Pregnancy and Labor Flashcards
Pregnancy is how long
38-42 weeks from conception to delivery
Counted from the first date of the last menstrual period
Typically 4 weeks pregnant when first positive test
Pregnancy - trimesters - total weight gain
3 trimesters
Total weight gain is 20-35 pounds (depends on BMI)
First trimester
Fertilized ovum implanted 7-10 days after fertilization
Majority of fetal systems formed but not function fully
First trimester is when
0-12 weeks
First trimester - symptoms
Emotional changes begin
Fatigue, n/v, inc urinary freq
MSK complaints may begin
First trimester - weight gain
0-3 pounds
Second trimester is when
13-27 weeks
Second trimester - symptoms
Begin to show
Most women feel great - more energy
Second trimester - fetus weight
1-2 pounds
Second trimester - fetus
Eyebrows, eyelashes, fingernails formed
Movement felt around 20 weeks
Third trimester is when
28-40 ish weeks
Third trimester - uterus
5-6 times its normal size and 20 times its normal weight
Contracts regularly
Pelvic organs become abdominal organs
Third trimester - common complaints
LBP, rib pain, freq urination, incontinence, fatigue, SOB, constipation, LE edema
Hormone charts
Day 21-28 drop in estrogen and progesterone
At ovulation, body temp rises about 1/2 degree
Endocrine changes - estrogen
Size inc in uterus and breasts
Contributes to CT changes
Estroiol inc to 1000x pre-pregnancy
Endocrine changes - relaxin
Peak level in 1st trimester and remains elevated
Inhibits uterine contraction, softens the cervix
Relaxes ligaments
Endocrine changes - progesterone
Smooth mm relaxation - GI constipation, uterus, veins have dec peripheral resistance
Inc sens to CO2 (hypervent)
Inc core temp 1/2 degree
CV changes - blood volume
BV 50%
CV changes
HR x SV = CO
HR x SV = CO (all inc and peak mid gestation)
Baseline HR inc about 12 bpm
CV changes - BP
Slight dec in BP initially then normal
Peripheral res dec, CO inc so BP doesn’t change much
CV changes - heart
Heart arrhythmias
CV changes - plasma and RBCs
40-60% inc in plasma, but only 30% inc in RBC
CV changes - venous pressure
Inc venous pressure in LE with standing
Varicose veins
Hemorrhoids
CV changes - IVC
Pressure rises in IVC Worse in late pregnancy Worse in supine Worse in supine with ex Leads to symptomatic supine hypotension
CV changes - aorta
Can be partially occluded in supine
Pulmonary changes - ribcage
AP and transverse in all diameters (2cm each)
Subcostal angle from 68 to 103 degrees
Ribcage elevates and does not always come back down
Diaphragm elevates passively 4cm
Pulmonary changes - Upper resp tract
Capillary dilation - inc secretions
Pulmonary changes - hyperventilation
Inc tidal volume
Steady freq
Pulmonary changes - oxygen
20% inc in oxygen consumption
Pulmonary changes - work of breathing
Inc and dec functional residual capacity - dyspnea with exercise early
Renal system changes
Micuration - detrusor relaxation, bladder is displaced ant and sup
Inc urinary freq
Thermoregulatory changes
BMR inc
Heat production inc
300 extra calories a day
Psych changes
Preg related depression
Post partum depression
Edinburgh postnatal dep scale can be used to screen
MSK changes - abdominal mm
Stretched to elastic limits
Esp RA
Can lead to diastasis Recti
Reduced mechanical advantage
MSK changes - PFM
Stretched up to 30% from inc weight
Birth trauma - pudendal nerve stretch, tearing, episiotomy
MSK changes - CT and joint
Hypermobility
Postural and balance changes
COG shifts upward and forward Subocc tighten Lumbar paraspinals tighten Thoracic kyphosis inc Changes often persist into infant care@
Labor - effacement
Thickness of cervix from 5cm to 1 mm
Labor - dilation
Opening of cervix from diameter of a fingertip to 10 cm
Labor - 3 stages
1 = cervical dilation (labor) 2 = pushing and expulsion (delivery) 3 = placental expulsion and uterine involution (afterbirth)
Vaginal birth - possible complications
Compromise to pudendal
Perineal tearing
Episiotomy
Inc strain against pelvic organs
Vaginal birth - possible complications - Episiotomy - what percentage of vaginal deliveries
51-75%
Becoming less common
Can be harmful in some cases
Surgeons say easier to put back together - but worse because going through deeper layers than if were to just tear naturally
PT during labor and delivery
Is underutilized! Relaxation training Breath control Vasalva avoidance TENS for LBP Sacral mob for LBP Position changes for slow progression of labor Alternate positioning
Labor - important hx questions
How long was stage 2 Did they have episiotomy Did they have a tear Did they have a ceserian How was their recovery Any birth complications
Ceserean delivery - rates
rose by 53% from 96 to 2007
32% of all deliveries
WHO recommends 10% though
Vaginal birth after cesarean
Some doctors will not allow it because higher chance of complications
but ACOG says it is fine
Vaginal birth after cesarean - what does research show
Risk of uterine rupture after VBAC is less than 1% when birth is at least 18 months after initial C section
Risk of fetal death in 6% of uterine ruptures
Ceserian delivery - afterwards
Extended recovery
Major abdominal surgery
Conflicting emotions/feelings of failure
May offer protective effect for pelvic floor but not always! - still may have long stage 2 prior to C section and pregnancy itself is stressful to PFM
C delivery is necessary or not
Absolutely necessary and appropriate in many situations
Absolutely unnecessary in other situations
C delivery - reasons for unnecessary
Scheduled c sections for convenience of provider and mother
Perceived risk and insurance company intervention
VBAC
Ceserian indications
Genital or cervical disease Premature labor with fetal distress Fetal distress Chronic disease Malposition of placenta Issues with multipl birth Hemorrhage Placenta abruption Prolapsed umbilical cord Malpresentation Failure to progress Cephalopelvic disproportion
Professional communication - Gravida
Base word for number of times pregnant
Professional communication - Para
Base word for number of times given birth (alive or stillborn)
Professional communication - Or in order like this 4, 1, 1, 4
1st - number of term deliveries
2nd - number of preterm deliveries
3rd - number of abortions
4 - number of living children
Professional communication - Nullipara
No pregnancy beyond 20 weeks gestation
Professional communication - Primipara
1 delivery beyond 20 weeks gestation
Professional communication - Multipara
2 or more feliveries beyond 20 weeks gestation
Professional communication - nulligravida
Never been pregnant
Professional communication - Primigravida
Pregnant once, regardless of outcome
Professional communication - Multigravida
More than one pregnancy
High risk pregnancy
1 complicate dby disease
2 pregnancy in which one is at inc risk of morbidiity or mortality before, during or after delivery
High risk conditions
Preterm rupture of membranes Premature onset labor Incompetent cervix Placenta previa Preeclampsia Multiple gestation Gestational diabetes
High risk conditions - incompentet cervix is what
cervix opens too soon
High risk conditioons - placent previa is what
Placenta implants low in uterus, may contribute to preterm labor or c section
High risk conditions - preeclampsia
gestational hypertension, water retention and protein in urine; progresses to headaches, blurred vision, fatigue, nausea, SOB = medical emergency
Acute care PT (1 to 3 days post partum)
Underutilized! Education Exercise sheet for HEP Initiation of PFM Pain control Posture and body mechanics Post surgical considerations for C Scar mobs Expectations for incontinence Return to exercise DR care
