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Sunday, 27 September 2015

Chest Pain during Pregnancy

Experiencing chest pain with or without a little shortness of breath is reasonably common during pregnancy, along with all the other aches and pains occurring in this period ^[1]. However, it is necessary to let your doctor know about the problem as it might indicate serious conditions or pregnancy complications.

Is chest pain an early sign of pregnancy?

Chest pain is not counted among the common early symptoms as it can occur anytime during pregnancy due to various causes. However, in some women it can come with the other symptoms like nausea and stomach pain.

Causes of chest pain in pregnancy

Apart from the rising hormone level, which is often to blame for most pregnancy complaints, certain other factors may also lead to the symptom:

Gas and indigestion: It is quite common for gas to get trapped in the chest area, leading to indigestion and sometimes a dull chest pain during pregnancy. It often gets worse with the beginning of the third trimester (around the 27th week) ^[2], but can occur in the first and second trimesters as well.

Heartburn and acid reflux: Acid reflux is a common pregnancy symptom in which the stomach acids pass through the lower esophageal sphincter (the valve usually preventing food and stomach acids from escaping the stomach) into the chest, often leading to pain and discomfort that might worsen after eating ^[3].

Stress and anxiety: Apart from leading to muscle tension, headache and backache, severe stress is a common causative factor behind chest pain as well ^[4].

Asthma and breathing difficulty: Women with a history of asthma or bronchitis are more likely to experience the symptoms of shortness of breath along with pain or tightness in the chest while pregnant ^[1].

Breast changes: Your breasts start changing and preparing for breastfeeding right from the time of pregnancy, often causing breathlessness and chest pain.

Pressure from the growing uterus: As the uterus continues to grow, it starts applying pressure on the adjacent areas, including the diaphragm and chest, often leading to pain and discomfort ^[5]. This type of pain tends to be worse in twin pregnancies as the uterus needs more space to grow.

Cough and cold: These are one of the most common causes of mild to moderate chest pain ^[1] along with a sore throat.

More serious causes

Serious causes for chest pain in pregnant women may include deep vein thrombosis, coronary heart diseases, heart attack and an ectopic pregnancy ^[6]. Recent studies show that the symptoms of congenital cardiac disorders such as heart murmur are becoming more common among pregnant women ^[1]. According to experts, the recent advancements in the medical field might be a key factor behind this as it is allowing more women with congenital heart abnormalities to survive and reach childbearing age. Another responsible factor may be that nowadays, most women do not plan on conceiving before reaching late twenties and being over 28-30 years of age heightens the risks of many cardiac complications.

Differential diagnosis for chest pain during pregnancy

Severe chest ache may indicate any of the following conditions ^[7]:

Gastroesophageal reflux disease (GERD)

Coronary ischemia

Pericarditis (Inflammation of the pericardium)

Pleurisy or pleuritis (inflammatory disease involving the pleura of the lungs)

Pneumonia

Progesterone induced muscle and ligament laxity

Pulmonary Embolism

How to relieve chest pain while pregnant

Consult your health care provider regarding the severity and possible treatment options for the pain. Managing the pain with useful lifestyle changes and natural remedies is advisable as most medicines are not recommended for pregnant women.

Tips for pain management

These tips can help keep the pain under control unless you have an underlying condition:

Sitting and standing straight as a bad posture can prevent your lung from getting enough oxygen ^[8]

Taking lots of rest

Using a cushion to keep the upper body propped up when lying down

Sleeping on your left to prevent the growing uterus from putting extra pressure on the major organs and blood vessels ^[5]

Avoiding lying down right after having a meal

Eating multiple small meals instead of three large ones (helps prevent acid reflux, heartburn, GERD etc)

Taking your prenatal vitamins and including plenty of vitamin, calcium, iron and magnesium rich foods in your diet

Practicing stress relieve techniques like yoga ^[1]

Avoiding alcohol, caffeine, greasy, spicy foods and fast foods (as these often flare up gas and heartburn)

Home remedies

Indigestion and heartburn are the most common causes of pain and discomfort in the chest. The following home treatments can help ease the pain by fighting these problems:

Drinking ginger and chamomile tea once or twice a day

Slippery elm is another natural remedy considered safe in pregnancy ^[9]

Drinking a glass of warm milk along with a tablespoon honey

Eating some almonds as their rich calcium content can help with digestion ^[10]

Having a cup of coconut water as it is one of the most effective natural acid neutralizers

Adding 2 teaspoons of caraway seeds in some boiling water, letting it steep for 10-12 minutes before straining the liquid and drinking it (use sweeteners if preferable) ^[11]

Apple cider vinegar, as it helps to curb the production of stomach acids

Treatment with medication

Chest pain resulting from serious diseases and complications often call for medical treatment ^[1]. Your doctor can diagnose the problem and prescribe medications for a healthy pregnancy. Apart from the serious causes mentioned above, pleuritic chest pain, severe breathing difficulty or asthma ^[12], digestive disorders and cardiovascular diseases may also require medication.

