Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Physiotherapy in Specific Groups > Women's Health > Flashcards

Women's Health Flashcards

1
Q

What are the three main antenatal and birthing care models?

A
  1. Public: midwife led care shared with GP or hospital
  2. Private: obstetrician-led care
  3. Private: midwife/homebirth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What patients attend a birth centre for care?

A

Low-risk pregnancies, transferred for medical reasons e.g. epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What percentage of women have a normal vaginal birth?

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the WHOs definition of a normal labour?

A

Labour is normal when it is spontaneous in onset, low risk at the start and remaining so throughout labour and birth. The baby is born spontaneously and in the vertex position between 37–42 completed weeks of pregnancy. After birth woman and baby are in good condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the relationship between the age of the mother and likelihood of delivering by caesaraen section?

A

C-sections increase with age - mothers aged 40 years and over are 3 x more likely to deliver by C-section compared with teenage mothers (52% vs 18%).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What adverse maternal perinatal outcomes are associated with young or advanced maternal age?

A
  • Postpartum haemorrhage
  • Eclampsia
  • Cephalopelvic disproportion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the four stages of normal vaginal delivery/birth?

A
  • First stage: 1 - 48 hrs

- Second stage: 5 mins - 2 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

At what stage is a women considered to be in the active stage of labour?

A

Cervix dilation >6cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two periods of first stage delivery (labour)?

A
  • Early: cervix dilation 0-6cm (at home)

- Established/active: 6-10cm (hospital)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the second stage of a normal delivery?

A

5 minutes - 2 hours: baby being pushed out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is involved in the second stage of delivery?

A

Positioning for routine delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be taken into account when preparing for spontaneous delivery?

A
  • Parity
  • Preference for positioning during delivery
  • The progress of labour
  • Presentation of the fetus
  • Any complications of the labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do the NICE clinical guidelines suggest for positioning during the second stage of delivery?

A
  • Discourage lying supine or semi-supine
  • Encourage guidance by urge to push
  • In a position which rapid access is possible if sudden unexpected complications occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the benefits of a water birth?

A

Water immersion during the first stage of labour reduces the use of epidural/spinal analgesia. Water births are associated with low risks for both the woman and baby when best practice guidelines are followed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do the RANZCOG Guidelines state in regards to warm water immersion during labour and birth?

A

Women who choose to labour immersed in water but with the intent of leaving the water for delivery should be supported. There should be appropriate protocols and arrangements in place to minimise the likelihood and hazards associated with unplanned delivery occurring immersed in water.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If it is anticipated that significant fetal manipulation may be required (twins, breech, shoulder dystocia), what position should the patient be in for delivery?

A

The lithotomy position: flexion/abduction of the hips (squatting position) to increase the size of the pelvic outlet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should episiotomy be considered?

A

High likelihood of:

  • Severe laceration
  • Shoulder dystocia
  • A requirement to accelerate the birth delivery
  • A need to facilitate operative vaginal delivery
  • A history of female genital mutilation (FGM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the four degrees of perineal injury?

A

1st degree: injury to the perineal skin only
2nd degree: injury to the perineum, but not anal sphincter (AS); 3rd degree: injury to the peri and AS (OASIS)
- 3a: Less than 50% of EAS thickness torn
- 3b: More than 50% of EAS thickness torn.
- 3c: Both EAS and IAS involved
4th degree: injury to perineum, AS and rectal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the four degrees of perineal injury?

A

1st degree: injury to the perineal skin only
2nd degree: injury to the perineum, but not anal sphincter (AS); 3rd degree: injury to the peri and AS (OASIS)
- 3a: Less than 50% of EAS thickness torn
- 3b: More than 50% of EAS thickness torn.
- 3c: Both EAS and IAS involved
4th degree: injury to perineum, AS and rectal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors associated with women sustaining an obstetric anal sphincter injury?

