Pregnancy Flashcards
What is the childbearing year?
- Pregnancy (~40 weeks)
- Labour & birth (2-36 hours)
- Immediate post-natal recovery (1-6 weeks)
- Continuing post-natal recovery up to 1st birthday
When would a physio treat a women in her childbearing year?
- Musc injuries whilst pregnant or post-natal
- Pregnancy-related musc conditions
- Hospital inpatient who is pregnant or post-natal in ortho, med, surgical, ICU or maternity wards
- Pre/post-natal exercise & education classes
What anatomical & physiological changes occur in the first trimester (0-13 weeks)?
- Amenorrhoea
- Minimal weight gain
- Breast tenderness due to
secretory alveoli developing - Relaxin peaks
- Urinary frequency increases
- Increased CO by 40%
- Significant foetal development (organogenesis)
- Foeto-protective physiology eg calcium
What are the functional implications in the first trimester?
- Low energy
- Less exercise
- Hyperemesis
- LBP/PGP
- Hopefully avoid teratogens (radiation, heat, smoking, alcohol)
- But may be no change
What does relaxin have a role in?
- Sperm motility (male fertility)
- Fertilisation
- Implantation
- Uterine growth and accommodation
- Control of myometrial activity to prevent preterm labour
- Cervical ripening and the facilitation of labour
What is the effect of relaxin on the musculoskeletal system?
Reconcile haemodynamic changes occurring during pregnancy (e.g. CO, renal blood flow, arterial compliance, weakening of pelvic ligaments)
What physio input is relevant in the first trimester?
- Encourage and advise re appropriate and modified exercise
- Encourage ante-natal physio education: ‘Healthy Pregnancy’
- Musculoskeletal treatment
- Discourage risky activity/teratogens
What anatomical & physiological changes occur in the second trimester (13-28 weeks)?
- Uterus out of pelvis
- Weight gain 0-5 kgs
- Foetal movements ~ 20/40
- Braxtonhicks contractions
- Stretch marks/striae
- Breasts producing colostrum
- Increase venous pr legs
- Periph vasodilatation
- Supine hypotension
What are the functional implications in the second trimester?
- Usually more comfortable
- Body image challenge
- Heartburn
- COG shifts forward
- Msk pain - T/S, L/S, PGP
- Hand/feet swelling
- Varicose veins (legs, vulva, haemorrhoids)
What physio input is relevant in the second trimester?
- Msk treatment
- Encourage/advise re appropriate & modified
exercise - Encourage ante-natal physio education
- Healthy preg class
- Pregnancy exercise class
- Discourage risky activity (supine, crunches, planks)
What anatomical & physiological changes occur in the third trimester (29-40 weeks)?
- Abdominal expansion
- Weight gain ~5-20kgs
- Rectus diastasis
- Diaphragm raised 4cm, decreased total lung vol, increased, O2 consumption by 20%
- Increased Braxton-Hicks contractions
- Increase urinary frequency
What are the functional implications in the third trimester?
- Increased physical discomforts
- COG shifting forward
- Increased spinal curves
- Msk pain - T/S, L/S, PGP
- CTS
- Breathlessness
- Heartburn
- Disturbed sleep
What physio input is relevant in the third trimester?
- Msk treatment
- Pregnancy exercise classes
- Birth education classes
What antenatal physio education should be advised?
- Refer onto women’s health physio for pelvic floor/incontinence symptoms
- Encourage participation in hospital/private practice pregnancy education/physio-led exercise classes
What is usually included in “Healthy Pregnancy” education sessions?
- Back care: posture, avoid heavy lifting, use dynamic core stability, treatment of PGP
- Abdominals: check RD, teach PF/TA activation
- PF: strength exercise for continence, co-contract with TA, treat LBP/PGP
- Safe exercise: guidelines & modifications, benefits of strength & fitness
What can motivational counselling be used for?
- Behaviour modification
- Adopting healthy lifestyle (more likely as increased motivation, frequent access to medical supervision)
- Controlling weight
- Improving diet
- Increasing exercise
What are the pregnancy exercise guidelines?