When to worry about chest pain during pregnancy

Chest pain accompanied by severe breathing difficulty, rapid pulse ^[13], fever, dizziness, shortness of breath, sweating [1], fatigue, persistent vomiting and numbness in your arms

Stabbing pain in the left side of the chest (might indicate serious cardiac disorders like a heart attack) ^[5]

Pain that radiates from the chest area into your ribs, arms and jaws

Severe pain in the right side of your chest (might indicate viral infections, gallbladder disorders and liver diseases) ^[14]

Sudden sharp pain in the chest area, along with swelling in one or both legs (might indicate a blood clotting disorder) ^[15]

Sharp pain centered at the middle part of your chest that comes and goes, lasting just a few minutes at a time (might indicate a heart attack) ^[16]

Chest pain that worsens when breathing deeply (might indicate Pericarditis) ^[17]

Burning pain in the upper chest area (often during or after meals) that tends to worsen while bending over (can be just heartburn, but might indicate serious conditions like hiatal hernia) ^[18]

Stabbing pain and palpitations after exercise or running

Pain with deep breathing, coughing or sneezing (might indicate pleuritis) ^[2]

Pain with movement of shoulders and arms along with the chest wall being tender to tough (might indicate a musculoskeletal problem) ^[19]

Severe chest pain occurring while lying down at night (might indicate coronary heart disorders)

Chest pain ICD-9 and ICD-10 codes

The ICD-9 code for this symptom is 786.5 ^[20] while its ICD-10 code is R07 ^[21].

References +

Chest Pain during Pregnancy

Leg Cramps during Pregnancy

Leg cramps are involuntary muscle contractions affecting the calves, feet and sometimes the upper leg. The painful sensation is quite normal during pregnancy, often occurring at night ^[1]. Although most common during the third trimester ^[2], you may experience occasional cramps early in the first and second trimesters as well.

What causes leg cramps in pregnancy?

The exact causes leading to this symptom are still unclear as it may result from a number of factors. The strenuous job of bearing all the extra baby weight might be the cause behind leg cramps towards late pregnancy ^[3]. The growing uterus puts direct pressure on the main vein in your legs. The rising progesterone level, affecting your leg muscle tone, is often the principal factor responsible for the problem in early pregnancy. Other possible risk factors include:

Lack of nutrients like calcium and magnesium

Dehydration in pregnancy ^[4]

A past leg injury

Changes in blood circulation from your legs to your heart due to the growing uterus ^[5]

Carrying twins

Why are pregnancy leg cramps more common at night?

Most women complain of intense cramping at night that wakes them up even from a deep sleep. It is quite difficult to pinpoint any specific factor behind such severe cramps at night. Extreme fatigue and high body fluid levels are believed to be responsible for these nighttime leg cramps ^[6].

How to prevent leg cramps in pregnancy?

Avoiding standing for extended periods of time

Avoiding sitting or standing for long periods, keeping your legs crossed ^[5]

Drinking lots of fluids to stay hydrated

Rotating the ankles and wiggling the toes while sitting down

Stretching the calf muscles several times throughout the day, especially before going to bed ^[1]

Going for a short walk every day or following a light prenatal exercise routine ^[2]

Wearing comfortable shoes with proper ankle and heel support

Avoiding sleeping positions that leave the toes pointing downward

Following a diet containing plenty of calcium, potassium and magnesium rich foods such as leafy vegetables, bananas and dairy products ^[4]

Nutrition deficiency causes a number of pain and complications while pregnant. You need extra nutrition during pregnancy for the wellbeing of your baby as well as your own. So, magnesium and vitamin B supplements may be recommended for preventing cramping; however, experts are still not sure about their effectiveness ^[1].

