7. pregnancy Flashcards
What is the primary recommendation for OB and related providers regarding perinatal depression?
Screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool
This recommendation emphasizes the importance of early detection of mental health issues in pregnant and postpartum women.
What specific questions should be asked during screening for perinatal depression?
Ask about mood, intrusive or frightening thoughts, and inability to sleep even when the infant is sleeping
These questions help identify specific symptoms that may indicate depression or anxiety.
When should additional screening for depression and anxiety occur after initial screening during pregnancy?
During the comprehensive postpartum visit
This ensures ongoing monitoring of mental health after childbirth.
What factors warrant particularly close monitoring in patients regarding perinatal mood disorders?
Current depression or anxiety, a history of perinatal mood disorders, risk factors for perinatal mood disorders, or suicidal thoughts
These factors indicate a higher risk for severe mental health issues.
What should providers be prepared to do if a patient screens positive for perinatal depression?
Initiate medical therapy, refer patients to appropriate behavioral health resources, or both
This ensures that patients receive the necessary support and treatment.
What systems should be in place for patients diagnosed with perinatal depression?
Systems should ensure follow-up for diagnosis and treatment
Follow-up care is crucial for effective management of mental health in perinatal patients.
What is the prevalence of perinatal depression among women?
Affects one in seven women
This statistic underscores the commonality of perinatal depression.
How does the prevalence of perinatal depression differ between genders?
Women are affected more than men
This highlights the gender-specific nature of the condition.
Why does perinatal depression often go unrecognized?
Changes in sleep, appetite, and libido may be attributed to normal pregnancy and postpartum changes
This can lead to underdiagnosis and inadequate treatment.
What is the most frequently used screening tool for perinatal depression?
Edinburgh Postnatal Depression Scale (EPDS)
The EPDS includes anxiety symptoms, which are a prominent feature of perinatal mood disorders.
What symptoms does the EPDS include and exclude?
Includes anxiety symptoms and excludes constitutional symptoms of depression, such as changes in sleeping patterns
This distinction is important for accurately assessing perinatal mood disorders.
What is the significance of good sensitivity in tests?
Indicates the test’s ability to correctly identify patients with a condition
High sensitivity reduces the likelihood of false negatives.
What does the posterior pelvic pain provocation test assess?
Identifies pain associated with sacroiliac joint dysfunction
Useful for diagnosing sacroiliac joint-related pain.
What is Menell’s test used for?
To assess the mobility and pain response of the hip in prone position
A specific test for evaluating hip and lower back pain.
What does Patrick’s faber test evaluate?
Identifies hip joint or sacroiliac joint pathology
Involves flexing, abducting, and externally rotating the hip.
What is the purpose of Trendelenburg’s test?
Assesses hip abductor strength and stability
Good sensitivity in pubic symphysis
Positive test indicates weakness in the gluteus medius.
What does palpation of the symphysis assess?
Evaluates tenderness or pain in the pubic area
Good sensitivity in pubic synthesis
Important for diagnosing pelvic girdle pain.
True or False: Pain provocation tests are more reliable than tests requiring palpation or evaluation of topography.
True
Pain provocation tests provide more consistent results.
What is postpartum diastasis recti?
Normal and expected adaptation of abdominal wall tissues in response to fetal growth
What may indicate a pathological condition of postpartum diastasis recti?
If the interrectus distance (IRD) remains large or interferes with functional activities, participation, or quality of life
What are the consequences of increased intra-abdominal pressure in postpartum diastasis recti?
Thinning and widening of the linea alba and a tendency for midline bowing
What is the primary cause of postpartum diastasis recti?
Myofascial stretch of the systems supportive of the abdominal viscera, rather than muscle separation
What do recent research and guidelines emphasize regarding postpartum diastasis recti management?
Pressure and force regulation in the core region, with a focus on transverse abdominis support and lumbopelvic function
What are the two phases of postpartum exercise guidelines?
Early postpartum and late postpartum
What should be avoided during early postpartum exercise?
Exercises that concentrically engage the superficial abdominal muscles, do not maintain continence mechanisms, and high-impact exercise
What type of exercises are prioritized during the early postpartum period?
