Pregnancy and Postpartum: A Physiological Overview of System Changes and Obstetric Terminology Flashcards
1
Q
Pregnancy Basics:
How many trimesters?
How long are they?
A
- 3 Trimesters, 12 wks in length
- 1st→ 0-12
- 2nd→ 13-27
- 3rd→ 28-40
2
Q
Gestational Age (GA) ===>
A
Duration of pregnancy in weeks
3
Q
Full term ==>
A
40 weeks +/- 2wks
4
Q
Pre-term ==>
A
LESS THAN 37wks gestation
5
Q
Obstetrics Terminology:
Gestational Age (GA)
A
Duration of pregnancy in Weeks
6
Q
Obstetrics Terminology:
Estimated Date of Delivery (EDD)
A
Due Date
Usually bw 38 and 42wks
7
Q
Gravida
A
Woman who IS pregnant
8
Q
Nulligravida
A
NEVER conceived child
9
Q
Primagravida
A
1st time pregnant
10
Q
Mutligravida
A
Completed 2 or more pregnancies
11
Q
Nullipara
A
Never completed pregnancy beyond abortion
12
Q
Primapara
A
Delivered 1 fetus beyond 20wks
13
Q
Multipara
A
Delivered more than 1 fetus beyond 20wks
14
Q
Para
A
Completed pregnancies beyond 20wks gestation
15
Q
Gravida
A
of pregnancies woman has had
16
Q
Ex. prima/gravida
A
30yo primagravida GA 28wks c/o severe RLE sciatica, LBP. Onset 4wks ago
17
Q
Overview of Physiological Changes in Pregnancy
BOLD=Important!!!
A
-
IMPORTANT ONES:
- 25-35lbs wt gain
- INC in CV function
- INC edema
- Hormonal changes drive many of these physio. changes
- Other
- Laxity of soft tissue structures (ligs, fascia), changes are NOT pathological, but physiologically normal
18
Q
Endocrine changes during Pregnancy
A
- Secretion of estrogen/progesterone
- *Estrogen rises 30x pre-pregnancy lvl→ INC uterine/breast size
- Placenta develops and becomes primary source of reqd hormones @ WEEK 11
- Relaxin, prolactin, adrenal hormones (aldosterone, cortisol) play important roles to support pregnancy
19
Q
Rapid rise of hormones when???
A
1st Trimester!!!!
- Estradiol→ Less cranky, bigger boobs
- Progesterone→ Cranky hormone
20
Q
CV System Changes
BOLD=IMPORTANT!!!
A
-
IMPORTANT ONES:
- INCd CO by ~30%
- reaches MAX in 2nd trimester*
- INCd HR by ~12bpm by term
- INCd SV by ~25%
- INCd blood volume (swelling calves/ankles)
- 50% inc in plasma vol.
- INCd O2 consumption
-
Remodeling of heart
- 50% inc in L vent mass, reduces afterload on heart
- DECd systemic vascular resistance w/ an initial DEC in BP
- returns normal late pregnancy
- INCd CO by ~30%
21
Q
CV System Changes
Other
Relaxin
A
Relaxin may be primary agent responsible for many of the CV changes during pregnancy!!!
22
Q
may be primary agent responsible for many of the CV changes during pregnancy!!!
A
Relaxin
23
Q
Respiratory System Changes
A
- INCd tidal volume, hypERventilation, DECd functional residual capacity, DECd residual volume, Dyspnea
- How might this affect PT?→* LOWER tolerance! Warm-up is Important*** and monitoring response to exercise!!!
24
Q
Respiratory changes
More on Dyspnea…
A
May occur as early as 20 weeks
MILD exercise, stairclimbing
25
**Skeletal Changes** during Pregnancy
## Footnote
**BOLD=IMPORTANT!**
* Ribcage moves _laterally_ INCing **sub-costal angle**
* **IMPORTANT:**
* INCs as pregnancy **progresses**
* Hormonally stim'd
* Occurs **prior to uterine enlarge.**
* Intercostal mm's and cartilage may sustain **overstretch injury**
26
More Skeletal Changes during Pregnancy
* Changes in **Bone Mineral Density (BMD)** due to **incd need for Ca+ by fetus:**
* **\*_INCd intestinal Ca+ absorption_**
* Ca+ conservation by kidney
* Mobilization of Ca+ from maternal skeleton
* **Transient OP** in pregnancy
* LOWER BMD than controls persists postpartum, **incomp. recovery of bone loss @ 5mos after weaning**
27
Postural Changes in Pregnancy
* FHP w/ inc thoracic kyphosis, INCd lumbar lordosis, INCd APT
* Change in BOS:
* Wider, Hip ER, Genu recurvatum, Foot PROnation
28
Gait Changes during Pregnancy
**“Waddling Gait”**
* INCd APT
* INCd demands→ hip ABDs, hip EXTs, ankle PF's
* INCd load on **lateral foot** and **hindfoot**
29
Mood Disorders:
## Footnote
**Postpartum psychosis**
MEDICAL EMERGENCY!!!!
