Perinatal PT Flashcards
LBP is reported to occur in ___-___% of pregnancies
50-80%
___% of the women who report of LBP during pregnancy have LBP at 18 months post-partum
37%
At __ weeks of gestation, the woman is 70% physiologically ready to give birth.
8 weeks
When do physiological changes of pregnancy occur?
8 weeks
The uterus of a pregnant woman shifts to the (left/right) and their COG moves (forward/backward)
right, forward
What are the placenta hormones?
Human placenta lactogen
human chorionic gonadotropin
relaxing
estrogen
progesterone
mechanism of hormone: Affects glucose and fat metabolism from 5th week gestation
–> Diverts glucose to the fetus
–> assists with occurrence of gestational diabetes
human placenta lactogen
What hormone is antagonistic to insulin so more glucose remains in maternal blood for transport to fetus?
human placenta lactogen
When does human placenta lactogen disappear?
after childbirth
mechanism of hormone: Suppresses maternal immunological reactions against the fetus until the placenta takes over
human chorionic gonadotropin
Low levels of human chorionic gonadotropin results in what?
miscarriage
When is peak concentration of human chorionic gonadotropin?
days 60-80 resulting in nausea
When does human chorionic gonadotroping disappear?
7-10 days post-partum
When is relaxin at its highest level?
12 weeks of pregnancy
Relaxin declines from week ___-___ and then is stable for the remainder of pregnancy at 50% peak value.
12-17
When does relaxin return to pre-pregnancy levels?
3 days after postpartum
(true/false) Twins have 2x the relaxin levels
true
(true/false) Relaxin results in separation of the pubic symphysis
true
Estrogen causes a (increase/decrease) in pH levels.
increase
High levels of pH due to estrogen can result in what?
yeast infections
excessive mucus
increase sodium and water retention (40-60% increase)
What hormone decreases contractility of a pregnant uterus and prepares the breasts for lactation?
progesterone
What hormone increases RR and body temperature?
progesterone
Progesterone increases body temperature by ___ degree(s)
1/2 degree
(pregnancy glow)
What hormone protects a pregnant women from bone loss?
estrogen from the ovaries
What hormone increases the epithelium in the vagina along with enlarging the uterus and genitalia?
estrogen from the ovaries
Progesterone from the ovaries cause (hypoventilation/hyperventilation) in pregnant women.
hyperventilation
What does progesterone from the ovaries block?
prolactin
What hormone results in decreased focus, alertness, and cognitive function?
progesterone
____ hormones increase basal metabolic rate by 25-50%
thyroid hormones
During pregnancy, estrogen and progesterone balance parathyroid hormones to prevent ____.
osteoporosis
There is a (increase/decrease) in adrenal hormones during pregnancy. what does it contribute to?
increase
–> attributed to the tendency to develop abdominal stretch marks, HTN, fluid retention, and weight gain
When does the concentration of prolactin start to rise during pregnancy?
week 5 to full term
What hormone is antagonistic to estrogen and progesterone?
prolactin
If there is leakage of milk during pregnancy, question if ___ and ____ levels are low
estrogen and progesterone
In postpartum, ______ can inhibit Luteinizing hormone to avoid ovulation
prolactin
What hormone may initiate labor?
oxytocin
Oxytocin levels are stable during pregnancy due to ___. Once oxytocin levels are higher, labor is initiated.
progesterone
(true/false) Hypersecretion of Insulin is normal with pregnancy
true
(increased/decreased) levels of insulin presents with gestational diabetes.
decreased levels
Women participating in any recreational physical activity for the year prior to pregnancy have decreased the risk of GDM by ___%
51%
Women participating in any recreational physical activity for the year prior to pregnancy and the first 20 weeks of pregnancy have decreased risk of GDM by ___%
60%
Future development of type II DM is ___-___% higher within 10-15 years postpartum in women who had gestational diabetes
30-50%
Gestational diabetes in another pregnancy is __-__% higher
50-70%
Only ____ extra calories is needed during the 2nd and 3rd trimester.
