Class 1 - Pregnancy Theory Flashcards
A component of the biopsychosocial lens referring to physiological or pathological factors.
Bio
A component of the biopsychosocial lens referring to thoughts, emotions and behaviours, such as psychological distress, fear/avoidance beliefs, current coping methods and attribution.
Psycho
A component of the biopsychosocial lens referring to socio-economical, socio-environmental and cultural factors, such as work issues, family circumstances and benefits/economics.
Social
The following are examples of __________ factors:
- Shifts in posture and alignment
- Changes to the musculoskeletal system (e.g. joints and ligaments, muscles and fascia, weight gain, re-distribution of weight)
- Changes to the hormonal system
- Changes to the organ system
- Changes to the epidermis
Biological
The following are examples of __________ factors:
- Increased susceptibility to postpartum depression (PPD) and anxiety (PPA)
- New fears related to pregnancy, postpartum and parenting
- New fears related to birth process
- Body image issues
Psychological
The following are examples of __________ factors:
- Changing roles in the family unit
- Changes to personal identity
- Increased sense of responsibility
- Increased home environment workload
- Possible changes in occupational workload, maternity leave, isolation from colleagues and changes to professional identity
Social
The average full-term pregnancy is ___ weeks ( ____ days).
40 weeks
280 days
Gestation can range from ___ to ___ weeks ( ____ to ____ days).
37-41 weeks
259-287 days
Premature birth occurs between ___ and ___ weeks gestation.
20 and 37 weeks
Babies born before the ____ week are classified as premature.
37th week
The first trimester is occurs from ___ to ___ weeks gestation.
0-13 weeks
The second trimester occurs from ___ to ___ weeks gestation.
14-27 weeks
The third trimester occurs from ___ to ___ weeks gestation.
28-40 weeks
Postpartum commences once the ________ is birthed.
Placenta
When the baby presents in a normal head down position, which occurs in the later weeks of pregnancy.
Cephalic/Vertex Presentation
When the baby presents in a buttock down position.
Breech Presentation
What fetal presentation is shown in the following image?
Cephalic/Vertex Presentation
What fetal presentation is shown in the following image?
Breech Presentation
When it comes to health care in Ontario, what are the 3 services pregnant patients have the choice of for pre-natal and postpartum care?
1) Midwife
2) Obstetrician
3) Family Doctor (GP)
A labour support role within our scope of practice as an RMT, but requiring additional training.
Doula
T/F - Doula services are not covered by OHIP for pregnant patients.
True
Some common side effects of __________ include:
- Edema
- Constipation
- Haemorrhoids
- Bladder & yeast infections
- Dyspnea
- Heartburn
- Nasal congestion & nose bleeds
- Spider angioma & varicosities in legs/vagina
- Mood disorder
- Nausea & vomiting
Pregnancy
A hormone that is only produced during pregnancy.
Human Chorionic Gonadotropin (hCG)
hCG is responsible for guaranteeing the ovaries produce _______ and __________ in the first 2 months of gestation before the placenta takes over.
Estrogen
Progesterone
A hormone produced in the ovaries that promotes growth of uterine muscles and blood supply.
Estrogen
T/F - Progesterone increases water retention, adipose tissue and skin darkening.
False - Estrogen increases water retention, adipose tissue and skin darkening.
Estrogen works in tandem with ________ to initiate labour.
Oxytocin
A hormone produced by the ovaries and placenta that relaxes the uterus, blood vessel walls, stomach walls, bowels and ligaments.
Progesterone
T/F - Progesterone increases blood pressure and can decrease constipation.
False - Progesterone decreases blood pressure and can increase constipation.
During late pregnancy, __________ decreases allowing contractions to take place.
Progesterone
A hormone produced by the ovaries and placenta that relaxes and softens ligaments, cartilage and cervix.
Relaxin
Laxity in ligaments, tendon and fascia contribute to joint ________ and strain on all joints, particularly weight bearing structures, especially in the ______ spine and pelvis.
Instability
Lumbar
T/F - Relaxin allows for stretch of tissues during pregnancy and facilitates opening of pelvic joints during labour and delivery.
True
A hormone produced by the hypothalamus and released by the pituitary glands that stimulates uterine contractions, which triggers and promotes labour.
Oxytocin
________ is responsible for the “_______” reflex during breastfeeding and creates feelings of calmness and well-being.
Oxytocin
Let Down
An organ for producing hormones and exchanging nutrients and waste products that is completely formed by 12 weeks of gestation.
Placenta
The ________ _____ attaches from the placenta to the baby’s navel and is responsible for providing oxygen and nutrients to the baby.
Umbilical Cord
The ________ acts as a strong barrier for bacteria in the pregnant patient’s bloodstream, however most viruses and drugs will pass to baby.
