Class 2 - Treatment Considerations in Pregnancy Flashcards
Contraindications for _________ massage include:
- First trimester of pregnancy
- High risk pregnancies
- Problems with cervix & placenta
- Pre-term labour/threat of pre-term labour
- Vaginal/uterine bleeding
- Health of fetus is in question
Abdominal Massage
T/F - Light abdominal techniques would never cause a miscarriage or still birth, however we want to eliminate the association and ease the mind of the RMT.
True
Abdominal massage is _________ and greatly beneficial for connection with baby, tissue and fascial stretch in the ______ and _____ trimesters to enhance birth parent’s connection with baby and increase tissue stretch.
Indicated
Second & Third
T/F - Always massage the abdomen in a medial to lateral direction so you are not increasing the possibility or severity of diastasis recti.
True
Some contraindications for ______ massage include:
- High risk pregnancies
- Mastitis
- Breast cancer/undiagnosed lump
- Post-surgical infection
- Current active infection
- Abscess
Breast Massage
T/F - Since we are never touching the areola or nipple in our breast massage, there is no way nipple stimulation can induce contractions.
False - ALTHOUGH we are never touching the areola or nipple in our breast massage, there is A POSSIBILITY THAT nipple stimulation can induce contractions.
Onsite work and direct pressure to the breasts is _______________ as mastitis is a bacterial _________.
Contraindicated
Infection
T/F - Manual techniques to a breast with mastitis cannot cause damage to blood vessels, thrombophlebitis and increase abscess size.
False - Manual techniques to a breast with mastitis CAN cause damage to blood vessels, thrombophlebitis and increase abscess size.
Milk that remains in the breast after a feeding can back up into a ____, inflaming the surrounding tissue and causing a blockage. This is a common cause of ________.
Duct
Mastitis
T/F - A small, hard lump that’s sore to the touch, or a very tender spot in the breast indicates there may be a clogged duct.
True
Applying ____ compresses/packs between feedings may ease the pain of mastitis. Applying a ____ compress just before breastfeeding may help with milk flow.
Cold
Warm
Always wrap a clean cloth/towel to prevent skin damage when applying compresses, especially with mastitis because it can affect the skin’s ability to gauge ___________.
Temperature
Indications for ______ massage during pregnancy include:
- High level of change in breast tissue
- Pain
- Congestion
- Structural imbalances due to pregnancy posture, TrPs and increased MRT in pectorals
- TOS due to pregnancy posture
Breast Massage
Indications for ______ massage during breastfeeding include:
- Pain
- Congestion
- Structural imbalances due to breastfeeding positions
- TOS due to breastfeeding positions
Breast Massage
T/F - Varicosities don’t usually appear for the first time in pregnancy.
False - Varicosities MAY appear for the first time in pregnancy.
With severe ____________, there may be clots in deeper veins.
Varicosities
Some symptoms of _____ _____ include:
- Sudden/severe pain, swelling, heat & redness
- Decreased circulation to affected limb
- Pain upon palpation
Blood Clots
T/F - 80-90% of blood clots occur in the right leg or iliofemoral vein.
False - 80-90% of blood clots occur in the LEFT leg or iliofemoral vein.
T/F - Blood clots can be asymptomatic.
True
Some risk factors for _____ _____ include:
- Cesarean section or other recent hip, pelvic and/or knee surgery
- Bedrest & immobility
- Leg injury
- History of previous DVT
- Smoking
- Age greater than 40 years
- Obesity
- Family history
Blood Clots
DVT’s are __ times more likely to occur in pregnant patient’s.
6 times
DVT’s are 5 times more likely to occur in the __________ time period and the patient has a ___ times greater risk for developing a pulmonary emboli in comparison to pregnancy.
Postpartum
15 times
_________________ for varicosities/DVT include:
- No massage over varicosities, known blood clots or phlebitis
- No deep pressure to the adductors or inguinal region
- No massage to legs if there are known clots
Contraindications
Some early warning signs and symptoms of ____ ____ __________ include:
- Pain
- Swelling
- Warmth
- Redness
- Leg cramps, often starting in the calf
- Leg pain that worsens when dorsiflexing the foot
- Blue/white skin discolouration
Deep Vein Thrombosis (DVT)
T/F - The level of blood-clotting proteins decreases during pregnancy, while anti-clotting protein levels increase.
False - The level of blood-clotting proteins INCREASES during pregnancy, while anti-clotting protein levels DECREASE.
T/F - Possibility of too much bleeding at childbirth tends to increase the blood’s clotting ability around birth, occasionally too much.
True
An enlarged ______ increases pressure on the veins that return blood to the heart from the lower body, leading to potential blood clots.
Uterus
_______ increase as pregnancy progresses, as it is needed for labour and delivery.
Relaxin
T/F - Stability is usually more of an issue than mobility in pregnant patients, and should play a large role in your treatment plan.
True
Relaxin and ____________ soften connective tissue in the body and this commences from ___ weeks gestation onwards and continues until __ months postpartum.
Progesterone
10 weeks
6 months
What are the 2 structures most affected by relaxin and progesterone?
1) Pelvis
2) Lumbar Spine
T/F - Relaxin and progesterone affect some ligaments and joints, as well as tendons and fascia.
False - Relaxin and progesterone affect ALL ligaments and joints, as well as tendons and fascia.
T/F - Muscles will increase in MRT to support unstable structures during pregnancy, and this places a great deal of strain on them, especially weight bearing structures.
True
It is not uncommon to see dysfunction of the _____ symphysis, low back pain and SI joints, and joints may even feel “______”.
Pubic
“Wobbly”
Some ________ related to ligament laxity include:
- Joint mobilizations (use low grade application)
- Rhythmic mobilizations
- Passive stretching (no overpressure)
- Prior dislocations
Cautions
Pelvic or ______ joint mobilizations are completely contraindicated as they may induce pre-term ______.
Sacral
Labour
For pregnant patients, we want to use ___-_____, gentle stretches and for self-care, we should instruct them to perform stretching ______ using their breath.
Mid-Range
Slowly
Contraindications for __________ include:
- High risk pregnancies (potential to destabilize pelvis & induce pre-term labour)
- Pubic symphysis dysfunction (avoid psoas and other hip flexors)
Stretching
Contraindications for ______ work include:
- No deep prolonged/pointed pressure work
- No joint mobilizations to this area
Sacral
T/F - Any sacral work is completely contraindicated for high risk pregnancies.
True
T/F - We can use general broader massage techniques to the sacrum in a healthy pregnancy.
True
Many pregnant individuals have heard your ______, back and ____ should not be massaged because it’s possible to cause uterine contractions and pre-term labour. It is ________ we can actually do this.
Ankles
Feet
Unlikely
___________ encompasses focused, intent based, deep sustained pressure.
Acupressure
The following ___________ points should be avoided:
- Large intestine 4
- Spleen 6
- Kidney 3
- Urinary bladder 60 & 67
- Liver 3
- Gallbladder 21
- Bladder 31-34
Acupressure
