The Obstetric Patient Flashcards
Define the trimesters of pregnancy
1st trimester
- month 0 = weeks 0-4
- Month 1 = weeks 5-8
- Month 2 = 9-12
- Month 3 = weeks 13
2nd trimester
- month 3 = weeks 14-17
- Month 4 = 18-21weeks
- Month 5 = weeks 22-25
- Month 6 = 26-27 weeks
*3rd trimester
- month 6 = 28-30 weeks
- month 7 = 31-34 weeks
- month 8 = weeks 35-38
- month 9 = 39-42 weeks
what systems
experience changes during pregnancy
- GI
- Urogenital
- Cardiovascular
- endocrine
- respiratory
- metabolic
- musculoskeletal
- neurologic
- integumentary
- psychiatric
Changes during pregnancy
- respiration rate unchanged – deeper breaths
- hyperventilation –to meet oxygen demands
- dyspnes –20% increase by 12 weeks
- heart rate increases 10-16 beats per minute
- CO increase 30-60%
- blood volume increases 40-45%
- weight gain average of 25-35 lbs
- uterus: non pregnant 2”x4 pregnant 10”x14
- chest circumference increases 5-7 cm
- diaphragm elevates 4 cm
Postural changes during pregnancy
- center of gravity shifts forward 4 cm and upward 4 cm
- exaggeration of A-P spinal curves
- shoulders internally rotate and protract
- knees hyperextended
- feet pronated
Examination: history
- previous pregnancies
- complications
- general health
- environment: physical, psychological, emotional
- medications
Examination considerations
- physical positioning
- avoid prolonged periods in supine
- prone position uncomfortable early not recommended in later stages
- left side-lying with pillows supporting from behind
- support belly
- avoid activites that strain pelvic floor and abdominal muscles
- avoid positions that cause rapid orr uncontrolled bouncing o swinging - balance
- avoid vigorous stretching of adductors - pubic symphysis
- avoid overheating or increasing core temp
- deep heat or electical stim over turnk is containidcated
Imaging considerations
- MRI or US preferred
- CT, x-ray not recommended due to radiation exposure
Lab tests for the pregnancy patient
chorionic Villus sampling (CVS)
- 10-13 weeks - genetic disorders
- US guided
- 1-2% chance of miscarriage
Amniocentesis
- high rrisk or over 35 recommended
- 15 weeks
- US guided
- 1 in 270 change of miscarriage
Glucose testing;
- 3 hr testing
Common medical conditions with obstetric patients
- backache
- HA
- heartburn
- nausea/vomiting
- CTS
- edema
- fainting
- Fatigue
- urinary frequency increase
- hemorhoids
- varicosities
- breast tenderness
Special concerns for Obstetric patient
Gallbladder disorders
- increase bile production decreased emptying time
- R upper quadrant pain referred pain to scapula
- food intolerance
will be related to eating - they feel better after eating
Special concerns for Obstetric patient
urinary tract
- acute cystitis 1% - referral over sacral spine
- acute pyelonephritis - flank pain, fever, nausea/vomiting
- incontinence 21-46%
Special concerns for Obstetric patient
Fecal incontinence
- postpartum
Special concerns for Obstetric patient
Organs
- organ prolapse
Special concerns for Obstetric patient
endocrine
- gestational diabetes
- relaxin production (especially post partum)
Special concerns for Obstetric patient
cardiovascular
- progressive dyspnea or orthopnea
- nocturnal cough
- hemoptysis
- syncope
- chest pain
- COVID-19
- supine hypotension due to compression of inferior vena cave
- hypertension
- venous thromboembolism
Special concerns for Obstetric patient
hypertension
- 5-10% pregnancies
- preeclampsia BP >/= 140/90 can cause death to fetus
- risk of intacranial hemorhage, renal failure, retinal detachment, pulmonary edema, liver rupture, abruptio placenta, death
Special concerns for Obstetric patient
venous thromboembolism
- 5x higher risk than non-pregnant
- DVT - 24% chance of PE => 15% mortality
Special concerns for Obstetric patient
MSK considerations
- LBP: increase laxity/changes in posture
- SI dysfunction: posterior pain aroudn pubic symphysis
- pubic symphysis dysfunction: 1/36, groin or pubic pain,painful gait/mobility
- Thoracic and rib dysfunction
- HA and cervical spine dysfunction
- extremity dysfunction
- osteoporosis
- diastasis recti >2 fingertops seperation
- coccydynia
What conditions get worse with pregnancy
- MS increases during 6 months postpartum
- epilepsy
- guillain-barre syndrome - postpartum first 30 days
- psoriasis flare after pregnancy
What conditions get better with pregnancy
- MS lowers during pregnancy
- RA
Spina bifida
with pregnancy
- folic acid lessens chance of development in fetus
Lupus with pregnancy
-risk increases last trimester: heart, kidneys, miscarriage
teen
pregnancy
- increase risk pertem
- nutrition
benefits of exercise
- promote relaxation
- improve circulation in lower extremities and pelvis
- muscle re-ed
- estabilish a balance of length and strength to accommodate the changes of prergnancy
- prevent MSK problems from developing
- promote elasticity and strength of perineal muscles – support pelvic contents, assist in labor
- adapt to structural and hormonal changes that affect the stability of joints
- promote elasticity and strength of the abdominals
- improved stability to the pelvis
- support gravid stuctures
- be effective for delivery
- facilitate postpartum rehab
exercise with pregnancy contraindications
- incompetent cervix
- vaginal bleeding of any amount
- placenta previa
- premature labor (prior to 37th week)
exercise precautions
with pregnancy
- multiples
- anemia
- diastasis recti
- uterine contactions > 2 hours after exercise
Guidelines for exercise and nutrition
- additional intake of 500 cal/day if exercise 300/day ifno exercise
- keep temperaturre below 102º
- frequentcy of exercise = 3-5 times per week ?150 min/week moderate intensity
- duration of exercise to patient tolerance up to 40 minutes
- cool down
exercise programs
- warm up - total body stetching
- pelvic floor muscle training
- aerobic 15-20 minutes – focus on retraction of UE and small foot movements
- cool down
- relaxation
exercise options
- stretching
- aerobic – walking, swimming
- strengthening – t-band, free weights, phsyioball
- back school - body mechanics
- positioning: avoid supine and prone especially in later stages