Placenta
T/F - The pregnant patient’s bloodstream and baby’s bloodstream are separate.
True
The placenta is responsible for removing the baby’s waste products and the pregnant patient will dispose of waste through the ________ and ______.
Kidneys
Lungs
During pregnancy, total blood volume increases by ___ to ___% ( __ to __ pounds).
45-50%
2-3 pounds
T/F - Blood volume returns to normal volume by 8 weeks postpartum.
False - Blood volume returns to normal volume by 6 weeks postpartum.
The heart enlarges in pregnancy by ___% and body temperature increases.
12%
Blood pressure ________ in the 2nd trimester and then ________ in the 3rd trimester.
Declines
Increases
_____ changes are a normal part of pregnancy and include:
- Presence or disappearance of acne
- Increase or decrease in hair growth
- Darkening or stretching of _____
Skin
During pregnancy, the linea _____ may darken to the linea _____.
Alba
Nigra
What is shown in the following image?
Linea Nigra
A skin disorder characterized by darkened macules on the face and referred to as the mask of pregnancy.
Chloasma (Melasma Gravidarum)
What skin disorder is shown in the following image?
Chloasma (Melasma Gravidarum)
Skin will stretch due to possible ______ or baby/uterine growth. Therefore, abdominal massage in the 2nd and 3rd trimester is beneficial.
Edema
A term given to stretch marks occurring during pregnancy, shown in the following image.
Striae Gravidarum
__________ fascia stretch marks are white, and _______ fascia stretch marks become red or dark brown.
Superficial
Deeper
During pregnancy, airway resistance is _______ and total lung capacity decreases by __% at term.
Reduced
5%
__________ directly impacts the lungs and the respiratory system by relaxing the bronchial musculature.
Progesterone
In later stages of pregnancy, the enlarged uterus presses against the ________ and creates issues with apical breathing.
Diaphragm
The average weight gain during pregnancy is ___ to ___ pounds, and by the end most of this weight is on the _______ portion of the body.
20-35 pounds
Anterior
Which muscles are most affected supporting the weight of the abdomen three dimensionally?
Abdominals, iliopsoas, erectors, adductors, hip rotators and pelvic floor.
Which muscles are most affected supporting the weight of the breasts?
Rhomboids, pectorals, subscapularis, scalenes and levator scapulae.
Joints and ligaments become lax due to the hormone _______. Therefore, muscles will _______ in MRT to support these structures, which places a great deal of strain on the musculature.
Relaxin
Increase
During pregnancy, there are possible dysfunctions of the _____ ________ or sacroiliac joints.
Pubic Symphysis
What condition is shown in the following image?
Symphysis Pubis Dysfunction
Breast tissue and nipples become very sensitive in the ___ trimester, which is important to consider when treating in prone.
1st Trimester
Areolas and nipples _______ and become darker due to the hormone ________.
Enlarge
Estrogen
First food for baby that is produced in the 3rd trimester. Milk can take __ to __ days to come in.
Colostrum
3-4 days
T/F - Pregnant patients experience increased nausea and vomiting in the 1st trimester due to hormones.
True
A rare disorder characterized by severe and persistent nausea and vomiting during pregnancy that may necessitate hospitalization due to dehydration.
Hyperemesis Gravidarum
Constipation during the 1st trimester is due to _________ changes, but during the 3rd trimester it is due to the ______ of the baby and uterus.
Hormonal
Weight
A burning sensation in the esophagus caused by acidic stomach contents creeping back up.
Heartburn
T/F - In pregnancy, heartburn is due to hormone changes, especially relaxin.
False - In pregnancy, heartburn is due to hormone changes, especially progesterone.
During pregnancy, fluids increase in the body by ___% and the _______ must filter this extra fluid.
50%
Kidneys
Increased urination during the ___ trimester is due to hormonal changes, but during the ___ trimester it is due to the weight of the baby and uterus.
1st Trimester
3rd Trimester
Symptoms due to ________ changes, which occur during the ___ trimester include:
- Possible exhaustion
- Increased urination
- Nausea & vomiting
- Constipation
- Heartburn
- Headaches
- Food and odour aversions
- Increased breast size, nipple tenderness and darkening of areola
- Mood changes (e.g. anxiety and depression)
Hormonal
1st Trimester
Symptoms due to ________ changes, which occur during the ___ trimester include:
- Dull ache above pubic bone
- Musculoskeletal concerns (e.g. heavier breasts can increase strain on HNS)
- Laxity of joints and ligaments
- Changes to pelvic floor
Physical
1st Trimester
T/F - Relaxin is present from 8 weeks onwards affecting joints and ligaments.
False - Relaxin is present from 10 weeks onwards affecting joints and ligaments.