Exercises that facilitate optimal coactivation of the inner unit muscles and promote tension-free diaphragmatic breathing
What habits are encouraged to manage intra-abdominal pressure in early postpartum?
Habits that reduce repeated increases in intra-abdominal pressure
What is emphasized in the late postpartum phase of exercise?
Importance of pressure and force regulation in the core region and reliance on transverse abdominis support and lumbopelvic function
What was the outcome of twelve of the fourteen studies on conventional abdominal strengthening?
Reported pre-to post-reduction in IRD at least at one site along the linea alba
List some exercises included in the studies for postpartum diastasis recti.
- Abdominal draw-in/static abdominal contraction exercises
- Bridging
- Head lift
- 4-point arm lift
- Controlled leg raise/lift
- Pelvic clock rotations
- Kegels
- Plank
- Posterior pelvic tilt
- Postural positioning/correction
- Reverse trunk twist
- Sit-ups/reverse sit-ups
- Squats
What adjunct modalities were included in the studies?
- Abdominal binding
- Controlled breathing/exhalation
- Education
- Electrical stimulation
- Taping
What improvements were attributed to deep core stability exercises?
Targeting the TrA, pelvic floor, multifidus, and diaphragm, which stabilize the trunk and support the spine and pelvis
Some studies showed reduced distance of rectus separation
What was the conclusion regarding motor control exercises?
They significantly reduced IRD by optimally engaging and associating fitness capacity between inner and outer unit muscles
True or False: Exercise in conjunction with electrical stimulation has benefits with and without exercise.
True
Fill in the blank: Exercise in conjunction with _______ did not provide signigicant reduction of IRD
Taping
What are the nerves of the pelvis associated with pregnancy/childbirth syndromes?
Sciatic, obturator, femoral, lateral femoral cutaneous, pudendal
What is the prevalence of soft tissue edema in pregnant women?
80% Peaks at last 8 weeks
How much weight gain increases force on joints during pregnancy?
20%. Gain of 20% can increase force on joints by 100%
What is the maximum widening of the pubic symphysis during pregnancy?
10mm
What is osteitis pubis?
Bony resorption about the symphysis followed by spontaneous reossification
What is the prognosis for osteitis pubis during pregnancy?
Good
course of conidtion may be long
Self limiting activities several days to weeks before gradual pain subsiding
What are common treatments for pubic pain of pregnancy?
Bedrest, ambulation with walker, anti-inflammatories postpartum, intra-symphyseal injection
What characterizes a true rupture of the symphysis pubis?
Sudden pain, audible crack, pain radiating into back or thighs, tissue swelling
What are the risk factors for low back pain during pregnancy?
Maternal age, history of previous low back pain, increases with each pregnancy
What are proposed causes of low back pain during pregnancy?
Mechanical strain, pelvic ligamentous laxity, SI pain, vascular compression
What is the incidence of nerve injury during pregnancy?
0.08-1%
What is Carpal Tunnel Syndrome and its common symptoms during pregnancy?
Pain and paresthesias in the first three digits, often bilaterally, worse at night
What is the prognosis for Carpal Tunnel Syndrome postpartum?
95% resolution within 2 weeks
What are the symptoms of Meralgia Paresthetica?
Burning, pain, or numbness in lateral thigh
What is femoral neuropathy and its consequence during labor?
Compression of femoral nerve under inguinal ligament leading to functional impairments
What are the symptoms of lumbosacral plexopathies?
Proximal or distal lower limb weakness, foot drop
What is DeQuervain’s syndrome?
Inflammation of abductor pollicis longus and extensor pollicis brevis tendons
What is transient osteoporosis of the hip?
Rare condition presenting with pain during weightbearing in the third trimester
What are some MSK related injureid that can happpen during preganacy
Hip labrum and knee meniscus may be at greater risk of injury during pregnancy
Sacral and tibial stress fractures, rib fractures, and vertebral fractures are reported during pregnancy related to OA or increased strain during 3rd trimester
Recurrent ankle sprains or patellofemoral symptoms
What are absolute contraindications to aerobic exercise during pregnancy?
