PT and Pregnancy Flashcards
What postural changes occur during pregnancy?
- Forward Head
- Kyphosis
- Increased Lumbar Lordosis
- Anterior Pelvic Tilt
(changes occur even after pregnancy due to carrying baby)
How does blood pressure change depending on trimester of pregnancy?
Blood Pressure Decreases: 1st and 2nd Trimester
Blood Pressure Increases: 3rd Trimester of Pregnancy
Why is Supine Lying not indicated in pregnancy?
Causes compression of the Inferior Vena Cava (IVC).
- Declines CO
- Can cause supine hypotensive syndrome
When is Supine lying contraindicated in pregnancy?
No supine lying after 1st trimester.
What is the best position to lay in during pregnancy and why?
Left Side-Lying:
- Decreases IVC compression
- Maximizes CO
- Decreases GERD
- Improvement to Maternal and Fetal Circulation
How is Resting HR affected during pregnancy?
Increases by 10-20 bpm
How is HR affected during exercise?
Does not proportionally increase with increased intensity during exercise
How do hormones during pregnancy affect ligaments?
- Decreases ligament tensile strength
- Hypermobility as result of ligament laxity
- Increases risk of injury to the back, pelvis and LE
What is Preeclampsia? When does it occur?
Pregnancy induced acute hypertension, after 20th week of gestation.
What signs and symptoms occur during preeclampsia?
- Increased protein in urine
- edema; sudden weight gain
- headache
How are reflexes altered during preeclampsia?
Causes Hyperreflexia
- increasing BP leads to hyperreflexia
How is a diagnosis of preeclampsia made, what blood pressure reading is indicative of preeclampsia?
Blood pressure > 140/90 mmHg.
Diagnosis made by second reading 4 hours after first to confirm diagnosis
In an event of confirmed preeclampsia, what action should be done?
This is an emergency, call 911 or get the bitch to the hospital
What is gestational diabetes?
Diabetes that occurs during pregnancy, returns to normal after childbirth.
What is Eclampsia?
Occurs after pregnancy, leading to
- headache
- visual disturbances
- development of seizures!
If lying in supine where should a wedge or towel be placed?
Small wedge under the R hip, to promote turning to the left.
Are breath-holding activities or Valsalva maneuver recommended for pregnant patients?
No, it increases intraabdominal pressure and should be avoided
What is Placenta Previa? Can we exercise?
Lower displacement of the placenta, which may cause it to detach before the baby is delivered.
- Exercise is Contraindicated!
In relation to BP when should exercise be contraindicated?
- Preeclampsia
- Pregnancy induced hypertension
What trimesters is exercise contraindicated in the event of vaginal bleeding?
Second and Third Trimesters
Cardiopulmonary Contraindications to Exercise?
- Hemodynamically significant heart disease
- Restrictive Lung Disease
- Severe Anemia
For patients with Gestational DM when is exercise contraindicated?
During uncontrolled maternal type 1 diabetes as there could be ketoacidosis
How to check for diastasis recti?
Have patient in hooklying
Ask patient to perform curl up (lift shoulders off mat)
Palpate for separation of the linea alba
What degree of separation is significant for Diastasis Recti?
> 2 cm separation
What patients with pregnancy should Diastasis Recti be checked? When can we perform this (how many days post-partum)
Check on all women after delivery, (does not matter if it was vaginal or C-section birth)
- Done 3rd day postpartum
For patients with> 2cm Diastasis Recti what maneuver must be performed during exercise?
Abdominal Bracing
For a patient with 3-4 cm Diastasis Recti, what exercise may be appropriate and how can we progress this?
Exercise with only lifting the head + bracing
- Progress to posterior pelvic tilt + head lift + bracing
Exercise appropriate for a patient with >4 cm diastasis recti?
Abdominal Bracing + Breathing Exercises
When is surgery for Diastasis Recti generally indicated?
> 6cm
How does a finger width correlate with measurements?
1 finger width = 1 cm
With all abdominal contractions/exercise when should exhalation occur?
Perform all abdominal exercise with exaltation
(exhale when contracting to reduce intra-abdominal pressure)
We do not want valsalva
Why should we limit single-leg weight bearing activities?
- Can promote sacroiliac or pupic symphisis discomfort
- Aggravate Sacroiliac dysfunction
When stretching what muscle groups do we want to avoid overstretching and why?
Hamstring and Adductor Muscles
- Can increase pelvic instability or hypermobility
(especially in patients with existing instability)
How is COG altered in pregnancy?
COG shifts forward and upward as the fetus develops
Which hormone causes ligament laxity?
Relaxin
What is Cystocele?
The herniation of the bladder into the vagina
What is Rectocele?
The herniation of the rectum into the vagina
What is Uterine Prolapse?
Bulging of the Uterus into the Vagina
For a patient who has undergone C-Section, what modality can be utilized to reduce incisional pain?
Postopertative TENS; placed parallel to the incision
