-A serious condition that may occur is that of ovarian hyperstimulation syndrome. • -When fertility drugs have been taken to stimulate the production of follicles • - massive enlargement of the ovaries and multiple cysts can develop • -Many women taking fertility drugs will experience a mild form of this syndrome, but in a considerable percentage (0.5–5%) this develops to include oliguria, renal failure and hypovolaemic shock.
-This risk increases when pregnancy has been achieved. • -The condition itself subsides spontaneously, but medical support and treatment is required for those who are severely unwell. • -In assisted conception, the risk of miscarriage is approximately 14.7%. This rate is probably associated with the quality and length of freezing of the oocytes or embryos that are used. • - no diﬀerences in the number of chromosomal malformations when compared with spontaneous pregnancies
-The number of multiple pregnancies increases with assisted conception, with rates of 27% for twins and 3% for triplets. • - there is an increase in the rate of pre-term birth, small for gestational age babies, placenta praevia, pregnancy induced hypertension and gestational diabetes.
Nausea, vomiting and hyperemesis gravidarum • - onset from 4–8 weeks' gestation • -lasting until 16– 20 weeks • - causes: • 1- hCG, • 2-oestrogen and/or progesterone • - ginger • wrist acupuncture,
-Hyperemesis gravidarum • -severest form of nausea and vomiting • - a history of vomiting • -weight loss • - dehydration • -postural hypotensiontachycardia, ketosis and electrolyte imbalance . • - treatment in hospital intravenous ﬂuids are given to re- hydrate the woman • - correct the electrolyte imbalance • - anti-emetics being administered to control the vomiting.
- exclude other conditions, such as • 1- a urinary tract infection • 2-disorders of the gastrointestinal tract • 3- a molar pregnancy, where vomiting may also be excessive. • -The aim of treatment is • 1- stabilize the woman's condition • 2- prevent further complications
NB: Continual vomiting during the pregnancy may lead to vitamin deﬁciencies, and/or hyponatraemia, which can present with confusion and seizures, leading to respiratory arrest if untreated . • For women who are immobilized through the severity of the vomiting, deep vein thrombosis is also a potential complication due to the combination of dehydration and immobility. • In cases of hyperemesis gravidarum the fetus may be at risk of being small for gestational age due to a lack of nutrients.
Pelvic girdle pain (PGP) • - pregnancy hormones, especially relaxin, can cause the ligaments supporting the pelvic joints to relax, allowing for slight movement. • known as symphysis pubis dysfunction, • -ligaments relaxation is excessive, • the pelvic bones move up and down when the woman is walking. • pain in the pubic area as well as backache • occurring any time from the 28th week of pregnancy.
symptoms varying from mild pain anddiscomfort to severe mobility diffculties. • - pain and discomfort when lying down and on standing • - PGP occurs without identiﬁable risk factors, • -a history of lower back or pelvic girdle pain, • -a job that is physically active.
-a referral to an obstetric physiotherapist. • - The woman should be advised to rest as much as possible and undertake activities that do not cause her further pain. • - movement that involves abducting the hips which increases the pain and discomfort. • -A physiotherapist supplying aids such as pelvic girdle support belts and in extreme cases, crutches
-in labor • -upright and kneeling • -analgesia requirements. • - a reduction in hip abduction • -Following the birth, the ligaments slowly return to their pre-pregnant condition, but this may take some time. • - Extra support may be required and physiotherapy may need to be continued beyond the postnatal period.