Symptoms due to ________ changes, which occur during the ___ trimester include:
- Birth parent may be anxious about pregnancy
- Worried about maintaining pregnancy and baby
Emotional
1st Trimester
___ trimester treatment planning includes and considers:
- Addressing MSK concerns (e.g. postural assessment)
- Increasing relaxation (e.g. support person regarding emotional changes)
- Effects of relaxin on joints and ligaments
- Treatment length regarding exhaustion
- Positioning for heartburn and breast tenderness
- Reflexive techniques for constipation
- Possible hormonal headaches (e.g. incorporating HNS massage)
- Breast massage for pain and congestion
1st Trimester
Contraindications for massage during the ___ trimester include:
- No abdominal massage
- No abdominal pillow in prone (creates increased intra-uterine pressure)
- No joint mobs to pelvis or sacrum
- No deep sacrum work, pointed pressure or prolonged work
- No overpressure (passive relaxed ROM)
- No deep work to specific areas (follow DVT protocol)
- No full body heat treatments without modification
- No heat over pelvis or abdomen without modification
1st Trimester
T/F - Mid-range gentle passive stretches and low grade joint mobs can be performed during the 1st trimester.
True
Name 3 areas to avoid using deep work on (e.g. muscle stripping, specific compressions) during the 1st trimester.
1) Adductors
2) Inguinal
3) Posterior Calf
T/F - During the 1st trimester, precaution should be taken when using essential oils and specific reflexology/acupressure points are contraindicated.
True
Symptoms due to ________ changes, which occur during the ___ trimester include:
- Acne
- Chloasma
- Decrease in fatigue and nausea; energy generally improves
- Linea alba becomes linea nigra
Hormonal
2nd Trimester
Symptoms due to ________ changes, which occur during the ___ trimester include:
- Begin to “show”
- Centre of gravity changes due to enlarged uterus, placenta and growing baby
- Begin to feel baby’s first movements
- Increased strain to lumbar spine
- Increased strain to thoracic spine (kyphosis)
- Strain on respiratory muscles
- Joints become looser due to relaxin
- Increased MRT in gluteal muscles due to gait changes
- Uterine ligament referral
- Presence of stretch marks on breasts and abdomen
- Presence of spider veins or varicosities
- Increased edema
- Gait changes
- Blood pressure drops
- Frequent urination due to pressure on bladder
- Constipation due to mechanical pressure on bowel
- Increased heartburn due to enlarging uterus
- Practice contractions begin
Physical
2nd Trimester
The baby’s first movements are felt when __________ begins between ___ to ___ weeks on average.
Quickening
14-21 weeks
T/F - Increased strain to the lumbar spine during the 2nd trimester results in a posterior pelvic tilt.
False - Increased strain to the lumbar spine during the second trimester results in an anterior pelvic tilt.
Increased strain to the thoracic spine during the 2nd trimester results in ________ due to increased weight on the anterior torso.
Kyphosis
During the 2nd trimester, the ________ flares up and out and the patient may experience ______ margin pain.
Ribcage
Costal
_________ pressure in abdomen leads to _________ pressure in lungs during the 2nd trimester.
Increased
Decreased
Name 3 things a pregnant patient may experience during the 2nd and 3rd trimesters related to gait changes.
1) Plantar Fasciitis
2) Pes Planus
3) Callouses
Practice contractions of the uterus that occur during the 2nd and 3rd trimesters.
Braxton Hicks Contractions
___ trimester treatment planning includes and considers:
- Re-assessment of posture and gait (e.g. pelvic changes, thoracic spine/ribcage changes, nerve compression)
- Abdominal massage indicated if patient desires
- Lymphatic drainage indicated for edema
- Breast massage indicated for congestion and drainage
- Greater trochanter pain due to side sleeping
- Orthostatic hypotension due to low blood pressure
2nd Trimester
Pelvic changes during the ___ & ___ trimesters include:
- Increased anterior pelvic tilt
- Sacroiliac joint dysfunction
- Innominate dysfunction
- Pubic symphysis dysfunction
2nd & 3rd Trimesters
A condition involving the compression of the sciatic nerve due to ligament and postural changes during the 2nd and 3rd trimesters.
Piriformis Syndrome
A group of disorders involving the compression of blood vessels or nerves between the clavicle and first rib that occurs during the 2nd and 3rd trimesters.
Thoracic Outlet Syndrome (TOS)
T/F - TOS can be caused by short pec major and scalene muscles due to spine changes, apical breathing and increased edema.
False - TOS can be caused by short pec minor and scalene muscles due to spine changes, apical breathing and increased edema.
A condition involving compression of the median nerve from increased edema during the 2nd and 3rd trimesters.
Carpel Tunnel Syndrome
T/F - Abdominal massage during the 2nd and 3rd trimesters should not involve deep downward pressure.