- No supine exercise after 16-28 weeks
- Moderate intensity (PRE 8-12)
- Low impact
- Low-mod weights
- No overheating e.g. hot yoga
- Follow guidelines for CIs
What are the benefits of exercise during pregnancy?
- Improved muscular strength & endurance
- Improved CV function & physical fitness
- Reduced back/pelvic pain
- Reduced fatigue, stress, anxiety & depression
- Fewer delivery complications
- Prevention & management of urinary incontinence
- Decreased risk of complications
- Decrease in excessive weight gain & retention
What types of exercise are safe for women with an uncomplicated pregnancy?
- Walking, jogging, cycling and swimming (mod intensity)
- Muscle strengthening exercises
- Water-based exercise
- Pregnancy specific exercise classes
What types of exercise are considered unsafe for pregnant women?
- Abdominal trauma or pressure (e.g. weight lifting).
- Contact or collision
- Hard projectile objects or striking implements (e.g. hockey)
- Falling (e.g. judo)
- Extreme balance, coordination & agility (e.g. gymnastics)
- Significant changes in pressure (e.g. scuba diving)
- Heavy lifting
- High intensity training at altitudes >2000m
- Exercise in the supine position
Why is exercise in a supine position considered unsafe?
- May cause hypotension in some women
- For safety, avoid supine exercise positions after 28 weeks’ gestation
What are the relative CIs for exercise in pregnancy?
- Severe anaemia
- Unevaluated maternal
cardiac arrhythmias - Chronic bronchitis
- Heavy smoker
- Poorly controlled T1DM
- Extreme morbid obesity
- Extreme underweight
- Extremely sedentary lifestyle
- IUGR (intra uterine growth restriction)
- Poorly controlled HTN
- Orthopaedic limitations
- Poorly controlled seizure disorder
- Poorly controlled hyperthyroidism
What are the absolute CIs for exercise in pregnancy?
- Haemodynamically significant heart disease
- Restrictive lung disease
- Incompetent cervix/suture
- Multiple gestation at risk of premature labour
- Persistent 2nd or 3rd trimester bleeding
- Pre-eclampsia/pregnancy induced Hypotension
- Premature labour during current pregnancy
- Placenta praevia after 26/40
- Ruptured membranes
What are the warning signs to cease exercise while pregnant?
- Vaginal bleeding
- Amniotic fluid leakage
- Unusual dyspnoea
- Dizziness
- Headache
- Chest or abdominal pain
- Muscle weakness
- Unusually high HR
- Contractions / Preterm labour
- Decrease foetal movement
- Insufficient weight gain
- Sudden swelling of ankles, hands and face & feeling unwell
What are the benefits of pregnancy-specific exercise classes?
- Safety for mum
- Participation of non‐exercisers
- Modification for over-exercisers
- Less OPD referrals for msk conditions
- Physio contact & advice
- Health promotion, education & prevention of PF probs
- Functional application to labour and baby care
- Networking/support group
What are the guidelines for sport in pregnancy?
- Frequent & close supervision if maintaining strenuous training schedule
- Avoid hyperthermia
- Maintain proper hydration
- Sustain adequate caloric intake
- Discuss benefits & risks with medical practictioner
What should be included in the subjective assessment of a musc issue during pregnancy?
- How many weeks
- Previous pregnancies
- If pregnancy has been healthy
- Complications
What complications should you consider in the subjective assessment of a musc issue during pregnancy?
- Multiple pregnancy
- Hyperemesis
- HTN/pre-eclampsia
- Ante-Partum Haemorrhage (APH)
- Placenta Praevia (PP)
- Cervical incompetence +/- stitch
- Intra-Uterine Growth Restriction (IUGH)
- Threatened Premature Labour (TPL)
- Poly/Oligohydramnios
- Blood group incompatibility
- Placental abruption
What are the risk factors for PGP?
- Parity
- Previous pelvic trauma
- History of LBP
- High work load
What are the treatments for PGP?
- Manual therapy
- ADL mods/avoid
- Stability exercise
- Pelvic belt
- Abdomen support
- Rest
- Ice joints
