Pregnancy Flashcards
What is Pregnancy?
- A state of wellness associated with many interrelated changes that occur throughout a woman’s body as the fetus develops
Changes that occur during pregnancy are physiological, affecting the entire body
They are emotional as the woman adjusts to her changing body and lifestyle
The main stages of pregnancy are termed the first, second and third trimesters. The first 3 months, the next 4 to 6, and the last 7 to 9 months
Some changes may continue for 6 months to 1 year after the birth, this period after childbirth is referred to as “postpartum”
First Trimester Symptoms
Nausea & vomiting are commonly referred to as morning sickness. These symptoms are not unusual in this stage of pregnancy and usually decrease by 10 weeks
Frequent urination, as often as every 2 hours
Constipation is common and is primarily because the hormone progesterone causes relaxation in smooth muscle. The decreased tone of the smooth muscle of the intestine results in a slower transit time of the fecal matter through the system
Blood pressure often falls, (diastolic pressure) as the presence of progesterone relaxes the muscular walls of the blood vessels
Breast changes begin during this stage; sense of increased fullness as well as some tenderness & heightened sensitivity
Musculoskeletal changes result under the influence of estrogen, progesterone and relaxin
Taste & smell are altered as certain smells & food become disagreeable
Mood swings are most common in the 1st trimester but may continue throughout the pregnancy
extreme fatigue during this time can increase feelings of irritability and/or depression
Second Trimester
Months 4-6 are known as the quiet months
The risk of miscarriage is greatly reduced when the pregnancy reaches this stage
Begin to feel fetal movement around 18-21 weeks
During this stage women may receive test results indicating potential problems with the fetus
At the end of the 2nd trimester, by 23 weeks, the fetus can survive a premature birth
- Second Trimester Symptoms:
- Edema: common at any time during the pregnancy due to the retention of fluid
- as pregnancy advances, edema can occur in the legs
- mechanical obstruction created by the uterus and its contents causes an increase in venous pressure distally
- Hypertension: can be chronic, exists before the pregnancy or pregnancy-induced (PIH)
- a serious concern; 2nd most common cause of maternal death
- 1st detected by a sudden increase in blood pressure, proteinuria (high concentrations of protein in the urine clody, darker) and generalized edema
- Edema in the hands and face is a good indicator
- Supine hypotension can occur as early as the 4th month and continues until end of pregnancy, as fetus grows, it compresses the aorta & inferior vena cava against the lumbar spine, may cause the woman to feel faint when lying on her back
- Shortness of breath may be experienced at any time during the pregnancy due to a combination of both mechanical and physiological changes
- Backache is common
- Abdominal pain can be caused by all the same things that cause abdominal pain pre-pregnancy , he round ligament supports the uterus and is located along the side of the Rectus abdominus muscles, can experience extreme stretch and then separate, Diastasis recti (tear the midline of rectus
- Diastasis symphysis pubis: separation of the pubic symphysis, causes pain of varying severity over the pubic area and down the inner thigh
- Varicose veins may develop at any time during the pregnancy, more likely as pregnancy advances
- Hemorrhoids are varicose veins in and around the rectum, often secondary to straining & constipation
- Pigmentation changes may occur in the skin
- Stretch marks may develop in tissue over the areas that rapidly enlarge
- Varied emotions as the woman experiences the many body changes that are occurring
Pre-eclampsia vs Eclampsia
Pre-eclampsia and eclampsia: pregnancy-related high blood pressure disorders
Pre-eclampsia = a sudden spike in blood pressure, swelling or high levels of
albumin in the urine (between 20th week and end of first week after delivery)
Eclampsia = more severe and can include seizures or coma (may be no other
causes)
- The cause of pre-eclampsia is unknown, but women who are predisposed are those with some of the following symptoms:
1st pregnancy
a multiple pregnancy
chronic hypertension or long-term hypertension
chronic renal disease
malnutrition
Diabetes
history of PIH in the family or in a previous pregnancy
younger than 20 years of age and older than 30
developing hydramnios đa ối, an excess of amniotic fluid
Third Trimester
- Many of the 2nd trimester symptoms continue into the 3rd trimester
- Physical discomforts increase as the pregnancy advances
- In the 8th month the fetus has almost reached its birth weight but has not yet positioned itself down into the pelvis
- In the 9th month the woman may feel less physical discomfort and more energy as the baby’s head drops into the pelvis in preparation for birth
- Gestational diabetes: type of Diabetes mellitus that develops during pregnancy, no known risk factors, frequently, late in the pregnancy, there are increased amounts of insulin in the blood because of an insulin resistance in the body
- Diabetes may have adverse effects on the pregnancy such as:
+ Increased possibility of pre-eclampsia or eclampsia
+ Increased risk and severity of infection
+ Possibility of hydramnios which can make it difficult for the mother to breathe and may also result in premature labour and delivery
+ A difficult delivery or possible cesarean section
+ A predisposition to postpartum hemorrhage
- Ketoacidosis: another danger secondary to diabetes (can’t produce enough insulin)
+ due to the increased stress experienced in the 2nd and 3rd trimesters
+ more likely when the woman does not eat for long periods (keep glucose stable is important)
+ body produces high levels of blood acids called ketones
- Edema can occur in the legs & hands and especially the fingers & face
- Compression syndromes such as TOS and CTS may occur
- Backache may increase
- Sacroiliac sprain can cause intense pain over the sacrum
- Leg cramps, especially in the calf
- Pelvic discomfort
- Costal margin pain occurs as the pregnancy advances and uterus compresses lower ribs
- Frequent urination and incontinence may occur with increased pressure of the uterus on the bladder
- Fatigue increases again in the 3rd trimester as the woman becomes heavier
- Insomnia and restlessness are common
Fourth Trimester or
Postpartum Period
Physical changes in the woman’s body linger after birthing