Hemodynamic significant heart disease, restrictive lung disease, incompetent cervix, multiple gestation at risk for premature labor, persistent 2/3 trimester bleeding, placenta labor during current pregnancy, ruptured membranes, pre-eclmapsia, pregnancy induced hypertension pregnancy induced hypertension
What are relative contraindications for aerobic exercise during pregnancy
Severe anemia, unevaluated maternal cardiac arrhythmia, chronic bronchitis, poor controlled type one diabetes, extreme obesity, underweight BMI under 12, extreme sedentary lifestlye, intrauterine growth, poor HTN orthopedic limitations seizure disorder poor hyperthyroidism heavy smoker
What are the recommended exercise guidelines for pregnant women?
Moderate exercise intensity, avoid high-risk activities, and seek medical advice if inactive
What are warning signs to terminate exercise while pregnant
Vaginal bleeding, dyspnea, dizziness, headache, chest pain, weakness, calf pain/swelling, preterm labor, decreased fetal movement, amniotic fluid leakage
What are some contraindications for physical agents during pregnancy?
Diathermy, therapeutic ultrasound to produce heat, e-stim to low back or abdomen
What is the role of therapeutic exercise during pregnancy?
Helps manage musculoskeletal dysfunction and control peripheral edema
Fill in the blank: The typical presentation of pain with weight bearing through the hip in the third trimester is indicative of _______.
Transient osteoporosis of hip
True or False: Exercise is protective against lower limb pain during pregnancy.
False
its not causative either
What is the recommended Borg Scale intensity for exercise during pregnancy?
12-14 (somewhat hard)
What are the symptoms of avascular necrosis of the femoral head?
Pain with weight bearing in hip, pelvis, or groin, may radiate to knee
What is the typical prognosis for natural recovery from avascular necrosis of the femoral head during pregnancy?
Good if OA is associated with pregnancy and not preexisting condition
What are common treatments for low back pain during pregnancy?
Activity modifications, scheduled rest, pelvic tilts, aquatic exercise, modalities
HR recomndation for exericse during pregnancy
Do NOT use %maxHR as heart rate response is blunted during pregnancy
Exercise rec for sedentary woman who want to get started on exericse
Previously sedentary women start with 15 minutes exercise 3x/week working towards total of 30 minutes 4x/week
What is an elective C-section?
A planned operation to deliver a baby before the onset of labor
Elective C-sections are scheduled deliveries, unlike unplanned ones that occur during labor.
What is a late-stage cesarean?
A cesarean delivery performed even though the cervix is fully dilated, typically occurring during the late stages of labor
This may occur due to complications like fetal distress or an abnormal fetal position.
Which delivery method is associated with significantly greater odds of stress incontinence?
Spontaneous vaginal birth
Compared to cesarean without labor, spontaneous vaginal birth shows higher rates of stress incontinence.
What tools are used in operative vaginal birth?
Forceps or vacuum
Increased chance of prolapse and PFD
What are the most common pelvic floor disorders reported amoung post-child birth ?
- Stress urinary incontinence (SUI) 11%
- Overactive bladder (OAB) 8%
- Anal incontinence
These disorders were identified as prevalent among women post-childbirth.
How does anal incontinence differ among delivery methods?
Symptoms of anal incontinence did not differ
This suggests that the method of delivery may not have a distinct impact on anal incontinence.
What percentage of women reported bothersome symptoms of prolapse?
3%
75% of women with prolapse to or beyond the hymen were asymptomatic or minimally symptomatic
However, 7% demonstrated prolapse to or beyond the hymen based on physical examination.
PFD outcomes for vaginal birth
women who had experienced at least one vaginal birth were significantly more likely to report stress incontinence and prolapse to or beyond the hymen
relationship of prolpase and operative delivery
Symptoms of prolapse were uncommon across all groups but were significantly associated with operative delivery
Age of most likely to report bothersome prolapse symptoms
After age 35 women were more likely to report
What is the correlation between obesity and prolapse symptoms?
Obese women were significantly less likely to demonstrate prolapse on examination
Symptoms of prolapse were expressed differently among obese women.
What factors increase the likelihood of reporting bothersome prolapse symptoms?
- Delivering the first baby after age 35
- Operative delivery
These factors were associated with increased reports of bothersome prolapse symptoms.
What impact does a history of operative delivery have on stress incontinence and overactive bladder?
The adjusted odds of stress incontinence and overactive bladder were more than quadrupled
This highlights the significant risk associated with operative deliveries.
