Clinical overview
"Minor complaints" is the umbrella term for the common, self-limiting symptoms of normal pregnancy: nausea and vomiting, heartburn, constipation, backache, varicose veins, haemorrhoids, leg cramps, carpal tunnel syndrome, ptyalism, fatigue, and the breast, skin and pelvic-girdle changes that almost every pregnant woman experiences. They are "minor" only in the sense that they do not usually threaten mother or fetus — to the woman experiencing them they are a daily reality, and they account for a large share of antenatal consultations. For the registrar, the objective verb is describe: you must know the mechanism, the expected gestation, the safe symptomatic remedies, and — crucially — the red-flag conditions that masquerade as a minor complaint.
The exam-and-clinic skill here is twofold. First, normalise and treat the genuinely minor symptom with the simplest safe measure, so the woman is not over-investigated or over-medicated. Second, and more important for safety, never let a minor-complaint label anchor you onto a sinister diagnosis: vomiting can be hyperemesis or a surgical abdomen; "heartburn" in the third trimester can be the epigastric pain of pre-eclampsia; breathlessness can be physiological or a pulmonary embolus; "indigestion" can be myocardial ischaemia. In the South African setting, where many women book late and the antenatal visit may be the only health contact, the minor-complaint consultation is also a screening opportunity — for hypertension, anaemia, HIV and depression. This chapter pairs naturally with Antenatal booking, Pregnancy nutrition and Respectful care.
Core knowledge
The minor complaints arise from three engines of normal pregnancy physiology: the hormonal milieu (high progesterone, oestrogen, hCG, relaxin), the enlarging gravid uterus (mechanical pressure and altered posture), and the expanded plasma volume and cardiovascular adaptation. Understanding the engine lets you predict the symptom, its timing, and its rational treatment.
Figure I10.1 — The three physiological engines behind minor pregnancy complaints and the screening discipline that prevents anchoring.
Nausea and vomiting of pregnancy (NVP)
The commonest complaint, affecting up to ~70–80% of pregnancies (standard teaching). It typically starts before 9 weeks, peaks around 9–11 weeks, and resolves by ~16–20 weeks. The pathophysiology is incompletely understood but is associated with rising hCG (hence worse in multiple and molar pregnancy) and oestrogen; the gene GDF15 has emerged as a strong mechanistic link (recent research, flag as evolving). NVP exists on a spectrum: at the severe end is hyperemesis gravidarum — protracted vomiting with dehydration, ketonuria, electrolyte disturbance and weight loss (classically >5% of pre-pregnancy weight) — which is no longer "minor" and is covered by Medical complications in pregnancy. The PUQE score (Pregnancy-Unique Quantification of Emesis) grades severity and guides escalation.
Gastro-oesophageal reflux / heartburn
Affects a majority by the third trimester. Progesterone relaxes the lower oesophageal sphincter and slows gastric emptying; the enlarging uterus raises intra-abdominal pressure and displaces the stomach. The result is retrosternal burning, worse lying flat and after meals.
Constipation and haemorrhoids
Progesterone reduces gut smooth-muscle motility; the gravid uterus compresses the rectosigmoid; oral iron supplements worsen it. Straining and venous congestion from the enlarging uterus and raised progesterone produce or aggravate haemorrhoids, which often flare in late pregnancy and the early puerperium.
Musculoskeletal: backache and pelvic-girdle pain
Relaxin and progesterone loosen pelvic ligaments and the symphysis pubis; the growing uterus shifts the centre of gravity forward, producing a compensatory lumbar lordosis. Pelvic-girdle pain (symphysis pubis dysfunction) is pain over the symphysis and sacroiliac joints, worse on weight-bearing, standing on one leg and turning in bed.
Venous and circulatory complaints
Raised venous pressure in the lower limbs (uterine caval compression, progesterone-mediated venodilation, increased blood volume) produces varicose veins, ankle oedema and vulval varicosities. Supine hypotensive syndrome — dizziness, pallor and faintness when lying flat — is caval compression by the gravid uterus, relieved by left lateral tilt. Dependent oedema is physiological; it becomes a red flag when it is sudden, facial, or accompanied by hypertension or proteinuria.