300
What is the most common medical complication during pregnancy?
gestational diabetes
What are the fetal consequences of gestational diabetes?
hyperglycemia secondary to insulin not crossing the placenta
increased risk for obesity/type II DM
Increased glucose with gestational diabetes is stored as fat and results in ___.
macrosomia
Fetal pancreas stimulated to increased insulin production results in (hypoglycemia/hyperglycemia) at birth
hypoglycemia
(true/false) gestational diabetes does not cause respiration problems at delivery
false (it does)
Blood volumes increase by 40-50% creating physiologic ___.
anemia
During pregnancy, the Heart shifts forward and tipped to (left/right)—changes in 3rd lead of EKG
left
Cardiac output during pregnancy increases by ___-___%
40-45%
stroke volume increases by 30%
Heart rate increases by __-___% in the first 4-5 weeks gestation, increases by __-__% in second trimester, and by __-__% during labor
3-5%
10-15%
15-20%
Why is there an increase in blood flow to the skin during pregnancy?
to dissipate heat
Due to aorta/vena cava compression in pregnancy, you have to avoid what position?
supine
Avoid prolonged supine for greater than 2-3 minutes after 16 weeks gestation
definition: Vena Cava is occluded by the pregnant uterus in prolonged supine and displaces the aorta laterally
supine hypotensive syndrome
(true/false) only 10% of women experience s/s of supine hypotensive syndrome
true
(true/false) Pregnancy results in Increased tidal volume by 35-50% without change in respiratory rate
true
(true/false) Exercise during pregnancy decreases the delivery of O2 to the fetus.
FALSE
What are s/s of pre-eclampsia?
BP >140/90 after 20 weeks of gestation
Proteinuria > 300 mg/24 hours
–> edema, severe HA, visual changes, abnormal reflexes, severe heartburn
What should happen if a patient is experiencing pre-eclampsia/ severe pre-eclampsia?
Needs to see a physician/medial attention IMMEDIATELY
What are s/s of severe pre-eclampsia?
BP > 160/110
Proteinuria > 5g/24 hours
–> present for >6 hours, HA, visual changes, decreased urine output, neuro s/s, deranged liver function, thrombocytopenia, acute renal failure
(true/false) Weight gain is a reason for back pain during pregnancy.
false
The suggested weight gain for a single fetus if the mother has a normal BMI is ____.
25-35 pounds
> 25 pounds if BMI < 18
10-21 pounds if BMI > 29
During pregnancy the BOS (increases/decreases)
increases
What is the normal size of the uterus at the end of 40 weeks of gestation?
10 x 14 inches
What is the largest muscle of the body when pregnant?
Uterus
When does the uterus return to normal size (2 inches x 4 inches)?
6-8 weeks post-partum
Lactation is a ___ response.
hormonal response
Milk production is dependent on what?
stimulation
An increase in breast weight can be up to ____ pounds.
2.5 pounds
–> can lead to upper thoracic pain and/or impingement
How much fluid retention is there at 30 weeks of gestation?
3+ liters
Avoid exercise in supine position after _____ months.
3 months
(true/false) You can scuba dive when pregnant.
FALSE (fetus cannot filter bubble formation)
Changes from pregnancy last about __-___ weeks post-partum so exercises plans should have slow progression.
4-6 weeks
Should electric modalities be used on a person who is pregnant?
no (only joint mobilization, postural education, and ther-ex)
What should you base exercise intensity off of for a pregnant patient?
BORG scale (NOT HR)
Water should be ____ degrees if exercising in water.
< 90 degrees
Hyperthermia > ____ degrees can increase risk of neural tube defects.
> 102 degrees
(true/false) ACOG now encourages bedrest for pre-term labor
FALSE
With bedrest, you will have __% bone loss after 7 days.
17%
What are the levels of bed rest?
strict
Trendlenberg (feet above head)
Up ad lib
Bedrest w/ bathroom privileges
sitting
What are the most common issues with pregnancy?
lumbar strains
diastasis recti
anterior or posterior pelvic ROT
sacral ROT
What can cause calf cramps with pregnancy?
Increased WB on MT heads
Definition: Separation of the rectus abdominis as the abdomen expands
diastasis recti
(true/false) Diastasis recti can occur with obesity.
true
What is a (+) finding for diastasis recti?
greater than 2 finger widths and any depth while palpating the umbilicus during Cx FLX
Where should a TENS unit be placed during the first stage of labor?
T12-L2 region
Where should a TENS unit be placed during the second stage of labor?
L4/L5
S2-S4
Gallpladder
Spleen
What is the preferred position for the pelvis and pelvic floor?
squatting
What are treatment options for blocked milk ducts?
- heat
- US
- elevate pain for manual drainage
- manual techniques
- pt education