True or False: Prolapse symptoms are strongly correlated with objective measures of prolapse.
False
Prolapse symptoms are weakly correlated with objective measures.
What type of exercise significantly reduced pain and functional disability more than usual prenatal care?
Land-based exercise
Various formats of land-based exercise showed effectiveness.
What was the impact of water gymnastics on sick leave due to low-back pain during pregnancy ?
Significantly reduced sick leave
More effective than usual prenatal care.
Which pain management method significantly improved pain and functional disability more than acetaminophen, exercise, or usual prenatal care?
TENS
Transcutaneous electrical nerve stimulation (TENS) was notably effective.
How effective was the supervised progressive muscle relaxation program compared to usual prenatal care?
More effective at significantly reducing pain and functional disability
Included music and was better than resting instructions.
What was the effect of using pelvic support belts on pain relief or functional disability during pregnancy ?
No significant difference
Between women who wore two types of pelvic support belt.
What potential benefit does Kinesio tape provide compared to exercise during pregnancy ?
Might provide more pain relief
Suggests effectiveness in pain management.
What is not recommnded in pelvic pain during pregnacy due to limited siginificance or no difference compaared to usual care
- Group exericse + info
- Ridgid pelvic belt + info
- Birth Prep program (exericse + Info )
In the number of women reporting pelvic pain.
Which method was better than stabilizing exercises at reducing evening pelvic pain during pregnancy ?
Acupuncture
However, no better than sham acupuncture for improving pelvic pain.
What was the outcome of using a non-rigid lumbo-pelvic belt with information?
Significantly reduced pain and functional disability (unlike a ridgid belt)
More effective than exercise plus information alone.
What was the effect of a 12-week exercise program on the risk of reporting lower back pelvic pain?
Significantly reduced the risk
However, group exercise plus information was no better than usual care for prevention.
What type of intervention significantly improved pain and related functional disability, but not sick leave?
Multi-modal intervention
Included manual therapy, exercise, and education.
When can acupuncture be started to reduce pain, leading to better than usual prenatal care?
At 26 weeks’ gestation. Improved ADL capacity better than PT, sham and usual prenatal care. Reduced pain
More effective if started later in pregnancy.
What conflicting results were found regarding exercise programs?
Effectiveness for preventing LBP, PP, or LBPP
Results varied significantly.
What was the outcome of osteopathic manipulative treatment (OMT) during the third trimester of pregnancy?
Prevented 40 cases of LBP-related functional disability for every 100 women
Indicates potential efficacy of OMT.
What caution should be taken regarding the evidence quality in this review?
Results must be considered with caution
Generalizing to all pregnant women is likely premature.
What shoudl be kept in mind for SIJ pain management and testing
tests for detecting motion or position of the SIJ unusable for the valid detection of SIJ movement
directly attributing SIJ-related pain to movement dysfunctions causing increased peripheral nociceptive input from SIJ tissues is flawed reasoning—mistaking association for causality
Positive pain provocation tests are likely indicative of increased sensitivity of the tissues, which might to some degree be subsequent to tissue loading
what beliefs can healthcare professionals play a dominant role in the development/reinforcement of ?
- Identity beliefs describing explanatory and prognostic labels: “I have an unstable pelvis.”
- Beliefs about potential causes: “I have pelvic pain because I have a weak core.”
- Beliefs about consequences: “My pelvis goes out of place.”
- Beliefs about perceived self-control over pain: “I should stop when I feel any pain.
- Expectations of how long the pain will last: “I will always have a weakness now so I must be carefu
in order to align Treatment Rationale With Explanation of Pain, how should an explaination of load to sensitive tissue be framed ?
- Explain how pain works tailored to the individual presentation (encompassing a biopsychosocial model).
- Constructively address unhelpful/aberrant health beliefs.
- Promote reassurance regarding structural integrity of the pelvis/SIJ.
- Design and discuss a management plan that is aligned with points 1 to 3.
What types of pain does the PGQ focus on?
Pelvic Girdle Pain (PGP) and Low Back Pain (LBP) and evening pain
The questionnaire is specifically designed for women experiencing these types of pain.
What MIC score can discriminate between participants who improved and those who did not improve?
