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medcon rehab iv > Pregnancy and Postpartum: A Physiological Overview of System Changes and Obstetric Terminology > Flashcards

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
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2
Q

Gestational Age (GA) ===>

A

Duration of pregnancy in weeks

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3
Q

Full term ==>

A

40 weeks +/- 2wks

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4
Q

Pre-term ==>

A

LESS THAN 37wks gestation

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5
Q

Obstetrics Terminology:

Gestational Age (GA)

A

Duration of pregnancy in Weeks

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6
Q

Obstetrics Terminology:

Estimated Date of Delivery (EDD)

A

Due Date

Usually bw 38 and 42wks

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7
Q

Gravida

A

Woman who IS pregnant

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8
Q

Nulligravida

A

NEVER conceived child

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9
Q

Primagravida

A

1st time pregnant

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10
Q

Mutligravida

A

Completed 2 or more pregnancies

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11
Q

Nullipara

A

Never completed pregnancy beyond abortion

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12
Q

Primapara

A

Delivered 1 fetus beyond 20wks

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13
Q

Multipara

A

Delivered more than 1 fetus beyond 20wks

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14
Q

Para

A

Completed pregnancies beyond 20wks gestation

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15
Q

Gravida

A

of pregnancies woman has had

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16
Q

Ex. prima/gravida

A

30yo primagravida GA 28wks c/o severe RLE sciatica, LBP. Onset 4wks ago

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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
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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
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19
Q

Rapid rise of hormones when???

A

1st Trimester!!!!

  • Estradiol→ Less cranky, bigger boobs
  • Progesterone→ Cranky hormone
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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
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21
Q

CV System Changes

Other

Relaxin

A

Relaxin may be primary agent responsible for many of the CV changes during pregnancy!!!

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22
Q

may be primary agent responsible for many of the CV changes during pregnancy!!!

A

Relaxin

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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!!!
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24
Q

Respiratory changes

More on Dyspnea…

A

May occur as early as 20 weeks

MILD exercise, stairclimbing

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25
Q

Skeletal Changes during Pregnancy

BOLD=IMPORTANT!

A
  • 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
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26
Q

More Skeletal Changes during Pregnancy

A
  • 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
Q

Postural Changes in Pregnancy

A
  • FHP w/ inc thoracic kyphosis, INCd lumbar lordosis, INCd APT
  • Change in BOS:
    • Wider, Hip ER, Genu recurvatum, Foot PROnation
28
Q

Gait Changes during Pregnancy

A

“Waddling Gait”

  • INCd APT
  • INCd demands→ hip ABDs, hip EXTs, ankle PF’s
  • INCd load on lateral foot and hindfoot
29
Q

Mood Disorders:

Postpartum psychosis

A

MEDICAL EMERGENCY!!!!

30
Q

Precautions and Contraindications to Exercise during Pregnancy and Postpartum

SAFETY ISSUES

A

HTN

Vaginal Bleeding

31
Q

Precautions and Contraindications to Exercise during Pregnancy and Postpartum

ACOG Precautions

A
  • *HTN (Safety issue)
  • Gestational DM
32
Q

Precautions and Contraindications to Exercise during Pregnancy and Postpartum

ACOG Contraindications

A
  • Premature rupture of membranes (PROM)
  • Risk factors for preterm labor
  • *Vaginal Bleeding (Safety issue)
33
Q

Precautions and Contraindications to Exercise during Pregnancy and Postpartum

More

A
  • Fatigue
    • Borg, “Talk Test”
  • LE edema
    • limit standing
  • Avoid:
    • PRONE > 2nd trimester
    • <6wks postpartum:
      • Knee to chest, Double leg lowering, High impact activity
34
Q

AVOID prone when?

A

>2nd trimester

35
Q

AVOID:

Knee to chest, double leg lowering, high impact activity

WHEN??

A

<6wks postpartum

36
Q

Avoid SUPINE pos. after mid-2nd trimester

WHY???