30
**Precautions** and **Contraindications to Exercise** during Pregnancy and Postpartum
## Footnote
**_SAFETY_ ISSUES**
HTN
Vaginal Bleeding
31
**Precautions and Contraindications** to **Exercise** during Pregnancy and Postpartum
## Footnote
**ACOG _Precautions_**
* **\*HTN (Safety issue)**
* Gestational DM
32
**Precautions and Contraindications** to **Exercise** during Pregnancy and Postpartum
## Footnote
**ACOG _Contraindications_**
* Premature rupture of membranes (PROM)
* Risk factors for preterm labor
* **\*Vaginal Bleeding (Safety issue)**
33
**Precautions and Contraindications** to **Exercise** during Pregnancy and Postpartum
More
* Fatigue
* Borg, “Talk Test”
* LE edema
* limit standing
* **_Avoid:_**
* PRONE \> 2nd trimester
* \<6wks postpartum:
* Knee to chest, Double leg lowering, High impact activity
34
AVOID **prone** when?
\>2nd trimester
35
**AVOID:**
Knee to chest, double leg lowering, high impact activity
WHEN??
\<6wks postpartum
36
Avoid **SUPINE pos. after _mid-2nd trimester_**
## Footnote
**WHY???**
Inferior Vena Cava Occlusion\*
* NO MORE THAN 2mins Supine
* **Recovery position→** LEFT S/L
* Dizzy, faint, INC HR, sweaty
37
INFERIOR VENA CAVA OCCLUSION IS A THING….
## Footnote
**Bc of this…..**
_AVOID_ **Supine pos. after _mid-2nd trimester_**
\*NO MORE THAN 2mins!!!
38
Lumbopelvic Pain
## Footnote
**Gen Facts**
* More than ½ exp LBP or lumbopelvic pain during pregnancy
* **⅓ who dev. pain during pregnancy will _CONTINUE_ to have sx's post-partum**
39
Lumbopelvic Pain
## Footnote
**Risk Factors**
* Parity, maternal age, hx of pain in prev. pregnancy, hx of LBP, intensity of pain during pregnancy, work factors, BMI, delivery pos., multiple births
* ***\*\*\*A set of _physical and psychosocial factors_ appears to be _MOST predictive of lumbopelvic pain_***
40
Lumbopelvic Pain during Pregnancy
## Footnote
**Predictors**
A set of **physical and psychosocial factors** appears to be **_most predictive_** of Lumbopelvic pain
41
Special Tests for LumboPelvic pain
## Footnote
**2 she mentions (specific to lumbopelvic)**
1. P4 Test (**P**osterior **P**elvic **P**ain **P**rovocation)
2. ASLR (Active Straight Leg Raise)
42
P4 Test
## Footnote
**Posterior Pelvic Pain Provocation**
See details in pic and **ACTUALLY TRY IT!!! (AGAIN!)**
43
ASLR for LumboPelvic Pain
## Footnote
**Active Straight Leg Raise**
See pic for details **and ACTUALLY DO IT!!! (AGAIN!)**
44
Interventions: **Functional Mobility**
## Footnote
**This can include _3 things_:**
1. Positions of comfort
2. Transfers
3. Use of **quadruped**
45
Pos's of Comfort
## Footnote
**Supported Sitting**
see pics
46
Pos's of Comfort:
## Footnote
**Supported S/L**
see pics
\***NOTE: BIG body pillow bw legs and under stomach**
47
Quadruped Exercises for Lumbopelvic pain
## Footnote
**2:**
1. Side sit to heels (**BIG Lat stretch too!)**
2. Look to Opp heel
\*see pics
48
Interventions:
## Footnote
**LE Stretching**
**2 big ones?**
Hip flexor
Piriformis
49
Interventions:
## Footnote
**LE Stretching**
**_Hip Flexor_ Stretching for LumboPelvic Pain**
* ½ kneeling
* Side sit in chair
* Modified “Runner's Stretch" @ **counter** w/ front knee flexed (bc pregnant\*\*\*)
50
Interventions:
## Footnote
**LE Stretching**
**Piriformis, Glute stretches**
**2:**
* **Supine “Figure 4” Stretch**
* **Symptomatic leg** crossed **on top of opp leg,** making shape of “L” or “4 points”
* **Low lvl:** gently pull thigh towards **ipsilat shoulder**
