-Common complain -specific causes of bleeding in pregnancy

*-uterine fibroid degeneration -Myoma -acute abdominal pain -nausea& vomiting – mild pyrexia -occur between weeks gestation -diagnosis: by u/s RX: bed rest –analgesia

-sever uterine torsion : -uterus rotate more than 90 -abdominal pain -predisposing factors : -fibroid –congenital malformation of the uterus -adenxial mass –pelvic fracture –pelvic surgery Rx:-bed rest -change maternal position to correct torsion -administer analgesia -rare cases.laparatomy c.s delivery

*pelvic girdle pain -suprapubic dysfunction (SPD) -abnormal relaxation of the ligament supporting the pubic pain -causes : 1-high level of pregnancy hormone especially relaxin 2-biomechanical factors 3-Genetic factors Incidence 1\300 Out come of this problem : 1-increase mobility of the joint 2-pubic bone move up & down when woman walk 3-strain sacroiliac joint c\p: -grand multigravida -pain in the pubic region -backache -occur 28 weeks or in postnatal -abdominal pain ( muscular action ) -tenderness over the symphysis pubis

Management :

-explanation to decrease anxiety -bed rest on firm mattress -avoid straddle movement -decrease non essential wt bearing activities -avoid abduct the hip -avoid squatting position -use supportive panty girdle (tubgrip ) -use comfortable shoes -increase risk for venous thrombosis

-physio- therapies -postnatal ligament gradually return to its normal position so arrangement for physiotherapy is important to strength & stabilize joint.