It is common to refer the woman for obstetric care after the 15-18 week ultrasound has confirmed dates and fetal morphology, and thereafter care is shared as dictated by the conditions of the pregnancy and the experience of the GP concerned. They require reassurance only. Pain is reproduced by gentle sideways traction on an otherwise non-tender and soft womb. Ankle oedema may relate to compression of inferior vena cava and to vasodilatation due to increased hormones. If no associated proteinuria or hypertension, it is best treated by rest with leg elevation, or natural diuretics such as celery or Vitamin B6.
Varicosities occur for the same reasons, and relief after confinement can be dramatic.
Heartburn is due to gastro-oesophogeal reflux combined with increased abdominal pressure. Constipation can occur early so at least in part is due to hormones, but is aggravated by enlarging pelvic contents. With the vasodilatation and compression of pelvic veins this may result in haemorrhoids. Women should be advised to increase their fluid and fibre intake, and if laxatives are needed they should be of the fibre based type, eg. Metamucil or Fybogel.