PT and Pregnancy Flashcards
Normal Pregnancy
- 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
Gestational age:
- •age of the pregnancy as measured by time from the mother’s last menstrual cycle
Fetal age:
- actual age of the fetus
1st Trimester: Weeks 1-5
- 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
- Vessel that will become heart starts contracting
-
By week 5
- Neural tube closed
- Limb buds visible
1st Trimester; Week 6-9
-
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
1st Trimester; Weeks 10-13
-
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
2nd Trimester: (week 13-28ish)
-
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
3rd Trimester: (28 weeks)
-
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
Hair and Nails
-
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
Skin
-
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
Breasts
- Enlarge
- Painful/tender
- During 3rd Trimester breasts often become tender to toucH
- Many women sleep with maternity bra for support/protection
Joints
- Ligaments
- Relaxin released to assist in loosening joints of pelvis
- Impacts entire body
- Increased risk of strain/sprain/ tear at this time
Feet
-
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
Braxton-Hicks
- 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
Weight Gain
- 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
Delivery
-
First Stage: Dilation and Effacement of Cervix
- early phase
- active phase
- transition phase
- Second Stage: Pushing and Birth
- Third Stage: Delivery of the Placenta
1st Stage (hours given for 1st time mom)
-
Early-6-10 hours
- Water may break
- Membranes rupture
- Cervix dilates 3-4cm
- Water may break
-
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
2nd Stage
- ~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)
3rd Stage
- 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
Pregnancy Problems
- Gestational diabetes
- Preeclampsia
- Placenta Previa
- Placental Abruption
- Diastasis Recti
Gestational Diabetes
-
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
Preeclampsia
-
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
Placenta Previa
-
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
Placental Abruption
-
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
Diastasis Recti
-
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
Exercise and Pregnancy
- 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
Benefits of exercise
-
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
Exercise Guidelines
- 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
PT and Pregnancy- Most common things we see…
- Back pain
- SI pain
- Diastasis Recti
Back Pain
- 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
SI Pain
- Pain in SIJs from weight of fetus, postural change, and relaxin
- Interventions
- Stabilization exercises
- Pregnancy or SI belt use
- Avoid activities that aggravate pain
Diastasis Recti
- Interventions
- Specific DRA exercise
- Only tx for abdomen until separation is 2cm or less
- Use of girdle
- After delivery
- Specific DRA exercise