Health Management Issues in Pregnancy

Principles: (1) Isolation of the patient to remove any neurotic element. (2) To combat dehydration and salt depletion by the administration of saline. (3) To supply glucose for acidosis and ketosis. (4) To prevent vascular and cerebral changes by combating dehydration and giving vitamins C and B. (5) To watch for grave signs requiring the termination of pregnancy.

Management can be given as follows:

1. Isolation, hospitalization and bed rest, are essential for moderate and severe cases. In mild cases, this is advisable where the condition is not responding to reassurances and treatment at home.

2. Diet: No feeding by mouth is allowed in moderate and severe cases for 24 to 48 hours; ice chips are given to mouth for sucking. As the condition improves or in mild cases, oral feeding of mainly carbohydrate food is given in small quantities at frequent intervals. Fat should be cut down. The food comprising mainly of barley-sugar, toast, biscuits, rice, fish, backed potato, fruit, vegetables; milk and eggs are to be given sparingly. Gradually the patient is given full diet on improvement.

3. Fluids: This is an essential therapy in severe and moderately severe cases. In moderately severe cases, intravenous saline - glucose drip is to be started. This can be followed by rectal saline drip with 10% glucose introduced by a catheter following a bowel wash. In severe cases, for combating dehydration quickly, intravenous drip of 5% glucose in saline is to be given till chloride appears in urine. To combat dehydration about 3 liter of glucose saline becomes necessary during first 24 hours. In addition, one liter (for loss by skin and lungs plus amount of fluid lost by urine and vomitus) is to be administered in the form of 5% glucose in 1/5 saline. Excess of saline administration is safeguarded. Intravenous infusion is continued till vomiting, abates or ceases by 24-28 hours when oral feeding is started. Oral administration of potassium can be effective by providing meat soup, green coconut water, orange juice or potassium chloride or pot. Citrate 1 gm three time a day is quite useful.