Pregnancy leg cramps treatment

Applying a hot compress or a heating pad (consult your doctor before opting for heat treatment) ^[7]

Standing on a cold surface or getting an ice massage to relieve the muscles ^[6]

Gently massaging the calves

Lying down on your bed with a few pillows under your legs to keep them elevated

Wearing supportive stockings ^[8]

Walking around in your room for some time to flex the leg muscles ^[5]

Taking a warm bath can ease the pain by relaxing the muscles ^[1]

According to some, sleeping with a bar of soap under your feet helps to avert the pain. But, there is no scientific proof for this home remedy.

Stretching exercise for leg cramp relief

Doing some pregnancy-safe stretching exercises whenever you feel your leg muscles cramping can help to get rid of the pain. Straighten both your legs, keeping the heels in contact with the floor. Then, gently bend the toes back toward the shins as far as you can. Hold in this position for about 10 seconds before releasing the pressure. It might hurt a bit in the beginning, but will gradually lessen the pain by easing the muscle spasm ^[5].

Medical Treatment

Drugs and medicines like quinine (tonic water) are not recommended for treating the symptom in pregnant women ^[9]. Some recommend taking acetaminophen for relieving severe pain ^[4]. But, it is advisable to avoid taking any medicines during this time to keep your baby safe.

When to call the doctor?

Constant muscle cramping that refuses to go away with exercise or any of the above remedies

Leg cramps accompanied by symptoms like swelling, tenderness and redness in the legs (might indicate blood clotting disorders) ^[3]

Persistent leg cramps during the last months of pregnancy (might be a sign of labor) ^[10]

Leg cramps with ankle and foot swelling (might indicate varicose vein)

Cramping accompanied by symptoms like extreme headache and diarrhea

ICD-9 and ICD-10 Codes for Leg Cramps

The ICD-9 code used for indicating cramp is 729.82 ^[11], while its ICD-10 code is R25.2 ^[12].

References +

Leg Cramps during Pregnancy

Abdominal Pain or Cramps during Pregnancy

Is it normal to have abdominal pain or cramps during pregnancy?

Having occasional mild to moderate abdominal pain is normal throughout pregnancy ^[1]. The pain is often more severe in women carrying twins than in single pregnancies. Severe pain with or without certain other symptoms may indicate a number of serious complications ^[2].

Are abdominal pain and cramping early signs of pregnancy?

Menstrual-like abdominal cramps that come and go are one of the earliest symptoms of pregnancy ^[3], often occurring even before you notice the missed period and a home pregnancy test shows positive results. It is generally accompanied by other symptoms like spotting (implantation bleeding) fatigue, breast tenderness, nausea and constipation ^[4] in the first months.

Why is lower right abdominal pain more common during pregnancy?

With the growth of the embryo, the uterus begins to tilt towards the right, causing the ligaments to stretch or contract. This often leads to lower right abdominal pain and cramping ^[5].

What causes upper/lower abdominal pain in pregnancy?

Common harmless causes

The embryo implanting itself to the uterus wall (constant low period-like pain in the upper abdomen, lasting for about a day) ^[1]

Indigestion, gas, bloating and constipation occurring as a result of the hormonal changes ^[6]

The growing uterus putting excessive pressure on the intestine, bladder, muscles and ligaments (the uterus pulling on the ligaments often cause pain around the bellybutton)

Exercising while pregnant, putting additional pressure on the muscles and ligaments ^[2]

The cramping may become more noticeable due to rapid movements such as standing up suddenly, coughing or sneezing

Round ligament pain, mainly occurring during the second and third trimester (caused by the extra stress on certain ligaments due to holding the growing uterus in suspension within your abdomen) ^[6]

Having a history of c-section delivery

Braxton Hicks contractions or false contractions

Pelvic girdle pain

Having intercourse

Serious causes

Ectopic pregnancy (especially during the first three months), a complication in which the embryo gets implanted outside the uterus

Miscarriage

Premature labor ^[7]

Placental Abruption

Preeclampsia or HELLP syndrome ^[8]

Chorioamnionitis

Acute fatty liver of pregnancy (life threatening complication usually occurring later in pregnancy) ^[9]

Acute polyhydramnios

Uterine fibroids ^[23]

Yeast infection ^[25]

Non-pregnancy related causes

A viral stomach infection ^[10], food poisoning or allergies

Kidney and urinary tract infections ^[10]

Appendicitis

Gallstones ^[6]

Inflammatory bowel syndrome

Gastroesophageal reflux disease (GERD) ^[22]

Pelvic inflammatory disease

Hernia

Lactose intolerance

How to prevent lower abdominal pain while pregnant?

