Ante-natal education

Question 1

contraindications of exercise in pregnant women

Answer 1

Placenta previa after 26/40
Incompetent cervix
Multiple gestation at risk for premature labour
Persistent bleeding in 2nd-3rd trimester
Premature labour during the current pregnancy
Preterm rupture of membranes
Pre-eclampsia
Pregnancy-induced Hypertension

Question 2

relative contraindications for exercise in pregnant women

Answer 2

Severe anaemia
* Unevaluated maternal cardiac
arrhythmia
* Chronic bronchitis
* Malnutrition/ Eating disorder
* Morbid Obesity (BMI>40)
* Poorly controlled Diabetes
Mellitus

Question 3

how is gestational diabetes diagnosed

Answer 3

Diagnosed when blood sugars are higher than normal in pregnancy by
glucose tolerance test (GTT) at 27/40

Question 4

what are the possible complications in gestational diabetes

Answer 4

Can result in babies with heavier birth weight and increased risk of
diabetes and obesity

Question 5

how is a gestational diabtes diagnosis tested

Answer 5

patient fasts for 24 hours is given a sugary drink to consume afterwards and blood glucose levels are tested

Question 6

positive impact of exercise in gestational diabetes

Answer 6

lowers blood glucose levels - inc. insulin sensitivity
manage symptoms
may help prevent gestational diabetes in future pregnancy and onset of T2DM

Question 7

pelvic girdle pain definition

Answer 7

pain experienced between
the posterior iliac crest and the gluteal fold, particularly in the
vicinity of the sacroiliac joints (SIJ). The pain may radiate in the
posterior thigh and can also occur in conjunction with/or
separately in the symphysis. (Vleeming et al, 2008)

Question 8

describe epidemiology of pelvic girdle pain amongst pregnant women

Answer 8

20%

Question 9

describe epidemiology of low back pain amongst pregnant women

Answer 9

50%

Question 10

what functional difficulties are pregnant women with low back pain expected to have

Answer 10

getting up from a sitting
position, turning over in bed, prolonged sitting, prolonged
walking, dressing/undressing and lifting and carrying small
weights.

Question 11

treatment plan for pelvic girdle pain

Answer 11

Education on nature of PGP
Inform and reassure
Postural advice
Movement strategy advice
Individualized exercise programme
Manual therapy
Supports

Question 12

function of pelvic floor

Answer 12

Prevent incontinence
Support pelvic organs and weight
of baby and prevent prolapse
Allow bladder and bowel emptying
Length and stretch for delivery
Sexual function
Part of core muscles supporting
pelvis and low back

Question 13

describe frequency of pelvic floor muscle exercises

Answer 13

10 long hold
10 quick
3 times a day

Question 14

what are good habits to adapt for a healthy bladder

Answer 14

1.5-2 litre fluid intake throughout the day. Limit caffeine or other
bladder irritants
Voiding every 3-4 hours, sit rather than hover

Question 15

what are good habits to adapt for a healthy bowel

Answer 15

Balanced diet, fibre, avoiding straining, correct toileting position
and pushing technique

Question 16

at what gestation period can early pregnancy class be offered

Answer 16

18-24 wks

Question 17

what is offered in an early pregnancy class

Answer 17

18-24 weeks gestation
* Promotion of exercise and guidelines for same
* Pelvic floor exercises
* Good bladder and bowel habits
* Back care, posture and ergonomics
* Coping strategies for minor discomforts
* Referral pathway for specific problems

Question 18

what is the content in labour classes

Answer 18

exposes your mani concerns about labour and opens a discussion on labour
review of labour - signs and stages
strategies for 1st stage of labour
2nd stage
postnatal recovery
baby’s physical development

Question 19

1st stage labour

Answer 19

from when contractions start til baby is pushed put
uterine contraction to form pathway for baby to come out
cervix thins and dilates
lasts 12 hours on average
want the pregnant person to stay at home for most of early stage labour to increase oxytocin levels

Question 20

techniques to manage contractions

Answer 20

breathing - breathe for 2 seconds and breathe out for 4 seconds
rubbing - rubbing muscle fibres of glutes
rocking - helping to stretch and open birth canal to 30%
rest - sight out at the end of each contraction
ice/heat
upright position

Question 21

transition stage

Answer 21

between end of first stage and beginning of 2nd stage
contractions closer together
can last up to an hour

Question 22

describe 2nd stage of labour

Answer 22

cervix fully dilated and ends with delivery of baby
last 2 hrs
upright gravity assisted positions
normal lumbar spine curve
chin tucked not flexed
PGP

Question 22

What is a peanut ball and how does it help

Answer 22

ball oval or peanut shape placed between legs to open pelvis and promoted dynamic position to assist the baby to move done vaginal canal
can be used in 1st and 2nd stage
can be used in conjunction with epidural

Question 22

how does the flexed position of the lumbar spine affect birth canal rectus abdominus and pelvic floor

Answer 22

curves birth canal and
closes pelvic floor, encourages separation of rectus
abdominus muscles

Question 22

recommended pushing technique during 2nd stage of labour

Answer 22

 Widen the waist and brace the abdomen out
 Breathe out as you push
 Push as if emptying bowels
 Keep open glottis and make a noise, “mooing”
 Keep abdomen braced and repeat
 Avoid holding breath for entire push

Question 23

disadvantages of purple pushing

Answer 23

dec. mother’s BP => reduced placental blood flow
infant HR slows => hypoxia
mother - exhausted, stressed, lactic acid build up
non reassuring foetal heart rate patterns
inc. risk of dvt
Inc risk of forceps
pelvic floor nerve and muscle damage

Question 24

benefits of perineal massage

Answer 24

reduce perineal trauma and need for episiotomy among primiparous women during childbirth

Question 25

dosage of perineal massage

Answer 25

daily from week 34 of pregnancy, 10 mins per day

Question 26

how should perineal massage be conducted

Answer 26

before session - empty bladder, wash hands, after bath, use mirror position for comfort use mirror
lubrication with natural oil
massage vaginal wall in u shape movement stretch and hold
integrate PF exercise

Question 27

post natal recovery

Answer 27

explanation of role in women’s health physio post natal
bed mobility
circulatory exercises
DRAM management
PF exercises
healthy bladder habits
Abdominal exercises
Specific advice after C section