pregnancy Flashcards
changes in centre of gravity
= there is more anterior weight
-Posterior chain (starting from nuchal point) needs to work harder to maintain upright standing position (increasing pressure on facets, discs, ligs, muscles)
-Lsp lordosis reduces at start as pelvis tilts posteriorly.
-Further into pregnancy= pelvis tilts anteriorly, increasing lordosis
changes in spinal curves/ body adapts and compensates
12 weeks–> anterior musculature (Reactive shortening of rectus abdominalis, Ant hip muscles need to be stretched (hip flexors, rec fem)), spine (Reduced Lsp lordosis, inc sacral counternutation, Increased kyphosis- stretches facets (P), inc risk of herniation (post-lat), Compromised thoracic outlet (closes it down, complaints of mid thoracic P)), pelvis (Post pelvic tilt)
24 weeks–> anterior musculature (Expanding uterus (outside pelvic bowl) + displaced abdominal viscera- pressure under diaphragm, as diaphragm elevates (difficulty breathing), Tsp must extend (opens ant abdominal cavity, allows space for baby and viscera)), spine (Lower ribs displaced need to expand laterally, Distal sternum elevates increased breast weight, Tsp increases, csp lordosis increases (facet irritation), TOS + 1st rib dysfunction (tingling in hands, P around first rib, 1st rib being pushed out of thoracic outlet)), pelvis (Pelvis may still be posteriorly rotated or starting to rotate anteriorly, Adductors try and stabilise hips (strain)
Relaxin- unstable- facet irrit
30 weeks–> anterior musculature ( Stretch through abdominals- core stability reduced
Rectus diastasis in 60%- slight weakening in linea alba, Pubis strain/SPD, 80% of women develop lordotic posture), spine (Altered head carriage
Increased kyphosis- strain at C/T, Thoracic inlet compromise, Sternal angle- elevates (1st rib/TOS)), pelvis (Deep lordosis, Ant pelvic rotation, Increased sacral nutation, Coccyx needs to flex), legs (Laterally rotated hips, Altered orientation feet and knees, Altered gait- feet and lower extremity loading)
40 weeks–> Pelvis rotated posteriorly, flattened Lsp, Weight bearing through pelvic floor/ligaments (working hard to stabilise) rather than Abd ms and SP, Rib circumference inc by 5-7cm, Increased venous pressure and congestion leading to haemorrhoids or varicose veins (hard for venous return from Lexx), Usually delivered at this time- 1st children common to arrive late, 42 weeks- induced
fluid dynamics
The amniotic fluid is dynamic throughout the pregnancy, which is essential for the fetus’s well-being. The amniotic fluid volume mainly includes the production and elimination of amniotic fluid. It also consists of water flowing in and out across the amnion and the placental membrane.
ligaments of the uterus (internal support)
Peritoneal folds–> duplicatures of peritoneum that attach to the body of uterus
1.broad ligament= extends from the sides of uterus to the lateral walls and floor of pelvis
2. Uterovesical fold= extends from the junction of uterine body and cervix to the bladder; creates uterovesical pouch
3. Rectovaginal fold= extends from the posterior vaginal fornix to the rectum; creates rectouterine poch (of Douglas)
True ligaments–> fibrous structures that attach to the cervix
1. Round ligament= extends from the lateral cornu of uterus through broad ligament to the connective tissue of labium majus; contains neurovasculature and lymphatic vessels from the uterus
2. Transverse cervical ligament= extend from the lateral pelvic walls to the supravaginal part of cervix; carries uterine artery
3. Uterosacral ligament= extend from the anterior side of sacrum to sides of the cervix and uterine body
role of relaxin
= Hormone only produced during pregnancy and for short amount of time post-labour (allows pelvis and innominate to open)
-Increases flexibility of ligaments during pregnancy to help open pelvis during labour
-89% of symphysis pubis dysfunction (SPD) occurs in 2nd/3rd trimester
-Peak production is at 12 weeks
-Body stops producing relaxin 3 months after breast feeding has stopped, could be up to 9 months post-partum
-18 months between pregnancies- allows relaxin production to stop and ligs to heal
hypermobility
Can be difficult to treat
Generally, have restriction in thoracic spine, with increased tension in erector spinae muscles to try and stabilise hypermobile segments Should avoid doing yoga (relaxin inc flexibility, potentially making themselves unstable), encourage swimming or Pilates