Drinking lots of fluid to stay hydrated ^[11]

Getting plenty of rest

Doing regular stretching exercise to keep the abdominal muscles strong and toned for avoiding conditions like round ligament pain (avoid exercises that require you to lie on your back for over a few minutes in the first trimester as they may be harm your baby by reducing the blood supply) ^[12]

Practicing relaxation techniques such as deep breathing

Avoiding lifting heavy objects or climbing stairs quickly (especially during the second and third trimesters) ^[13]

How to relieve pregnancy abdominal pain?

Taking a warm bath ^[14]

Lying down on the opposite side of the pain

Massage therapy by a licensed practitioner

If the symptom is resulting from round ligament pain, reducing the amount of daily activities and avoiding the sitting, standing and lying positions that trigger the pain can help manage it ^[15]

For sudden pain, bending forward to the point of pain relief and then relaxing the muscles again (this helps to reduce the tension of the muscles and tissues) ^[11]

Home remedies such as lemon juice and ginger may help with fast pain-relief (make sure to consult your doctor before using these natural remedies)

Walking or changing positions (helps to relieve pain caused by gas) ^[21]

When to call the doctor?

Severe pain that wakes you up at night

Sharp lower abdominal pain in early pregnancy accompanied by vaginal bleeding or passing blood clots and tissues (might indicate miscarriage or ectopic pregnancy) ^[16]

One sided abdominal pain ^[24]

Constant pain with or without bleeding (especially during the first trimester) ^[2]

Pain accompanied by fever or chills ^[5]

Pain along with the symptoms of faintness or lightheadedness

Intense pain in the upper abdominal area along with headache, nausea and vision disturbances, especially during the third trimester (might indicate preeclampsia) ^[17]

Abdominal cramps accompanied by a burning sensation while urinating (might indicate urinary tract infection)

Pain accompanied by lower back pain and diarrhea ^[18]

Menstrual-like cramping accompanied by over 5 contractions within an hour before the 37th week of pregnancy (might be a sign of premature labor) ^[7]

ICD-9 and ICD-10 Codes

The ICD-9 code used for indicating abdominal pain is 789.0 ^[19] while its ICD-10 code is R10 ^[20].

References +

Abdominal Pain or Cramps during Pregnancy

Back Pain during Pregnancy

Is upper and lower back pain normal in pregnancy?

Back pain is quite common in pregnancy with most women experiencing mild to moderate pain in the lower ^[1] or upper ^[2] back area in pregnancy. Usually, it just signifies that your baby is growing inside you. But in some rare occasions, it may indicate some serious complications ^[3]. Back pain is believed to be more common in twin pregnancies ^[18].

Types of Back Pain during Pregnancy

A mild to moderate lower and middle back pain when you stand up or sit down^[3]

Severe pain in the back of the pelvis and the buttocks

Considerable lower back pain experienced when lying down in bed

Is lower back pain an early sign of pregnancy?

Although back pain can occur anytime during the first, second or third trimester, mild chronic lower and middle back pain is considered one of the less common early symptoms of pregnancy^[4], often resulting from the hormonal changes occurring in your body^[5]. It is often accompanied by other symptoms like nausea, vomiting, gas, heartburn, constipation, fatigue and headache in the first trimester.

Back Pain in Pregnancy Risk Factors

Being overweight ^[6]

Being over 30 years of age^[7]

Second pregnancy

What causes back pain in pregnancy

The hormonal changes associated with pregnancy is often responsible for back pain in late pregnancy as well, as it loosens the pelvic joints and softens the ligaments in the area to prepare the body for labor and childbirth^[8]

Your center of gravity, moving forward with the growth of your baby can lead to back pain by altering your posture ^[9]

The additional weight gained during pregnancy^[3]

Poor posture and standing or bending over a lot

Lifting something heavy or performing something strenuous

Excessive stress associated with pregnancy

Past injury to the pelvic region can lead to back pain while pregnant

Pelvic girdle pain or a slipped disk

It is quite normal to experience back pain after pregnancy due to the hard work associated with delivery as well as the body changes after childbirth [27].

How to prevent back pain in pregnancy?

