Overview
Introduction
Mouth: Hyperemia and hypertrophy of gums (progesterone effect) → bleeding gums common Ptialism (excessive salivation) — benign but distressing, especially with NVP Pyalism can w...
Mouth: - Hyperemia and hypertrophy of gums (progesterone effect) → bleeding gums common - Ptialism (excessive salivation) — benign but distressing, especially with NVP - Pyalism can worsen nausea; treatment: sugar-free gum, frequent small sips of water Stomach and esophagus: - Lower esophageal sphincter (LES) tone decreases (progesterone relaxes smooth muscle) → gastroesophageal reflux - Stomach emptying slows (decreased motility from progesterone) - Gastric acid production may increase in later pregnancy - Result: heartburn/GERD is extremely common (>50% of pregnant women) - Management: small frequent meals, avoid lying down after eating, head of bed elevation, antacids (calcium carbonate safe), H2 blockers (famotidine safe), PPIs if needed Nausea and vomiting of pregnancy (NVP): - Affects 70–85% of pregnant women; peaks 8–12 weeks; typically resolves by 14–16 weeks - Caused by: rising hCG stimulates CTZ (chemoreceptor trigger zone); progesterone slows gastric emptying - First-line: vitamin B6 (pyridoxine) ± doxylamine (Diclegis/Bonjesta); ginger; small frequent meals - Hyperemesis gravidarum (HG): persistent vomiting, weight loss >5% pre-pregnancy weight, dehydration, ketonuria → hospitalization, IV fluids, IV antiemetics Small and large intestine: - Progesterone decreases intestinal motility...