A

Inferior Vena Cava Occlusion*

  • NO MORE THAN 2mins Supine
  • Recovery position→ LEFT S/L
  • Dizzy, faint, INC HR, sweaty
37
Q

INFERIOR VENA CAVA OCCLUSION IS A THING….

Bc of this…..

A

AVOID Supine pos. after mid-2nd trimester

*NO MORE THAN 2mins!!!

38
Q

Lumbopelvic Pain

Gen Facts

A
  • 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
Q

Lumbopelvic Pain

Risk Factors

A
  • 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
Q

Lumbopelvic Pain during Pregnancy

Predictors

A

A set of physical and psychosocial factors appears to be most predictive of Lumbopelvic pain

41
Q

Special Tests for LumboPelvic pain

2 she mentions (specific to lumbopelvic)

A
  1. P4 Test (Posterior Pelvic Pain Provocation)
  2. ASLR (Active Straight Leg Raise)
42
Q

P4 Test

Posterior Pelvic Pain Provocation

A

See details in pic and ACTUALLY TRY IT!!! (AGAIN!)

43
Q

ASLR for LumboPelvic Pain

Active Straight Leg Raise

A

See pic for details and ACTUALLY DO IT!!! (AGAIN!)

44
Q

Interventions: Functional Mobility

This can include 3 things:

A
  1. Positions of comfort
  2. Transfers
  3. Use of quadruped
45
Q

Pos’s of Comfort

Supported Sitting

A

see pics

46
Q

Pos’s of Comfort:

Supported S/L

A

see pics

*NOTE: BIG body pillow bw legs and under stomach

47
Q

Quadruped Exercises for Lumbopelvic pain

2:

A
  1. Side sit to heels (BIG Lat stretch too!)
  2. Look to Opp heel

*see pics

48
Q

Interventions:

LE Stretching

2 big ones?

A

Hip flexor

Piriformis

49
Q

Interventions:

LE Stretching

Hip Flexor Stretching for LumboPelvic Pain

A
  • ½ kneeling
  • Side sit in chair
  • Modified “Runner’s Stretch” @ counter w/ front knee flexed (bc pregnant***)
50
Q

Interventions:

LE Stretching

Piriformis, Glute stretches

2:

A
  • 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
Q

Diastasis Rectii Abdominus (DRA)

Gen Facts

A
  • 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
Q

Diastasis Rectii Abdominus (DRA)

What is considered POSITIVE?

A

MORE THAN 2 finger breadths

53
Q

DRA Assessment

TRY IT/DO IT!!!

A
  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
Q

Risk Factors for DRA

A
  • 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
Q

TrA and DRA Connection

A
  • Muscle synergy exists bw TrA and Pelvic Floor
  • BOTH play important role in stabilizing pelvis, spine
  • Exercise has protective effect for DRA
56
Q

DRA Mgmt:

4:

A
  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
Q

Abdominal Re-Education: Progression #1

Take the ideas and be able to design/write it on your own!!

A

See pics

58
Q

Abdominal Re-Education: Progression #2

A

See Pics

59
Q

Abdominal Re-Education: Progression #3

A

See pics

Use and be able to write/implement/design!!!

*Understand the progressions!!!

60
Q

Symphysis Pubis Dysfunction (SPD)

A
  • 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
Q

Symphysis Pubis Dysfunction (SPD)

Examination and Mgmt

BOLD=IMPORTANT!!!

A
  • 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
Q

SPD Exam/Mgmt

Other stuff

A

Palpate pubic tubercle if tolerated (consent!), Pt edu. for transfers, ADLs, Core/Pelvic stabilization program

63
Q

Pelvic Stability Belts & Binders

A
  • Assists→ Form closure of pelvic joints, force closure of abdominals*
  • LOW cost, user friendly, min. risk of harm
64
Q

Summary Slide:

Mods for Prenatal & Postpartum Clients

A
  • Asymmetrical pos’s and lumbopelvic pain
  • Wt bearing helps to DEC pain and promote form-force closure thru pelvis
  • Quadruped for INCd WB, comfort
  • S/L***

THINK BACK ON THE LECTURE!!! YOU KNOW THESE!!!

medcon rehab iv (18 decks)

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