Avoiding slouching or bending down

Avoiding sitting or standing still for a long time

Wearing comfortable low-heeled shoes (not flat) that provide proper arch support ^[10]

When getting out of bed, rolling on to the side of the bed before sitting up and finally getting into a standing position

Maintaining good posture (keeping your back straight when sitting or standing) and using proper lumbar support when sitting in a chair

Avoiding lifting heavy objects unless necessary (bending down your legs and lifting with your hands and legs instead of the back, keeping the object close to your body can prevent the pain) ^[11]

Avoiding twisting your body; instead, move your feet while turning around ^[12]

Sleeping on one side in a pregnancy pillow to support your body (supporting your back and legs with a normal pillow can help as well) ^[10]

Sleeping in a firm mattress that can properly support your back (placing a hard board between the box spring and mattress can make a soft mattress firm) ^[3]

Wearing a maternity support belt (especially to prevent upper back pain)

Doing exercises like pelvic tilts to strengthen your back ^[13]

Getting plenty of rest

Drinking lots of fluid to eliminate certain toxins, which may cause various complications, leading to upper back pain ^[14]

Sleeping on your left side

Pregnancy Back Pain Relief

Home Remedies for Relieving Back Pain in Pregnancy

Applying a hot water bag or a heating pad (make sure the temperature is not too high; wrapping the hot water bag with a towel helps to avoid excessive temperature) ^[3]

Applying a cold compress to the painful area to relax the sore muscles ^[13] (make sure the ice pack is not too cold; avoid applying it for an extended period of time)

Taking a warm bath ^[19]

Bed rest

Asking a friend to rub the painful area gently

Exercises

Light exercises like pelvic tilts ^[15], walking and stretching can help. But, avoid forcing yourself to exercise too hard as it may strain the ligaments further or harm the baby. Here is a simple exercise technique to help ease the pain ^[12]:

Begin by resting in a box position, with your knees under the hips, your hands under the shoulder and your fingers facing forward

Make sure your abdomen is lifted high enough to keep the back straight

Next, pull in the stomach muscles before lifting your back up in the direction of the ceiling while curling the trunk and letting your head relax gently forward (do not lock the elbows)

Hold in this position for a few seconds before slowly returning to the previous (box) position (keep your back straight)

Repeat the whole procedure slowly 10 times

This exercise helps to strengthen your muscles; but be careful not to put too much pressure on your back or you may hurt it further.

Water exercises and swimming are good for your back as well (make sure to avoid the styles that are likely to strain your neck and back)^[16].

Natural Remedies

There is a lack of scientific research regarding the safety of using natural back pain cures, like devil’s claw, in pregnancy ^[16]. So, it is safe to avoid these herbal remedies.

Medication

Pain relieve medicines are usually not recommended to pregnant women as they may increase the risks of various complications^[3]. It is recommended to talk to your doctor before considering using any pain medication for fighting back pain.

Other Treatments to Relive Back Pain

Massage therapy by a trained professional therapist ^[6]

Chiropractic therapy by a licensed practitioner ^[20]

Practicing relaxation techniques (e.g. slow breathing, tai chi etc)

Doing pre-natal yoga ^[17]

Taking homeopathic medicines like rhus tox 12C and arnica 30C ^[21] or applying arnica ointment to the affected area ^[16] (make sure to consult a qualified professional homeopath)

Taking an aromatic warm bath with a few drops of lavender oil (not recommended during first trimester as lavender may induce premature contractions) ^[16] or using special aromatherapy massage oils meant for pregnant women

Studies show acupuncture to be an effective treatment option ^[22]

Lower Back Pain Vs Sciatica during Pregnancy

Sciatica is a relatively uncommon pregnancy complication related to the sciatic nerve, occurring due to a herniated disk in lower spine. Severe lower back pain radiating into the thighs and buttocks is often mistaken for sciatica. But, sciatica is characterized by leg pain that is usually more severe than the lower back pain along with a tingly numbness in the knees, foot and toes^[1].

When to call the doctor?

Lower back pain severe enough to wake you up at night

Severe back pain accompanied by vaginal bleeding and abdominal pain (might indicate a miscarriage)^[23]

Severe upper, lower or middle back pain that continues for more than 2 weeks^[20]

Burning pain that gradually runs down your legs to the knees and ankles (might indicate a rupture disk)^[24]

Lower back pain accompanied by low blood pressure, dizziness and vaginal spotting (might indicate an ectopic pregnancy)^[25]

A dull pulsing pain in the lower back area that may be accompanied by pelvic pressure, menstrual-like cramping, over four contractions in an hour and diarrhea (might indicate pre-term labor) ^[26]

Pain on either the right or left lower back along with pain during urination and blood in the urine (might indicate a kidney stone) ^[24]

References +

Back Pain during Pregnancy