Pregnancy Flashcards
Internal support – ligaments of Uterus
- Ligaments of Uterus don’t just support it, they come together from the ilia and the pelvic bones to create t a sling that supports the uterus and the bladder.
Abdominal viscera.
- Intestines pushed up against the diaphragm, stomach and liver.
- Diaphragm rises higher up
- Why pregnant women experience heart burn, diaphragm higher up and more stretched, gastric sphincter softens and opens up allowing for gastric reflux
- Once they are past their first trimester don’t treat them supine, Baby will be sitting on abdominal aorta, sitting on their back for too long will feel faint and dizzy.
Umbilical cord 3 x blood vessels
- Unique, 3 blood vessels, one arterial and 2 venous
- Mothers heart and liver doing the work for the baby
- Reason why Pregnant women are slightly warmer, 1deg
Rare problems with the placenta and or cord:
- Placenta Previa – placenta positioned over cervix.
- Abruptio placentae- Medical emergency, placenta detached from uterus, forces a premature labour.
- Unusual position of placenta
- Short umbilical cord -
- Cord around infants neck
Cesarean Section
- Majority is a low transverse incision
- But must recognise if Linea alba is cut through as it doesn’t heal – vertical incisions
Instability; the role of Relaxing.
- Relaxin is a hormone only produced during pregnancy.
- Its role is to increase the flexibility of the ligaments during pregnancy to help open up the pelvis during labour.
- Loosens SI ligaments
- 89% of symphysis pubis dysfunction occurs in the 2nd and 3rd trimesters.
- Peak production is at 12 weeks.
- Body stops producing relaxin 3 months after breast feeding has stopped. In reality, that could be up to 9 months postpost-partum
- Need 18 months before they start another pregnancy for body to return to normal.
Hypermobility and Pregnancy.
- These patients can be difficult to treat; generally, they may have restrictions in the thoracic spine , with increased tension in the erector spinae muscles to try and stabilize the hypermobile segments.
- Hypermobile patients should avoid doing yoga – as they are mobile enough already! Encourage them to swim or do Pilates
- Recommend continuing exercise they’ve already been doing rather than starting something new.
Most valuable view when Pt is pregnant
lateral, See COG and pelvis, is it anteriorly or posteriorly rotated. Anterior pelvic tilt- Increased lumber lordosis – increases distance between facets but irritates discs.
Lower ribs get moved out, Diaphragm gets stretched flattered out – Struggle to breath
12 Weeks – First ultrasound scan (First trimester 0-13)
Uterus /baby
* Baby size of grapefruit
* Uterus rises above pelvic rim
Anterior musculature
* Reactive shortening of rectus abdominalis
* Anterior hip muscles need to be stretched
Tsp
* Breasts enlarge
* Increased Tsp kyphosis
* Compromised Thoracic outlet
Pelvis
* Posterior pelvic tilt
* Reduced Lsp lordosis
* Increased sacral counternutation
All these structures need healthy motility to adapt to these changes
24 Weeks (14-24)
Anterior musculature/viscera
* Expanding uterus and displaced viscera – pressure under diaphragm, as diaphragm elevates – Tsp has to extend.
Tsp
* Lower ribs displaced, need to expand laterally
* Distal sternum elevates
* Increased breast weight
* Tsp kyphosis increases
* Csp lordosis increases
* TOS and 1st rib dysfunction
Pelvis
* Pelvis may still be posteriorly rotated or starting to rotate anteriorly
Still flattened LSP
* This can depend on how many pregnancies
30 weeks (27-40 weeks 3rd trimester)
80% women develope Lordotic posture.
Stretch thru abdominals
Rectus diastasis in
60%.
Pubis strain/SPD.
Tsp
* Altered head carriage.
* Increased kyphosis – strain at C/T.
* Thoracic inlet compromise
* Sternal angle – elevates, (1st rib/Th outlet)
Pelvis
* Deep L.Sp lordosis.
* Anterior pelvic rotation
* Increased sacral nutation.
* Coccyx needs to flex
Legs
* Laterally rotated hips
* Altered orientation feet and knees.
* Altered gait – feet and lower LEX loading.
40 Weeks
Pelvis rotated posteriorly, flattened lumbar spine
Weight bearing through pelvic floor/ligaments rather than Abd ms and SP.
Rib circumference inc by 5-7 cm.
Increased venous pressure and congestion leading to haemorrhoids.
Changes in C.O.G
Forward Shift: As the fetus grows and the uterus expands, the woman’s centre of gravity gradually shifts forward. This shift occurs to accommodate the increasing weight and size of the uterus, which pulls the body’s centre of mass forward. This shift creates an increased lumbar lordosis.
Lumbar Lordosis
This is a natural adaptation that helps maintain balance and stability. The exaggerated curvature in the lower back helps to compensate for the anterior shift and prevent the woman from falling forward
Increased extension approximates facets and can lead to increased stretch on hamstrings, leading to muscle hypoxia and micro trauma.
Fluid dynamics
Decreased venous return due to increased pressure on the inferior vena cava and lilac veins.
Pressure from baby
Reduced blood pressure due to reduced neurovascular tone due to progesterone. Increased likelihood of haemorrhoids.
inferior cava flow can decrease up to 80%.
In supine pressure is a-lot more, why you cant do supine technique.
