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Special Populations > PT and Pregnancy > Flashcards

PT and Pregnancy Flashcards

1
Q

Normal Pregnancy

A
  • Last 40 weeks (280 days)
  • Range is 38-42 weeks
  • Broken up by trimesters

***Used to permit induction at 38 weeks but have found fewer complications if born at 40 weeks

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2
Q

Gestational age:

A
  • •age of the pregnancy as measured by time from the mother’s last menstrual cycle
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3
Q

Fetal age:

A
  • actual age of the fetus
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4
Q

1st Trimester: Weeks 1-5

A
  • 6-12 days after conception blastocyst imbeds in uterus marking the beginning of the embryonic stage
  • By week 4 (speck of glitter)
    • Vessel that will become heart starts contracting
      • ‘heart’ is only a single large fused vessel
      • Some conduction cells (SA/AV nodes) have formed causing contraction
  • By week 5
    • Neural tube closed
    • Limb buds visible
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5
Q

1st Trimester; Week 6-9

A
  • By week 6
    • Lung buds have formed
  • By week 7
    • Brain has divided into ventricles and lobes
    • Heart now has 4 rudimentary chambers
  • By week 9 (jelly doughnut)
    • Fetal heart tone can be picked up by doppler
    • Spontaneous limb movements can be seen on ultrasound
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6
Q

1st Trimester; Weeks 10-13

A
  • Week 10 (size of a cocktail weenie)
    • marks transition to fetal stage
    • Called fetus instead of embryo
  • By week 12
    • Heart beat can be heard on ultrasound
  • By week 13
    • Active limb motion occurs
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7
Q

2nd Trimester: (week 13-28ish)

A
  • By week 16 (pint of ice cream)
    • Fetus is ~6 inches long
  • By week 21
    • Generally can start to feel fetus move
    • (movement may be felt as early as week 16 but rare)
  • By week 24
    • Gas exchange could be possible in lungs
    • Lungs are still developing
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8
Q

3rd Trimester: (28 weeks)

A
  • By week 31
    • Fetus is 15-17 inches long
  • By week 35
    • Finger nails reach the end of fingers
  • By week 36
    • Fetus has a high chance of survival with medical intervention if born now
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9
Q

Hair and Nails

A
  • Estrogen
    • Hair grows thicker and fuller due to increased estrogen
    • Hair may also grow thicker over entire body
    • Nails also grow thicker
  • After delivery
    • Mother may lose hair
    • Nails return to normal
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10
Q

Skin

A
  • Stretch marks
    • Rapid weight gain
    • Large fetus
    • Obesity before/during pregnancy
    • Prevention
      • Not a surefire way
      • Vitamin E oil and/or cocoa butter
  • Mask of pregnancy
    • Increased melanin release by skin
    • Results in darkened patches on upper lip, other areas of face
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11
Q

Breasts

A
  • Enlarge
  • Painful/tender
    • During 3rd Trimester breasts often become tender to toucH
    • Many women sleep with maternity bra for support/protection
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12
Q

Joints

A
  • Ligaments
    • Relaxin released to assist in loosening joints of pelvis
    • Impacts entire body
    • Increased risk of strain/sprain/ tear at this time
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13
Q

Feet

A
  • Swelling
    • Pressure on vena cava from fetus
    • Increased fluid retention
  • Arches
    • May flatten permanently due to relaxin
    • Especially if mother does not wear supportive shoes
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14
Q

Braxton-Hicks

A
  • Practice contractions
  • Start as early as 28 weeks
    • Occasionally end of 2nd Tri
  • Uterus contracts for 30-60s
    • Thought to be a way to tone the uterus
    • Increase blood flow to placenta
    • Soften cervix
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15
Q

Weight Gain

A
  • Normal weight mother-25-35 lbs
  • Obese mother-10-20 lbs
  • Underweight mother-28-45 lbs
  • General rule
    • 2-4 lbs in 1st Trimester
    • 1 lbs per week after

***Some women lose weight during the 1st Tri, that is ok as long as their appetite picks up later

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16
Q

Delivery

A
  • First Stage: Dilation and Effacement of Cervix
    • early phase
    • active phase
    • transition phase
  • Second Stage: Pushing and Birth
  • Third Stage: Delivery of the Placenta
17
Q

1st Stage (hours given for 1st time mom)

A
  • Early-6-10 hours
    • Water may break
      • Membranes rupture
    • Cervix dilates 3-4cm
  • Active-4-6 hours
    • Cervix dilates 4-7cm
    • Labor truly begins
    • Epidural given now
  • Transition-2 hours
    • Cervix dilates 7-10 cm
    • Contractions 1-3 min apart
    • DON’T PUSH
18
Q

