pregnancy part 2 Flashcards
physical therapy interventions (post cesarean complication)
➤ Postoperative TENS for pain (electrodes parallel to incision)
➤ Assist with breathing and coughing: prevent postsurgical pulmonary complications
Use of a pillow to support the incision when coughing or breastfeeding
➤ Gentle abdominal exercises
➤ Scar tissue mobilization, friction massage
➤ Pelvic floor exercises
Especially given that most women would have had lengthy labor before cesar-
ean section
➤ Postural exercises
➤ No heavy lifting for 4 to 6 weeks; no vigorous exercise for 6 to 8 weeks postpartum
high risk pregnancy
● Goal is to prevent preterm delivery → focus on activity modification
➤ Bed rest is rare
➤ No abdominal exercises that stimulate uterus contractions
premature rupture of membranes
amniotic sac breaks and amniotic fluid is lost before the onset of labor
Requires immediate medical attention
incompetent cervix
painless dilation of cervix in 2nd trimester (after 16 weeks’
gestation) or early 3rd trimester
May use stitches to keep cervix closed (cerclage)
Without timely intervention, may lead to continued dilation of the cervix →
rupture of membranes → delivery of fetus
placenta previa
placenta attaches too low on the uterus → as the cervix dilates,
the placenta begins to separate from the uterus and may present before the fetus
Life threatening to the fetus
Bleeding is the primary symptom
preclampsia
starts in 3rd trimester and disappears postpartum
Pregnancy-induced acute HTN
BP > 140/90 (measured 2 times within 4 h) → medical emergency
S/S: HTN, protein in urine, severe fluid retention
Complications: maternal convulsions, coma, and death
multiple gestation
more than one fetus
Complications: premature onset of labor and birth, prenatal mortality, low-
birth-weight infants, increased incidence of maternal complications
eclampsia
Seizure due to high BP after childbirth
Medical emergency
gestational diabetes
High blood sugar during pregnancy
⚬ Occurs only during pregnancy and disappears postpartum
ectopic pregnancy
tubal pregnancy
Fertilized egg is implanted outside the uterine cavity (mainly in the fallopian
tube)
Medical emergency
S/S
⚬ Sudden onset of sharp pain on one side of the lower abdomen or pelvis
lasting more than a few hours
⚬ Referred pain to shoulder
⚬ Amenorrhea, irregular bleeding, and spotting
⚬ Dizziness, fainting, paleness, and shock
pelvic inflammatory disease
➤ Inflammation of the female reproductive organs
Endometritis = uterus
Salpingitis = Fallopian tubes
Tubo-ovarian abscess
Pelvic peritonitis
➤ Bacterial infection: typically associated with an STD
➤ S/S
Often asymptomatic
Abdominal vaginal discharge or bleeding
Dysuria
Moderate to severe lower abdominal and/or pelvic pain; back pain
Dyspareunia
Painful menstruation
Fever, chills, nausea, vomiting
➤ Complications
Pelvic adhesions, infertility, ectopic pregnancy, chronic pain, abscess
➤ Treatment
Antibiotic therapy: treat infection and prevent complications
pelvic floor disorders
➤ Red flag: pain radiating down to posterior thigh
➤ Weakness of pelvic floor muscle (pubococcygeal muscle) due to overstretching
➤ Can lead to prolapse
Cystocele: herniation of bladder into vagina
Rectocele: herniation of rectum into vagina
Uterine prolapse: bulging of uterus into vagina
➤ Pelvic floor muscle can go into spasm
Pelvic pain, urinary incontinence (urge), pain with sexual intercourse
Need to teach relaxation techniques
coccydynia
pain in the region of the coccyx
➤ Joint becomes hypermobile, which causes coccyx pain
➤ Causes: trauma (fall directly onto the tailbone), events associated with childbirth
diastasis recti
➤ Separation of the rectus abdominis at the midline of the linea alba
Any separation ≥ 2 finger widths
Commonly seen in pregnant women due to hormonal effects on connective
tissues and biomechanical changes during pregnancy
Can develop during labor as a result of excessive breath holding
Can occur above, at, or below the level of the umbilicus
Can produce associated LBP
➤ Testing should be performed on all pregnant women prior to exercise prescription
Positive if ≥ 2 fingers fit into separation when patient lifts head and shoulders
off the table in hook-lying position
⚬ If > 4 fingers fit, use of an abdominal binder is recommended
⚬ Very severe separation, so advise only light exercises
⚬ Deep breathing, sitting
PT interventions diastasis recti
Strengthening and stabilization exercises, postural awareness, body mechanics
⚬ Partial sit-ups (knees bent, pelvic tilt)
⚬ Exhale, perform partial sit-up while compressing the rectus abdominis
muscle toward the midline
➤ Avoid abdominal exercises: bilateral SLR, full sit-up
Can resume when separation is < 2 cm