* **Higher lvl:** gently pull **contralateral thigh** upwards toward **chest**
* **Sitting Mods for work tasks, pregnancy**
* **Supine Piriformis Stretch**
* **Symptomatic leg** pulled to **opp shoulder**
* **Floor:** symptomatic leg in front, lean over leg ("Paper Readers")
51
Diastasis Rectii Abdominus (DRA)
## Footnote
**Gen Facts**
* **Separation** of **rectus abdominus mm bellies**
* **Due to _expansion_ of abdomen during pregnancy and _“softening effects"_ of maternal hormones**
* **\***_MORE THAN_ 2 finger breadths==\> **Positive**
* **NOTE:** _Ineffective abdominal control may lead to LBP, PGP, or postural dysfunction_\*\*
52
Diastasis Rectii Abdominus (DRA)
## Footnote
**What is considered _POSITIVE?_**
**MORE THAN** 2 finger breadths
53
DRA Assessment
## Footnote
**TRY IT/DO IT!!!**
1. **Palpate in _hooklying:_**
1. @ Navel
2. 2" Above
3. 2" Below
2. Instruct **isometric TrA contraction→** “Bellybutton to spine”
3. Pt performs **head lift w/ _exhalation_**
4. \*Document # finger breadths present
1. **Ex. 1/3/2 (bc 3 pos's)**
54
**Risk Factors for DRA**
* Older women (\>33yo)
* Multiparous women (**women having had @ least one prev. birth)**
* Multiple gestation
* Carrying larger baby (\>3636g)
* Wt gain during pregnancy (\>35lbs)
* C-Section delivery
55
TrA and DRA Connection
* **Muscle synergy** exists bw **TrA and Pelvic Floor**
* BOTH play important role in **stabilizing pelvis, spine**
* Exercise has **protective effect** for **DRA**
56
DRA Mgmt:
## Footnote
**4:**
1. SUB-max, isometric, **pain-free contraction** of TrA
2. Abdominal bracing or taping (towel, **manual approximation→ exactly what it sounds like!)**
3. Training in Pelvic Floor Muscle Contraction **(PFMC)**
4. Exercise **progression** into **abdominal** and **hip strengthening program**
57
Abdominal Re-Education: **Progression #1**
## Footnote
**Take the _ideas_ and be able to _design/write_ it on your own!!**
See pics
58
Abdominal Re-Education: **Progression #2**
See Pics
59
Abdominal Re-Education: **Progression #3**
See pics
## Footnote
**Use and be able to write/implement/design!!!**
**\*_Understand_ the progressions!!!**
60
Symphysis Pubis Dysfunction **(SPD)**
* Occurs **during pregnancy** OR **as result of trauma during delivery**
* **\*Lithotomy pos.**
* **Radiographic testing→** Reveals _separation_ **post-partum**
* **\*\*\*Occurs _in conjuction w/_ lumbopelvic, PGP**
* **\*Often _severe_ case presentation**
61
Symphysis Pubis Dysfunction (SPD)
## Footnote
**Examination and Mgmt**
**BOLD=IMPORTANT!!!**
* **BOLD/IMPORTANT STUFF:**
* _AVOID_ **asymmetrical pos's!**
* **→ Promote _EQUAL WB_ thru pelvis**
* Provide **AD for gait (SW, RW)**
* **Modalities** to DEC **inflammation:** pulsed US (postpartum), ice
* Supportive belt around **greater trochs**
62
SPD Exam/Mgmt
Other stuff
Palpate pubic tubercle **if tolerated (consent!),** Pt edu. for transfers, ADLs, Core/Pelvic stabilization program
63
Pelvic Stability Belts & Binders
* Assists→ **Form closure of pelvic joints, force closure of abdominals\***
* **LOW cost, user friendly, min. risk of harm**
64
Summary Slide:
## Footnote
**Mods for Prenatal & Postpartum Clients**
* Asymmetrical pos's and lumbopelvic pain
* Wt bearing **helps** to DEC pain and **promote** f**orm-force closure** thru pelvis
* Quadruped for INCd WB, comfort
* S/L\*\*\*
**THINK BACK ON THE LECTURE!!! YOU _KNOW_ THESE!!!**