2nd Stage

A
  • ~2 hours for first time mothers
  • Cervix is fully dilated
  • Pushing begins
  • Contractions are often farther apart but much stronger
  • Episiotomy occurs at this point (if permitted)
19
Q

3rd Stage

A
  • Delivery of placenta
  • Few smaller contractions
  • Physician/Midwife
    • May massage abdomen to assist in separation of placenta
  • Many women don’t even notice as they are focused on baby
20
Q

Pregnancy Problems

A
  • Gestational diabetes
  • Preeclampsia
  • Placenta Previa
  • Placental Abruption
  • Diastasis Recti
21
Q

Gestational Diabetes

A
  • What
    • High glucose levels during pregnancy
  • Risk factors
    • Obesity
    • Hispanic or Native American race
    • Rapid weight gain
    • Poor diet
  • Complications
    • Preeclampsia
    • Poor liver function in fetus
    • Large fetus
    • Fetus with poor glucose control
  • Management
    • Most can be with diet/exercise
    • Some women require insulin
22
Q

Preeclampsia

A
  • Occurrence
    • 20 wks or more
    • HTN with kidney involvement
    • Other organs can be involved
  • S&S
    • High BP
    • Swelling hands/face
    • Proteinuria
    • Headache
    • Abdominal/back pain
    • Vomitting
    • Headache/blurred vision/dizziness
  • Management
    • Delivery is only cure
    • If infant near term (36wks +) infant will be delivered
    • If too early mother will be on bed rest
    • May stay in hospital or sent home if symptoms do not worsen
    • May require medications to prevent seizures

***If you question if a mother has preeclampsia, send to the ER

23
Q

Placenta Previa

A
  • What
    • Placenta covers part or all of cervix opening
  • S&S
    • Painless vaginal bleeding
    • Occurs in 2nd or 3rd Tri
    • Some may not have any symptoms
  • Management
    • If DX after wk 20, mother must cut back on activity level
    • May be placed on bed rest
    • If bleeding heavily, mother may be admitted
    • C section deliver is generally recommended
24
Q

Placental Abruption

A
  • What
    • Placenta separates from uterine wall, limits O2 to fetus
  • S&S
    • Vaginal bleeding
    • Cramping
    • Abdominal pain
    • Uterine tenderness
  • Management
    • If separation is small bed rest until bleeding stops
    • If moderate complete bed rest recommended
    • If severe (1/2 or more separated) emergency delivery commences
25
Q

Diastasis Recti

A
  • What
    • Separation of the linea alba
  • S&S
    • Palpable separation of rec abdom
    • ‘pooching’ out of abdomen after delivery
  • Risk Factors
    • Obesity
    • Rapid weight gain
  • Management
    • Surgery
    • Exercise
    • PT
26
Q

Exercise and Pregnancy

A
  • Safe to exercise throughout a normal pregnancy
  • If woman has a high level of activity before, can maintain a higher level during as long as:
    • Weight is safely gained
    • Fetus is healthy
    • NO complications arise
    • Woman understands intensity will need to decrease as pregnancy goes on
27
Q

Benefits of exercise

A
  • Evidence suggests:
    • Baby can be smarter
    • Labor and delivery are faster and easier
    • Can relieve aches and pains of pregnancy
    • Can decrease risk of gestational diabetes
28
Q

Exercise Guidelines

A
  • Avoid heavy repetitive weight training during 1st Tri
    • May be associated with increased miscarriage
  • If a workout leaves a woman feeling truly exhausted
    • Time to decrease intensity
  • No evidence of higher activity levels and any birth complications
  • An increase in intensity during pregnancy should be avoided
  • The potential for direct trauma should be considered
29
Q

PT and Pregnancy- Most common things we see…

A
  • Back pain
  • SI pain
  • Diastasis Recti
30
Q

Back Pain

A
  • Associated with postural changes and relaxin
  • Intervention
    • Traditional exercise interventions OK as long as position is safe
    • Postural training key
    • Body mechanics key
    • Mobilization
      • Caution with positioning and force
    • Modalities
      • Deep heat, traction, e-stim contraindicated
31
Q

SI Pain

A
  • Pain in SIJs from weight of fetus, postural change, and relaxin
  • Interventions
    • Stabilization exercises
    • Pregnancy or SI belt use
    • Avoid activities that aggravate pain
32
Q

Diastasis Recti

A
  • Interventions
    • Specific DRA exercise
      • Only tx for abdomen until separation is 2cm or less
    • Use of girdle
      • After delivery

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