True
During the 2nd and 3rd trimesters, extra _______ can be used to promote drainage from limbs, as well as _____ foot and arm baths.
Pillows
Cool
A condition that occurs during the 2nd and 3rd trimesters due to side sleeping. Compression leads to ischemia, fascial and ITB restrictions.
Greater Trochanteric Pain Syndrome
Contraindications for massage during the ___ & ___ trimesters include:
- No abdominal pillow in prone (creates increased intra-uterine pressure)
- No joint mobs to pelvis or sacrum
- No deep sacrum work, pointed pressure or prolonged work
- No overpressure (passive relaxed ROM)
- No deep work to specific areas (follow DVT protocol)
- No full body heat treatments without modification
- No heat over pelvis or abdomen without modification
- Follow DVT precautions if patient is on bed rest (consider exhaustion/fatigue)
- Modify accordingly for gestational diabetes
2nd & 3rd Trimesters
Symptoms due to ________ changes, which occur during the ___ trimester include:
- Increased fatigue
- Formation or increased Diastasis Recti
- Possible Pubic Symphysis Dysfunction
- Increased pressure on bladder
- Increased Braxton Hicks contractions
- Shortness of breath
- Increased gait changes (e.g. may see plantar fasciitis, pes planus and callouses)
- Baby “drops”
- Increased weight gain
- May feel nauseated again due to pressure from stomach
Physical
3rd Trimester
A condition during the 3rd trimester where the rectus muscles become separated by an abnormal distance.
Diastasis Recti
A term that refers to when the baby “drops” and engages on top of cervix during the 3rd trimester.
Lightening
Symptoms due to ________ changes, which occur during the ___ trimester include:
- Eagerness and anxiousness about new baby, pregnancy to end, labour and delivery, changing relationships/roles
Emotional
3rd Trimester
___ trimester treatment planning includes and considers:
- Re-assessment of posture and gait (e.g. pelvic changes, thoracic spine/ribcage changes, gait changes, nerve compression)
- Abdominal massage indicated if patient desires
- Lymphatic drainage indicated for edema
- Breast massage indicated for congestion and drainage
- Greater trochanter pain due to side sleeping
- Modify for high blood pressure
- Increased calf cramps (e.g use cold foot bath, GTO release, reciprocal inhibition)
3rd Trimester
During the 3rd trimester, greater trochanter pain may develop into greater trochanter ________.
Bursitis
During the 3rd trimester, increased calf cramps may be due to a _______/__________ imbalance and the patient should be referred to their primary caregiver.
Calcium/Magnesium
With increased calf cramps, it is important to check for DVT possibility using _______ sign and refer the patient to their medical doctor.
Homan’s
T/F - You can only massage the abdomen in the 3rd trimester, if the patient desires and consents.
False - You can only massage the abdomen in the 2nd and 3rd trimesters, if the patient desires and consents.
___ trimester positioning includes:
- Supine with additional lumbar support (e.g. 2x pillows under knees)
- Prone with no abdominal pillow
- Semi fowlers with additional lumbar support (e.g. 2x pillows under knees)
- Sidelying
1st Trimester
___ & ___ trimester positioning includes and considers:
- Sidelying
- Semi fowlers
- Supine with modifications
- Extra pillows under limbs to help facilitate lymph drainage
- Small support under lateral aspect of abdomen to decrease pelvic ligament strain
2nd & 3rd Trimesters
During the 2nd and 3rd trimesters, treatment in supine should be no longer than ___ minutes and the ______ hip should be bolstered due to supine __________.
15 Minutes
Right
Hypotension
A decrease in blood pressure when the pregnant patient is supine due to the weight of the baby and uterine contents placing pressure on the aorta and inferior vena cava.
Supine Hypotension
T/F - Supine hypotension only affects the pregnant patient.
False - Supine hypotension affects the pregnant patient and baby.
With supine hypotension, the ________ will feel dizzy, nauseated and uneasy; the ______ will have decreased heart rate and oxygen.
Patient
Baby
T/F - Prone positioning is contraindicated in the 2nd and 3rd trimesters.
True
Many postpartum patients may not be comfortable lying ______ due to ________ birth, breast issues and low back/epidural procedure.
Prone
Caesarean
For a caesarean birth, the patient should only ever be treated in __________ position until the incision has healed __ to __ weeks postpartum and cleared by medical doctor.
Sidelying
4-6 weeks
T/F - Semi fowlers is always a safe and generally comfortable position for any trimester.
False - Sidelying is always a safe and generally comfortable position for any trimester.
Cut out tables are often not safe because they create __________ pressure, strain on musculature and supporting ligaments.
Intrauterine
T/F - Sidelying position supports a neutral pelvis with no tilt or rotation.
True
