2230 part 1 Flashcards
Pop risk factors x 5
- Vaginal birth
- Birth > 4kg
- 3rd/4rth degree tears
- Instrument delivery
- Pushing phase or labour > 1.2 hours
SUI treatment x 3?
Supervised PFMT
The knack
Weight loss
UUI/OAB treatment x 4?
Bladder retraining
Urge suppression
Supervised PFMT
Weight loss
Extended management for bladder SUI, UUI/OAB? for GP
SUI
GP - medication (alpha-adrenergic agonist)
GP - Medication (antimuscurinic or topical eostrogen)
Pelvic floor muscle assessment x 3? + 1 extra extended
Superficial palpation of TA
Real time ultrasound
Vaginal examination (assess trauma,
Levator ani avulsion and sensory loss)
Biofeedback (WHP)
Explain transabdominal ultrasound and limitations?
Assess voluntary PFM contraction & length of hold
Empty bladder 1 hr prior and drink 500 ml within the hour. Look for bladder case and aim to visualise PFM contraction. Cue to reduce bracing or breath holding or glute/adductor co-contraction.
Limitations: 1. Only assess deep layer
2. Only movement, not strength
3. Requires moderate bladder volume
4. Can’t assess prolapse
Bowel dysfunction treatment x 4?
- E+A: go on first urge, avoid straining, seated < 10 mins, movement for motility
- hydration and fibre for BSS
- Positioning: foot elevation, thigh support, relax abs
- PFM relaxation / diaphragmatic breathing
Extended management for WHP with SUI, UUI and bowel symptoms?
SUI: Vaginal pessery
UUI/OAF: TTNS
Bowel: PFMT (down- training /relaxation)
PGP risk factors? x 6
- History of pregnancy
- Ortho dysfunction
- BMI
- Smoking
- Work dissatisfaction
- Belief of improvement
AN red flags x 2?
Fluid loss or vaginal bleeding
Neurological symptoms
PGP differential diagnosis x 3
Piriformis syndrome
Somatic pain lumbar spine
Myalgia
P –ERFECT and what to assess for during?
Endurance
Repetitions to fatigue
Fast contractions
Every Contraction Timed
**Assess for bracing, breath holding, pelvic tilt and glute/adductor squeezing
AN contra-indications x 2?
Poorly controlled T2 diabetes
Pre-eclampsia
ACOG guidelines for exercise
20-30 mins of moderate exercise most days
<60-80% of age predicted max maternal GR
Avoid head (thermoneutral)
Birth prep treatment x 4
- Positions for labour (constant movement) e.g. laying on 3 pillows with knees bent or laying on chair with knees bent
- Pelvic floor relax / brething techniques
- Perineal massage post 35 weeks (1-2 times per week)
- TENS in labour
5 types of PGP assessments to conduct? for SIJ and Pubic symphysis?
SIJ:
ASLR (0-5)
Long dorsal ligament palpation (> 5 seconds pain)
Thigh trust (posterior pain +-)
Pubic symphysis:
1. Modified trendelenburg (pain + pelvic drop)
2. Palpation of pubic symphysis (>5 sec pain)
how to do ASLR and what to look for?
Pain
0-5 difficulty
Pelvic stability / breath holding or coning
Does compression help?
PGP management (general) x 4
Reassurance ++
Support belts
Exercise
Manual therapy
Extended management for PGP (GP + WHP)
GP - pain medication
WHP - PFM concerns
Incontinence and prolapse management x 3?
- E + A on risk factors for prolapse such as constipation, modify heavy lifting, weight.
- PFMT reduces US during and post natal
- The knack (SUI) pre cue prior to cough
Referral (incontinence + prolapse) GP and WHP
WHP/Gyni/GP - ongoing UI symptoms
WHP/GP/Gyni prolapse assessment = VE+Pop-Q
Management of pregnancy related PGP x 6
- Modify SL standing activities
- Frequent position changes
- Log roll in bed
- mermaid into car
- Pillow between legs
- SIJ belts
**Core and pelvic floor exercises
**Avoid supine 16 weeks
