common occurrence in the vaginal region during pregnancy. It is also more common in the diabetic patient (pregnant or otherwise).

It produces a whitish discharge, which may be copious. This in turn causes tenderness, and often a marked itch at the vaginal entry.

The doctor can readily check this, and on inspection can be fairly certain of the diagnosis. But simple tests are available which reveal the fungus under the microscope.

Treatment is usually quite successful. Suppositories of nystatin canesten or other “antifungal” antibiotic are inserted once or twice a day for a week, thence daily for a further fortnight, or even longer. Re-infection from the sexual partner may occur, producing further problems unless therapy is continued.

(b) Trichomonas vaginalis. This is an infection with a micro-organism which has a wildly wagging tail and can propel itself along. It produces a very irritating yellowish discharge. The organism can be detected with straightforward pathology tests. When detected, natamycin suppositories are ordered and these are usually highly effective. Frequently, local applications are needed to reduce the external irritation brought about by the discharges. This condition is usually contracted from an infected partner at intercourse.

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Infections which occur in the bladder, and which spread into the narrow tubes leading to the kidney (called the ureters) are common during pregnancy, particularly after the twentieth week.

Because of increased amounts of hormone in the bloodstream, the ureters tend to dilate, and this may encourage germs to travel from the bladder into the cavities of the kidney.

Due to changes occurring in the pelvis, complete emptying of the bladder is often difficult. Small amounts of urine are left, forming a reservoir for proliferating germs. Here they multiply rapidly. Frequently, no symptoms occur, and the infection simply smoulders on silently.

But when the germs commence moving into the ureters and on into the kidneys, symptoms can suddenly flare. Elevated temperatures, chills, fevers, aches in the lower back region, aches and pains all over, frequency of urination, the desire to empty the bladder a short time after this has already been done, with little satisfaction, all become commonplace symptoms. Vomiting and a high pulse-rate might also occur.

These demands prompt medical attention. The doctor will probably order a laboratory test on the urine. In this manner the organism producing the infection can be isolated, and the antibiotic to which it is most responsive determined. Treatment is usually commenced at once. Bed rest and lots of fluid are essential.

The results are usually satisfactory, and reduction in discomfort, temperature and the frequency of passing urine and a lessening of the scalding sensation take place rapidly. However, as re-infections are highly likely, continuation of treatment for the remainder of the pregnancy is often necessary.

Stick closely to the doctor’s recommendations. Take the medication given exactly as prescribed. This is the quickest way to recover.

Although the use of medication during pregnancy has been discussed previously, when serious symptoms arise, it is often essential to embark on suitable medication. Any risks of this must be carefully weighed against the risks of the infections. The doctor will order medication with a careful eye on all aspects of risks.

However, many of the complications do not arise until the second half of pregnancy. By this time, the major risks have disappeared. The major cell multiplication and the development of each organ are long since complete, and for these reasons the risks of congenital malformations decrease.

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