Pregnancy Flashcards
First trimester: Sx
Morning sickness Constipation Frequent urination Decreased BP Full/tender/sensitive breasts Ligament and joint capsule laxity
Second trimester: Sx (normal)
Edema Shortness of breath Back pain Abdominal pain Pubic symphysis pain Varicose veins Hemorrhoids
Second trimester: complications
Preeclampsia
Supine hypotension syndrome
Diastasis recti
Third trimester: Sx (normal)
Edema Compression syndrome Backache SI pain Leg cramps Pelvic discomfort Costal margin pain Frequent urination/incontinence
Third trimester: complications
Gestational diabetes
Ketoacidosis
Supine hypotension syndrome:
Fetus compresses vena cava
If supine, pillow under right hip
Side lying (especially on left)
Cause of pregnant edema
Mechanical blockage (weight of uterus in inguinal region)
Causes of shortness of breath during pregnancy
Mechanical: uterus shoves guts into diaphragm
Physiological: 20% increase in O2 needed
Inguinal compression can cause
Varicosities
Edema
Diastasis recti
Separation of rectus abdominus at linea alba
Test supine, knees bent – more than three finger width
Remex: TVA (plank, leg drop, glute bridge). No crunches.
Gestational Diabetes
Pregnancy acquired diabetes mellitus (insulin resistance)
Usually 3rd trimester
Increased chance of: (pre)eclampsia, infection, hydramnios, macrosomia, regular Type II later in life
Ketoacidosis
Macrosomia
Big honkin’ baby
Ketoacidosis
Medical emergency
2° to diabetes
Excessive ketosis –> decreasing pH of blood.
Ketoacidosis: Sx
Warm dry skin Tachycardia Hypotension Lethargy Vomiting Coma
Distinctive breath
Hydramnios
Excessive amniotic fluid
Increased chance of early labour
Maternal respiratory discomfort
Pre-eclampsia
Pregnancy induced hypertension (PIH)
Change in values more significant than absolute numbers
Usually 2nd trimester
7% pregnant women; 2nd most common cause of maternal mortality.
Preeclampsia: Sx
Headaches Blurred/altered vision Abdominal or shoulder pain NOE Nausea and vomiting Confusion SOB Generalized Edema
Preeclampsia: Dx
Sudden increase in BP
Proteinuria
Generalized Edema
Eclampsia
AKA toxemia
Preeclampsia + seizures
Risk factors for (pre)eclampsia
Multiples Pre existing hypertension Chronic kidney disease Diabetes Over 30 years old
Effects of progesterone during pregnancy
Relaxes smooth muscle
> constipation
> frequent urination
> decreased BP
Placenta previa
Implantation of cervix over uterus
Placenta can shear off and cause antepartum hemorrhage
Abruptio placenta
Premature detachment of placenta
Hemorrhage
Fetal distress
Possible causes of pitting edema
Increased blood hydrostatic pressure Decreased colloid osmotic pressure Increased permeability of blood vessels Increased ECF volume Lymphatic blockage Local histamine release.
Possible causes of pitting Edema
Systemic conditions (congestive heart failure, liver or kidney disease, pre-eclampsia)
Broad ligaments
Lateral uterus to lateral sacral bowl
Refer pain to low back, buttock, sciatic pattern, especially 6th month
Round ligaments
Anterior uterus to public symphysis
Diagonal pain from top of uterus to groin. Usually unilateral.
Second trimester.
Sacrouterine ligament
Posterior uterus to anterior sacrum
Achiness around sacrum
Most common location of clot formation for DVTs
Iliac
Femoral
Saphenous veins
Obturator internus TrP
Coccyx area - circular pattern
May refer down posterior thighr
Obturator internus
Medial greater trochanter –> ischiopubic ramus and obturator membrane.
Lateral rotation with hip extension
Abduction with hip flexion
Travels through lesser sciatic foramen
Pelvic floor muscle TrP
Oblong pattern coccyx to crack
Generalized edema can be a sign of
Pre-eclampsia
High blood pressure
Kidney dysfunction
Heart failure.
During pregnancy blood volume can increase by how much?
40-50%
In pregnancy to avoid pubic symphysis pain
Avoid forward and lateral lunges
According to WTFK no supine exercise
After first trimester
When positioning no supine massage
After 22 weeks
Most common locations for clot formation
Iliac femoral saphenous veins
Prone position is not recommended after first trimester because
Increased intrauterine pressure
Stresses sacrouterine ligament
Increased lumbar lordosis
Increased mucus
Supine position is not recommended after first trimester because
Supine hypotensive syndrome
