Ask the woman for the following symptoms in the present pregnancy: Symptoms that indicate discomfort nausea

nausea and vomiting heartburn constipation increased frequency of micturition Fever Vaginal discharge Palpitations, easy fatiguability and breathlessness at rest Generalized swelling of the body; puffiness of the face Vaginal bleeding Decreased or absent foetal movements Leaking of watery fluid per vaginum (P/V) Decreased urinary output

Common symptoms and signs that may be encountered in a pregnant woman, probable diagnosis and action required at primary level
Symptoms Signs/investigations Most probable diagnosis Action(s) to be taken

Vomiting during the first trimester

May be physiological (morning sickness)

Advise the woman to eat small frequent meals; avoid greasy food, eat lots of green vegetables and drink plenty of fluids. If vomiting is excessive in the morning ask her to eat dry foods such as biscuits or toast after waking up in the morning.

Excessive vomiting, especially after the first trimester; inability to retain anything taken orally

The woman may be Hyperemesis dehydrated gravidarum

Provide management

Palpitations, easy

Conjunctival

Severe anaemia

fatiguability, breathlessness at rest

Puffiness of the face, generalized body oedema

and/or palmar pallor present Hb level <7 g/dl BP >140/90 mmHg Hypertensive Proteinuria absent disorder of BP >140/90 Pregnancy mmHg Proteinuria present

If the BP is <160/110 mmHg, advise home management with rest and regular follow up.
If the BP is >160/110 mmHg .

BP >140/90 mmHg Proteinuria present

Heartburn and nausea

Reflux

Pre-eclampsia Hypertensive disorder of pregnancy

Increased frequency of urination up to 10-12 weeks of pregnancy Increased frequency of urination after 12 weeks, or persistent symptoms, or burning on urination Constipation Bleeding P/V, before 20 weeks of gestation

Tenderness may be present at the sides of the abdomen and back.

May be physiological due to pressure of the gravid uterus on the urinary bladder Urinary tract infection Physiological
Threatened abortion/ spontaneous abortion/ hydatidiform mole/ ectopic pregnancy

Advise the woman to avoid spicy and rich foods. Reassure her that it will be relieved on its own

The body temperature may be raised

Check the pulse and BP to assess for shock

Ask for history of

violence Spontaneous abortion due to violence

Bleeding P/V, after 20 weeks of gestation Fever

Check the pulse and BP to assess for shock The body temperature is raised Blood peripheral smear is positive for malarial parasite FHS heard, and within the normal range of 120-160 beats/minute
FHS

Site of infection somewhere, including possible sepsis Malaria

Decreased or absent foetal movements (NOTE: Foetal movements are felt only after about 4 months of gestation)

Baby is normal

Reassure the woman.

Re-check the FHS after 15 minutes.

heard, but the rate is <120 beats/minute, or >160 beats/minute. FHS not heard

Foetal distress

Intrauterine foetal death

Premature or prelabour rupture of membranes

Leaking of watery fluids P/V

Wet pads/cloths