MIC of 6
This value is specifically for participants with low baseline PGQ scores.
What does a total score and activity subscale change score smaller than 25 indicate?
Insignificant change
A change score of 26 or larger is detectable and significant.
What is the significant change score for the symptom subscale?
21 and higher
Scores below this threshold are considered insignificant.
Does the PGQ measure disability, and how is it interpreted?
Yes, measures disability; higher score = worse
This means that a higher PGQ score indicates greater disability.
What are the anatomic changes during pregnancy?
Weight gain and shift in center of gravity changing lordosis
These changes can lead to increased force across joints during weight-bearing exercises.
What percentage of women experience low back pain (LBP) during pregnancy?
60%
Strengthening exercises can help alleviate LBP.
What cardiovascular changes occur during pregnancy?
Blood volume, HR, Stroke volume, cardiac output increase; systemic vascular resistance decreases
These changes support increased metabolic demands.
What is the effect of the supine position after 20 weeks of pregnancy?
May cause aortocaval compression from the gravid uterus causing hypotension
This can lead to reduced blood flow to the mother and fetus.
How does minute ventilation change during pregnancy?
Increases to 50% due to increase in tidal volume. Oxygen availability for anaerobic exercise is limited due to pulmonary reserve decrease
This is important for meeting the increased oxygen demands.
What is the effect of exercise on fetal heart rate during moderate exercise?
Fetal HR increases by 10-30 beats
This indicates a response to maternal exercise.
What are temperature regulation considerations for pregnant women during exercise
Temperature regulation depends on hydration and environment. Exercise does not increase core temperature to concerning level like hot tubs saunas and fevers due which caused neural tube defects
What are the benefits of exercise in pregnancy
Higher incidence of vaginal delivery lower incidence of colon excess gestational weekend, gestational diabetes mellitus, gestational hypertensive disorders, preterm birth, cesarean birth, lower birth weight
What is the observed effect of vigorous exercise in the third trimester on infant weight?
Infants weighing 200-400 grams less, without risk of growth restriction
Vigorous exercise is defined as 85% of capacity.
What are the benefits of exercise during pregnancy?
- Decrease risk of GDM
- C-section
- Operative vaginal delivery
- PP recovery time
- Prevention of depressive disorders
- Less concerns on MSK pain
Significant reduction of GDM in obese pregnant mothers.
What is the recommended exercise duration and frequency during pregnancy for moms with GDM and obesity
30 mins x 3x/week of cycling
Aerobic exercise for 35-90 mins 3-4x/week is not associated with risk of preterm birth.
Exercise recs for preg to reduce GDM, HTN, C sec, and preeclampsia
30-60 mins
2-7 xweek
Compared to sedentary woman
Aerobic exercise for 35-90 mins 3-4x/week is not associated with risk of preterm birth
what is vigourous exercise
Vigorous exercise into 3rd trimester, infants weighing 200-400 grams less, withou risk of of growth restriction
Vigorous defined as 85% of capacity
30 min of strenuous exercises was tolerated well by women in 2nd trimester
What are the Five A’s in exercise program recommendations during pregnancy?
- Ask
- Advise
- Assess
- Assist
- Arrange
These steps help in creating a supportive exercise environment.
Fill in the blank: Women who exercised with higher intensity can continue at their previous _______.
intensity
Those new to exercise should have a gradual progression.
What should be monitored during exercise in pregnant women?
- Thermal environment
- Caloric intake
- Water intake
These factors help maintain safety and health during exercise.
What is the recommendation for high-level athletes during pregnancy?
- Maintain caloric intake
- Can have high intensity in 3rd trimester
- Avoid overheating
Careful consideration of valsalva maneuver is advised.Careful with first and second trimester and exercise that exceed greater than 90% HR max
True or False: Prolonged bed rest is recommended during pregnancy.
False
It leads to venous thromboembolism, bone demineralization, and deconditioning.
What is the recommendation for postpartum pelvic floor (PF) exercises?
Can start immediately
Some women can return to activity within a few days of delivery.
What effect does cardiovascular exercise have postpartum?
Can help with milk production
It does not automatically reduce milk production.
Rec for exercise intensity
Somewhat hard 13-14 on the borg scale or talk test can be used