A
  • Nulliparity (first baby)
  • Asian or indian sub-continent ethnicity
  • Woman has Female Genital Mutilation (FGM)
  • Baby is large in relation to maternal size (> 4kg)
  • Previous history of perineal trauma requiring repair
  • Previous history of obstetric anal sphincter injury
  • Precipitate or faster than expected second stage
  • Instrumental birth
  • Active second stage longer than 1 hour
  • Inappropriate maternal position (e.g. lithotomy position)
  • Midline episiotomy or an inadequately angled mediolateral episiotomy which functions like a mid-line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the third stage of normal delivery?

A

Placenta expelled: 10 mins to 1 hour

22
Q

What is the fourth stage of normal delivery?

A

First breastfeed

23
Q

What happens to the linea alba during a C-section?

A

Not cut - pulled aside

24
Q

What are the rates of surgical complications between emergency and planned C-sections?

A

Overall, the chance of any surgical complication was 12.1%, significantly higher in the emergency CS group (14.5%) compared with the elective CS group (6.8%).

25
Q

What aspect of care do physiotherapists cover?

A
  • Teaching of active/”natural” labour and birth strategies
  • Non-pharmacological pain relief
  • Post-natal recovery
26
Q

What aspects of the biomechanics of labour can be taught in birth preparation classes?

A

Upright positions and movement

  • Increase pelvic opening
  • Improve contractions and cervical opening
  • Help baby move own and turn through the pelvis
27
Q

What can physiotherapists teach in regards to non-pharmacological pain relief and strategies?

A
  • Explain pain (neurophysiology)
  • Contraction pain is good
  • Fear/stress increaes pain perception
  • Manage adrenalin/oxytocin
  • Calm and support carers and environment
  • Movement, massage, water, relaxation, heat, TENS, diaphragmatic breathing
28
Q

What protective strategies can be taught for the second stage of delivery to minimise the risk of damage to pelvic floor/pudendal?

A
  • Upright positions

- Spontaneous, relaxed pushing

29
Q

What aspects are involved in early post-natal recovery?

A
  • Pelvic floor RICE + exercise
  • Bladder and bowel function
  • Pelvic floor and TA activation and functional use
  • Backcare/wrist care with baby care and breast feeding
30
Q

What are the two stages of post-natal period?

A
  • First six weeks

- Period up until baby’s first birthday and/or cessation of breastfeeding

31
Q

What anatomical and physiological changes are involved in the first stage of the post-natal period?

A
  • Uterus involuting and bleeding
  • Abdomen ‘deflated’
  • Rectus diastasis
  • Perineum healing
  • Establishing lactation breast engorgement, high prolactin and progesterone
  • Relaxin decreased, but not to pre-pregnancy level
  • Sleep deprivation
32
Q

What are the functional implications met during the first stage of the post-natal period?

A
  • Sub-optimal abdominal and pelvic floor
  • Poor posture while breastfeeding
  • Baby care: lifting, carrying
  • Fatigue
33
Q

What anatomical and physiological changes are involved in the second stage of the post-natal period?

A
  • Rectus diastasis
  • Pelvic floor weakness
  • Breast feeding fully to 6 months - may continue to 2 years
  • Relaxin decreased, but not to pre-pregnancy levels until breast feeding ceases
34
Q

What are the functional implications met during the second stage of the post-natal period?

A
  • May have sub-optimal core stability and pelvic floor
  • Stress incontinence
  • Possible mastitis with breast feeding changes
  • Lifting and carrying (~10kg weight all day)
35
Q

What is involved in physio input in the first stage of the post-natal period?

A
  • Automatic referral for third degree tear
  • Post-natal inpatient screen
  • Post-natal education
  • Post-natal exercise class
  • Musculoskeletal treatment
36
Q

What is involved in physio input in the second stage of the post-natal period?

A
  • Automatic referral for third degree tear
  • Pelvic floor rehab/stress incontinence treatment
  • Post-natal exercise class
  • Musculoskeletal
  • Mastitis treatment
37
Q

What might be included in an inpatient education session post-natal?

A
  • Backcare: with feeding, babycare, housework, toddler
  • Pelvic floor: RICE/ rehab exercise
  • Re-establish good bladder and bowel habits
  • TA/Core stability exercise
  • Advice re graded return to exercise/sport – safe exercise to prevent stress incontinence
  • When to see physio
38
Q

What does post-operative care following a lower segment caesarean section involve?

