Physiotherapy In Pregnant Population - Changes and Red Flags Flashcards
Hormonal Changes (6)
- ↑ Oestrogen: ↓ ligament and tendon stiffness, ↑ water retention.
- ↑ Progesterone: smoot muscle relaxation, ↓ vascular tone.
- Relaxin: ↑ ligament laxity + softens cartilage of SIJ and pubic symphysis.
- Cortisol: may have inhibitory affect on immune system.
- Oxytocin: uterine contractions.
- Prolactin (milk secretion) & melatonin: uterine contractions.
Cardiovascular Changes - Arterial System (4)
- ↑ cardiac output due to ↑ stroke volume and HR.
- 50% ↑ in blood volume around 6 months.
- ↓ BP due to vasodilation and ↓ vascular resistance (progesterone).
- Anemia die to ↓ blood volume -> dilution.
Cardiovascular Changes - Venous System (3)
- ↑ diameter of veins in LL due to hypotonia (progesterone)
- Compression of venous system in pelvis and LL by uterus & weight gain -> varicosities.
- Supine Hypotension Syndrome: uterus compresses Inf. vena cava -> fainting, BP drop. No exercise in supine after 20 weeks.
Respiratory Changes (4)
- ↑ RR to 18/min, ↑ O2 consumption to 20%.
- Ribs flare out and up.
- Diaphragm elevates 4 cm and chest wall widens by 2 cm -> leaning back (bell rung up).
- Lung capacity remains the same.
Cognitive Changes (2)
- Baby brain: brain fog, ↓ concentration, absentmindness.
- ↓ brain volume by 4%, returns to normal post partum.
Urinary Changes (2)
- Uterus compresses bladder + ↑ renal blood flow -> ↑ urinary frequency.
- ↓ antidiuretic hormone - ↑ urination at night.
GI Tract Changes (2)
- ↓ peristalsis -> constipation (due to progesterone) -> ↑ UI postpartum by 50%, ↑ pelvic organ prolapse.
- Never ignore a bowel call, do PA, water + fibers.
Bone Density Changes (3)
- ↑ need for calcium by fetus -> mobilization of calcium from maternal skeleton.
- Bone mineral density ↓.
- ↑ Risk of fracture during pregnancy and post (lactating).
Postural Adjustments (9)
- Foot pronation
- Knee hyperextension
- Anterior pelvic tilt
- Lx lordosis
- Tx kyphosis
- Cx lordosis
- Forward head movement
- Scapula prtraction
- ↑ Tx perimeter, ↑ subcostal angle
Balance and Gait Changes (3)
- Displacement of center of gravity.
- Compensatory gait: ↓ step length, speed, ↑ double support time, step width, BoS.
- ↑ Risk of falls (PA and support belts can ↑ postural stability and ↓ risk of falls).
Medical Complications (5)
- Hyperemesis Gravidarum: severe vomiting.
- Gestational diabetes.
- Placental abruption (will end pregnancy)
- Cervical insufficiency
- Pre-eclampsia (BP >140/90, very high risk for baby).
Red Flags - Medical Referral - Onset of Labor (4)
- Vaginal spotting or bleeding.
- Leaking amniotic fluid.
- Regular progressive uterine contractions.
- Back or abdominal pain, rhythmic, radiating.
Red Flags - Medical Referral - Neurological (5)
Vision changes
Mental confusion
Slurred speech
Cauda equina symptoms
Severe, persistent headache
Red Flags - Medical Referral - Cardiovascular (5)
BP > 140/90
Sudden, severe chest pain
Tachycardia
Dyspnea
Signs of DVT
Red Flags - Medical Referral - Visceral (5)
Acute abd. pain
Flank/suprapubic pain + fever
Shoulder + abd pain
Dysuria and hematuria
Infection symptoms