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Physio in Specific Groups > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What is the childbearing year?

A
  • Pregnancy (~40 weeks)
  • Labour & birth (2-36 hours)
  • Immediate post-natal recovery (1-6 weeks)
  • Continuing post-natal recovery up to 1st birthday
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2
Q

When would a physio treat a women in her childbearing year?

A
  1. Musc injuries whilst pregnant or post-natal
  2. Pregnancy-related musc conditions
  3. Hospital inpatient who is pregnant or post-natal in ortho, med, surgical, ICU or maternity wards
  4. Pre/post-natal exercise & education classes
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3
Q

What anatomical & physiological changes occur in the first trimester (0-13 weeks)?

A
  • 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
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4
Q

What are the functional implications in the first trimester?

A
  • Low energy
  • Less exercise
  • Hyperemesis
  • LBP/PGP
  • Hopefully avoid teratogens (radiation, heat, smoking, alcohol)
  • But may be no change
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5
Q

What does relaxin have a role in?

A
  • 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
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6
Q

What is the effect of relaxin on the musculoskeletal system?

A

Reconcile haemodynamic changes occurring during pregnancy (e.g. CO, renal blood flow, arterial compliance, weakening of pelvic ligaments)

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7
Q

What physio input is relevant in the first trimester?

A
  • Encourage and advise re appropriate and modified exercise
  • Encourage ante-natal physio education: ‘Healthy Pregnancy’
  • Musculoskeletal treatment
  • Discourage risky activity/teratogens
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8
Q

What anatomical & physiological changes occur in the second trimester (13-28 weeks)?

A
  • 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
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9
Q

What are the functional implications in the second trimester?

A
  • 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)
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10
Q

What physio input is relevant in the second trimester?

A
  • 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)
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11
Q

What anatomical & physiological changes occur in the third trimester (29-40 weeks)?

A
  • 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
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12
Q

What are the functional implications in the third trimester?

A
  • Increased physical discomforts
  • COG shifting forward
  • Increased spinal curves
  • Msk pain - T/S, L/S, PGP
  • CTS
  • Breathlessness
  • Heartburn
  • Disturbed sleep
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13
Q

What physio input is relevant in the third trimester?

A
  • Msk treatment
  • Pregnancy exercise classes
  • Birth education classes
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14
Q

What antenatal physio education should be advised?

A
  • Refer onto women’s health physio for pelvic floor/incontinence symptoms
  • Encourage participation in hospital/private practice pregnancy education/physio-led exercise classes
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15
Q

What is usually included in “Healthy Pregnancy” education sessions?

A
  • 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
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16
Q

What can motivational counselling be used for?

A
  • Behaviour modification
  • Adopting healthy lifestyle (more likely as increased motivation, frequent access to medical supervision)
  • Controlling weight
  • Improving diet
  • Increasing exercise
17
Q

What are the pregnancy exercise guidelines?

A
  • 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
18
Q

What are the benefits of exercise during pregnancy?

A
  • 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
19
Q

What types of exercise are safe for women with an uncomplicated pregnancy?

A
  • Walking, jogging, cycling and swimming (mod intensity)
  • Muscle strengthening exercises
  • Water-based exercise
  • Pregnancy specific exercise classes
20
Q

What types of exercise are considered unsafe for pregnant women?

A
  • 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
21
Q

Why is exercise in a supine position considered unsafe?

A
  • May cause hypotension in some women

- For safety, avoid supine exercise positions after 28 weeks’ gestation

22
Q

What are the relative CIs for exercise in pregnancy?

A
  • 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
23
Q

What are the absolute CIs for exercise in pregnancy?

A
  • 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
24
Q

What are the warning signs to cease exercise while pregnant?

A
  • 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
25
Q

What are the benefits of pregnancy-specific exercise classes?

A
  • 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
26
Q

What are the guidelines for sport in pregnancy?

A
  • Frequent & close supervision if maintaining strenuous training schedule
  • Avoid hyperthermia
  • Maintain proper hydration
  • Sustain adequate caloric intake
  • Discuss benefits & risks with medical practictioner
27
Q

What should be included in the subjective assessment of a musc issue during pregnancy?

A
  • How many weeks
  • Previous pregnancies
  • If pregnancy has been healthy
  • Complications
28
Q

What complications should you consider in the subjective assessment of a musc issue during pregnancy?

A
  • 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
29
Q

What are the risk factors for PGP?

A
  • Parity
  • Previous pelvic trauma
  • History of LBP
  • High work load
30
Q

What are the treatments for PGP?

A
  • Manual therapy
  • ADL mods/avoid
  • Stability exercise
  • Pelvic belt
  • Abdomen support
  • Rest
  • Ice joints

Physio in Specific Groups (12 decks)

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