Post-surgical recovery may arise from an episiotomy or a cesarean section
Episiotomy involves an incision in the perineum before the birth in order to prevent tearing in the area
If a cesarean was performed, the woman will be recovering from major abdominal surgery and full recovery takes between 4-6 weeks if no complications
Breasts may be sore with cracking around the nipples
Emotionally, a woman may experience extreme joy but also sadness, fear, anger or anxiety
Postpartum blues: more mild form
Postpartum depression: more serious form which involves strong feelings of sadness, anxiety or hopelessness
refer patient for counselling and treatment
- Signs & symptoms of Postpartum depression include:
Postpartum blues that last more than 2 weeks or strong feelings of depression
Increasingly intense feelings of anger, hopelessness and sadness that interfere with the mother’s ADL’s
Inability to sleep, even when tired
Extreme changes in appetite
Worrying about the baby excessively, or taking little interest in the baby
Panic attacks
Fears of harming the baby or herself
Contraindications
Abdominal and sacral massage is comprised of only light strokes or should be avoided
Deep massage & fascial techniques are CI’d over the low back during the 1st trimester
Care is taken when massaging over the abdomen during the entire pregnancy
Fascia should be assessed for a stabilizing role in posture before using techniques to stretch it
Aggressive joint play & mobilizations are avoided for the entire body because of increased joint laxity during the whole pregnancy and 6 months after (UNTIL THEY STOP BREASTFEEDING)
Avoid deep massage over varicose veins
Massage is CI’d if a change in blood pressure is noted and if it is combined with other symptoms of pre-eclampsia
If the patient has diabetes, a snack or juice should be eaten just prior to the treatment to maintain blood sugar levels
In the 2nd and 3rd trimesters, the patient must be carefully positioned on her back to avoid compression of the aorta and inferior vena cava ( put pillow on the right side so the clt can lie more to the left)
When complicating postural concerns or compression syndromes are treated, the massage must be modified according to the previously listed CI’s
Warning Symptoms
(considered serious and immediate reporting to midwife or physician)
Vaginal bleeding, especially in the first 24 weeks of pregnancy
Severe continuous abdominal pain
Breaking of water or rupture of membranes that precedes the onset of labour
- Pre-eclampsia warning signs:
In the 2nd trimester, mistiness, blurring or change in vision, elevated blood pressure
Continuous severe headache usually over the front or the back of the head accompanies by visual disturbances
Swelling of the hands, especially the face & fingers
Pain on the upper right side of the abdomen (liver there)
Warning Symptoms
(early reporting to the midwife or physician within 24 hours)
Temperature of 38.5C or more
Frequency of urination & pain with urination can indicate a urinary tract infection
Absence of fetal movement is not unusual for periods of time, even up to 24 hours. Generally as a precaution, if no movement is felt for longer than 24 hours, the physician should be notified
Excessive vomiting is not uncommon in the first trimester and occasionally in the last trimester
Excessive itching, not the common generalized itching, may occasionally suggest liver dysfunction
Health History Questions
How is your general health? Is there any history of risks and complications associated with pregnancy?
What stage is the pregnancy?
Do you have a history of other pregnancies? (Have you had pregnancies before?) Were there any complications?
What symptoms is the patient experiencing?
Blood pressure should be taken throughout the pregnancy
Massage
- The primary goal is to promote relaxation and provide a supportive environment
- Hydrotherapy for any trimester:
+ A warm foot bath
+ Heat to decrease pain and increase local circulation to hypertonic muscles and for relaxation (calf)
+ Contrast or cold baths to the feet and legs will help reduce edema
+ Cold figure-eight wraps around the breasts will decrease congestion and pain
- Massage-First Trimester:
Positioning is for patient comfort, but by the end of the 1st trimester, the woman may feel uncomfortable in the prone position
- Massage-Second & Third Trimester:
Positioning in sidelying, supine and seated are appropriate unless pregnancy pillows are available
Supine hypotension may occur and can be relieved for a short time by placing a small pillow or folded towel under the patient’s right hip. This repositions the weight of the fetus off the vascular structures
Near the end of the 2nd trimester until the end, the patient should always be placed in a semi-seated position while in supine, 80% left side
The massage is performed in the context of a relaxation massage
Breast tenderness is treated with cold hydrotherapy and lymphatic drainage
Abdominal massage is useful in treating constipation and to facilitate relaxation
General relaxation with additional focus on areas requested by the patient
- Massage-Labour:
Positioning is however the woman wishes and usually changes frequently during the course of labour
Some women prefer not to be touched during labour
For those who would like massage, it often provides a decrease in pain and anxiety
Massage is directed by the woman for the duration of the labour
The long-term treatment goals after delivery focus on helping the woman to regain proper posture and biomechanics
If cesarean surgery was performed, once the area has sufficiently healed, massage addresses the patient’s concerns
Self-Care During Pregnancy
Relaxation exercises & apps, deep diaphragmatic breathing, and visualization
Self-massage to the costal border, suprapubic attachments of the abdominals and perineum is recommended
Stretching and lubricating the perineal area should begin in the last 6 weeks of the 3rd trimester in preparation for birth ( not in our scope of practice)
AROM of the ankles, toes and knees to increase circulation for leg cramps
For varicose veins, avoidance of excessive weight gain and standing still or crossing the legs for a prolonged period of time
A mild to moderate exercise program
A physiotherapist is recommended for Diastasis symphysis pubis and Diastasis recti
Self-Care After Delivery
A specific remedial exercise program is recommended to restore postural alignment of the individual based on a thorough assessment ( don’t over exercise too)
Hydrotherapy, as appropriate is encouraged
Relaxation strategies