A
  • Prevent respiratory complications
  • Circulation exercises
  • Wound support with movement and coughing
  • Early mobilisation
  • Pelvic floor/TA activation with lifting baby
39
Q

What is diastasis of the rectus abdominis muscle?

A

Separation, thinning and stretching of the linea alba during pregnancy.

40
Q

How is diastasis of the rectus abdominis muscle assessed?

A
  • Crook lying, woman lifts head and shoulders up in a “curl-up”
  • Feel 10cm above umbilicus, palpate firm edges of rectus and soft ligament between in finger widths and cm
41
Q

What did Coldren et al 2008 show about diastasis of the rectus abdominis muscle?

A
  • The inter recti distance (IRD) is significantly greater in the post natal population than it is in the nulliparous population.
  • IRD decreases rapidly in the first 8 weeks post natal but then plateaus.
  • At 12 month post natal the IRD remains greater than 2cm (just caudal to the umbilicus), compared with the nulliparous control group of approxiamtely 1cm.
  • Most research indicates that the IRD is greatest at the level of the Umbilicus.
42
Q

What has research shown about the use of tubigrip in the management of rectus abdominis diastatis?

A

The use of tubigrip / abdominal braces has not shown an improvement in inter recti distance (IRD) nor in rectus abdominis strength

43
Q

What are the important ADL modifications for the management of RAD?

A
  • Avoid ‘doming / peaking’ as this ‘may’ be a sign of increased stretch on the Linea Alba
  • Modified transfers; in / out bed, on / off floor.
  • Avoidance of heavy lifting and use correct lifting technique. Eg lifting toddlers, prams, washing baskets
  • Avoidance of excessive abdominal muscle straining (avoid breath holding – ensure exhale)
  • Management of constipation/ avoid straining at stool straining due the rise of IAP.
  • Engage PF/TA for cough or sneeze.
44
Q

What should be included in abdominal exercises for the management of RAD?

A
  • Teach and practice graded “core” exercises PF/TA
  • Activate deep stabilisers prior to superficial global muscle
  • Consider progression of body position (static then dynamic)  Supine + leg movements eg ASLR, clam  4-point kneeling  Sitting / fitball  Standing + Functional / ADL integration in all positions
45
Q

What role might physiotherapists play with the newborn?

A
  • Positional talipes
  • Development dysplasia
  • Plagiocephaly
  • Newborn neuro assessment
46
Q

What considerations should be made when prescribing post-natal exercise prescription?

A
  • PF activation and control in good postural positions first. PF be able to resist rises in IAP for duration of exercise session.
  • Care with weight/ strength training in relation to vaginal pressures (O’Dell et al 2007, Pelvic floor first).
  • “stress test” – reasonably full bladder, jump and cough x10 – if no UI or vaginal heaviness – ready to return to higher impact exercise
47
Q

What physiological changes can persist after pregnancy?

A
  • CV changes, up to 12 months

- Increase in VO2 max and performance

48
Q

What percentage of mothers return to exercise?

A
  • 80% continue post-natally

- 70% reach or exceed pre-pregnancy fitness levels

49
Q

What should a objective assessment of mastitis include?

A
  • Measure affected area
  • Degree of redness, pain, firmness, lumps
  • Temperature locally or core
50
Q

How is mastitis managed?

A

Therapeutic pulsating ultrasound

  • 1.5 – 2w/cm2 5-10 mins depending on area
  • Feed baby asap after treatment
  • Heat and massage of lump before feed (toward nipple)
  • Ice and lymphatic drainage after massage after feed (toward axilla)
51
Q

What are the two types of mastitis? What are the symptoms of each?

A
  1. Non-infective:
    - Red and hot area
    - Tender lump (galactocoele)
    - Milk backs up behind, inflammation develops
    - No systemic symptoms
  2. Infective:
    - Milk stasis leaks out of blocked ducts into surrounding tissue
    - High vascularity results in inflammation++
    - Flu-like symptoms: temp, chillds, aches, malaise, swelling

Physiotherapy in Specific Groups (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions