Maternal digestive system and adaptation

Question 1

Physiological changes in digestive system

Answer 1

Physiological changes- results of progesterone in smooth muscles

Sphincters are out of place

Changes in gastrointestinal motility during pregnancy include decreased lower oesophageal pressure, decreased gastric peristalsis and delayed gastric emptying

Gastrointestinal motility is inhibited generally during pregnancy, with increased small and large bowel transit times

These changes may in part be responsible for common symptoms of constipation and nausea and vomiting in early pregnancy

Question 2

Hyperemesis gravidarum

Answer 2

High levels of HcG - pregnancy hormone ( less than 5 IU/ML is normal)
Admitted to hospital
Nausea and vomiting are both common in pregnancy, affecting at least 50% of pregnant women
Hyperemesis gravidarum occurs in 0.1- 1% of pregnancies
Onset is always in the first trimester, usually weeks 6-8 In addition to nausea and vomiting, there may be ptyalism and associated spitting

Question 3

Constipation

Answer 3

This is very common, experienced by up to 40% of women, especially in early pregnancy
Decreased colonic motility
Oral iron supplements
Poor fluid and food intake related to nausea and vomiting in the first trimester

Question 4

Reflux oesophagitis- heart burn

Answer 4

Approximately 60% of women experience heartburn at some time in the third trimester

Decreased lower oesophageal pressure, decreased gastric peristalsis and delayed gastric emptying, all make reflux more likely - splashes into the oesophagus
Later in pregnancy, the enlarging uterus exacerbates oesophageal reflux

Reflux of acid or alkaline gastric contents into the oesophagus causes inflammation of the oesophageal mucosa

Gastric sphincter loosens
Give women milk- alkaline
Rebiterine

Question 5

Appendicitis

Answer 5

Appendix becomes affected and can burst
This is the commonest non-obstetric indication for laparotomy in pregnancy
It usually presents in the first two trimesters with an incidence of about 1 in 3500
Abdominal pain, rebound tenderness, nausea and vomiting

Question 6

Gall bladder disease

Answer 6

Gall bladder disease - deposits of bile salts
Symptomless gallstones are detected in between 2.5% and 11% of pregnant women
The prevalence of acute cholecystitis in pregnancy is about 0.1%
Pain is present in the right upper quadrant or epigastrium, and it may radiate through to the back and tip of the scapula- upwards pain
Nausea and vomiting are common
Ultrasound provides a safe and accurate method of detecting gallstones

Question 7

Labour

Answer 7

Increase in intra-abdominal pressure during labour leads to a slowdown in gastric emptying
This means the acidity of the stomach contents rises
The use of narcotics for pain relief will further affect gastric emptying
Mendelson’s syndrome: caused by regurgitation of stomach contents

Question 8

Postnatal

Answer 8

Decrease in circulating levels of progesterone

Constipation

Question 9

The neonate

Answer 9

The digestive system is fully functioning by the end of the pregnancy
Ao is able to digest breast milk
First stools: meconium → contains epithelial cells, waste products such as bile salts, fatty acids, mucus and amniotic fluid.
Meconium passed during labour cn show fetal stress
Yellow stools of breastmilk will be shown within 4-5 days