8: Antepartum Flashcards
Why is it essential for the fetus to make it to at least 27 weeks?
Lungs secrete surfactant to keep airway open
What is primigravida?
Female in her first pregnancy
What is primipara?
Female who has delivered a child after 20 weeks gestation
What is multigravida?
Female who has been pregnant more than once
What is multipara?
Female who has completed two or more pregnancies to the point of viability
What does the term “gravid” refer to?
Pregnant
What does the term “parity” refer to?
Delivered
When documenting pregnancy, what do T, P, A/M, and L stand for?
T = carried to term
P = pre-term
A/M = abortion/miscarriage
L = living
Describe G# PT - P - A - L
Pregnancy #, # carried to term, # pre-term, # abortions/miscarriages - # living
What does G3 P1-1-0-2 mean?
Third pregnancy, 1 carried to term, 1 pre-term, 0 abortions, 2 living children
What does G2 P0-1-1-1
Second pregnancy, 0 term, 1 pre-term, 1 abortion - 1 living child
What 6 reproductive changes happen with pregnancy?
- Uterine hypertrophy
- Myometrial walls thicken
- Increased uterine blood flow
- Increased vascularization of cervix
- Ovarian unlargement
- Vulvar edema
What 5 renal changes happen with pregnancy?
- Increased urine output
- Increased function
- Increased renal blood flow
- Increased GRF by 50%
- Increased ECF retention
What 6 cardiac functions increase with pregnancy?
- Blood volume
- Blood plasma
- Cardiac output
- Stroke volume
- HR
- Arterial blood pressure
What are 3 circulation changes that can happen with pregnancy?
- Vena cava syndrome
- Leg varicosities
- Leg cramps
What is vena cava syndrome?
Fetus compresses vena cava when supine
Based on abdominal anatomy, what is the optimal position someone who is pregnant to lie down?
Left sidelying
What 5 GI changes can happen with pregnancy?
- Gum hypertrophy
- Lower esophageal sphincter tone
- Decreased motility
- Decreased emptying time
- Constipation/hemorrhoids
How much weight gain is healthy for pregnancy?
25-35 lbs
What 4 pulmonary changes can happen with pregnancy?
- Increased oxygen consumption
- Increased progesterone
- Diaphragm elevation
- Respiratory alkalosis risk
What are 4 metabolic changes with pregnancy?
- Insulin levels
- Mineral demand
- Increased fat storage
- Fluid retention
What minerals have increased demand with pregnancy?
- Sodium
- Potassium
- Calcium
- Iron
What are common MSK changes with pregnancy?
- Cervical pain
- LBP
- Pelvic pain
- Carpal tunnel
- DRA
How does posture change with pregnancy?
- Anterior COG
- Increased ligament laxity
- Increased lordosis/kyphosis
- Decreased muscle tone
When are pregnant people at the highest risk for falls?
7 months - coincides with the peak rate of pelvic pain
What should you assess for fall risk?
Gait speed, short physical performance battery, functional reach test
Describe PGP anterpartum
56-72% of pregnancies
What are risk factors for PGP anterpartum?
- History of pregnancy
- Orthopedic dysfunction
- Increased BMI
- Smoking
- Work dissatisfaction
- Anxiety and depression
What are differentials for PGP antepartum?
Transient osteoporosis, DRA, lumbar/pelvic/hip dysfunction
Are support belts beneficial during pregnancy?
Inconclusive
What evidence is there for exercise for antepartum PGP?
Low risk with minimal adverse effects
What are the ACOG guidelines for exercise?
150 minutes per week of moderate intensity
What are the benefits of meeting the ACOG guidelines for exercise?
Decrease discomfort and stress, improve mood, less total weight gain, improve pain tolerance, shorter labor
What % of women meet the ACOG guidelines for exercise?
15%
What are the 7 precautions for exercise antepartum?
- Anemia
- Heavy smoker
- IUGR in current pregnancy
- Poorly controlled DM, hypertension, hypothyroidism
- Extreme obesity
- BMI < 12
- Cardiac arrhythmia
What are the 9 contraindications for exercise antepartum?
- Complications that exclude activity
- Persistent bleeding in 2/3 trimester
- Incompetent cervix
- Ruptured membranes
- Hypertensive disorders
- Multiple gestation risk for premature labor
- Pre-eclampsia
- Placenta previa after 26 weeks
- RLD
What are warning signs to stop exercising antepartum?
- Dyspnea without exertion
- Dizziness
- Headache
- Muscle weakness
- Calf pain and swelling
- Chest pain
- Decreased fetal movement
- Vaginal bleeding
- Uterine contractions
- Suspected ROM
What are exercise guidelines for someone who was sedentary prior to becoming pregnant?
Short bouts of exercise for 10-15 minutes, 2-3x per day
What are other positional precautions for exercise?
- Abdominal compression
- Supine longer than 5 minutes
- Buttock higher than chest
- Strain pelvic floor and abdominals
Why should you avoid positions with the buttock higher than the chest?
Can cause the baby to breach
What is diastasis recti?
Separation of the rectus abdominis muscle
What is the cause of diastasis recti?
Muscle weakness, hormonal changes, exertion on abdominal wall by growing fetus
How do you assess for diastasis recti?
Ask patient to raise their head and shoulders off the table in hooklying
What is the normal measurement when assess for diastasis recti?
1-2 finger width
What measurement is considered pathologic for diastasis recti?
> 2 fingers
What are interventions for diastasis recti?
- Rectus abdominus training
- Eccentric training
- Modalities
- Diaphragmatic breathing
- Functional
